You can feel the “period” cramps but there’s no bleeding? Find out what it could mean

Periods are rarely delightful, but they are more or less predictable. It’s completely normal if any quirks in your monthly episodes can put you a bit on the edge. It’s equally unnerving if you get all the tell-tale period signs – especially those pesky cramps – but the period is not what causes them.

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What kind of cramps are considered “normal”?

Textbook period cramps feel like a “spasmodic pain that comes from the lower abdomen. They typically start 1–2 days before or at the onset of menstruation. Cramping may last a couple of hours or up to four days,” says gynaecologist Dr. Nina Osvald Avgustin.

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Keep an eye out if cramps suddenly become more painful and last longer than your usual menstrual episodes. This cramping can change over time and is less responsive to treatments. “Cramps may occur outside your menstruation or they occur together with other symptoms,” Dr. Nina Osvald Avgustin explains. These symptoms, which you may experience along with cramping, include:

• Vomiting
• Diarrhoea
• Fever
• Weight gain or weight loss
• Pain or bleeding during or after sex
• Blood in urine or stool
• A change in vaginal discharge

Although most non-scheduled cramps are harmless, we still encourage you to visit your gynaecologist if you think something’s off. Pain can point to certain diseases that need to be diagnosed and taken care of. There are a bunch of causes that may explain the pelvic pain mystery.

An inflammatory bowel disease

Inflammatory bowel disease (IBD) is a term mainly used to describe 2 conditions: ulcerative colitis and Crohn’s disease. They both involve inflammation of the gut. Ulcerative colitis affects the colon, while Crohn’s disease can affect any part of the digestive system, from the mouth to the bottom. People of any age can get IBD, but it’s usually diagnosed between the age of 15 and 40. Cramps or swelling in the tummy are common.

Signs of early pregnancy

If you get pregnant, your period – and period-related cramps – stops. Very early on in your pregnancy, however, you may still experience menstrual-like cramping – a result of the fertilized egg attaching to the uterine wall. These slight twinges, accompanied by light implantation bleeding, usually last only a day or two.

Some cramping during pregnancy, especially in the first months, is also quite common and usually innocent. There’s probably no immediate cause for concern if the pain you feel isn’t severe, one-sided, or accompanied by bleeding. Severe cramping, on the other hand, should always be investigated to rule out an ectopic pregnancy – a condition when the fertilized egg implants outside of the uterine cavity. Signs of ectopic pregnancy – abnormal light bleeding and sharp abdominal pain – typically appear in the first-trimester. ¹

Ovulation

Middle pain (commonly known by its German name “mittelschmerz”) occurs during ovulation as the follicle ruptures and releases its egg. Some women+ experience mittelschmerz every month; others only occasionally. Cycle tracking app Clue found that 1 in 3 people regularly track ovulation pain. ²

The mittelschmerz pain may be a dull cramp or a sharp and sudden twinge. It’s usually on either the left- or right-hand side of your tummy depending on which ovary is releasing the egg. It lasts a few minutes to a few hours, but it may continue for as long as a day or two. It could also come with slight vaginal bleeding or discharge.

Experiencing some discomfort during ovulation is not necessarily a reason for concern. But contact your doctor if the pain is bad, it persists or is accompanied by nausea or fever. ³

Ovarian cyst

Ovarian cysts are small fluid- or tissue-filled pouches on or in the ovary. They are very common and typically harmless. In some cases, however, an ovarian cyst can rupture and open a door for bacteria that can cause sepsis. In most cases, the cyst fluid will dissipate, and it’ll heal without any intervention. Consider it an emergency if you experience excessive bleeding or an infection. ⁴ The standard treatment is to take antibiotics but the condition sometimes also requires hospitalization for drainage.

The pain from bigger ovarian cysts may feel like a sharp or dull pain in the lower belly. When a cyst ruptures, you may feel sudden, severe pain. ⁵

Ovarian cysts are usually small enough that most women+ don’t even realize they have one. Many cysts are diagnosed during annual pelvic exams or imaging tests that are performed for some other reason.

Endometriosis

Endometriosis is a condition when the tissue, similar to the tissue that lines the inside of the uterus, grows outside of the womb. Endometriosis commonly affects ovaries, fallopian tubes and the tissue lining your pelvis. The exact number of women+ with endometriosis is unclear but estimates suggest roughly 10 percent of reproductive-aged women+ have endometriosis. ⁶

Endometriosis can cause a number of severe symptoms, including period pain. But painful periods alone, even if they are bad, aren’t a sure-fire indicator of endometriosis. Endometriosis cramps also come with heavy and prolonged menstruation, often including blood clots.

These cramps may start out feeling like normal menstrual cramps, but the level of pain can suddenly and quickly escalate to an incapacitating level. They can occur not only during menstruation but also during ovulation. Also – keep an eye on other abnormal period symptoms such as stomach discomfort and leg pain.

Pelvic inflammatory disease (PID)

Pelvic inflammatory disease (PID) is an infection of the reproductive organs and is often a complication of an untreated sexually transmitted infection, like chlamydia or gonorrhoea. Bacteria can enter the vagina and then cervix, causing an infection. Over time, the infection moves into the pelvic organs, including the uterus, tubes, and ovaries. ⁷

Stomach cramps are the first symptom of PID. The pain can range from dull pressure to intense cramping pain. Other symptoms include unusual vaginal discharge, pain or bleeding during sex, fever or vomiting.

