Lower abdominal pain missed period negative pregnancy test

When you’re trying to conceive, some bodily clues can tip you off that you’re expecting before you miss — or get — your period. The confusion in this, of course, lies in the fact that premenstrual syndrome (PMS) and early pregnancy can have very similar symptoms.

Cramping is one of these frustrating signs that can sometimes indicate PMS and other times the start of a pregnancy. To help you sift through what could be behind annoying cramps but no period, here are some of the most common conditions that cause it. 

Pregnancy

If you’ve conceived, you may notice some cramping during early pregnancy that’s similar to what you usually feel during your menstrual cycle. Luckily, these types of cramps, which may occur in the lower back, often remain very mild and short-lived. You may even experience light spotting or pink discharge early in pregnancy when the embryo implants in the uterus.

Cramping can also be a sign of miscarriage, but it would likely feel more severe than what you’d notice during early pregnancy. And these cramps would come with heavier bleeding marked by larger blood clots than seen in a typical period.

And while it’s relatively rare, sharp cramps can possibly indicate an ectopic pregnancy, which also comes with lower back pain and abnormal vaginal bleeding. Place a call to your doctor if you’re experiencing intense cramping and bleeding, or just want some peace of mind.  

Ovulation

Sometimes called “mittelschmerz” (German for middle pain), ovulation pain can feel like a slight twinge or mild cramping when the ovary releases an egg every month. It’s usually felt in the lower belly and pelvic region, either in the middle or only on one side. While 40 percent of reproductive-age women experience ovulation pain, even more never notice it at all. 

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Along with cramps and possibly nausea, you might also spy some light spotting or pink discharge during ovulation. Again, this is due to the “bursting” of your egg from the follicle.

Ovarian cysts

These small fluid- or tissue-filled sacs attach themselves to an ovary, occasionally causing abdominal pain. Most ovarian cysts are harmless and not terribly painful — and some even go away on their own. In fact, you may not realize you have one until it’s diagnosed during your annual pelvic exam or via imaging tests.

Other symptoms that may accompany ovarian cysts include feeling bloated, painful sex, unusual weight gain or loss, and changes in bowel movements or urination.

Endometriosis

Endometrial tissue normally grows inside the uterus, forming a lining, but endometriosis is the result of similar tissue growing outside the uterus. This endometrial-like tissue can’t exit your body, causing pain, pelvic discomfort and cramping that may start before your period and last several days into it.

In addition to bad cramps but no period, you might also experience lower back and belly pain, along with painful intercourse, painful bowel movements or urination, and heavy bleeding during periods and between them.

Pelvic inflammatory disease (PID)

Pelvic inflammatory disease is a common infection of the reproductive organs that affects more than a million women every year. Bacteria from two sexually transmitted infections, gonorrhea and chlamydia, is the culprit, though it can also stem from an infection that’s not sexually transmitted, like bacterial vaginosis.

Some women who have PID don’t notice any symptoms or have only mild discomfort. Cramping is one sign of PID, along with abnormal vaginal discharge, unusual menstrual bleeding, painful urination, nausea, fever, chills and pain during sex.

Urinary tract infection (UTI)

An infection connected to the urinary system (think kidneys, bladder, urethra) is called a UTI,  and women are more likely to develop one than men. Pelvic pain is a common symptom, though a need to pee frequently as well as pain and burning during urination (and possibly blood in the urine) also point to a UTI.

Irritable bowel syndrome (IBS)

This common disorder affects up to 20 percent of Americans, and women and those younger than 50 are more likely to have it. The constellation of IBS symptoms includes cramping, stomach pain, diarrhea and constipation — and unfortunately there’s no known cause and cure, but you can try different treatments to help alleviate the GI distress.

You may also spot mucus in your stool, experience bloating, have gas and also feel uncomfortable, overly full or even nauseous after eating a normal meal. And women with IBS may have more symptoms during their monthly menstrual cycles.

When to talk to your doctor about cramping

If you're worried about any kind of cramping, pelvic pain or discomfort in your back or abdomen during any point in your menstrual cycle or while you’re pregnant, check in with your doctor. And make an immediate call to your health care provider if you experience intense cramping and bleeding or severe, persistent lower belly pain. 

While you may ultimately chalk it up to regular, old PMS, pinpointing the cause of your cramps can help you get the care you need — and maybe even kick you off on your pregnancy journey. 

From the What to Expect editorial team and Heidi Murkoff, author of What to Expect When You're Expecting. What to Expect follows strict reporting guidelines and uses only credible sources, such as peer-reviewed studies, academic research institutions and highly respected health organizations. Learn how we keep our content accurate and up-to-date by reading our medical review and editorial policy.

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