Many people experience lower back pain some time in their lives. However, if you’re a woman, the lower back pain you experience might be related to something specific to women. It's important to advocate for yourself and ensure that these common causes of back pain are properly investigated.
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Before a menstrual period begins, some women experience certain symptoms, including mood swings, tender breasts, and food cravings. While PMS frequently causes abdominal pain, it is not commonly a cause of back pain — though it can be in some cases.
If you are routinely experiencing severe back pain right before your period starts, it's worth talking to your doctor. Depending on your symptoms, oral contraceptives can sometimes alleviate PMS symptoms involving back pain.
Dysmenorrhea means painful periods. Menstrual cramps can sometimes radiate from the abdomen to the lower back. Although some measure of cramping is normal during menstruation, very severe cramping is not normal. It should always be investigated as it can be a sign of polycystic ovary syndrome (PCOS), endometriosis, or another disorder.
Primary dysmenorrhea is the term used when there is no underlying disorder causing painful periods, and it seems to run in families. Once you have been evaluated and diagnosed with this condition, various therapies include taking nonsteroidal anti-inflammatory drugs (NSAIDs) or oral contraceptives.
Other measures may involve using a transcutaneous electrical nerve stimulation (TENS) device to relieve pain. Here’s a pro tip: avoid TENS devices specifically marketed for menstrual periods as they tend to be more expensive for no extra effect.
Exercise can help with dysmenorrhea, as can working with a nutritionist. You may have to try a few things before you can find a solution that works for your specific situation. Teenagers are highly likely to experience dysmenorrhea, which often (but not always) improves with age.¹
Again, severe cramping and lower back pain with menstrual periods are not normal and should be addressed. It is not simply part of being a woman. Seek a second opinion if necessary.
Endometriosis is the most common cause of secondary dysmenorrhea. In this condition, the tissue that forms the inside lining of the uterus, called the endometrium, starts growing elsewhere in the body, most often the lower abdomen or pelvis. You are more likely to develop endometriosis if it runs in your family, and it is sometimes a complication of abdominal surgery, especially C-section deliveries.
Endometriosis in the lower abdomen can cause severe abdominal and back pain as these tissues respond to period hormones by bleeding. Typically, the pain occurs during the first few days of the menstrual period. Untreated endometriosis can also lead to significant fertility issues.
You should suspect endometriosis as a cause for your lower back and abdominal pain if you have:
Pain during intercourse (dyspareunia)
Symptoms that tend to cycle with your periods
Abnormal vaginal bleeding or heavy spotting between periods
Blood in your urine or pain with urination
Associated bloating and constipation (bloating can also cause or worsen lower back pain)
Conservative treatment for endometriosis includes NSAIDs for pain, oral contraceptive pills, and other hormone-related medicines. Surgical treatment is sometimes helpful to remove scar tissue and lesions, especially if they block the fallopian tubes and interfere with fertility. Other options are the removal of the ovaries or uterus if you are not planning a future pregnancy.
Most ovarian cysts don't cause symptoms, but larger cysts can cause significant pelvic pain, usually in the lower abdomen on one side and can sometimes radiate to the lower back. These cysts typically happen when the mechanism for egg production malfunctions. Either a follicle fails to release an egg, or fluid is left in the follicle after releasing the egg. Usually, these cysts go away on their own.
Cystadenomas are more serious cysts that develop on the surface of the ovary. Another type is dermoid cysts, which contain all kinds of weird tissue and even include teeth. These are the kind that generally grows large and move your ovary out of position. This can result in ovarian torsion, or twisting, which causes severe pelvic pain, lower back pain, nausea, and vomiting. If a large cyst ruptures, this can also cause severe pain.
Polycystic ovary syndrome is a disorder caused when the body doesn’t produce enough of the hormones needed to ovulate properly. The half-developed follicles stick around as small cysts that generate an excess of androgens. This hormone causes a variety of symptoms, including:
Irregular or light periods
Excess body hair on the chest, stomach, and back
Excess facial hair
Weight gain, especially around the abdomen
Acne or oily skin
Skin tags on the neck or armpits
Dark or thick patches of skin on the back of the neck, in the armpits, and under the breasts
PCOS can also cause abdominal and back pain, although less commonly as the cysts tend to be small.