Some women don’t experience any signs or symptoms. As a result, you might not realize you have it until you have trouble getting pregnant or you develop chronic pelvic pain. The good news is that if it’s diagnosed early, PID can be treated with a short course of antibiotics.

Appendicitis

The appendix is a small, thin pouch connected to the large intestine. Nobody knows exactly what it does.

The appendix can cause problems if it gets clogged up, often by poop, causing it to become swollen and infected – the condition known as appendicitis. The tell-tale symptoms of appendicitis include pain on the right side of the lower abdomen, nausea, bloating, and possibly fever or vomiting.

You’ll notice pain around your belly button at first. It then gets worse and moves to the lower right side of your stomach. Cramps get bad fast, and they may wake you up during sleep. It may hurt if you cough, sneeze or move.

About half of the people with appendicitis also feel sick in their stomachs or throw up. Medical treatment is a must, especially if the appendix bursts. In that case, it can be life-threatening. ⁸

Anovulation

Some women sometimes stop ovulating even though they continue to menstruate. A condition where the egg doesn’t release is called anovulation. It can occur completely randomly or is caused by being overweight, extreme exercise, stress and low ovarian reserve. Anovulation is also pretty common: 10 to 18 percent of all regular cycles happen without ovulation. ⁹ If you do not release an egg during a cycle, you technically won’t get your period – but you could still bleed and experience cramping. Other symptoms of anovulation may include shorter or longer menstrual cycles and heavy menstrual flow. Infertility is also commonly associated with anovulatory cycles. ¹⁰

Polycystic ovary syndrome (PCOS)

PCOS is a hormonal disorder in which the ovaries produce an excess of male hormones that are usually present in women+ in small amounts. The ovaries may also develop numerous small collections of fluid (cysts) and fail to regularly release eggs. Not everyone with PCOS has ovarian cysts, however. It is estimated that 5–10 percent of women+ of childbearing age suffer from the condition. ¹¹

Women+ with PCOS can also experience painful periods, cramps, bloating, heavy bleeding and clotting. There are other symptoms of PCOS that are even more specific, such as irregular periods, excess facial hair, oily skin, acne and weight gain.

Treatment for PCOS is often done with medication. They can’t cure PCOS, but medicines can help reduce symptoms and prevent some health problems. ¹²

Uterine polyps

Uterine polyps are growths that form and attach to the inner wall of the uterus and extend into the uterine cavity. They can range in size from as small as a sesame seed to as big as a golf ball. You may have just one polyp or many of them at once.

The majority of uterine polyps are benign. They are more likely to develop in women+ who are between 40 and 50 years old. ¹³

Uterine polyps may cause dull or aching pain in the abdomen or lower back. You may also have irregular menstrual bleeding, bleeding between menstrual periods or heavy periods. Some women+ experience a full spectrum of symptoms, while others only light spotting or are entirely symptom-free.

The common treatment involves removing the polyps. Small polyps without symptoms might resolve on their own.

Some sex positions

There are lots of reasons why women experience cramps after sex. Deep penetration, especially in women+ with a tilted cervix (one in five women+ have it ¹⁴), can cause irritation and cramping. Injury or infection of the cervix can also make it more susceptible to cramping or pain.

Even the good old orgasm is sometimes to blame. Orgasms are just spontaneous contractions of the uterine muscle and they briefly continue after sex as well. Post-sex cramps typically happen in the front bone of the pelvis. They can also radiate to your lower back and upper thighs.

Stress

Stress can affect the part of the brain which is responsible for producing hormones. “Hormonal imbalances may cause an increase of prostaglandins – chemicals which are responsible for causing cramping pain,” explains r. Nina Osvald Avgustin. No wonder many women+ say that when they feel stressed their menstruations are more painful. Fight stress with exercise, meditation, a healthy diet and by giving yourself some downtime to relax.

What can you do about cramps?

Luckily, in most cases, pain is optional. There are different ways to ease the cramping pain and they include:

• Painkillers
• Heat
• Warm bath
• Quitting smoking
• Ditching salty & fatty foods
• Healthy diet
• Ginger tea
• Raspberry leaf extract
• Exercise

Check our article where we describe the anti-cramping fighting force in more detail.

When should you call a doctor?

There are certain clues that you should follow here. Gynaecologist Dr. Osvald Avgustin suggests paying the doctor a visit if the pain happens outside the cycle and if it lasts the whole period. “Have it also checked out if cramps become stronger, return in intervals, happen during sex or if you notice any abnormal discharges that might indicate an underlying condition behind the cramping,” she concludes.

REFERENCES

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4643163/
2. https://helloclue.com/articles/cycle-a-z/ovulation-pain-101
3. https://ufhealth.org/mittelschmerz
4. https://health.clevelandclinic.org/when-an-ovarian-cyst-ruptures-is-it-an-emergency/
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4503903/
6. https://www.who.int/news-room/fact-sheets/detail/endometriosis
7. https://www.ncbi.nlm.nih.gov/books/NBK499959/
8. https://www.hopkinsmedicine.org/health/conditions-and-diseases/appendicitis
9. https://www.cemcor.ubc.ca/ask/anovulatory-cycles
10. https://www.pfcla.com/anovulation
11. https://www.pcos-selbsthilfe.org/pcos
12. https://www.mayoclinic.org/diseases-conditions/pcos/diagnosis-treatment/drc-20353443
13. https://my.clevelandclinic.org/health/diseases/14683-uterine-polyps
14. https://www.issm.info/sexual-health-qa/what-is-a-tilted-uterus-how-might-it-affect-a-woman-sexually/

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