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Are you having pain or cramps but no period in sight? Pelvic pain can signal a variety of different health issues—some are serious, while others are nothing to worry about.
“There is a lot going on in the pelvic area,” notes Sony S. Singh, an ob-gyn and professor at the University of Ottawa. Generally, your pelvis is considered your abdomen and lower back, below your belly button. The pain could have its origins in your uterus, but it could also be an issue with the bladder, bowels, ovaries, fallopian tubes or the pelvic muscles and ligaments. “For a patient with non-menstrual pelvic pain, we ask if it’s intermittent or always there. Does it radiate or stay in one spot? How intense it is on a scale of one to 10, and if there are things they do that make it better or worse.” It’s always a good idea to talk to your doctor (and in some situations, get immediate medical help) if you’re experiencing pain. Here’s a closer look at what could be going on if you have cramps but no period.
1. Early pregnancy
When you’re around four weeks pregnant (about two weeks after ovulation, when your period would ordinarily be due) you can have what’s called implantation bleeding and cramping, as the embryo implants into the lining of your uterus.
What’s the pain like? Mild and doesn’t last long.
Keep in mind: The bleeding is light spotting, and not every pregnant woman has this symptom. If you already know you’re pregnant, there are some other mild cramps that may be part of a healthy pregnancy.
2. Miscarriage
Another possibility when experiencing cramps but no period is miscarriage. That is, the end of a pregnancy before 20 weeks, because the pregnancy stops growing normally.
What’s the pain like? Similar to period cramps, which can then get stronger and more painful.
Keep in mind: Some women have both bleeding and cramping with a miscarriage, but others have no symptoms of pregnancy loss and may still feel pregnant. This “missed miscarriage” means the body doesn’t release the pregnancy tissue on its own and some medical intervention may be needed.
3. Ectopic pregnancy
An ectopic or tubal pregnancy is when a fertilized egg is growing outside of the uterus, usually inside one of the fallopian tubes. The pregnancy can not grow, and you might experience internal bleeding.
What’s the pain like? Mild cramps but no period, then sudden intense stabbing pains on one side of your abdomen. Depending on how the blood is leaking inside your body, there may also be pressure on nerves that leads to pain in your shoulders.
Keep in mind Ectopic pregnancies are diagnosed in the early stages of pregnancy, before you may even know you’re pregnant. “This can be a life-threatening situation for a woman,” says Singh, so get immediate medical help. Other symptoms include severe light-headedness and vaginal bleeding.
4. Ovulation
Some women can actually feel their ovary release an egg when they ovulate, which happens about two weeks before a period is due. (Another name for it is “mittelschmerz,” which means “middle pain” in German.)
What’s the pain like? A sudden, sharp twinge or mild cramp on one side of your belly.
Keep in mind You may feel the pain on one side every month, or it may vary. Either way, it’s not anything to worry about.
5. Ruptured ovarian cyst
There are several different kinds of cysts (which are pockets of fluid) that can develop on an ovary. If a cyst ruptures, or breaks, it may cause pain.
What’s the pain like? Sudden dull or sharp cramps on one side of your stomach, below your belly button. Other symptoms include fever, chills, mild nausea or vomiting.
Keep in mind If the pain is severe or you feel light-headed, seek medical attention, says Singh. A cyst rupture may occur in the middle of your cycle, but it can also happen outside ovulation, depending on the kind of cyst it is. Talk to your health care provider.
6. Ovarian torsion
“Torsion is when an ovary twists and its blood supply is blocked off,” says Singh. “Often it’s because there is a cyst on the ovary that makes it a little heavier. The weight causes it to twist.” Sometimes, the ovary and tube become stuck together, similarly causing a twist in the fallopian tube.
What’s the pain like? Sudden cramping on one side of the belly.
Keep in mind Other symptoms may include severe nausea and vomiting. Seek immediate medical attention.
