Menopause lower back pain: what causes it and what can help?

Can back pain can be a symptom of menopause? The short answer is yes. It’s particularly common during perimenopause, when your hormones are fluctuating, but low levels of oestrogen after menopause can also increase your risk of health conditions that cause lower back pain.

Changes in your body composition, and even the use of hormone replacement therapy, can contribute to lower back pain during the menopause transition too.

We’ll delve into this in more detail below, as well as looking at what menopause back pain can feel like and what you can do to help treat it, from lifestyle changes to targeted muscle-strengthening exercises, physical therapy and medication.

The link between menopause and back pain

Women are more likely than men to experience lower back pain at any time of life – but when we enter middle age, the time of the menopause transition, that difference in risk starts to increase even further.

As with many menopause symptoms, changing levels of reproductive hormones like oestrogen and progesterone can be a significant contributing factor to worse back pain.

Oestrogen regulates inflammation and helps to keep the joints, muscles and bones of your spine healthy. Reduced levels of oestrogen can disrupt these processes and increase your risk of developing health conditions that cause lower back pain.

Low oestrogen also leads to an increase in the stress hormone cortisol, which can intensify pain, while reduced levels of progesterone can lower your pain threshold.

Exactly how these changes impact you can also depend on where you are in the menopause transition.

Low back pain during perimenopause

Perimenopause refers to the years leading up to menopause when your reproductive hormones are in a state of flux. Menopause is the point 12 months after your last period when your hormone levels settle at their lowest point.

Although many women still struggle with back pain after menopause, studies suggest that it’s during perimenopause that women are most likely to experience lower back pain, and when their symptoms tend to be the most severe.

In this case, it may be the potential rollercoaster of fluctuating hormones, rather than simply low levels, that are causing your back pain. If you’ve had premenstrual syndrome (PMS), you’ve probably already experienced the abdominal cramps and lower back pain that these sorts of hormonal changes can cause.

Changes to body composition

During perimenopause, an increase in the ratio of testosterone to oestrogen prompts your body to store more fat around your waist and torso. At the same time, changing levels of ‘hunger hormones’ like ghrelin and resistin can increase your appetite, leading to overall weight gain.

This redistributed and additional body fat can change your posture, increasing the strain on your lower back muscles. In fact, some studies have found that higher body mass index (BMI) – a measure of body fat – is linked to increased back pain in menopausal women.

As you get older, your body also becomes less efficient at turning protein into muscle, and you can gradually start to lose muscle mass. Some experts think menopause may speed up this process. Reduced or weakened muscles could lead to less support for your spine, creating tension and pain in your back.

Spinal joint conditions

Low oestrogen can negatively impact the health of your joints. After menopause, women are at an increased risk of developing degenerative disc disease (DDD), where the discs between the vertebrae in your lower back start to deteriorate. By compressing the nerves in your spine, this can cause anything from a persistent ache to severe pain.

Postmenopausal women are also more likely to develop a related condition called facet joint disease, or facet joint osteoarthritis, which can lead to chronic lower back pain.

Hormone replacement therapy and back pain

Hormone replacement therapy (HRT), also known as menopausal hormone therapy (MHT), is medication that replenishes hormones lost during the menopause transition.

There’s no question that HRT helps bring relief from a wide range of menopause symptoms for millions of women worldwide. But when it comes to back pain, things may not be so simple.

Large-scale studies have shown that continuing use of HRT, especially oestrogen-only treatments, may actually increase your risk of chronic lower back pain.

This just highlights how much science still has to learn about the complex relationship between hormone levels and menopause symptoms.

What does menopause back pain feel like?

Your experience of menopausal back pain will depend on what’s causing it and how severe it is, as well as other factors individual to you.

Many women experience a deep ache in their lower back, similar to period cramps, but it can sometimes involve sudden sharp pain too.

The pain can vary in intensity and may radiate into your coccyx, or tailbone, hips and other areas. With degenerative disc disease, the pain is often felt in your buttocks or legs as well as your back. If you have facet joint osteoarthritis, you may find your back pain is worse when you stretch or rotate your spine.

Many women have ‘flare-ups’ of lower back pain on certain days, or for weeks or months at a time, which then disappears again.

The intensity of your back pain can also change depending on the time of day. You may find your pain is worse in the morning before you get moving, or at night.

Menopause back pain at night

Many women going through the menopause transition find their lower back pain, and other aches and pains, are worse at night. This is also reflected in other menopause symptoms, like hot flushes.

When it comes to back pain, it may be that a lack of movement while you’re in bed is contributing to stiffness and aching. But nighttime is also a time when, with nothing else to occupy your mind, you may be more aware of menopause symptoms – and when anxiety can take hold, making symptoms feel more acute.  

If your back pain is worse at night, the NHS recommends talking to your doctor.

Menopause hip pain

As we’ve seen, menopause back pain can often radiate into other areas of your body, including your hips.

But if your pain is mostly concentrated in your hips, rather than your back, it’s possible that hormonal changes are contributing to a condition called gluteal tendinopathy. You can find out more about this in our dedicated article on menopause hip pain.

How to treat menopause back pain

Depending on what’s causing your back pain, lifestyle changes, targeted exercises, physical therapy, certain medications or a combination of these approaches could improve your symptoms.

