Period-Like Cramps Can Actually Be A Sign Of A UTI
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Whether they're dull and achy or sharp and throbbing, there are few things worse than abdominal cramps. Cramping is often a telltale sign that your period has made its arrival (or it's about to), and while its typically associated with your menstrual cycle, that's not always the case. If you notice cramps but no period and can't figure out what's happening, don't panic—it's actually more common than you think.
A wide range of health issues (think: infections, stress, and hormonal conditions) can throw off your cycle. Physical abnormalities in your uterus and ovaries can also cause cramping that feels like pre-menstrual syndrome (PMS) symptoms, adds Chailee Moss, MD, an ob-gyn at The Centers for Vulvovaginal Disorders.
If you suspect an underlying medical issue is messing with your flow, check in with your doctor. They can help you figure out the cause and what you need to do to get your cycle back on track. In the meantime, here are all of the potential reasons you might have cramps but no period, according to experts.
Meet the experts: Staci Tanouye, MD, is an ob-gyn in Jacksonville, Florida. Chailee Moss, MD, is an ob-gyn at The Centers For Vulvovaginal Disorders in Washington, DC. Jessica Shepherd, MD, is a Chicago-based ob-gyn. Yasmin Akhunji, MD, is an endocrinologist with Paloma Health. Sherry A. Ross, MD, is an ob-gyn and the author of She-ology. Nicole Scott, MD, is an ob-gyn at Indian University Health. Greg Marchand, MD, is an ob-gyn and the program director for the minimally invasive gynecologic surgery fellowship at Steward Health. Jodie Horton, MD, is an ob-gyn and chief wellness advisor for Love Wellness.
What causes cramps but no period?
1. Anovulation
Every once in a while, your body goes through similar hormonal changes associated with PMS but doesn't actually release an egg that month. This is known as an anovulatory cycle. If you do not release an egg during a cycle, you won't actually get your period (but you could still get the cramps).
"Ten to 18 percent of all regular cycles are anovulatory,” says Chicago-based ob-gyn Jessica Shepherd, MD. An anovulatory cycle can happen randomly on occasion, or it may be related to another issue, like low body weight, polycystic ovarian syndrome (PCOS), or if you're getting close to menopause, according to Cleveland Clinic.
While skipping a period every now and then is usually nothing to worry about, if you feel nauseous, have a fever, or have pain that you can’t control with simple OTC medications or that doesn’t improve within a week, check in with your doctor right away. It’s also time to see your doc if you skip more than three cycles in a row, notes Dr. Shepherd.
2. Pregnancy
If you've had unprotected sex in the past month, missed taking your pill, or rely on the pullout method for birth control, it's worth taking a pregnancy test. Many of the symptoms of early pregnancy—including breast tenderness, mood swings, fatigue, and (you guessed it) cramping—mimic the symptoms you typically have before and during your period.
3. Thyroid Conditions
Your thyroid, a small butterfly-shaped gland in your neck, regulates many of your body’s functions, including your metabolism and menstrual cycle. If your thyroid gets out of whack, your cycles can become irregular, says Dr. Shepherd. As a result, you may go a long stretch without having your period while still experiencing period-like cramps, adds Dr. Moss. Spotting or cramping may also occur because the lining of your uterus has built up, but hasn’t shed because you’re not ovulating.
It's common for thyroid conditions to be misdiagnosed or to have a delay in diagnosis, especially among certain minority populations, explains Yasmin Akhunji, MD, an endocrinologist with Paloma Health. "Conditions like hyperthyroidism, or Grave's disease, if it is caused by autoimmune factors, are more prevalent in Black and Asian communities in the U.S., especially among females," says Dr. Akhunji.
Hyperthyroidism, where the body produces too much thyroid hormones and can cause increased anxiety, insomnia, and tremors, affects Black women twice as much as white women. Asian and Pacific Islander-identifying women also have a 78 percent increased risk of Grave's disease compared to white women, notes Dr. Akhunji. However, the opposite condition, hypothyroidism, or Hashimoto's thyroiditis—characterized by a slower metabolism, fatigue, hair loss, and in some cases, weight gain—tends to be more common in white women.
