Cramps But No Period: What Are the Possible Causes?

You’re experiencing cramps in your pelvic region, but it’s a couple of weeks before your next menstrual period is expected. What’s going on? There are a breadth of possibilities, from minor issues to major concerns, says Sherry Ross, M.D., an OB/GYN at Providence Saint John’s Health Center in Santa Monica, CA, who adds that mid-cycle cramping is fairly common. “There are many conditions that can cause cramping or pelvic pain not associated with your period,” Dr. Ross says.

Let’s take a look at some of the top possibilities, along with when you should reach out to your doctor about pelvic pain or even head to the emergency room.

Within a woman’s pelvic area are several organ systems that can contribute to cramps, says Maureen Cernadas, M.D., an OB/GYN at Saint Peter’s University Hospital in New Brunswick, NJ:

• The gastrointestinal system, which includes your colon and rectum

• The reproductive system, containing the uterus, ovaries, and fallopian tubes

• The urologic system, including your bladder

In addition, various muscles and ligaments run through the pelvic area. Because there are so many body systems in this region, the possibilities for cramps outside your menstrual cycle are wide-ranging. Some of the most common are:

Ovulation

According to Cleveland Clinic, about one in five women experience cramps or pain during ovulation, which happens in the middle of the menstrual cycle. Ovulation is when an egg is released from an ovary—about two weeks before your menstrual period—and travels down the fallopian tube.

There is even a name for pain experienced during ovulation: “mittelschmerz.” (The term comes from the German words for “middle” and “pain.”) Unless pain or cramps are severe, this is usually considered harmless and is treated with over-the-counter pain remedies, Dr. Cernadas says.

Ovarian Cysts

Ovarian cysts are fluid-filled sacs in the ovaries, and they’re very common—the National Institutes of Health notes that about one in 10 women have them. Ovarian cysts are usually benign and rarely cause problems, but they can become enlarged and prompt bloating and pain, says Dr. Cernadas.

Sign up for our weekly Women’s Health Newsletter.

Your Email...requiredPlease Enter a Valid Email Address

Your privacy is important to us.

“Some ovarian cysts can twist on their blood vessels, and this can cause cramps that come and go,” she says. “If pain is intense, you may need immediate medical attention to preserve the ovary.” Without that intervention, the cyst may grow large enough to damage the ovary and could rupture, causing bleeding, she says.

Uterine Fibroids

According to the U.S. government’s Office on Women’s Health, uterine fibroids are muscular tumors that grow in the wall of the uterus and are almost always noncancerous. While most fibroids don’t cause symptoms, some can cause cramps and discomfort, as well as other issues including:

• Feeling of fullness in the pelvic area

• Frequent urination

• Lower back pain

• Pain during sex

• Painful periods, sometimes with heavy bleeding

Endometriosis

Another potential issue that could be causing cramps is endometriosis, says Monte Swarup, M.D., an OB/GYN at Women’s Health Arizona in Chandler, AZ. With this condition, tissue similar to the uterine lining grows outside the uterus, leading to inflammation and scar tissue forming in the pelvic region. Symptoms include:

• Bloating

• Chronic abdominal pain

• Depression or anxiety

• Difficulty getting pregnant

• Fatigue

• Heavy bleeding during periods or between periods

• Nausea

PCOS

Polycystic ovary syndrome (PCOS) is a hormonal condition that affects between 6% and 12% of women of reproductive age in the U.S., according to the Centers for Disease Control and Prevention. It’s a chronic condition that doesn’t have a cure, but its symptoms—including cramping and pain—can often be managed through lifestyle changes and medication.

The condition occurs when the ovaries produce an overabundance of androgens, male sex hormones that are usually present in women in small amounts, which in turn creates a hormonal imbalance. This can lead to irregular periods as well as cramping, per Mayo Clinic.

Sexually Transmitted Infection

Among sexually transmitted infections (STIs), chlamydia and gonorrhea are the typical culprits when it comes to pelvic cramping, says Dr. Ross. “Getting STI checkups between new sexual partners is so important, to ensure you are not a carrier of these damaging infections,” she adds.

