If we each had to pick a part of having a uterus that we wish would go away, cramps during and before our periods would be up there for most of us. For some people, they're utterly debilitating, while for others they're mild or non-existent. But for some folks, cramps in your pelvic area don't seem to be tied to having your period at all; they come without apparent reason or method, at any point in the menstrual cycle. What's going on? Is it a major illness? Is your uterus exploding? Chances are that the answer is no; abdominal pain and cramp-like sensations can come from a variety of different conditions, most of which are not at all dangerous — but some of which are a bit unexpected.
The current scientific perspective on menstrual cramps is that they're caused by the release of prostaglandins, a type of hormone that induces the uterine muscles to contract; it's a way of ejecting the uterine tissue that gets sloughed off during a period. The reality, however, is that cramping from prostaglandins can sometimes be indistinguishable from abdominal pain from other causes — particularly if these causes are related to the pelvic area and the reproductive system in general.
So if you're getting mysterious cramps that don't seem to be syncing with your period at all, there may be another medical explanation for it. Hold onto your hat; things are about to get quite medically intimate.
According to the American Pregnancy Association, cramps in the abdomen can occur throughout a pregnancy, including before you even know you're pregnant. They're not a sign that you should be worried or that your pregnancy is abnormal; the cause is typically the uterus expanding in the first trimester (if you're in your second trimester, it's likely related to the ligament that supports the uterus stretching to accommodate the baby). "Mild cramping is common in early pregnancy, and does not necessarily indicate someone is having a miscarriage," Anna Druet, a research scientist for the period tracking app Clue, tells Bustle. "It can be scary, but is usually just a normal symptom as the uterus adjusts to the new pregnancy."
These cramps may feel like menstrual cramps, but they're different in nature — menstrual cramps involve mild to severe contractions of the uterus that temporarily cut off its blood supply, inducing pain. (Yeah, the female body doesn't f*ck around.) Lowering your exertion levels, warm baths, and stretches may help.
If you're not aware of endometriosis, get educated: it's a disorder in which the tissue that normally grows inside the uterus — the endometrium — grows outside it as well, including on the surface of other organs. It's an intensely painful condition because this tissue also "sheds" with every menstrual cycle, leading to build-ups of blood, cysts made of leftover tissue, and scars and adhesions that may need surgery. Cramps stemming from endometriosis may be related to that scar tissue, and consequently not follow the menstrual cycle. "The pain experienced by people with endometriosis is different from normal menstrual cramping," Druet tells Bustle.
We're not talking light cramps, though. The Endometriosis Foundation Of America describes these cramps as severe, unaffected by NSAIDS (non-steroidal anti-inflammatory drugs), and likely to impede quality of life. So if you're getting seriously awful cramps at random times, plus very heavy periods? Get to a gynecologist and ask for an endometriosis test. "Advocating for yourself about pain can be tough, but will help you to feel heard and to get the treatment you need," says Druet.
It turns out there might not be a special reason you're cramping up out of nowhere — because mid-cycle cramps are completely ordinary, as they can be your body's response to ovulation. "Some people experience a cramp-like pain around the time when they ovulate, mid-cycle," Druet tells Bustle. "Ovulation pain, can feel like a sharp, or like a dull cramp, and happens on the side of the abdomen where the ovary is releasing an egg. It generally happens 10 to 16 days before the start of your period (depending on when you ovulate), is not dangerous, and is usually mild. It generally lasts a few hours, and for some people can last a few days."
It's also not uncommon; cramping pain related to ovulation may happen in up to 50% of women, and is reported by three million American women every year. Ovulation obviously occurs mid-cycle, between periods, so you may get quite confused if cramping turns up unexpectedly with no corresponding blood flow.
4. Ovarian Cysts
If you've got sudden sharp cramping pain that is more intense than a typical menstrual cramp, and you have no real explanation for it, it's possible that it's an ovarian cyst that has ruptured. Technically, there are two types of ovarian cysts, both related to the menstrual cycle: one when an egg isn't properly released from its ovarian follicle, where it's been growing, and the other when the sac doesn't fully "deflate" after the egg is released properly. This isn't as bad as it sounds: they're massively common, and the U.S. Department Of Women's Health estimates that all people who currently have periods probably average at least one cyst in their lives. It doesn't present an issue unless it bursts or grows too big, both of which are pretty rare.
If those do happen, cramps will not be the only symptom: you'll also likely experience abdominal swelling and nausea if it's overgrown, and some spotting and feelings of pressure if it has burst. It's a good idea to see a doctor to monitor the situation and make sure everything heals.
5. Autoimmune Oophoritis
This is a very rare disorder, and shouldn't be your first thought if you have cramps at an unusual time of the month — but it does exist. Autoimmune oophoritis is a condition in which the immune system literally begins to attack the ovaries. It can occur on its own or, more commonly, as a related issue with other autoimmune disorders, and Medscape points out that it's actually a pretty vague diagnosis; there's no precise test for it for current doctors on the case. According to the National Institute of Health (NIH), it affects less than 200,000 women in the U.S., so it's extremely unlikely. If you already have an autoimmune diagnosis and are getting unexplained cramps, this may be a solution; discuss it with your doctor.
6. Pelvic Inflammatory Disease
PID, as it's called, is an infection of the organs of the pelvis — most often the vagina, cervix, or uterus — caused by sexually transmitted infections or by bacteria being introduced into the pelvis . During a PID infection, the tissue of the affected organs becomes upset and inflamed, and that by itself can cause the sensation of cramping or severe lower abdominal pain at irregular times throughout your monthly cycle. Fortunately, most cases of PID can be treated pretty with antibiotics, but it's important to get treated early.
7. Ovarian Cancer
Pelvic cramp-like pain is associated with ovarian cancer, but it's one of a panoply of several different common symptoms, so don't immediately start freaking out because your cramps seem out of place. According to the American Cancer Society, the most common symptoms besides cramping are abdominal bloating, the sensation of feeling full after only eating a little bit of food, and problems with urinating, usually to do with going a lot or constantly feeling as if you need to pee.
Cancer Research UK also mentions that symptoms that are "new, quite severe, and don't come and go" are more likely to be related to ovarian cancer, and recommends monitoring the pain for a little bit to see what it does. It will likely be centered on your lower abdomen or side (though the specific side depends on which ovary is affected). If you do monitor things and feel concerned, talk to your doctor as soon as you can.
8. Undiagnosed STIs
"Untreated STIs, and a condition like pelvic inflammatory disease can cause pain that worsens over time if left untreated," Druet tells Bustle. "Research done by Clue with Oxford University also found that cramps may be worse for people with undiagnosed sexually transmitted infections (STIs). Clue users with undiagnosed STIs were more likely to experience certain premenstrual symptoms, including cramps, than those without STIs. The presence of an infection made it twice as likely for someone to report they had cramps, as well as sadness and headaches premenstrually."
If you are experiencing cramps outside of your period and the pain is persistent, Druet says it's important to get help. "Female pain is often overlooked and/or under-treated in comparison to male pain presentation. It’s common for a young person suffering from severe menstrual pain not to talk about it with their doctor. This can lead to health conditions that go undiagnosed for years, and cause further issues down the line, like infertility," she says. "If your cramps are bad enough that they are not eased by a typical painkiller, and if they affect your ability to work, study or do any other everyday activities, it is best to talk to a healthcare provider. You should also see your healthcare provider if your cramping is suddenly or unusually severe, or lasts more than a few days." Don't be afraid to talk about your pain; be your own advocate, because you don't have to suffer in silence.
This post was originally published on September 7, 2016. It was updated on June 13, 2019.