4. Hormonal Birth Control
One very common side effect of hormonal IUDs is skipped periods. That’s because one of the ways the device prevents pregnancy is by thinning out the endometrial lining in your uterus, so there’s nothing to shed come that time of the month.
Hormonal IUDs do not always suppress ovulation, or the normal hormonal cycling, says Staci Tanouye, MD, an ob-gyn in Jacksonville, Florida. “Many people will still feel PMS symptoms and period-like cramping, but no period because there is no lining to shed,” she explains.
Birth control pills can also result in a light flow or spotting, so you might feel period symptoms, like cramps and breast tenderness, even without a heavy, full-blown period, says Dr. Shepherd.
5. Stress
Stress is a surprisingly common reason for missing your period—and potentially cramps, too. “It increases your cortisol levels, which affects your hormone balance,” says Dr. Shepherd—including the hormones that regulate your ovaries and uterine lining.
Exams, the news cycle, and even breakups are all big-time stressors that can cause periods to go awry. But even subtle things, like juggling a ton at work, can add up and affect your mind and body.
“Some people don’t realize they’re so stressed, but once they talk about it, they realize they are going through something,” says Dr. Shepherd. If you think stress is messing with your periods, talk to your doctor. Therapy, exercise, yoga, and meditation can all help with stress, regulating your period, and reducing those cramping symptoms.
6. Polycystic Ovary Syndrome (PCOS)
Frequent skipped periods can be a sign of PCOS, which is "a condition in which a patient has an excess of androgens, chemicals in the body that affect ovary function, hair growth, weight gain, and sensitivity to insulin,” says Dr. Moss.
Up to 20 percent of women worldwide are affected by PCOS, and it's more common among women who are overweight or have a mom or sister with the condition, Dr. Moss says. It's not necessarily more prevalent in any one racial or ethnic group, but the symptoms might present differently between certain communities.
For example, Hispanic people tend to have more severe PCOS symptoms, including hirsutism (excess hair) and acne, one study found. Black individuals with PCOS might have a greater risk of developing heart disease too, Dr. Akhunji adds. In addition, medical racism is often at play; people of color might not have access to quality care to evaluate hormonal conditions like PCOS, and healthcare providers might not take BIPOC individuals' health concerns seriously, Dr. Akhunji says.
If you think you might be suffering from PCOS (and have cramps as a result), ask your doctor about it. While there is no cure, birth control and other medications can help manage symptoms.
7. Uterine Polyps
You might associate polyps with your colon, but the same small benign tumors can grow in your uterus, too. These polyps can cause cramping and period-like discomfort, even when you’re not on your period, says Dr. Moss.
Because polyps can make it harder to get pregnant—and because there is a small risk they may develop into uterine cancer down the line—your doctor will likely want to remove them, most often with a relatively simple procedure known as a hysteroscopy. During a hysteroscopy, a doctor inserts a long tube up through the vagina and into the uterus. The doctor is able to use the scope to both see and cut out the polyps.
8. Ovarian Cysts
Every month, your ovaries make several cysts in preparation for ovulation, but only one cyst releases an egg. Although the others usually dissipate on their own by the time you get your period, sometimes one cyst (or more) sticks around. Although ovarian cysts often cause no symptoms at all, they can sometimes trigger period-like pain when you’re not on your period.
“Cysts in and of themselves aren’t usually a problem,” says Dr. Moss. “But if they get particularly large, they can cause the ovary to twist—a.k.a. an ovarian torsion—which is painful and requires an emergency procedure to save your ovary.”
9. Pelvic Inflammatory Disease (PID)
Cramping is a common symptom of PID, which is an infection of the uterus, fallopian tubes, or ovaries that typically occurs when sexually transmitted bacteria spread from your vagina to your reproductive organs.
“Sexually transmitted infections such as chlamydia and gonorrhea are the typical culprits of this serious pelvic infection that can lead to pelvic pain and infertility,” says Sherry A. Ross, MD, an ob-gyn and the author of She-ology. “Make sure you’re getting regular STI checks between new sexual partners to ensure you are not a carrier of damaging STIs."
