For over six months, my friend suffered from intense cramps and heavy menstruation. She associated it with her menstrual cycle and hormonal changes. It wasn't until the pain worsened and her abdomen began to grow in size that she figured something wasn't right and sought medical attention. As it turned out, she had fibroids. Given so many conditions that may cause cramps resembling our menstrual cramps, let's learn how to identify them, shall we?
19 Reasons why you might have cramps but no period
As if the pain during our period is not enough, we can also have cramps and pelvic discomfort outside our periods. Cramps can be acute and short-lived or chronic (progressive and intensifying pain). There are many reasons we can have cramps outside our menstrual cycle. Some of the most common causes include:
- Fibroids
- inflammatory pelvic disease
- irritable bowel syndrome
- ovarian cyst
- ectopic pregnancy
- and many more!
Below we'll outline each to give you a sense of what to look out for when identifying potential causes of cramps outside of menstruation.
1. Fibroids
You might know them as fibroids or myxomas. These benign growths in the uterine wall are very frequent especially in women between 35 and 50 years of age and in African-American women. More than 50% of women who suffer from fibroids have no idea they have it as it can be asymptomatic. Symptomatic women experience pelvic pain and pressure accompanied with increased abdominal size, abnormal vaginal bleeding, painful sexual intercourse and anemia. These myxomas can grow up to the size of a watermelon and cause intense discomfort for the woman. If you are experiencing cramps and abdominal growth then you have to see a doctor.
2. An inflammatory bowel disease (like Crohn's or ulcerative colitis)
Cramps are not only associated with reproductive health conditions. They can be present in a variety of other systems and the gastrointestinal tract is not an exception. Sometimes our immune system can destroy our own tissues and cause damage. This is what happens in inflammatory bowel disease, the immune system attacks the GI tract causing inflammation. Crohn's disease and ulcerative colitis, autoimmune-induced swelling will cause bloating, rectal bleeding, bloody stool, weight loss, extreme tiredness and of course cramps.
3. Irritable bowel syndrome (IBS)
That lower abdominal cramp you have been experiencing off and on might be an IBS especially if you also have diarrhea or constipation, bloating or abdominal distension. The cause of IBS is not known but it is frequent in adolescents and people above the age of 20. Stress is an important trigger for IBS. IBS has no cure but can be managed with the right medications and diet.
4. Ruptured ovarian cyst
So cysts are small bags of fluid that can appear on our ovaries. Our ovaries work hard to produce many follicles, of these follicles only one will mature and be released as an egg during ovulation. After ovulation a bag of fluid can form on one or both ovaries known as an ovarian cyst. Ovarian cysts are benign but in some cases they can rupture causing acute and intense pelvic pain or pressure accompanied with nausea or vomiting and abnormal vaginal bleeding. The pain can be one sided or on both sides depending on which ovary releases the egg.
5. Ectopic pregnancy
The entire idea of pregnancy is for a fertilized egg to attach itself to the uterine wall which is the only conducive part of the reproductive apparatus for the development of new life. Ectopic pregnancy occurs if the fertilized egg begins its development in any other part of the reproductive tract aside the uterine wall. To give you a sense of how common this is, one in every 90 women in the UK develops an ectopic pregnancy. The most common site for ectopic pregnancy is the fallopian tube.
In this case, the fertilized egg will remain in the fallopian tube and begin to develop. This will expand the tube until it ruptures. Ectopic pregnancy can also occur in the cervix, in the ovary, at the point between uterus and fallopian tube. Ectopic pregnancy might be asymptomatic but in symptomatic cases, the woman will have intense pelvic pain and vaginal bleeding like in a miscarriage.
6. Ovulation
Right before the luteal phase of your menstrual cycle, ovulation occurs releasing a mature egg from one of your ovaries with the hope that a sperm will fertilize it and give rise to new life. At this point, the uterine walls are ready and awaiting the fertilized egg. This egg moves from the ovary to the fallopian tube where it waits for 24 hours to be fertilized by the bravest of sperm cells. If fertilization occurs, the fertilized egg travels through the fallopian tube to the endometrium (uterine wall) to begin the developmental process. In the absence of fertilization, our monthly visitor comes knocking, often causing bleeding and pain.
7. Pelvic-floor muscle dysfunction
Pelvic floor muscles support the bladder, vagina, uterus, rectum and anus. These muscles might become weak, overstretched or too tight making it difficult to support the pelvic organs. When this happens, the patient will have urinary and fecal incontinence, constipation, bloating, pelvic organ prolapse, pain during and after sex and a chronic intense pelvic pain (cramps).
8. Exercising too much
Most days I love exercising, other days I am too lazy to move. We all know the importance of exercising and being fit but sometimes we tend to force our body to go the extra mile. Rest is an important part of exercising because it helps the body recover. Over-exercising without rest causes wear and tear of pelvic muscles, including the pelvic floor muscles. This will give rise to chronic and intense pelvic pain.
9. Miscarriage
Pregnancy is a beautiful process of creating life. In a normal pregnancy, the fetus continues to develop and grow without causing cramps or bleeding until during childbirth. Sometimes during pregnancy, before the fetus is capable of surviving outside the womb, a miscarriage or a spontaneous abortion can occur.
A pregnant woman, less than 20 weeks pregnant who begins to have cramps and vaginal bleeding is most likely miscarrying. Aside from bleeding, the woman can also bleed out fetal tissues. It's important to pay attention to these symptoms in the early stage of pregnancy. There are many reasons a woman may miscarry but none of them is her fault.
