Period cramps can be the worst — you're minding your own business, then suddenly, it feels like someone's wringing your back like a wet towel and you can barely move off the sofa. After decades of getting your period, however, you probably have your own go-to remedies (ibuprofen and heating pad, stat!). But what if you're hit with cramps, but there's no telltale blood? Or what if you look at your calendar and it turns out you're not expecting your period for days or weeks?
Gynecologist explain that there are several possible causes of abdominal cramps, and it's not always easy to tell what's going on.
First off, let's remember what causes menstrual cramps: They happen when the uterus contracts to help expel blood and other tissue from the body. The uterus and other reproductive organs can also be the source of non-menstrual pain in the pelvic region, but they aren't the only potential culprits. A lot of different body parts live within your pelvic region, so it can be tricky to pinpoint the exact cause of the pain, especially if you're not a doctor.
Here, top gynecologists explain the potential causes for cramping when you don’t have your period — and when to seek medical attention.
Cramping can actually be caused by the opposite of getting your period—it may be a sign of early pregnancy, says Julia Cron, M.D., site chief and vice chair of the Department of Obstetrics and Gynecology at New York-Presbyterian Lower Manhattan Hospital. “I would say for people that are supposed to have their period, and they’re not on birth control and are sexually active with a male partner, your first thing to think about is pregnancy.”
2. Hormonal birth control
Some birth control can have the side effect of making your period vanish, particularly hormonal IUDs, such as the Mirena. Birth control pills can also make your uterine lining so thin that there is nothing to shed, says Dr. Cron, adding "It’s quite normal when people are on birth control pills not to have their period.” But even without the bleeding, you may still feel mild abdominal discomfort.
3. Ectopic pregnancy
An ectopic pregnancy happens when a fertilized egg grows outside the uterus (usually in a fallopian tube). It can cause cramping as well as abnormal vaginal bleeding, but if left untreated, the embryo may continue to grow and lead to tubal rupture, which can be life-threatening, according to The American College of Obstetricians and Gynecologists. This is why it's always a good idea to check in with your OB-GYN when you're having unexplained abdominal pain.
A miscarriage can happen so early that you might not even realize you're pregnant yet. While bleeding is the most well-known sign of a pregnancy loss, cramping and back pain or a decrease in symptoms such as breast tenderness or nausea can also signal a miscarriage.
One of the biggest clues to the cause of your cramping can be found on your calendar. “If you have cramping or pain two weeks before you’re supposed to get your period, that could just be from ovulation,” says Dr. Cron. “Mittelschmerz is the term used for the feeling of ovulation.” Of course, if you’re on hormonal birth control, you shouldn’t be ovulating so in that case, Mittelschmerz wouldn’t be the cause of your cramps.
6. Ovarian cyst
Cysts are sacs of fluid that form in or on an ovary. They often form when an egg is released and cause no symptoms. However, in some instances, ovarian cysts can cause pain, bloating or swelling in the abdomen, according to the Office on Women’s Health. If you feel sudden, severe abdominal pain accompanied by fever, vomiting, dizziness, weakness or a rapid heartbeat, seek medical help immediately, as it may be a sign a cyst has ruptured.
When tissue that is similar to the tissue that lines the uterus pops up in other places outside the uterus, that’s a condition called endometriosis. “If a person has endometriosis, they may experience cramping or pelvic pain outside the time of their menses, just due to the endometriosis being on the ovaries or the bladder or the rectum and causing discomfort,” says Kiarra King, M.D., a board-certified obstetrician/gynecologist in Chicago.
“Sometimes when women have polycystic ovary syndrome, they will have really irregular cycles where they won’t have bleeding — they may go two or three months without a period,” says Dr. King. “And sometimes with patients like that, they may have intermittent cramping.” PCOS is thought to be caused by an imbalance of hormones.
Some women develop uterine fibroids — benign tumors in the uterus which can cause pain as well as frequent urination, lower back pain, a feeling of fullness and enlargement of the lower abdomen, according to the Office on Women’s Health. If the pain becomes severe, treatments can include medications and different types of surgery, such as myomectomy, which removes the fibroids while keeping the uterus intact.
10. Pelvic inflammatory disease
Cramping that’s accompanied by a fever or abnormal vaginal discharge could signal a pelvic infection or pelvic inflammatory disease, according to Dr. Cron. Many times the underlying cause is a sexually transmitted disease, but other types of infection can lead to PID as well. If you think an infection could be behind your cramping, you should definitely seek medical care.
Urinary tract infections are known for causing frequent urination and a burning sensation during urination, but those aren’t the only potential symptoms of a UTI. “Even something as simple as a urinary tract infection can cause pain that may be perceived around the area of the uterus because the bladder rests on top of or in front of the uterus,” says Dr. King. “So even a UTI can cause cramping.”
12. Interstitial cystitis
Interstitial cystitis occurs when the bladder is inflamed, which can result in cramping, according to Dr. King. You may also feel tenderness or pressure in your pelvic region. Treatments for interstitial cystitis include lifestyle changes, bladder training, physical therapy, medications, and surgery.
13. IBS or IBD
Many body parts beyond your uterus, urethra and bladder are located in the pelvic region —including your intestines. “If someone has IBS or irritable bowel syndrome or if they have inflammatory bowel disease like Crohn’s disease, then those types of bowel concerns can lead to cramping,” says Dr. King.
Your appendix is a little finger-like pouch that’s attached to the large intestine; appendicitis occurs when the appendix gets inflamed. Abdominal cramps or swelling, nausea, fever and loss of appetite are signs of appendicitis.
15. Musculoskeletal problems
Issues with muscles, ligaments, or bones in the pelvic region can cause pain. “That probably wouldn’t cause the same type of pain that you would confuse for a menstrual cramp, but it can certainly cause pain,” says Dr. King.
When to see a doctor
If you have cramping with a missed period, and you’re a female who is sexually active with a male, Dr. Cron recommends taking a pregnancy test. If you’re not pregnant, pay attention to what else is going on in your body. “Think about if there are other associated things like are you having normal bowel movement? Do you have blood in your stool? Do you have pain when you urinate? Do you feel like you can't empty your bladder? Think about the other things in that area,” says Dr. Cron. If symptoms persist, and you can’t figure out the root cause, go see your doctor. During the visit, they will ask you to describe what you’re experiencing, perform a physical exam and order any relevant testing, such as a urine culture, ultrasound or blood tests.
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