On rare occasions, if you have uterine fibroids, they can press against the muscles and nerves of your lower back, causing pain. Considering how uncommon this is, you should check other causes of pain first. However, it’s worth checking out if you have other symptoms of fibroids, such as:
Extremely heavy menstrual periods, sometimes to the point where you are unable to leave the house
Pelvic discomfort or pain
Frequent urination, especially at night, or an inability to urinate
Difficulty with bowel movements
Pain during sexual intercourse
Again, it's rare for fibroids to cause back pain, but it's worth mentioning as it can happen.
Pelvic inflammatory disease is generally the result of an untreated sexually transmitted infection (STI), usually chlamydia or gonorrhea. In addition to lower abdominal and sometimes back pain, PID can cause:
Unusual vaginal discharge, typically with a bad odor
Pain or bleeding during sex
Heavy spotting between periods
PID is treated with antibiotics but can lead to long-term issues like scar tissue in the fallopian tubes and chronic pain syndromes. It can reduce fertility and increase the risk of tubal pregnancy. The best way to avoid it is to get tested regularly for STIs. It is especially true if you are sexually active or have unprotected sex and more than one partner.
Back pain is a common pregnancy complication, especially in the third trimester. It usually goes away after birth but can sometimes linger. In late pregnancy, back pain is often caused by the shift in your center of gravity and weakness in your abdominal and back muscles. It happens because your uterus expands to accommodate your growing baby and because you are carrying even more weight than usual. You can reduce this kind of back pain by doing the following:
Wearing comfortable, supportive shoes and avoiding both completely flat shoes and high heels
Paying attention to your posture
Avoiding lifting heavy objects
Not standing for long periods, or if you must, resting one foot on a stool or box
Wearing an abdominal support garment, which you can get at a maternity store
Sitting in chairs with good back support or tucking a small pillow behind your lower back
Back pain may also show up early in pregnancy and occur intermittently, in which case it is caused by the hormones released during pregnancy. This helps prepare you for the birthing process by loosening pelvic ligaments but can also reduce the support your back receives.
If you are not physically active, you are more likely to experience this early back pain. Those who engage in sports and active hobbies have a stronger core, which helps compensate for some of the changes that occur in the body during pregnancy.
Talk to your doctor if your back pain is severe and if it lasts for more than two weeks. You should also do the same if your back pain is accompanied by fever, vaginal bleeding, or a burning sensation during urination. This can signify a urinary tract infection (UTI), which is more common when pregnant but can be easily treated. Untreated UTIs can lead to premature labor and low birth weight.
A constant low backache in the third trimester can signify preterm labor, especially if accompanied by pelvic pressure, pain, cramping, and vaginal spotting. Low backache is also a common sign of early full-term labor if you are due or close to due.
Lower back pain is known to increase at menopause.² Spinal pain becomes more prevalent around the time menopause begins, especially if you are overweight. The drop in estrogen causes lower bone density and can potentially cause other problems that make lumbar pain more prevalent.
To reduce the risk of back pain, do weight-bearing and resistance exercises that support the spine. Movement and stretching are beneficial for the whole body, and exercise helps strengthen back muscles that support the spine. Physical therapy and chiropractic care can improve problems affecting your spine. There's also some indication that sleep issues, common during perimenopause, may impact back pain.
Postmenopausal women are also more prone to vertebral compression fractures caused by osteoporosis. These can be identified by back pain that is sudden in onset, worse when standing or walking, and lessened by lying on one's back.
Some people will need surgery, but many can be treated conservatively with over-the-counter pain medications, bone-strengthening drugs, physical therapy, and back bracing. Extended rest is no longer recommended. Again, this is connected to hormone levels and lack of physical activity.
Issues with your hormones or reproductive system can sometimes cause lower back pain.
It's also worth remembering that your back pain could be caused by musculoskeletal issues such as a strain, sprain, or slipped disc. However, as issues with the female reproductive system are so often missed, it's good to remember that your low back pain might indicate another problem, especially if you are having difficulty getting pregnant.
Back pain during pregnancy | American College of Obstetricians and Gynecologists
Vertebral compression fractures – symptoms, complications, diagnosis and treatments | American Association of Neurological Surgeons