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

Lower abdominal pain, also known as pelvic pain, is felt between the navel and the groin. It may affect one or both sides symmetrically and can be sharp, dull, throbbing or constant. It can sometimes involve several systems: the gynaecological, urinary, digestive or musculoskeletal systems.

This symptom is non-specific, meaning that 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 any other associated symptoms.

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

Pregnancy (or an ectopic pregnancy)

Pregnancy is one of the first causes to consider in cases of pelvic pain without a period. Cramps in the lower abdomen are common in early pregnancy, caused by the implantation of the fertilised egg or the stretching of the womb. Please note that sharp, one-sided pain accompanied by bleeding may be a sign of an ectopic pregnancy, which is a medical emergency.

To confirm or rule out a suspected pregnancy, it is essential to take a pregnancy test.

Endometriosis or adenomyosis

These two conditions affect the endometrium, i.e. the tissue that normally lines the inside of the womb. In the case of endometriosis, fragments of this tissue migrate outside the womb (to the ovaries, rectum, bladder, etc.) and cause chronic pelvic pain, sometimes outside of the menstrual period. This is referred to as uterine pain, endometriosis pain outside the menstrual period, 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 period pain, even though their period has not yet started. This may be due to a delay in ovulation, a disrupted cycle or premenstrual syndrome, which manifests as tension, bloating, pelvic pain and mood swings a few days before the period. This is premenstrual syndrome, also known as PMS.

Digestive or urinary problems

Abdominal pain may be caused by digestive problems (irritable bowel syndrome, constipation, wind, intestinal inflammation) or urinary problems (cystitis, lower urinary tract infection). Lower abdominal pain without a period can therefore be misleading. For example, cystitis causes pelvic pain in women, accompanied by a burning sensation when passing urine.

Temporary hormonal imbalances

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

Ovarian cysts or fibroids

A functional ovarian cyst may develop during the cycle without causing a period. It causes pain on one side, which may be intermittent or persistent. Uterine fibroids, on the other hand, can cause pain and bleeding outside of your period, 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 in the premenopausal period, can cause pain similar to that experienced during periods, without any menstrual bleeding. Polycystic ovary syndrome (PCOS) or hormonal fluctuations linked to stress, a change in lifestyle or diet may also explain these irregular cycles. In all cases, the regularity and intensity of these pelvic pains should be monitored to guide any necessary gynaecological assessment.

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

• Bleeding outside the period: spotting, metrorrhagia (bleeding outside the 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, this may indicate an underlying pelvic condition or be caused by endometriosis

• Urinary problems: a burning sensation when passing urine, frequent urge to urinate, and sometimes blood in the urine.

When a woman reports having period pain but no period, there are several possible explanations. The differential diagnosis is broad and requires a detailed history of symptoms. Certain benign conditions, such as a delayed period due to stress or an anovulatory cycle, may be sufficient 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 prescribed.

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

The psychological impact of this unexplained pain should not be overlooked, especially if it persists over time. It can lead to anxiety, sleep disturbances, social isolation and even the need to take time off work.

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“Unexplained pelvic pain should never be ignored. When it is chronic, it is often indicative of a hormonal imbalance, an underlying medical condition or a functional disorder. Paying close attention to your body and receiving personalised support 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 products that were healthy and respectful of their wellbeing and the environment. Having suffered from endometriosis since her teenage years, she chose to prioritise natural solutions to alleviate 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.