As if cramping during your period wasn’t burdensome enough, it's possible to have cramps without a period, too.
‘Pelvic pain’ is a catch-all term for pain in the lower abdomen, below the belly button but above the legs. Period cramps are one type of pelvic pain, but a number of other things can also cause pelvic pain, some of which don’t involve the reproductive system at all.
When you have cramps without a period, it can be hard to tell if it’s your period that’s causing them, or another condition.
Determining the root cause of pelvic pain requires some detective work, and should involve a conversation between you and your doctor. The purpose of this article is to help you understand some possible reasons one may have pelvic cramps but no period.
This article is *not* intended to diagnose any condition, or replace medical advice. If you are in extreme pain, go to the ER immediately.
Is it period cramps, or something else?
The answer is really between you and your doctor. But the pattern (or lack thereof) of the cramps can help reveal if they’re related to the menstrual cycle or not. Specifically, you’ll want to notice—and relay to your doctor—if your cramps:
- Happen consistently, around the same time each month
- Don’t seem to follow a regular pattern
- Arose recently, and are severe
'Period' cramps that happen consistently, around the same time each month
Since periods are cyclical, cramps that show up in a predictable, rhythmic way, starting and stopping around the same point in your cycle each month, may be a telltale sign they’re menstrual cramps, even if they don’t always overlap with your bleeding days.
Tracking your cycle or keeping a cramp journal can help you recognize patterns from month to month.The timing of cramps during your cycle can indicate the underlying cause. For example, if you tend to cramp:
1-3 days before your period starts:
It could be regular ol’ period cramps, also known as Primary Dysmenorrhea. This type of cramping is caused by normal uterine activity at the start of menstruation, not by a separate underlying disease.
Natural drops in the hormones estrogen and progesterone trigger inflammatory compounds to build up in the uterus, making the uterine muscles contract very tightly. This tightening is a period cramp.
Pain can last anywhere between 8 and 72 hours, may radiate to the back and thighs, and may be accompanied by other symptoms like nausea, diarrhea, fatigue, and insomnia.
Estrogen and progesterone begin to drop about a week before bleeding starts, but the time it takes for these hormonal fluxes to manifest as cramps varies from person to person.
Most people get their worst period cramps on the first day of bleeding, but everyone’s period is different. Having cramps without a period isn't necessarily a sign something is wrong. If cramping a day or two before you start bleeding is typical for you, this may just be your personal cramp pattern.
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The amount of pressure that's generated in the uterus mid-cramp is the same amount of pressure that's generated during the second stage of labor, while you're pushing. Period pain is real pain, and actually like a free sample of what it’s like to give birth. #themoreyouknow
If you don’t normally get cramps before your period, but suddenly did one month, less-than-stellar diet and lifestyle choices made in the weeks leading up to your period may be responsible.
Your period is like a monthly wellness report card. Changes in your diet, sleep patterns, exercise routine, medication regimen, or stress levels—even if the changes happen weeks before you’re expected to start bleeding—can alter levels of circulating hormones that influence the intensity, duration, and timing of period cramps. Try to focus on healthy, realistic habits, and keep them consistent.
1-3 days before your period starts, AND 1-3 days after your period ends:
It could be some form of Secondary Dysmenorrhea, or period cramps caused by an underlying condition separate from (and in most cases, more serious than) normal menstrual activity.
Pain associated with secondary dysmenorrhea often lasts longer than pain from primary dysmenorrhea. While the conditions that cause secondary dysmenorrhea can be painful at any time of the month, pain is typically the worst around or during menstruation. But pain may not always match up with your period, and is more likely to happen before and after the days you’re bleeding.
A number of conditions can cause secondary dysmenorrhea. Some of the most common include:
- Endometriosis—when uterine tissue grows outside the uterus in places where it doesn’t belong, like the bladder, ovaries, or fallopian tubes. People with endometriosis often have debilitating pain during their periods, in addition to chronic pelvic pain when they’re not on their periods.
- Adenomyosis—when cells that should grow on the lining of the uterus protrude into the wall of the uterus instead. Symptoms include a heavy flow, clots in menstrual blood, pain during sex, and severe cramping during and around your period.
- Ovarian Cysts—when the ovaries try to release an egg, but the egg gets stuck in the ovary and forms a cyst. Cysts usually go away on their own, but can still cause swelling, pressure, and pain. Your doctor can spot them during a pelvic exam, so regular gyno appointments are important.
