Period cramps but no period – what could it mean?

Us women are very in tune with our bodies, so when you're experiencing period cramps but no period arrives, you might be worried. Could it mean you're pregnant? Or could something else be causing it?

Of course, feeling stomach aches and pains from time to time is totally normal, and you could be mistaking other types of stomach pain for period cramps.

The NHS says it could be period pain if it occurs at the start or several days before your period. They say the pain can be felt in your belly but also spread to your back and thighs, and that it can be a sharp pain or a dull ache and will usually last for up to three days and affect your daily activities.

If you're feeling both cramps and having irregular periods, and want to know - what does it mean to have cramps but no period? It's definitely worth visiting your GP as they can help determine what's causing this.

Possible causes of period cramps but no period

1) Pregnancy

If you're wondering - is cramping a sign of pregnancy? It's always worth taking a pregnancy test if your period is late and you think you might be pregnant, even if you're experiencing pains. It is possible to have period-like cramps during early pregnancy. Remember it's important to take pregnancy tests if you feel you could be pregnant, even if you are using contraception like the combined pill, these aren't always fully reliable.

2) Stress

This is probably the most common reason for a missed period. That's because it increases your cortisol levels, which can affect your hormone balance including the hormones that regulate the ovaries and uterine lining. If you're experiencing cramps when not menstruating, stress could likely be the cause, this is because not only can stress put the breaks on your period and how regular it is, but it can also cause bowel problems, which result in cramping.

3) Ovulation

If you're experiencing menstrual cramp pain but no period has shown up, it's a good idea to try an ovulation calculator or ovulation tracker to work out when you're ovulating. Some women also experience ovulation symptoms around the time of ovulation including pain, ovulation bleeding, ovulation discharge, bloating during ovulation and cramping, which could be mistaken for period pains.

4) Constipation

Did you know many of us experience constipation before our period starts? The increase of the hormone progesteroneand estrogen can lead to constipation before our period is due to start. These feelings of constipation can make us feel full and bloated as well as causing cramps and pains in the lower abdomen.

5) Trapped wind / gas

If you're experiencing discomfort similar to period pain, bu no period comes, the cause could be something as simplet as a digestive issue. Digestion issues are a common cause of abdominal pain around your period, as the change in hormones can also wreak havoc on your bowel health. Something as simple as trapped wind can cause stomach pain and bloating.

6) Menopause

One sign that the menopause is on the horizon is irregular periods. If you're over the age of 40 and you're experiencing some of the other signs of menopause, then you may want to discuss your symptoms further with your GP.

7) IBS

If you're experiencing regular abdominal pain, it could be a sign of IBS. If you've been experiencing things like constipation, diarrhoea and regular cramping over the past three months, then you should speak to your doctor.

8) PCOS

If you find you are frequently missing periods but aren't pregnant, it could be a sign of PCOS. This is a condition that impacts around 20 per cent of women and you should definitely discuss this with your GP if you think you might have PCOS.

9) Medications or illness

Although it's unlikely to be the culprit, some women believe certain medications or periods of illness have delayed their periods. If you've recently started some new medication or think illness may be causing the issue, then it's a good idea to speak with your GP.

10) Cysts

Our ovaries make cysts each month in preparation for ovulation, and although they usually disappear when your period arrives some can stick around. Although they may not trigger symptoms, some women can experience cramping with their cysts. If you're experiencing pain of any kind, you should speak with your doctor.

11) Endometriosis

This is a condition which can affect women at any age. Symptoms vary, but some women experience extreme period pain and cramping, as well as pain in the lower back and tummy during and leading up to the period.

12) Pelvic inflammatory disease

Pelvic inflammatory disease or PID as it's often called happens when the reproductive organs including the uterus, fallopian tubes, or ovaries get infected. This usually happens when sexually transmitted bacteria spreads to your reproductive organs. If you're worried, it's a good idea to have an STI check and speak with your doctor.

Is it just my period on its way?

It's normal to notice physical and emotional changes in the lead up to your period, including stomach cramps, but it doesn't stop you wondering - why do I have cramps but no period? It's very common to get period cramps before a period actually arrives though.

If your period is a little late, there could be a number of lifestyle factors that could be causing your periods delay, so it doesn't automatically mean you're pregnant. If you do think you're pregnant, you should take a pregnancy test to put your mind at ease. Things like stress, weight loss and contraception can all impact your cycle.

Your age can also play a part in this. If you're yet to experience your first period, this could just be your body's way of preparing itself for its first menstrual cycle. Alternatively, if you're in the early stages of the menopause, you could also experience period pains without bleeding.

