When you experience pain and cramping in your pelvic area, it’s usually a good indication that Aunt Flo is coming. But what when she doesn’t arrive, and you still have cramps? Well, it’s not always your period that’s to blame for your pain. Everything from cysts, constipation, pregnancy, and even cancer can make it feel like your monthly visitor is knocking on the door. And, sometimes, it can be quite difficult to tell what’s causing your cramps but let’s look at some of the possibilities.
Inflammatory Bowel Disease (IBD)
Inflammatory bowel disease, or IBD for short, is a long-term condition that causes your bowels to become inflamed. It’s unknown what actually causes IBD, but it’s thought that the inflammation is caused by an incorrect response from your immune system. The symptoms you experience with IBD fully depend on which form you’re suffering from. The most common forms are Crohn’s disease and ulcerative colitis. Crohn’s can affect any part of your digestive system, even your mouth, and you will feel mild to severe cramps on the lower side or middle of your abdomen. Ulcerative colitis, on the other hand, generally only involves your large intestine, and you’re more likely to feel cramps on the left side of your abdomen. If you suffer from IBD, cramps will unlikely be the only symptom you experience; others can include:
- Changes in bowel movements like diarrhoea or constipation
- Feeling like you have to go to the loo urgently
- Feeling like your bowels aren’t empty even after you just went for a poo
- Blood in your poop
- Losing weight
- Joint pain
- Skin problems such as rashes
Pretty much in the middle of your menstrual cycle – usually somewhere around 10 to 14 days before your next period – you might notice some mild cramping. This is no cause for concern, however, as it likely has to do with ovulation which is the process in which your ovaries release an egg. The cramping, which affects about 20% of all ovulating people, even has its own name: Mittelschmerz, meaning middle pain. So, when you’re ovulating, you might feel a sharp and sudden pain or dull cramp on one side of your lower belly. On which side you feel those cramps fully depends on which ovary releases the egg. Don’t stress about it, though, the cramping will only last anywhere from a few minutes to a few hours and is usually very manageable. There isn’t a whole lot you can do about these cramps as it’s really just your body doing its thing but if the pain gets too uncomfortable, try using some over-the-counter pain relief.
Ruptured ovarian cyst
Your ovaries are a very common place for cysts to form. Why? Because during every cycle, your ovaries will develop multiple follicular cysts of which one will be chosen to release an egg. After the egg has been released, all the cysts that were developed during this cycle will usually disappear. Sometimes, however, it can happen that one or more of the cysts stay behind and fill with fluid. As long as they are small, you’ll likely not even notice that they’re there and they’re pretty harmless. Once they get bigger, however, you’ll experience symptoms like dull, cramping pain, a general feeling of fullness or heaviness in your abdomen or back, feeling bloated and swollen, and you might experience period-like pain. If the cyst gets too big, it might rupture which can cause very sudden and sharp cramps on the side of the abdomen where the cyst was. If you have a ruptured ovarian cyst, it’s also likely that you feel nauseous, have to throw up and you might experience some light spotting.
In the very early stages of pregnancy, there’s something called implantation pain which comes when your baby attaches to the lining of your uterus. The cramps you feel will be very similar to mild menstrual cramps and often happen around 4 weeks into the pregnancy which is around the time when you’d usually get your period. And although it might be scary, especially if you already know that you’re pregnant, it’s completely normal and generally nothing to worry about. If you experience bleeding as well as cramping, you should definitely go see a doctor.
An ectopic pregnancy happens when the embryo doesn’t make its way to the uterus but attaches somewhere else, most commonly in your fallopian tubes. Ectopic pregnancies can be life-threatening for you and can never result in the live birth of a baby. At the beginning, an ectopic pregnancy can look just like any other normal pregnancy including missed periods, sore breasts, and feeling nauseous. As the foetus grows, however, there’s a significant risk that your fallopian tube ruptures which can lead to life-threatening internal bleeding that requires immediate surgery. You might start by feeling mild cramps which can progress to severe, sharp pain in your lower abdomen that can spread to your back and you might even feel it in your shoulder. You might also feel weak, dizzy, and there’s a chance that you might faint.
A miscarriage means that your pregnancy comes to an unplanned end before the 20th week and it’s actually much more common than you might expect. In fact, every pregnancy has a 25% chance of ending in miscarriage! How do you know if you’re miscarrying? It might start with menstrual like cramping that will likely progressively get more severe, and you might also experience spotting and bleeding. All these symptoms aren’t tell-tale signs for a miscarriage, however, and some women will experience them and still have a successful pregnancy.
