The Lifecycle of Back Pain in Women

Biological circumstances that are unique to women can influence the way they experience back pain.

BACK PAIN IS ONE OF THE highest reported reasons for pain, discomfort and disability among men and women in the United States. But did you know that the way it manifests, and the conditions it can lead to, differ between the two genders?

It’s true. Plus, the significant hormonal changes that affect women throughout a lifetime can explain the varying ways they experience back pain episodes. Both menstruation and menopause can cause back pain. 

Most women who have experienced premenstrual symptoms report back pain. Hormones called prostaglandins are hard at work during this time, promoting contractions in the uterus to prompt it to shed its lining. Unfortunately, these hormones can also affect the lower back muscles, resulting in back pain or back muscle spasms in the days leading up to the start of a period

A more extreme version of the PMS experienced by many women is called premenstrual dysmorphic disorder. Though this condition affects fewer women, the symptoms experienced by those with PMDD are often more severe – including back pain episodes. A condition called endometriosis can also result in back pain. Endometriosis occurs when the tissue (called the endometrium) that lines the uterus grows outside the uterine walls. Pain is the most common symptom, and it often manifests as extreme pelvic pain radiating to the low back.

Of course, the purpose of a woman’s monthly cycle is a biological design to prepare the body for pregnancy. And, as one can imagine, this decidedly female experience also commonly results in back pain. Many believe that the reason for this is an expanding abdomen and weight gain that’s merely causing a lot of internal compression and strain. While that’s true, what you may be surprised to know is that the expansion of the pelvis to make room for the delivery of a full-term baby is a process that can result in the most intense pregnancy-related causes of back pain. 

What’s also important to understand is that back pain can occur during any pregnancy stage, not only in the later months. And women who have previously experienced low back pain tend to it again during pregnancy. The strain on the spinal muscles during childbirth is also one cause of back pain in women. So if your back hurts after the baby is born, the body trauma of delivery is often the main reason and usually subsides with rest and healing in the postpartum phase.

When a woman transitions from the childbearing years and menstruation stops, she enters menopause. This time in a woman’s life can be marked by symptoms such as hot flashes, and unfortunately, back pain. One of the most significant hormonal changes at this time is a steep reduction in the production of estrogen. When this happens, it leads to an increased risk of osteoporosis fractures of the spine, because the decline in estrogen signals a decrease in bone protection and production. Women lose bone density faster after menopause, so it’s essential to do everything possible to go into this transitional phase of life with strong bones.

The female body is intricately designed to withstand so many tremendous changes throughout a lifetime. Sometimes, those changes can increase the risks of back pain episodes that men won’t experience. Fortunately, these episodes are rarely permanent and often resolve independently with very little, if any, intervention.

Of course, preventing back problems before they start is one of the most important things anyone can do for their spine health. Maintaining a healthy body weight (pregnancy notwithstanding), getting regular exercise, a diet with appropriate amounts of calcium, and not smoking are all things that can be done to help keep back pain at bay for a lifetime.

Neel Anand MD

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