What causes period pain?

We know how painful period cramps can be at times, and sometimes, it can help to understand what's actually going on down there.

Those pains are happening because the muscular wall of your womb is contracting (tightening). Did you know that womb contractions are always happening? But most of the time they're so minor that we can't feel them. During our periods however, these contractions get stronger, meaning we can feel them.

What helps cramps?

Period cramps aren't serious but they can be very painful, and stop you from functioning well, or at all. Some women may even have to take time off work if their period cramps are too intense. Period cramps are common though, and there are various ways to help ease the pain and discomfort.

Here are some ideas from the NHS:

They also say to try cutting down on alcohol and not smoking as these can help ease period pain too.

If your cramps are more serious and you find yourself havinvg to take more and more time off work every month it's worth visiting your GP, as they can prescribe anti-inflammatory medicines. They may put you on a contraception that'll make your period lighter, which can help to reduce pain. In some cases you might need more specialist testing to find out any underlying conditions so that you can get proper treatment.

According to Dr Deborah Lee, Dr Fox Online Pharmacy, they say: "t's not uncommon for a woman to experience pain, just like period pain, but have no menstrual bleeding. Anything that causes inflammation in the ovarian, uterine, endometrial or other pelvic tissues can cause pain due to the local production of prostaglandins. Remember that there are other causes, apart from gynaecological causes, of lower abdominal/pelvic pain – such as irritable bowel syndrome (IBS) or appendicitis.

Symptoms?

The pain can vary from mild cramping pains, felt low in the back, in the lower abdomen, pelvis and thighs, to severe sharp pains in the abdomen and pelvis. These could be one side or the other or can be bilateral. Alternatively, you might feel a generalised aching in all these regions, says Dr Deborah Lee.

If the pain is acute and severe, there may be systemic symptoms such as fever, nausea, vomiting and collapse.

What causes cramps but no period?

Fibroids – These are benign tumours that develop in the uterine wall. They are almost always benign - not cancerous.  Fibroids can be as large as 20 cm in diameter. Rarely they can be the size of a melon. They grow and press on surrounding structures such as the bladder and the bowel, says Dr Deborah Lee.

Although many women have no symptoms from fibroids, sometimes they can be problematic. They can cause abdominal or pelvic pain, vaginal discharge, painful sex, urinary symptoms, constipation and abdominal distension. The pain varies but can be aching or throbbing and may be felt in the lower abdomen, pelvis and the low back.

Fibroids are diagnosed on an ultrasound of the pelvis. Other investigations such as a hysteroscopy – a telescope in the pelvis may be necessary. Treatment depends on the age of the woman and her wishes in terms of her fertility. It is possible to obliterate a fibroid by embolisation. However, a hysterectomy may be needed. Fibroids tend to shrink naturally after menopause, says Dr Deborah Lee.

For more information

Endometriosis  - One of the characteristic features of endometriosis is that the pain comes before the onset of bleeding. Endometriosis affects 5% -10% of women of reproductive age.

It occurs when the endometrium (cells lining the uterus) grows outside the uterine cavity. This can take place anywhere – around the ovaries, fallopian tubes, bowel and bladder and involve the pelvic peritoneum – the membrane lining the abdominal cavity.

Each month, as the endometrium thickens inside the uterus in preparation for a pregnancy, the endometriotic tissue elsewhere does too. When the period comes at the end of the month, bleeding also occurs internally, at these endometriotic sites. Bleeding inside the abdomen and pelvis is excruciatingly painful. Fibrous (scar) tissue develops which sticks the organs together so they cannot move freely as they would normally. This further worsens the pain which can become chronic and unbearable, even if there is no vaginal bleeding, adds Dr Deborah Lee.

Chocolate cysts can develop – large cysts that range from 2-20cm in diameter. They get their name as they are filled with old blood and look dark brown in colour. These can rupture causing intense pain.

30%-50% of women with endometriosis will experience infertility. Studies show that whereas most women have a 10%-20% chance of pregnancy each month, in those with endometriosis, this falls to 1-10%.  However, 60%-70% of women with endometriosis will get pregnant naturally. For those who don’t, assisted conception methods such as IVF are needed, continues Dr Deborah Lee.

If you think you could have endometriosis, see your GP. The diagnosis is made by having a laparoscopy – a small telescope passed inside the pelvis. This is done under a general anaesthetic. Once the diagnosis is made, treatments can be discussed. There is no cure for endometriosis, but it can be managed. As with most conditions, the earlier the diagnosis the better.