Endometriosis is a long-term condition that means that tissue similar to the one in your uterus will grow on other organs in your pelvic area like your bowels or ovaries. The tissue also behaves like the one in your uterus which means it’s affected by your menstrual cycle and can lead to period-like cramps. The cramps don’t necessarily just happen around the time your period is due, however, and can happen at any time of the month. The cramps you experience with endometriosis are different to PMS as they can start 2 weeks before your period and last for a few days after your period has already gone. This means that you might only have very few pain-free days during your menstrual cycle. Other symptoms of endometriosis are include painful sex when deep penetration is involved, painful bowel movements, and it can be difficult getting pregnant.
Pelvic inflammatory disease (PID)
PID is a bacterial infection of the female reproductive system that’s usually caused by sexual contact. The most common causes for PID are gonorrhoea or chlamydia but it can also be caused by other sexually transmitted infections. It happens when the bacteria wander from your vagina and cervix upwards into your uterus, fallopian tubes, and ovaries. If you suffer from PID, you’ll likely experience pain on both sides of your lower belly ad back which can happen at any time of the month, you might have abnormal and foul-smelling vaginal discharge, spotting, fever, nausea, vomiting, a burning pain when peeing, and pain or bleeding during sex.
Urinary tract infections (UTI)
Cramps in your pelvic region are a very common symptom of a urinary tract infection. If you have any other symptoms like having to pee often and urgently, pain and burning when peeing, bloody, cloudy & strong-smelling urine, it’s probably time to give your GP a ring who will likely prescribe a course of oral antibiotics.
Interstitial cystitis is a long-term bladder condition that’s also called painful bladder syndrome. It’s a chronic inflammation of the bladder and often causes cramps in your pelvic region that can remind you of menstrual pain. It’s unknown what actually causes interstitial cystitis, but it’s believed it is caused by a damage to the lining of the bladder, an autoimmune reaction, an infection, or allergy. Usually, those cramps will get worse as your bladder gets full and, often, they will also be worse at the time of your period. Other symptoms you’ll experience with interstitial cystitis are painful sex, feeling like you have to pee more often, having to pee urgently, and constantly feeling like you need to pee.
Irritable bowel syndrome (IBS)
IBS is different to IBD and generally causes symptoms that are related to your digestion but there’s generally no chronic inflammation as there would be with IBD. Cramps are a very common symptom for IBS and can range anywhere from mild to severe. They often come on fairly suddenly and might go away after you’ve had a bowel movement. Other common IBS symptoms are diarrhoea, constipation, not feeling empty after you’ve been for a poo, mucus in your poop, a swollen stomach, bloating and gas, discomfort in your upper abdomen, and feeling uncomfortably full or nauseated after eating. Any of your symptoms can get worse during your period. There’s currently no cure for IBS but there are ways to manage your symptoms, for example with dietary changes and over-the-counter medication.
There’s a small pouch that sits at the end of your large intestine, called the appendix, that can become blocked by foreign objects, for example poop. If this happens, it can cause irritation, swelling, and an infection to your appendix. At the beginning, you might feel this as pain around your belly button. It will then likely get worse and move towards the right lower side of your abdomen. The cramps will only feel like menstrual cramps right at the beginning, however, as they will soon be very sharp and painful. They might even get so bad that they wake you up and they’re often worse when you cough, sneeze, or just move in general. Other symptoms that you might experience are fever, feeling sick, or throwing up. If you’re sure showing of appendicitis, it’s super important that you get seen by a doctor as soon as possible as your appendix can burst which can lead to life-threatening situations.
Ovarian cancer is thankfully a fairly rare cause for your cramps, but it can happen. As the name suggests, ovarian cancer starts in your ovaries and, because there are rarely any symptoms in the early stages, it is one of the deadliest cancers for women. Possible symptoms that can point towards ovarian cancer are menstrual like cramps which can feel very vague. You might put them down to something else like constipation or gas but, other than temporary digestive issues, the pressure in your lower belly won’t go away. If your cancer has reached a later stage, it can get quite large, and your belly may start swelling which means you might have difficulty buttoning up your pants. You might also get full quite quickly when you’re eating, you might have to pee more often, and you might also lose some weight.
When should you go see a doctor?
If you have cramps but no period and they won’t go away, it’s always a good idea to have a chat with your doctor. If you experience sudden, severe pain in your belly that continues to get worse, it’s super important that you get medical help right away. To diagnose what’s causing your pain, your doctor may perform certain tests like a pelvic exam, an ultrasound, or a laparoscopy. The latter is an exploratory surgery to look at your pelvic area, including your uterus, cervix, ovaries, and fallopian tubes. Depending on the outcome of these tests, your doctor may refer you to someone who specialises in intestinal disorders or a urologist if they suspect that the root cause of your problem lies in one of these areas.