If untreated, STIs can lead to pelvic inflammatory disease (PID), an infection that occurs in your uterus, fallopian tubes, or ovaries. Cleveland Clinic notes that other PID symptoms include:

• Abnormal vaginal discharge, usually yellow or green, and often with an unusual odor

• Burning sensation during urination

• Chills or fever

• Irregular periods

• Nausea or vomiting

• Pain during sex

• Pain or tenderness in the lower abdomen

Kidney Stones

According to the National Kidney Foundation, a kidney stone is a hard clump that forms from minerals present in your urine and blocks one of your ureters (the tube that carries urine from each kidney to the bladder). In addition to cramping in the abdomen, you may have these symptoms:

• Blood in the urine

• Fever and chills

• Severe pain on either side of your lower back

• Stomachache that doesn’t go away

• Urine that smells bad or looks cloudy

IBS or IBD

Irritable bowel syndrome, or IBS, can cause pain and irritation in the abdomen; so can the more serious conditions known collectively as inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis. Per the Crohn’s & Colitis Foundation, symptoms that can occur with both IBS and IBD include:

• Abdominal bloating and distention

• Chronic and persistent abdominal pain

• Constipation alternating with diarrhea

• Mucus in the stool

• Nausea

• Urge to have a bowel movement but being unable to do so

Urinary Tract Infection

Pelvic cramping commonly accompanies a urinary tract infection, says Dr. Cernadas. In addition to menstrual-like cramps and discomfort, she notes that other symptoms may include:

• Blood in the urine

• Burning sensation with urination

• High frequency and urgency of urination

• Pressure in the lower abdomen

Pregnancy

Let’s say you’ve missed your period entirely, and now you’ve got cramping. Could there be a baby on board? Yes: Some degree of mild cramping is normal with early pregnancy—typically because the uterus is expanding, causing ligaments and muscles to stretch. This pain tends to be dull and achy and generally isn’t cause for concern. Severe and sharp pain during early pregnancy, however, can indicate a potentially life-threatening condition called an ectopic pregnancy, says Dr. Cernadas.

According to the American College of Obstetricians and Gynecologists, ectopic pregnancy occurs when a fertilized egg grows outside the uterus, usually in a fallopian tube. As the pregnancy grows, it can cause the tube to rupture, leading to internal bleeding. That’s why it’s crucial to detect an ectopic pregnancy early. If you’re experiencing this type of intense pain, it’s advisable to be seen by a medical professional as soon as possible, Dr. Cernadas says.

To determine what’s at the root of your cramps if they’re not connected to a menstrual period, your doctor will start by taking a history of your symptoms, says Dr. Swarup. To prepare for the visit, it’s a good idea to keep track of variables like:

• How frequently cramps occur and how long they last

• Intensity of pain

• What helps to alleviate them, if anything

• Whether other symptoms are present like nausea, headache, or fatigue

• Whether symptoms are worsening over time

Your doctor may recommend testing to pinpoint the cause. For example, Dr. Swarup says an abdominal or pelvic ultrasound is often used because it can show an array of organs that might be involved in your cramps, such as the liver, gallbladder, pancreas, bile ducts, uterus, cervix, fallopian tubes, and ovaries. An ultrasound can show problems like fibroid tumors and cysts, inflammation, infection, ectopic pregnancy, and abnormalities in the anatomic structure of the uterus, among other issues.

To continue ruling out different possibilities, your doctor will likely also suggest testing for a sexually transmitted infection, urinary tract infection, or possibly pregnancy, adds Dr. Ross.

With any of the conditions above, cramps can be intense enough to sideline your work and social plans. But there are certain symptoms that should prompt getting immediate medical attention, Dr. Ross says. She recommends contacting your healthcare provider or going to the emergency room if any of these occur:

• Bleeding when you don’t have your period. (Usually, light spotting between periods isn’t a cause for worry, per Cleveland Clinic, but you should get checked out by your OB-GYN just in case.)

• Chills and body aches

• Dizziness and lightheadedness

• Fever above 103 degrees Fahrenheit

• Nausea or vomiting

• Persistent and worsening abdominal pain

If you begin having cramps and it’s not time for your period, that doesn’t necessarily mean something serious is going on; there are many instances when abdominal or pelvic cramps are tied to common issues like constipation or ovulation. But if the cramps start occurring regularly or they’ve lasted for more than a couple days, Dr. Ross suggests talking with your doctor to find out the cause and begin treatment if necessary.