Lower abdominal pain but no period: what are the possible causes?

Lower abdominal pain, also known as pelvic pain, is located between the navel and the groin. It can affect one or two symmetrical areas and may be sharp, dull, throbbing, or constant. It sometimes involves multiple systems: gynaecological, urinary, digestive or musculoskeletal.

This symptom is nonspecific, meaning it cannot, on its own, lead to a diagnosis. It must therefore be analysed in the context of the patient’s menstrual cycle, contraception, age, medical or surgical history and other associated symptoms.

Good to know: Pelvic pain can be cyclical (hormone-related) or non-cyclical (related to an underlying condition).

Pregnancy (or ectopic pregnancy)

Pregnancy is one of the first causes to consider in cases of pelvic pain without a period. Lower abdominal cramps are common in early pregnancy, caused by the implantation of the egg or the stretching of the uterus. Be aware that sharp, one-sided pain accompanied by bleeding may be a sign of an ectopic pregnancy (EP), which is a medical emergency.

To confirm or rule out the possibility of pregnancy, it is essential to take a pregnancy test.

Endometriosis or adenomyosis

Both of these conditions affect the endometrium, which is the tissue that normally lines the inside of the uterus. In the case of endometriosis, fragments of this tissue migrate outside the uterus (to the ovaries, rectum, bladder, etc.) and cause chronic pelvic pain, sometimes even outside of menstruation. This is referred to as uterine pain, endometriosis pain outside of menstruation, and pelvic and lower back pain in women. Adenomyosis, on the other hand, refers to the infiltration of the endometrium into the uterine muscle.

Premenstrual Syndrome (PMS)

Some women experience pain similar to menstrual cramps, even though their period hasn’t started yet. This could be due to a delayed ovulation, an irregular cycle, or premenstrual syndrome (PMS), which manifests as tension, bloating, pelvic pain, and mood swings a few days before menstruation. This is premenstrual syndrome, also known as PMS.

Digestive or urinary disorders

Abdominal pain can be caused by digestive disorders (irritable bowel syndrome, constipation, gas, intestinal inflammation) or urinary issues (cystitis, lower urinary tract infection). Lower abdominal pain without a period can be misleading. For example, cystitis causes pelvic pain in women, accompanied by a burning sensation when urinating.

Temporary hormonal imbalances

A simple hormonal imbalance can disrupt the menstrual cycle without any underlying medical condition. Stress, a change in birth control, travel, or rapid weight loss can delay ovulation or cause an anovulatory cycle. This often manifests as pain similar to menstrual cramps, without menstruation occurring. These functional disorders are common and generally temporary, but if they become recurrent, it is recommended to consult a healthcare professional for medical advice.

Ovarian cysts or fibroids

A functional ovarian cyst can develop during the menstrual cycle without causing a period. It causes one-sided pain that may be intermittent or persistent. Uterine fibroids, on the other hand, can cause pain and bleeding outside of menstruation, as well as a feeling of heaviness.

An anovulatory or irregular cycle

Sometimes the menstrual cycle occurs without ovulation: this is known as an anovulatory cycle. This common phenomenon, particularly during adolescence, postpartum, or perimenopause, can cause pain similar to menstrual cramps, without menstrual bleeding. Polycystic ovary syndrome (PCOS) or hormonal fluctuations linked to stress, a change in lifestyle, or diet can also explain these irregular cycles. In all cases, the regularity and intensity of these pelvic pains should be monitored to guide any necessary gynaecological evaluation.

• Chronic pelvic pain: diffuse or localised pain, often intense, which may radiate to the back or legs

• Bleeding outside of menstruation: spotting, metrorrhagia (bleeding outside of the menstrual period), or brown discharge between cycles

• Abdominal bloating: frequent digestive discomfort, sometimes accompanied by constipation or diarrhoea

• Chronic fatigue: often linked to endometriosis or hormonal imbalances

• Pain during or after sexual intercourse: known as dyspareunia, it may indicate an underlying pelvic condition or be caused by endometriosis

• Urinary problems: burning sensation during urination, frequent urge to urinate, sometimes blood in the urine.

When a woman reports, “I have period pain, but no period,” several possibilities exist. The differential diagnosis is broad and requires a detailed assessment of symptoms. Certain benign conditions, such as a delayed period due to stress or an anovulatory cycle, may be enough to explain the pain. However, persistent, cyclical pain, or pain associated with other symptoms (fever, vomiting, unusual discharge) should prompt you to seek medical advice. A pelvic ultrasound or blood tests may then be ordered.

Common causes of lower abdominal pain without menstruation include: endometriosis, functional cysts, ectopic pregnancy, or digestive disorders. A multidisciplinary approach (involving a gynaecologist, gastroenterologist, and primary care physician) may be necessary to diagnose the condition.

The psychological impact of these unexplained pains should not be overlooked, especially if they persist over time. They can lead to anxiety, sleep disturbances, social isolation, and even the need to take time off work.

Natural products are potent. Always follow the dosages indicated on the product labels. Yarrow is not recommended for people who are sensitive or allergic, particularly to the Asteraceae family. As a precaution, avoid use during pregnancy and breastfeeding. If in doubt, it is best to consult a healthcare professional.

"Unexplained pelvic pain should never be ignored. When chronic, it often indicates a hormonal imbalance, an underlying condition, or a functional disorder. Paying close attention to your body and receiving personalised care can often effectively relieve this pain and help you regain an optimal quality of life."

Formerly a manager at an organic shop, Alice spent several years helping her customers choose healthy products that respect both their health and the natural world. Having suffered from endometriosis since her teenage years, she chose to prioritise natural solutions to ease her symptoms and improve her day-to-day wellbeing. Drawing on her knowledge of naturopathy, she has always explored the benefits of plants and nutrition. Passionate about ecology and deeply connected to nature, Alice makes her own cosmetics and household products to reduce her impact on the planet and all its inhabitants.