10. Certain sex positions
We can all agree that sex is sometimes painful pleasure. Being wild in the bedroom can spice up your sexual relationship. Certain sexual positions that overwork your pelvic muscles or the pelvic floor muscles can cause cramps after sex. Deep penetrations too can cause cramps especially with the doggie style . Another cause of cramps related to sex is orgasm, this is one cramp every woman would kill to have. Orgasm is an involuntary contraction of the pelvic and pelvic floor muscles which can cause cramps. I think I speak for most women when I say this is a cramp we are willing to accept.
11. Pelvic inflammatory disease (PID)
One other condition that causes us to have cramps is PID (Pelvic inflammatory disease). PID is an infectious type of swelling in the endometrium, fallopian tube and adjacent structures. In most cases, it is of bacterial origin and is frequent in young sexually active women. PID will cause an acute onset of pelvic pain accompanied with vaginal discharge, painful sex, painful urination, bleeding after sex and fever. They are mostly associated with STIs such as gonorrhea and chlamydia infections.
12. Endometriosis
So we know that our uterus has specialized tissues that help with its functions. Sometimes these tissues can grow outside the uterus due to hormonal imbalance. For example they can grow in the ovaries, in the ureter, bladder and other surrounding organs. This process causes pelvic pain, painful menstruation, pain in the lower back, painful sex, painful urination, bloody stool and a chronic fatigue.
13. Ovarian cancer
Ovarian cancer is the most lethal form of gynecological cancer in women. It affects most postmenopausal women between the ages of 55 and 64 with a very low rate of survival. Cramps can also suggest an advanced ovarian cancer since early stage ovarian cancer is asymptomatic. Ovarian cancer will present with chronic pelvic pain, abdominal pain, bloating, increased abdominal size, fatigue and early satiety. Family history is a very important risk factor, so make sure you know your family health history.
14. Appendicitis
Your cramps could be as a result of an inflammation in your appendix. Fecal matter and foreign bodies can cause your appendix to swell resulting in a bacterial infection. Appendicitis is characterized by an acute onset of pain that can start at the upper part of the abdomen and gradually move to the right lower part of the abdomen. If you have this kind of pain, pay attention to accompanying symptoms such as nausea, vomiting and fever. Appendicitis is a medical emergency so make sure to see a doctor immediately.
15. Interstitial cystitis
If you have been having an urgent and frequent need to urinate accompanied with pelvic pain or pressure, you might have interstitial cystitis. Interstitial cystitis also known as painful bladder syndrome is a noninfectious swelling of the walls of the bladder which can continue to deteriorate over time. The patient can urinate up 60 times a day and these symptoms can get worse during menstruation, ovulation, physical or emotional stress and even during sex. Also be careful what you consume as citrus fruits, chocolate, alcohol, tobacco and tomatoes can worsen the symptoms.
16. Mittelschmerz
Ovulation for most women is uneventful but for many other women ovulation means pain. Ovulation occurs on the 14th day or the middle of your menstrual cycle. The release of mature eggs from the ovary can cause pelvic pain. This pain can last from minutes to hours and is mostly one sided depending on the ovary releasing the egg. Mittelschmerz is a German word for middle and pain which characterizes ovulation in some women.
17. Stress
Stress is the way we react to excessive pressure or demands. One of the physical symptoms of stress on the human body is cramping. Aside from that, stress worsens other health conditions that cause cramping. They include IBS, gastritis and inflammatory bowel syndromes. Now you know, your cramps might just be stress. Speaking of stress, one thing that can be stressful when your period is coming is dealing with your flow. We happen to really love some of the period panties on the market today - read our reviews of Ruby Love vs Modibodi and Think vs Speax.
18. Uterine Adenomyosis
As we already know, in endometriosis endometrial tissues grow outside the endometrium. These tissues can also grow within the muscles of the uterus. When this happens, the uterus enlarges until it is the size of a 12 weeks pregnancy. Women who have adenomyosis will experience chronic pelvic pain, increased abdomino-pelvic size, painful and heavy menstruation and anemia.
19. Urinary tract infections (UTI)
UTIs are very frequent in women and even more during pregnancy. The urinary tract infection is a very important cause of pelvic pain in women. It can affect the urethra, bladder or kidneys and are mostly caused by bacteria. Aside from pelvic (flank) pain, UTI causes lower back pain, urinary frequency and urgency, burning sensation during urination, fever, vomiting and sometimes hematuria (blood in urine).
If you're looking for care for UTIs, check out our review of Wisp. They offer virtual care that can help clear up outbreaks reactively, as well as supplements for proactive care to prevent symptoms in the future.
Diagnosing cramps with no period
Any cramp outside your menstrual cycle requires the attention of a physician. Chronic or sudden pain can be a red flag especially when accompanied with other symptoms. Remember to pay close attention to the timing and intensity of your pain so you can provide your physician with complete information so they can arrive at the right diagnosis.
When to talk to your doctor about cramping
From what we have seen so far, cramps are not always as a result of your menstruation. There are a million possible reasons you could be having cramps. The best option is always to see your physician when you have sudden pelvic pain or a chronic pain accompanied with any of the symptoms already mentioned in this article.
For a long time we have masked our pain and discomfort because society expects that of us. But the truth is, many women have lost their lives by not reacting fast enough to period pain outside of their menstrual cycle, so it's important to seek help as soon as possible.
Luckily now we have the knowledge to act, whether that means seeking non-drug treatments for regular menstrual cramps, such as pain relief devices from Livia or Ovira, or seeing a doctor right away for irregular pelvic pain. Either way, relief and guidance are always available.