Experiencing headaches, abdominal pain, and bloating during your period is quite common. However, for many people, lower back pain is another symptom they regularly experience with their period. Is this normal, or does it indicate something more severe?
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One study¹ of females between 18 and 25 found that around 16% of those who reported period pain also experienced lower back pain.
While lower back pain during a period can cause discomfort, it usually doesn't indicate a serious medical issue. Even so, certain health problems could be causing the pain, so it should be taken seriously.
Period-related lower back pain can range from mild discomfort to debilitating pain that disrupts your day-to-day activities. Period-related back pain can begin several days before your period and often improves after your period ends.
There are several causes of lower back pain which occur before, during, and after your period. Some of these causes include:
PMS is a combination of emotional and physical symptoms many women experience in the week or so leading up to their periods.
The exact causes for PMS are unknown. However, it's thought that it can occur in the days following ovulation due to progesterone and estrogen levels falling drastically (if you're not pregnant).
Another possible cause is the change in chemicals in your brain (like serotonin) during this time. Symptoms of PMS subside within a few days of you starting your period, as your hormone levels begin to rise again.
Some women have no or only very mild symptoms of PMS. Others, however, experience such intense PMS symptoms that it makes it difficult for them to perform day-to-day activities like attending school or work.
75% to 100% of women² with a regular menstrual cycle experience PMS symptoms. One study³ reported 100% of study participants (398 women) struggled with PMS symptoms.
Between 2-6% of women of childbearing age experience more severe PMS, known as premenstrual dysphoric disorder (PMDD).
PMDD is marked by severe, often psychological, PMS symptoms. These include depression, anxiety, irritability, and extreme mood swings that may disrupt daily life, impacting relationships, school, and work.
Lower back pain is one symptom of dysmenorrhea, which refers to particularly painful periods. Many women who menstruate have some type of primary dysmenorrhea¹, such as:
Lower back pain
Primary dysmenorrhea means that the condition happens due to high levels of prostaglandins and not because of any diseases in the reproductive system or the pelvic area.
During menstruation, your uterus contracts to shed its lining. Certain hormone-like chemicals (prostaglandins) increase the uterine contractions and cause cramping during your period. Right before your period, the endometrial cells in your uterus produce numerous prostaglandins. The buildup of prostaglandin can lead to cramping, and the higher the level of prostaglandins, the more painful the uterine contractions usually are.
For some women, this muscular contraction pain spreads to their lower back.
Typically, women with this condition experience pain when first starting their period. Primary dysmenorrhea occurs more often in women under 20 years old⁴ and in women with heavy periods. Primary dysmenorrhea can also run in families.
Certain risk factors that increase your chance of primary dysmenorrhea include:
Certain physical activities
Secondary dysmenorrhea⁵ is period pain caused by a problem in the reproductive system. This pain often starts earlier than the primary dysmenorrhea, lasts longer, and can also be felt at times when you do not have your period.
Causes of secondary dysmenorrhea
Some causes of secondary dysmenorrhea include:
This is a common gynecological disorder that affects up to 10% of women⁶. Uterine tissue grows outside of some women's uterus, wrapping around other organs, which causes extreme pain.
Endometriosis can cause you to experience a clotty or heavy period and bleeding between periods.
Your menstrual cycle creates hormonal changes that cause the misplaced endometrial tissue to bleed. This causes the area to become painful and inflamed, and the tissues break down. The tissue that's broken down over time doesn't have anywhere to go and becomes trapped in the pelvis, often on the ovaries, fallopian tubes, rectovaginal septum, intestine, and bladder.
You may have pain in the location of the misplaced endometrial tissue. In extremely rare cases, some women have spinal endometriosis. This causes their tissue to grow around their spine and other lower back areas, leading to intense back pain.
These are noncancerous growths in the uterus. They can grow quite large and often result in extreme pain during periods, including back pain.
Pelvic inflammatory disease (PID)
PID is an infection of the reproductive system, moving from the vagina to the uterus, ovaries, and fallopian tubes. It is commonly caused by STIs, although non-sexual transmitted bacteria can also cause PID. Symptoms include mild to severe pelvic and abdominal pain during and/or between periods, bleeding during or after intercourse, fever, and painful urination.
This condition occurs when your endometrial tissue (tissue that lines your uterus) grows into your uterus’s muscular wall. The displaced tissue then continues to act as it should — becoming thick, breaking down, and bleeding — during each of your menstrual cycles. This can result in heavy periods and knife-like pelvic pain while you’re menstruating (dysmenorrhea) and sharp, severe cramping.
For some women with back issues, the symptoms they experience before or during their periods can get worse. This may be due to the buildup of prostaglandins in their uterus, which release inflammatory chemicals that can worsen back pain.
While treatment will depend on the specific condition and overall health, some women find that physical therapy and exercise helps. Those with more severe issues, such as severely herniated disks, may require surgery.
Complementary therapies, medication, and surgery are common treatments for serious lower back pain during your period.
1. Heat therapy
Heat and cold therapy can provide relief for many forms of lower back pain, but each treatment is different in how it works.
There's some evidence⁷ that heat can help reduce lower back pain. On the other hand, there is limited research that indicates cold therapy can do the same. However, cold therapy often helps in the case of an acute injury or trauma to the back.
To ease your lower back pain with heat therapy:
Apply heat therapy for about 15 minutes at a time. Use moist heat (i.e., baths, showers, hot packs) since it works better than dry heat.
If you use a heating pad, don't fall asleep while using it. Set a timer to go off in 20 minutes if you think you may fall asleep. Don't use heating pads on a high setting.
2. Hormonal birth control
Women with painful periods are commonly prescribed hormonal birth control. Combination birth control contains progesterone and estrogen, while others only contain progesterone.
Hormonal birth control can reduce pain and heaviness of your period, helping to provide relief from:
3. Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs can help improve your lower back pain by reducing the inflammation caused by prostaglandins. Because of this, they make a good treatment for period cramps. Ibuprofen (Advil) is a prime example of an NSAID.
A systematic review⁸ found that naproxen, ibuprofen, and other NSAIDs are very effective at decreasing dysmenorrhea pain in clinical trials.
4. Acupressure and acupuncture
Acupressure and acupuncture are a couple of complementary therapies that work by applying pressure to different body areas to decrease pain and promote healing. One small study⁹ found that 12 acupuncture sessions were able to reduce period pain significantly for up to one year.
Transcutaneous electric nerve stimulation (TENS) is a procedure where electrodes are placed on your skin to deliver electric shocks. These help your body release its natural endorphins to decrease pain.
A study¹⁰ involving a 27-year-old female participant used a combination of TENS, heat, and spinal manipulation to decrease dysmenorrhea pain. Following three to four cycles of monthly treatment, the patient experienced a short-term reduction in lower back pain during therapy.
Endometriosis may call for surgery to remove the uterine tissue causing your symptoms. Your doctor, in some cases, may only need to remove small amounts of displaced uterine tissue. If you have extensive damage and scarring, it can call for a full hysterectomy (surgical removal of the womb).
Many women experience painful periods. While lower back pain isn't the most common symptom, many women do experience it at some point in their periods.
Home care remedies can often alleviate the pain and other symptoms. However, it's always a good idea to see your doctor, particularly if you're experiencing severe pain. They can suggest ways to ease your pain and rule out any potential underlying causes.
Period pain: Overview (2022)
Facts about endometriosis | Endometriosis.org