10. Urinary Tract Infections (UTI)
One common UTI symptom is pelvic cramping, Dr. Ross says. You may also find yourself running to the bathroom more often and notice pain, burning, and bleeding when you pee. Sometimes bacteria can get inside your urinary system and cause an infection.
As many as one in five women will have a UTI at some point in their lives. If you think your cramps might be associated with a UTI, head to your ob-gyn or primary care physician ASAP. Antibiotics will clear it up quickly. But left untreated, a UTI could turn into life-threatening kidney infection.
11. Mittelschmerz
If you have PMS-like cramping (especially one-sided, lower abdominal pain), bloating, and breast tenderness but no period, one reason may be that it's not *quite* time for your period yet—but it's coming.
German for "middle pain," mittelschmerz happens about half-way through your menstrual cycle—around day 14 when you ovulate, says Nicole Scott, MD an ob-gyn at Indiana University Health. It's a totally normal experience—affecting about 40 percent of women—and it doesn't mean anything is wrong, she says.
Since it's just your ovaries doing their thing, there's not much you can do to prevent it and the symptoms should go away within a day or two. But if you're in extreme pain or notice signs of infection (think: fever and chills), call your doc ASAP, Dr. Scott says.
12. Exercising Too Much
Moving or exercising daily is one of the best things you can do to calm PMS symptoms. However, going at it too hard or too often can actually mess up your cycle and make you miss your period altogether in some cases, Dr. Scott says.
All that physical stress can make your period go AWOL and cause abnormal fluctuations in your hormones, especially if you lose a lot of body fat. These shifts can result in moodiness, irregular spotting, acne, and other PMS-like symptoms (i.e., cramping with no actual period).
13. Certain Sex Positions
It’s ironic that something so pleasurable can also lead to pain, but “experiencing cramping or pain after sex is completely normal,” says Dr. Ross.
Why is that? “Some sexual positions are known to be anatomically harder on the vagina and female organs, including the uterus and ovaries,” she explains. “For example, doggy style allows deeper penetration but can cause discomfort for many women, while missionary position tends to be easier and more comfortable for women.” Experiment with your partner to figure out which positions are best for your body.
“Sex positions that specifically move the uterus may bring on a sharp, stabbing pain if the ligaments are challenged. This may radiate to the groin," says Greg Marchand, MD, an Arizona-based ob-gyn and the program director for the minimally invasive gynecologic surgery fellowship at Steward Health. Your best bet? "Avoid repeating any movements that are painful and see your doctor if the pain continues the next day,” he says.
14. Interstitial Cystitis
Also known as painful bladder syndrome, interstitial cystitis can cause symptoms that are similar to those of a UTI, including pelvic pain, pain between the vagina and anus in women, pain during intercourse, and a continual urge to pee. It can also cause cramping in the lower abdominal area, Dr. Ross says.
With this condition, your bladder wall becomes inflamed and irritated, causing scarring and stiffening of the organ. The result: Your bladder can't hold as much urine as it used to. The exact causes of this condition aren’t known, but it may be associated with a defect in the protective lining (epithelium) of the bladder, an autoimmune reaction, infection, or allergy. It may also be hereditary.
There's no cure for the condition, but it can be managed with medication, bladder training, or surgery, per Johns Hopkins Medicine.
15. A Miscarriage
Miscarriages are much more common than you might think—every pregnant woman has a 25 percent chance of having a miscarriage, says Dr. Ross. Signs of a miscarriage can include severe menstrual-like cramping. If you're pregnant and are experiencing severe cramping, contact your doctor immediately.
16. Endometriosis
Endometriosis occurs when tissue that normally grows inside of the uterus grows outside of it—typically in the pelvic area, which can cause significant cramping, says Dr. Ross.
Pelvic pain associated with endometriosis differs from regular PMS pain in that it often shows up days or weeks earlier than typical PMS cramping, and it may last for days even after your period is done.
