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Breaking news: Nobody likes period cramps.
But what do you do when those usually just-annoying period cramps suddenly turn into something more as you get older? As in, now, instead of grabbing a heating pad or taking some pain meds, you’re calling out sick from work and canceling fun plans at the last minute.
While the increased discomfort could be due to any number of reasons, worsening period cramps, like any other kind of pain, should be viewed as a warning that it’s time to see your healthcare provider.
If you’re experiencing more intense period cramps as you age, “it should warrant an investigation, especially if it’s affecting quality of life,” says Dorothy Bestoyong, DO, an OB/GYN based in Orlando, Florida.
Luana Barajas, 42, believes her worsening period cramps signaled that she was starting perimenopause:
“I cramp all the time now,” Barajas tells Rescripted. “There’s only one week a month that I don’t cramp.” Although Barajas did seek medical attention, her doctor chalked her symptoms up to perimenopause. “It’s normal [for your cramps] to change when you’re in perimenopause,” her doctor explained.
Barajas’s physician wasn’t kidding: “This month, I ended my period, then two days later I started cramping and my period started again!” says Barajas.
As it turns out, Barajas's worsening period cramps may be a perimenopausal family trait: “My mom told me this is exactly how she started perimenopause,” she says.
Why am I cramping so much?
According to Dr. Bestoyong, potential reasons for increased period cramps in older age include hormone changes (hello, perimenopause!) or the exacerbation of pelvic-related conditions like fibroids, adenomyosis, and endometriosis.
So let’s break these possible culprits down one by one:
Perimenopause/hormone changes
Although Dr. Bestoyong points out that perimenopause “may cause periods to become irregular and usually lighter,” the hormone changes that accompany perimenopause might explain Barajas’s intensified period cramps. In a normal menstrual cycle, your estrogen levels decline after you’ve ovulated. But during perimenopause, estrogen levels may remain high after ovulation (yay perimenopausal hormone fluctuations!). This can cause your body to release prostaglandins, which are the chemicals that make your uterus contract – aka, cramps.
Uterine fibroids
Uterine fibroids are noncancerous growths that appear in the uterus. While fibroids don’t always present with symptoms, they can be the source of secondary dysmenorrhea (painful cramps caused by a reproductive system condition). Keep in mind that secondary dysmenorrhea is more common as women age, so if you’re experiencing more intense menstrual cramps, it’s worth checking for fibroids or other similar conditions.
Endometriosis
Endometriosis occurs when tissue similar to the inner lining of the uterus grows outside the uterus. Unlike fibroids, one of the common symptoms of endometriosis is painful period cramping. (Endometriosis is also the most common cause of secondary dysmenorrhea.) So if you’re experiencing worsening period cramps as you get older, it’s a good idea to see your healthcare provider for an assessment.
Adenomyosis
Adenomyosis is a condition where tissue grows into the muscle wall of the uterus, instead of lining the uterus. Like endometriosis, adenomyosis can cause painful periods, although about one in three people with this condition don’t experience any symptoms. Adenomyosis is also more common in people over the age of 40, which could account for more intense, age-related period cramps.
Don't ignore those painful period cramps
If there’s a silver lining to painful period cramps, it’s that you are that much closer to a diagnosis and treatment. Considering that some reproductive conditions don’t necessarily present with symptoms, those worsening cramps can serve as a powerful warning system.
“It's really important to visit your doctor to get the symptoms evaluated and to discuss treatment options that would be right for you,” says Dr. Bestoyong. Depending on your diagnosis, she says your treatment options “may entail medical management with hormone treatments (e.g. birth control; pills, rings, IUD, etc.).” Certain forms of birth control can help regulate your hormones and, subsequently, alleviate cramping.
Other potential treatment options include over-the-counter medications like NSAIDs/ibuprofen, which can help with pain relief. Your healthcare provider will recommend the best treatment plan based on your diagnosis.
People with menstrual cycles have been conditioned for decades that they’re just supposed to “grin and bear” period cramps. But debilitating pain that forces you to miss work or important events is not normal, so if you’re experiencing worsening period cramps as you get older, it’s critical that you pay attention to your body. “When pain is starting to affect your quality of life,” says Dr. Bestoyong, “this means that it is time to get evaluated and not to ignore the symptoms.”
Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist dedicated to reporting on women's health, parenting, mental health, TV, and pop culture. Her work has appeared in HuffPost, Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. Subscribe to her Substack, the Critical Communicator, and follow her on Instagram, BlueSky, or Threads.