If your back pain is severe or won’t go away, talk to your doctor

Maintaining a healthy body composition

Maintaining a healthy weight with enough lean muscle mass could help to reduce the strain on your lower back, support your spine and improve your posture.

The following steps can all help with this, as well as improving your overall health during the menopause transition and beyond:

• Take regular exercise: Exercise, including resistance work like weight training, bodyweight exercises or using resistance bands, can help strengthen your muscles, boost your metabolic rate and reduce body fat. If you’ve been diagnosed with a back problem, your doctor or physiotherapist can help you choose the right exercises for you.
• Eat a healthy diet: Following a varied, plant-focused eating pattern like the Mediterranean diet can reduce your risk of becoming overweight, as well as supporting your estrobolome, the community of friendly gut bacteria that help your body recycle oestrogen. Find out more about the Mediterranean diet here.
• Get enough protein: As you get older, you need more protein to stop you losing muscle. Guidelines for menopausal women suggest eating 1–1.2 grams (g) per kg of body weight per day, but studies have shown that those with the most muscle and least body fat eat an average of 1.6 g. In line with the Mediterranean diet, healthy sources of protein include beans and pulses, tofu, nuts and seeds, fish, chicken, eggs and whole dairy products.

Core strengthening exercises

Certain exercises can target specific muscles that support your lower back.

Try the following, which you can do lying down to reduce the strain on your back:

• Pelvic floor exercises: Working the muscles at the base of your pelvis can improve your core strength and stability. Pelvic floor exercises involve a combination of long and short squeezes, also known as Kegels. The NHS has some detailed guidance on how to do them.
• Deep core exercises: Deep-lying core muscles called the transversus abdominis and multifidus are the most important for supporting your lower spine. You can target these muscles by lying on your back and ‘sucking in’ your core from your belly button and below – there’s more detailed guidance in the ‘Training the Core’ section of this science journal article.

Physical therapy

Working with a professional who focuses on tailoring exercises, stretches or other physical therapy to your particular needs can be an effective way to reduce lower back pain.

Physical therapy approaches include:

• Physiotherapy exercises: Physiotherapists can recommend specific stretches and exercises depending on what’s causing your back pain. There’s good evidence that targeted physiotherapy like this can lead to moderate improvements in low back pain symptoms.
• Chiropractic treatment: Chiropractors manipulate your muscles, joints and bones to relieve pain and discomfort. Studies suggest chiropractic treatment is similarly effective to physiotherapy in helping with lower back pain.
• Massage: Massage therapy that targets the muscles and soft tissues can help some people with chronic back pain, especially by relieving stiffness. You can get massage therapy from a dedicated masseur or a physiotherapist.

Medication

We’ve already mentioned that long-term hormone replacement therapy may actually increase your risk of developing lower back pain. Nevertheless, by replacing lost oestrogen, HRT can help with many other menopause symptoms so it’s possible your doctor may suggest trying it if they think your back pain is menopause-related.

HRT can also help to maintain muscle strength and reduce your risk of developing osteoporosis, which can weaken the bones in your spine.

HRT comes in tablets, skin patches or as a gel that you rub onto your skin.

For short-term relief of lower back pain, the NHS suggests non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, which reduce pain and inflammation.

If your back pain is severe and not improving, your doctor may prescribe stronger painkillers or a muscle relaxant.

Probiotics for menopause symptoms

Probiotics are friendly bacteria that support your gut health, and provide other health benefits, when you consume them.

Better Gut is a supplement containing probiotic strains chosen specifically to help with perimenopause and menopause symptoms.

Benefits include:

• improves bone density
• reduces the risk of osteoporosis
• aids oestrogen metabolism
• reduces inflammation
• improves mood and sleep
• helps calm burning sensations and hot flushes
• reduces bloating and improves gut function

When to see a doctor

When you have back pain, the NHS recommends seeing a doctor if:

• it doesn’t start to get better after you’ve treated it at home for a few weeks
• it’s stopping you from doing your usual day-to-day activities
• it’s severe or getting worse
• it’s worse at night
• the pain is in your upper back, between your shoulders
• it’s worse when you sneeze, cough or go to the toilet
• you also have a high temperature
• you're losing weight without trying to
• you have a lump in your back or your back has changed shape
• you're worried about the pain

Summary

The menopause transition comes with an increased risk of lower back pain. While it’s more common during perimenopause, when hormone levels are going up and down, it’s also a symptom of postmenopause, when low oestrogen can contribute to spinal conditions like degenerative disc disease.

There’s even evidence that hormone replacement therapy – used successfully to treat many other menopause symptoms – may increase the risk of developing lower back pain if used long-term.

What menopause back pain feels like can vary but it’s often a deep ache, similar to period pain. Depending on the cause, it can also radiate into the tailbone, hips, buttocks or legs. And it may be worse at night.

Regular exercise and a healthy diet, with plenty of plants and protein, can help you maintain muscle mass and manage body fat, supporting the spine, improving your posture and reducing the strain on your lower back.

Exercises that target your pelvic floor and other deep core muscles can also increase the support for your lower back, while tailored physical therapy can help reduce lower back pain and stiffness.

Over the counter anti-inflammatory drugs like ibuprofen can help with short-term pain relief. If your pain is severe or is not going away, or if you’re worried about it, it’s a good idea to talk to your doctor.