It can take years to get an endometriosis diagnosis. "Black and Latinx populations are only about half as likely to be diagnosed with endometriosis. However, Asian women were more likely to be diagnosed with endometriosis when compared to white women," says Jodie Horton, MD, an ob-gyn and chief wellness advisor for Love Wellness. Part of this has to do with racial bias, Dr. Horton explains—Black patients' pain is often undertreated. BIPOC individuals might also have their endometriosis symptoms downplayed or attributed to anxiety due to ongoing biases in healthcare.
The other difficulty in diagnosing endometriosis is due to the fact that a variety of conditions can cause painful periods and pelvic pain. Endometriosis symptoms also vary from person to person. "A woman may have very few lesions and have severe symptoms compared to another woman who may have severe disease and may have no symptoms at all," says Dr. Horton. Sometimes it requires excision surgery to remove tissue and diagnose endometriosis.
17. Irritable Bowel Syndrome (IBS)
“Lower abdominal cramping is a common complaint in women suffering from IBS,” Dr. Ross says. IBS, which is more prevalent in women than men, is associated with recurring abdominal pain or discomfort, along with altered bowel habits over a period of at least three months. These can include constipation, diarrhea, or the double whammy—both constipation and diarrhea (yes, this is possible!), Dr. Ross says.
18. Ovarian Cancer
Ovarian cancer is relatively rare, but it ranks fifth for cancer death among women, per the American Cancer Society. A big part of this is because it often shows no, or very subtle, symptoms, Dr. Scott says.
The majority of ovarian cancers occur post-menopause, when you're no longer getting periods anyway, but cancer can cause abdominal and pelvic pain and cramping, says Dr. Tanouye. However, there are rare types of ovarian cancers that can happen in premenopausal women, she adds.
That said, abdominal bloating, urinary problems, weight loss, and abdominal or pelvic pain are all possible symptoms of ovarian cancer. If you've missed your period for three months or more, or you have other concerning symptoms, including inexplicable pelvic discomfort, call your doctor.
19. A Ruptured Cyst
Cysts—such as those caused by PCOS, an anovulatory cycle, or simply your ovaries—are fluid-filled sacs that often come with no symptoms, according to the National Library of Medicine (NLM). That being said, cysts can sometimes cause the sensation of pressure, bloating, swelling, and period-like pain but without menstruation.
Although cysts are typically not a problem, they can get rather large and potentially rupture, causing sudden, sharp cramps, often in tandem with nausea and vomiting, per the NLM. Because it depends on which ovary has (or had) the cyst, there’s no hard-and-fast rule as to where in your abdomen you might experience this pain.
20. Pelvic Floor Muscle Dysfunction
The pelvic floor is a group of muscles and other tissues that form a sling across the pelvis, which holds together the vagina, uterus, bladder, rectum, and other pelvic organs, according to the NLM. Just like any other part of your body, your pelvic floor can become weak or injured, particularly after pregnancy and childbirth, and cause symptoms such as pelvic pain, lower back pain, and the feeling of pelvic pressure or fullness that are akin to those during your period.
The standout difference from menstruation pain? If you can feel a bulge inside the vagina or, in more extreme cases, you can see your organs start to push out of the vaginal opening, then you are probably dealing with pelvic floor muscular problems, per the NLM.
Other symptoms include pain during sex, burning feeling in the vagina and while peeing, leaking urine when you cough, laugh, or exercise, and leaking stool or having a hard time making it to the bathroom in time. To determine what’s going on, your health care provider will typically conduct vaginal and rectal exams, the Cleveland Clinic says.
21. Ectopic Pregnancy
Simply put: An ectopic pregnancy is when a fertilized egg grows outside the uterus, about 90 percent of the time in a fallopian tube, according to the American College of Obstetricians and Gynecologists (ACOG). As the pregnancy grows, it can cause the tube to burst, potentially causing life-threatening internal bleeding that warrants immediate surgery.
At first, this pregnancy might appear and feel just like any typical pregnancy, thanks to signs such as missed period, tender breasts, and an upset GI system. You might also experience low back pain, abdominal pain, or pelvic pain (think: cramping)—all of which still make it hard to tell if you’re experiencing an ectopic pregnancy or a typical one.