- Uterine Fibroids or Polyps—growths in the uterine lining and/or the uterine cavity. Uterine fibroids are almost always non-cancerous; polyps are usually non-cancerous, but can turn cancerous over time. They don’t always cause symptoms, but can eventually become painful. They can also worsen period cramps and bleeding.
- Pelvic Inflammatory Disease (PID)—an infection of the reproductive organs usually caused by an STD that went untreated, causing permanent damage to reproductive organs. Symptom include pelvic pain, fever, abnormal vaginal discharge, pain while peeing, and pain during sex.
10-14 days before you expect your period to start:
It could be Mittelschmerz, or pain from ovulation. Mittelschmerz is German for “middle” and “pain”, since ovulation happens mid-cycle, or roughly two weeks after your last period.
Ovulation is the once-a-month process of the ovaries releasing an egg, that then travels down the fallopian tube to the uterus. Like menstruation, ovulation involves some inflammatory processes, and can be painful for some people.
Mittelschmerz pain may be concentrated on one side of the pelvic area, and it may switch sides from month to month, depending on if the right or left ovary released the egg. Pain can range anywhere from a mild twinge to severe cramping, and can last minutes to hours. Pain can be accompanied by nausea if it’s very severe. Some people also spot or have vaginal discharge.
Cramps but no period, that don’t seem to follow a regular patternSome conditions that can cause irregular, non-cyclical pelvic cramping include:
Irritable Bowel Syndrome (IBS)—a chronic gut disorder also known as spastic colon. Symptoms include abdominal cramps, bloating, diarrhea, and constipation. Symptoms happen episodically, flaring up then gradually going away. There’s no cure, but you can control it with diet changes, stress management, and medication.
Pelvic Adhesions—scar tissue in the pelvic area that can remain after an infection, endometriosis, or other issues. They can cause chronic pain as surrounding organs struggle to adapt to the scars.
- Chronic Pelvic Pain Syndrome—a complex condition that doctors and researchers don’t fully understand. It can be caused by a single disorder, like one that results in secondary dysmenorrhea, or it can be caused by a combination of multiple disorders in which pelvic pain is a symptom.
Cramps that arose recently, and are severe
Tell your doctor. Regardless of whether you're having severe cramps without a period or with one, any new, intense pain needs medical attention. It may not be serious, but you won’t know until you get it checked out.See a doctor ASAP if you:
- Have vaginal bleeding you weren’t expecting, in addition to severe pain.
- Have already been diagnosed with a condition that causes pelvic pain, and the pain suddenly changed (i.e. it got worse, it used to be dull but is now very sharp or stabbing, or it used to come and go but now is constant).
- Have other symptoms in addition to pelvic pain, like nausea, vomiting, or a fever.
- Cystitis—inflammation of the bladder caused by a Urinary Tract Infection (UTI). You may have a UTI if it hurts when you pee, you have to pee frequently, you feel like you have to pee even when your bladder is empty, or you feel pressure in the lower abdomen.
- Sexually Transmitted Diseases (STDs)—like gonorrhea and chlamydia. They don’t always cause symptoms, but possible symptoms include bleeding between periods, pain while peeing, and abnormal vaginal discharge.
- Ectopic Pregnancy—when an embryo implants somewhere outside the uterus and begins to grow. Symptoms include sharp pelvic cramps, vaginal bleeding, nausea, and dizziness.
- Appendicitis—or inflammation of the appendix. Symptoms include sharp pain in the lower right part of the torso, vomiting, and a fever.
- Kidney Stones—a build-up of salt and mineral deposits in the bladder or kidneys. Symptoms include pain in the pelvic area and lower back, and blood in the urine.
Where De Lune can help
Pain Tonic, our liquid supplement for cramps, is designed to relieve mild to moderate period pain resulting from primary dysmenorrhea—pain due to normal uterine activity during your period, not from an underlying condition.
Pain Tonic is formulated with anti-inflammatory nutrients and herbs that have been shown in clinical trials to reduce inflammation in the uterus. It can be used for cyclical, period-related pain, even if the pain occurs before or after you’re bleeding. Pain Tonic is not intended to diagnose, treat, cure, or prevent any disease.