There are dozens of causes of lower back pain, which can affect both men and women equally. But, amongst those causes, some affect women much more than men. 

It’s important to understand the cause of back pain to find the best treatment strategy. This guide from HealthTap looks at the different causes of low back pain in women and ways to treat it. 

The following are some of the most common conditions that cause low back pain in women. While some of these conditions may affect men, hormonal differences make them more likely in women. 

1. PMS/PMDD

Premenstrual syndrome (PMS) is a condition many women get before their period. It affects a little under half of all menstruating women — albeit in different ways. Some symptoms of PMS can include bloating, fatigue, food cravings, irritability, and pain. 

Premenstrual dysphoric disorder (PMDD) is a more severe form of PMS. It’s associated with many of the same symptoms as PMS but with more extreme mood changes. Women who experience PMDD may become depressed or anxious during this period, which may affect their school, work, or social life. 

Some women experience back pain during and after their period. That said, PMS and PMDD don’t necessarily cause low back pain. But, evidence suggests that inflammation increases significantly in the week leading up to a woman’s period, potentially exacerbating pre-existing back pain.

Pain with PMS/PMDD generally begins a week before menstruation and ends a day or two after it begins. Women who eat highly-processed diets, smoke cigarettes, and don’t exercise are more likely to have severe symptoms. 

2. Endometriosis

Endometriosis is when endometrial tissue, similar to the tissue that lines the uterus (also known as the endometrium) begins to grow outside the uterus. The endometrial tissue grows on organs in the pelvis, e.g. on the ovaries or Fallopian tubes.

The endometrium can thicken, break down, and bleed with each menstrual cycle. But, because this tissue is growing outside the uterus, it can’t exit the body like a regular menstrual cycle. Therefore, it can begin to build up, leading to pelvic pain that may radiate to the lower back. 

The pain usually gets worse during menstruation. Women with uterine fibroids or cysts on their ovaries may also have increased lower back pain.

3. Pregnancy 

Low back pain during pregnancy is due to several things. Pregnancy causes weight gain, especially in the abdomen, and relaxes ligaments to prepare for childbirth. 

Later in pregnancy, it’s more common to experience back pain as the increasing weight of the baby puts more pressure on the pelvis and lower back.

4. Spinal osteoarthritis

Osteoarthritis is a type of arthritis due to wear-and-tear of the cartilage that cushions the joints.

In spinal osteoarthritis, the joints connecting the spine begin to wear down. Without proper cushioning, the bones in the spine may rub together, causing pain in the upper or low back, buttocks, or thighs.

Women are more likely to experience osteoarthritis, and may have more severe symptoms. 

5. Spinal osteoporosis 

Osteoporosis causes bone density to decrease, making bones weak and brittle. This condition happens when there is more bone loss than the formation of new bone. Low calcium and vitamin D consumption can increase the risk of developing osteoporosis.

In moderate to severe cases, spinal osteoporosis can lead to bone pain, affecting the lower back. Spinal compression fractures can cause back pain between the mid and lower back. The pain can even radiate to the front of the torso, mimicking heart or lung problems. 

Women are more likely to develop spinal osteoporosis after menopause.

6. Piriformis syndrome

Piriformis syndrome is a condition that causes spasms in the piriformis muscle. 

Piriformis syndrome can lead to compression of the sciatic nerve, which passes through the back of the leg. Compressing the sciatic nerve can cause pain, numbness, and tingling along the back of the leg. This pain can even mimic sciatica pain, which is a separate condition. 

Women are more prone to piriformis syndrome due to differences in pelvic bone structure. 

7. Sacroiliac joint dysfunction

The sacroiliac (SI) joint connects the pelvis to the base of the spine. Sacroiliac joint dysfunction that leads to instability in the pelvis can cause low back pain. SI joint dysfunction is among the most common causes of low back pain.

Women are more prone to sacroiliac joint dysfunction than men due to both the increased angle of the pubic bone paired with decreased curvature in the joint. Women also have a differently-shaped sacrum (the bone located under the lumbar spine). 

Sacroiliac joint dysfunction can look like sciatic pain, with a dull ache in the lower back and sharp pain in the hamstrings. 

8. Degenerative spondylolisthesis

Degenerative spondylolisthesis happens when one vertebra in the spine slips over another. This can cause the vertebrae to rub against each other, leading to lower back pain that can radiate to the legs. 

This condition is more common in women going through menopause due to declining estrogen levels. Low estrogen can weaken the vertebrae and loosen the ligaments. This can make the spine more unstable and increase the chances of low back pain.

9. Coccydynia 

Coccydynia is the term for tailbone pain and mainly occurs due to physical trauma, such as a back injury. The tailbone is also known as the coccyx.