For more information

Adenomyosis  - This is not an uncommon diagnosis. In one study, 20.9% of women attending a gynaecology clinic were found to have adenomyosis. It was more common in women who were older, had had children or who also had endometriosis.

Adenomyosis occurs when endometrial tissue grows down into the deeper muscular layers of the uterus. The uterus can double or triple in size. Although it can be highly problematic, it does not increase the risk of cancer.

Strangely, 1 in 3 women with the condition don't have any symptoms. But those who do often have extremely painful periods and heavy bleeding. Chronic pelvic pain can set in. Sex can become painful. Adenomyosis is linked to infertility, says Dr Deborah Lee.

If you think you could have adenomyosis see your GP. The diagnosis requires an ultrasound and possibly an MRI scan of the pelvis. It cannot be cured but it can be treated.

For more information

Ovulation pain – Around 40% of women have pain in the middle of the month when they ovulate. This is called mittelschmerz. When the follicle (sac) containing the egg ruptures to release the egg into the fallopian tube, this can result in pain. It may be left or right-sided or across the whole pelvis.

You can make the diagnosis by tracking your ovarian cycle for a few months and working out when the pain occurs. You may need a mid-cycle ultrasound if the diagnosis is in doubt.

There is no need for treatment, but if you want help, you can prevent ovulation every month by using contraception, such as the combined pill, patch or ring.

Ruptured ovarian cyst – Ovarian cysts are common. They are fluid-filled sacs that develop on the ovary. There are different types of cysts- follicular and corpus luteum cysts are related to the natural process of ovulation. Pathological cysts include dermoid, fibroma and cystadenomas, says Dr Deborah Lee.

Ovarian cysts may be found asymptomatically when having an ultrasound for some other reason. If they are less than 5 cm, benign and not causing symptoms they may be safe to be left alone. However, if they are causing symptoms, enlarging or there are any suspicious features, they need further investigation and may need removal.

Cysts can cause a variety of symptoms from lower pelvic pain, painful sex, or a pressure feeling in the abdomen. A woman may feel the need to pass urine frequently due to pressure on the bladder. Sometimes they cause abnormal vaginal bleeding but not always, adds Dr Deborah Lee.

One of the complications of an ovarian cyst is that it can rupture suddenly, causing severe abdominal/pelvic pain due to internal bleeding. If this happens, you are likely to feel suddenly very unwell, light-headed, dizzy, feverish, nauseated and vomit. Your body goes into shock. This is a gynaecological emergency, and you need to phone 999 for immediate help.

For more information

Ectopic pregnancy  - An ectopic pregnancy means the pregnancy has implanted somewhere outside of the uterus. This could be anywhere in the pelvis but most commonly it is in one of the fallopian tubes. As the pregnancy grows it stretches the fallopian tube which is at risk of rupture. Around 1 in 100 pregnancies are ectopic.

Symptoms usually start from around 6 weeks of pregnancy, meaning your period will be two weeks late. You may have other symptoms of pregnancy such as tiredness and sore breasts. Typically, women feel pain in one side of the lower abdomen or the other, which can be severe. The pain may radiate to the tip of the shoulder. There may be pain on passing urine or opening the bowels. There can be watery, brown vaginal discharge, bleeding or no abnormal vaginal loss, says Dr Deborah Lee.

If you have missed a period and develop any of these symptoms, get help without delay – phone NHS 111. This is even if you haven’t had a positive pregnancy test. An ectopic pregnancy is a serious condition which can be fatal.

An ectopic pregnancy is a gynaecological emergency. If you are acutely unwell call 999 or go to A&E.

For more information

Pelvic Inflammatory Disease (PID)

PID is a medical term for an inflammatory condition of the pelvic tissues. It is caused by a bacterial infection. Often the exact cause is not known but it is a common complication of sexually transmitted infections such as chlamydia and gonorrhoea, says Dr Deborah Lee.

The symptoms include pelvic pain, lower abdominal pain, and painful sex, often pain on deep penetration. There may be unusual vaginal discharge, heavier periods than usual, and bleeding in between periods or after sex.

However, some women have no symptoms with PID. Sadly, it's not uncommon to find a woman with infertility who has blocked fallopian tubes but has no knowledge of an infection.

It's vital that young sexually active women go for regular STI checks at the Sexual Health Clinic. The majority of STIs cause no symptoms. STIs like chlamydia and gonorrhoea are still most common in women under the age of 25, but STIs are still not uncommon in older age groups. If chlamydia and gonorrhoea are picked up early, they can be treated, and these long-term sequelae can be prevented.