But as the fetus grows, more serious, defining symptoms may start to develop, such as sudden and severe abdominal or pelvic pain, shoulder pain, weakness, dizziness, or fainting, per ACOG. If you experience any of these, you should visit your doc or the ER immediately.
22. Appendicitis
This painful scenario happens when one end of the appendix gets blocked by a foreign object such as poop (yup, you read that right). Blockage inside this small, tube-like organ can lead to infection, and in turn, pain around your belly button that gradually gets sharper and moves towards the right, lower part of your abdomen, per the NLM.
But unlike period-related cramps, the pain from appendicitis typically comes on *fast* and may be even worse when you cough, sneeze, or even walk. Other signs that distinguish this pain from that of your period include fever, nausea, and vomiting—all of which mean you should head to a doctor's office or ER as soon as possible for treatment, hopefully before the appendix bursts.
23. Inflammatory Bowel Disease (IBD)
Different from IBS, IBD is an umbrella term that encompasses several conditions, including Crohn’s disease and ulcerative colitis, that are characterized by chronic inflammation of the GI tract. While the exact cause is unknown, IBD is thought to be a result of your immune system responding incorrectly to triggers that cause inflammation, according to the Centers for Disease Control and Prevention (CDC). Genetics may also be at play.
Note: For patients with Crohn’s, pain is typically localized to the lower, right side of the abdomen. For those with ulcerative colitis, pain may radiate towards the left. To diagnose an inflammatory bowel disease, your doctor will likely refer you to a gastroenterologist, who may order blood tests, stool samples, and an endoscopic exam.
24. Lactose Intolerance
When you cannot digest foods with lactose, the sugar found in milk and milk products, you’re left with gas, diarrhea, bloating, and pain. This sick-to-your-stomach sensation might mimic the cramping and bloating you feel when you're on your period, and can be mild or severe, per the National Institute of Diabetes and Digestive and Kidney Diseases.
To help, keep a food log to spot patterns regarding when you feel cramping and what you just ate. This can help pinpoint whether a food intolerance is to blame.
25. Indigestion
Do you get stomach cramps—particularly in your upper belly—that started shortly after (or even during) eating? Indigestion, often during or right after eating, might be to blame. Other symptoms include heat, burning, or pain in between the belly button and the lower part of the breastbone, an unpleasant sensation of fullness during or right after a meal, bloating, and nausea, according to the NLM.
Most of the time, indigestion is not a sign of a serious health problem—although you might want to slow down when eating and avoid lying down immediately after a big meal.
How To Treat Cramping
In need of some much-needed relief? Try one of the following treatments recommended by Dr. Tanouye:
Pain relievers: Over-the-counter pain medications like ibuprofen or acetaminophen can help control the pain.
Heat: A warm bath or heating pad on the lower abdomen can ease symptoms.
Exercise: Physical activity can be a natural pain reliever since it stimulates the release of endorphins, which can help block the perception of pain.
Herbal tea: Warm chamomile or magnesium tea can help soothe cramps and relax the uterine muscles.
Hormonal birth control: Hormonal birth control including IUDs, the pill, and vaginal ring can help prevent ovulation and reduce the severity of menstrual cramps. Your doctor will help decide the best option for you.
When To See A Doctor For Your Cramps
The occasional cramp with no period is usually nothing to worry about, but if your cramps become recurrent or persistent, it’s time to see a doctor, says Dr. Tanouye. “In addition, if you’re having severe pain that is not easily resolved with things like rest, heating pad, ibuprofen, or acetaminophen, and it’s preventing you from doing your normal daily activities, this should be evaluated,” she explains.
On top of that, the following symptoms may signal a trip to the emergency room for immediate medical attention, adds Dr. Tanouye.
Pain so severe that you have difficulty moving or are curled up in a ball
Pain with persistent nausea, vomiting, or diarrhea
Severe pain when peeing or having a bowel movement
Worsening pain with fever and/or chills
Significant pain accompanied by abnormal vaginal discharge that is foul-smelling, yellow, green, or brown
Finally, anytime you miss a period for more than three months, are pregnant, or think you could be pregnant, schedule a visit with your gynecologist, adds Dr. Tanouye.
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