Coccydynia may lead to pain when sitting down, leaning back while sitting, and standing up from a seated posture. The pain may get better upon standing. 

Women have differently-shaped tailbones than men, making them more likely to experience pain in their coccyx. Childbirth injuries may cause pain in the coccyx and therefore increases the risk for women.

10. Herniated disk

A spinal disk has a jellylike, soft interior (called the nucleus) with a harder exterior. They serve as cushioning between each bone that makes up the spine (aka, the vertebrae). 

A herniated disc or slipped disk occurs when the nucleus of a spinal disk bulges through the exterior protection. 

Some herniated disks are asymptomatic. If the bulged disk presses against nearby nerves, it can result in pain or tingling in the arms, legs, and back. Those with degenerative disk disease are more prone to herniation due to disk deterioration. 

Treatment for a herniated or slipped disk includes physical therapy, medication, and possibly surgery. 

11. Weight gain

Due to hormonal differences, women are more likely to gain weight in the abdomen, especially after menopause. Excess belly fat can strain the back muscles and ligaments, leading to lower back pain. 

Healthy weight loss through diet and exercise can relieve pressure on the spine.

How do doctors treat back pain in women?

Low back pain treatment depends on the underlying cause of the pain. If a doctor determines there is a specific medical condition causing the pain, it’s important to treat the condition to relieve the symptoms.

Here are some potential treatment options for low back pain in women. 

1. Pain relievers

NSAIDs, like aspirin and ibuprofen, can be a good first choice for treating low back pain on a short term basis. Most people don’t experience severe side effects when taking NSAIDs, and they don’t lead to dependence. Taking NSAIDs may increase the risk of bleeding in the stomach, which is why it’s best to consult a doctor before taking them.

2. Muscle relaxants

Doctors can prescribe muscle relaxants along with NSAIDs or on their own. They work by reducing muscle spasms and muscle tension, which may reduce some pain. Muscle relaxants can help patients resume their normal daily activities, including exercise.

Some medications in this group include cyclobenzaprine (Flexeril), tizanidine (Zanaflex), and metaxalone (Skelaxin). They are most effective in the first two weeks of acute lower back pain. 

3. Cortisone injections

If medication doesn’t help, then cortisone injections may be an option. If more conservative measures don’t relieve the pain, a specialist may recommend cortisone injections.

Cortisone is a type of hormone that can reduce inflammation. When injected into painful tissues in the lower back, cortisone can reduce pain by decreasing inflammation.

Having too many cortisone injections in the same area can cause damage to nearby tissues. Cortisone can also cause the skin at the injection site to thin out. For this reason, cortisone shots are usually used as a last resort and should only be used in the short-term. 

4. Hormonal birth control

Hormonal birth control may help balance hormones, improving some premenstrual symptoms. Hormonal birth control options include the implant, the shot, the pill, the ring, or the patch. In women with PMS or endometriosis, hormonal birth control may improve pelvic pain and/or back pain during the menstrual cycle.

Hormonal birth control requires a visit with a doctor and a prescription. Some women have medical conditions that make it unsafe for them to take hormonal birth control. Hormonal birth control can cause mild side effects including headaches, nausea, and dizziness.

5. Antidepressants

Some studies show that antidepressants improve the symptoms of chronic pain. While antidepressants don’t specifically treat back pain, they can change how a patient perceives it. Chronic low back pain may cause or worsen anxiety and depression. In conjunction with other treatments, taking antidepressants may help improve pain. 

Home remedies to treat low back pain in women 

When back pain is mild, doctors may approve or recommend one or more of the following home remedies to improve the pain.  

• A heating pad 
  Applying heat to a painful area can boost circulation and speed healing.
• An ice pack
  ⁠Ice reduces inflammation and often improves pain. It may help to alternate cold therapy with heat therapy. 
• Gentle exercise
  ⁠Gentle exercise can boost circulation while releasing endorphins. Being sedentary can make low back pain worse. 
• Stretching
  Stretching for the lower back can promote flexibility and make it easier to move.
• Lumbar support
  ⁠Poor posture can make low back pain worse. Sitting in a chair with good lumbar support can help keep the back straight and ease some pain. 
• Warm bath
  ⁠Not only does warm water increase circulation, but it is an excellent form of self-care. It can boost mood and make pain feel less distressing. 

Takeaways 

PMS/PMDD, pregnancy, and endometriosis may cause back pain in women. Women also have an increased risk of developing certain conditions which cause back pain. 

If you experience low back pain, getting to the root cause is essential for relief. 

HealthTap can connect you with a medical professional specializing in women’s health. They can diagnose and treat you through our virtual platform — so you never have to leave home. 

Schedule your visit today to get the relief you need.