If you have unexplained pelvic lower abdominal or pelvic pain and haven’t had an STI screen, it’s a good idea to make an appointment at your local Sexual Health Clinic. You can find your local sexual health clinic here.

For more information

Polycystic ovarian syndrome (PCOS) – Around 10% of women in the UK have PCOS. It is an endocrinological condition in which your body makes too many androgens (male hormones). The ovaries are full of tiny thick-walled cysts that often fail to rupture, so there is anovulation.

The typical symptoms are obesity, hirsutism, irregular or absent periods, and infertility. Women with PCOS have an increased risk of developing high blood pressure, type-2 diabetes, depression and sleep apnoea, says Dr Deborah Lee.

PCOS is usually diagnosed in women in their 20s or 30s. It may come to your attention if you start missing periods, but you are not pregnant, or your periods become very irregular or stop altogether.

The diagnosis is made by doing blood tests to check hormone levels, and an ultrasound scan, which may show the typical appearance of multiple cysts in one or both ovaries.

If you think you could have PCOS, see your GP. PCOS cannot be cured but it can be treated. Although there is a link with infertility, most women with PCOS can achieve a pregnancy, says Dr Deborah Lee.

For more information

Common reasons for cramp, but no period?

Anything that causes inflammation in the pelvic organs can cause period-type pain, even if there is no vaginal bleeding. This could be any of the conditions listed above.

What the cramps feel like?

Pain is very subjective. It can be hard to describe, and it varies a lot from woman to woman. Most women say period pain is a deep aching pain in the lower abdomen/pelvis. It can be throbbing or cramping. It can radiate into the tops of the thighs.

The pain of endometriosis is often more severe. It can be excruciating, and associated with sweating, vomiting or collapse. According to The Endometriosis Society, the pain feels like a barbed wire fence running across the abdomen, says Dr Deborah Lee.

Note that shoulder tip pain is characteristic of a ruptured ectopic, and it causes pain in the shoulder due to internal bleeding irritating the peritoneal lining of the abdominal/pelvic cavity.

Does Period Pain Mean That My Contraception Isn’t Working?

That's a good question. The answer is No. However, contraception often stops ovulation, and many causes of period pain are due to ovulation and its consequences. Stopping ovulation, such as taking the combined pill continuously, is a good treatment for endometriosis. But even when ovulation ceases, pain can persist if there is pelvic pathology.

If you have period pain, despite using contraception, don’t stop your contraception. Go and see your GP or make an appointment at the Sexual Health Clinic.

How Can You Tell Whether You’re Having Period Pain or Not?

Period pain, by definition, occurs when you are bleeding vaginally. Usually, the bleeding starts, and the period pain soon follows, says Dr Deborah Lee.

If it's the other way around, you have the pain but no bleeding, this means something else is causing the pain. This is when you should call for help.

When to see a doctor?

The NHS advises  you should see a doctor or get help from NHS 111 if you have pelvic pain and:

What Else Can Cause Symptoms Like Period Pain?

Other causes  -

What foods can I eat while experiencing cramps?

Studies show that increasing the amount of fruit and vegetables, as they are such good sources of vitamins and minerals, eggs, plus fish, milk and dairy products is associated with less period pain. Skipping meals and following a weight loss diet can make period pain worse, says Dr Deborah Lee.

Many vitamins, such as vitamins C and E,  are potent antioxidants and can counteract the oxidative stress and free radicals produced in primary dysmenorrhea.

Eggs contain high levels of magnesium and calcium which help prevent period pain.

Fish oil is high in omega-3 which can inhibit prostaglandins.

Milk is high in calcium which is needed to stabilise the way muscle cells respond to nerve stimuli. Lower calcium levels are associated with muscle cramps and spasms.

Dehydration and worse period pain so make sure you drink at least 2L of water per day – more in hot weather", says Dr Deborah Lee.

Meet the expert

Having worked for many years in the NHS, mostly as Lead Clinician within an integrated Community Sexual Health Service, Dr Deborah Lee now works as a health and medical writer, with an emphasis on women's health, including medical content for Dr Fox pharmacy. She has published several books and remains passionate about all aspects of medicine and sexual health. After completing her Medical Degree at University of Southampton Medical School in 1986, Dr Leetrained as a GP and after a number of years specialised in Sexual & Reproductive Health (S&RH).

Lorna White is a Senior Digital Writer for Mother&Baby. After running the Yours magazine website, specialising in content about caring for kids and grandchildren, Lorna brought her expertise to Mother&Baby in 2020. She has a keen interest in a range of topics surrounding all things motherhood and has a wide range of experienced medical experts and professionals at her fingertips.