7. Endometriosis
Endometriosis is a condition where tissue similar to the lining of the uterus grows outside of the uterus. This tissue thickens and bleeds into the pelvic area with each period, leading to scarring and adhesions on other organs like the bladder or ovaries.
What’s the pain like? Painful periods, pain during sex, and pain during bowel movements or peeing are the most common symptoms of endometriosis, although some women don’t have symptoms at all, says Singh. The pain can be severe.
Keep in mind Other symptoms include heavy period bleeding, bleeding between periods, infertility, fatigue, bloating and nausea. In some cases endometriosis can also cause an ovarian cysts known as endometrioma, commonly called chocolate cysts, which will similarly cause pelvic pain. If you think you might have endometriosis, talk to your health care provider.
8. Adenomyosis
Adenomyosis happens when tissue that normally lines the uterus (this is the blood and tissue that your body sheds during a period) also grows into the uterine wall.
What’s the pain like? Severe cramping during a period as well as chronic pelvic pain and pressure. “There can be cramping up to a week before a period and pain that persists after a period is over,” says Singh.
Keep in mind Another symptom is prolonged, heavy period bleeding. Talk to your health care provider.
9. Pelvic inflammatory disease (PID)
PID is the result of a bacterial infection, often because of a sexually transmitted infection like gonorrhea or chlamydia. The infection can affect your uterus, fallopian tubes, ovaries, vagina or cervix.
What’s the pain like? Pain on both sides of your lower belly and lower back. It can happen at any time in your cycle.
Keep in mind Fever, nausea, vomiting, spotting, abnormal vaginal discharge and pain or burning during sex or peeing are all symptoms of PID. It must be treated with antibiotics.
10. Appendicitis
The appendix is a small pouch at the end of your large intestine. It can get infected, inflamed, irritated and swollen.
What’s the pain like? “It starts in the belly button, then can move over to the right quadrant [lower side of the belly],” says Singh.
Keep in mind Fever, nausea and vomiting are other symptoms. If you’re experiencing these, seek medical help.
11. Painful bladder syndrome
Your doctor may also call this interstitial cystitis.
What’s the pain like? “There is pain as the bladder fills, with intense pain when it’s full. There may be an urgent sense of having to go to the bathroom and perhaps pelvic pain and cramping symptoms as well,” says Singh, adding that you may feel better after you pee.
Keep in mind Citrus, caffeine and carbonated drinks may be irritants.
12. Bowel issues
Inflammatory bowel diseases, which includes Crohn’s disease and ulcerative colitis, can be a source of cramping and pelvic pain. Irritable bowel syndrome (IBS) is another possible cause.
What’s the pain like? Sudden cramping in the belly or bowels associated with irregular bowel habits.
Keep in mind Other symptoms include bloating, gassiness, heartburn, mouth sores and bowel changes like diarrhea or constipation. Cramping accompanied by rectal bleeding should be addressed immediately by a doctor.
13. Pelvic floor pain
The pelvic floor is a band of muscles that supports the organs in the pelvis. If the pelvic floor has tight, clenched muscles, it can lead to pain. This condition is called pelvic floor myalgia or pelvic floor pain, and it may especially be a factor for those with other chronic conditions (like endometriosis). It could also be due to pregnancy, childbirth or pelvic surgery. It’s a way the body tries to protect that area from trauma, says Singh. “It’s actually one of the most common, under-recognized, undiagnosed reasons for pain.”
What’s the pain like? For some, this feels like a burning ache in the pelvic area. For others, it may be more of a spasm-like shooting pain, and could be associated with sex, using a tampon or having a vaginal exam.
Keep in mind A pelvic floor physiotherapist or other health care provider can help retrain the muscles to relax.
If pelvic pain is sudden, severe and associated with fever or heavy bleeding, go to your doctor or an emergency room. However, less severe or chronic pain is also worth a conversation with a healthcare professional. “I think that any pain that is affecting quality of life needs to be addressed. If you’re not doing well; if this is affecting your work or your school, talk to somebody. That’s the bottom line,” says Singh.