How to Treat Menopause Back Pain

While poor posture, excessive sitting, and sports injuries can play a role in low back pain, women in midlife have another cause to contend with: menopause. One study found that nearly 78 percent of postmenopausal women experienced lower back pain, with women in late menopause being four times more likely to have severe back pain. ¹

While wear and tear of the spine is normal as we age, a significant drop in estrogen can accelerate lumbar disc degeneration in the lower back and weaken core muscles, leading to pain. ²

But if you’re a woman in menopause, you aren’t doomed to a life of persistent backaches. Experts explain how lifestyle changes, medications, and physical therapy can work in tandem to ease menopause back pain.

About the Experts

Heather Alaniz, PT, DPT, OCS is a board-certified orthopedic specialist at the Des Moines University Physical Therapy Clinic who specializes in pain associated with orthopedic conditions.

Jessica Magee, DPT, is the Women’s Health Physical Therapy Residency Program Coordinator at Jacksonville-based Brooks Institute of Higher Learning. She is a board-certified clinical specialist in Women’s Health Physical Therapy.

Samuel Pare, DC, is a Chicago-based chiropractic physician who specializes in research-backed pain reduction.

Can Menopause Cause Back Pain?

Declines in estrogen during menopause directly contribute to lower back pain by weakening core muscles, cartilage tissue, and bones.

Low estrogen and back pain

Decreased estrogen levels in menopause can lead to faster disc degeneration, reducing spinal flexibility and contributing to back pain, says Heather Alaniz, DPT, a board-certified orthopedic specialist and physical therapist. “Estrogen has protective effects on intervertebral discs, keeping the spine cushioned and flexible,” she explains.

Declining estrogen contributes to lower back pain during menopause in other ways as well, says Alaniz:

• As estrogen drops, muscle strength and ligament elasticity decline, removing important support around the spine and pelvis.
• Loss of estrogen can trigger bone loss and increase the risk of osteoporosis and vertebral fractures.
• As estrogen declines, pain sensitivity can increase, since estrogen influences pain-modulating neurotransmitters.³

Perimenopause and back pain

Perimenopausal women often report cyclical lower back pain that ebbs and flows with sharp fluctuations in estrogen.

A 2006 SWAN study found 65 percent of women in early perimenopause reported lower back pain. ⁴

“Perimenopausal women frequently have sporadic low back discomfort that relates to changes in hormone levels,” says Jessica Magee, DPT, a board-certified clinical specialist in Women’s Health Physical Therapy. “Hormonal changes can impact the performance of muscles that support the vertebrae and the flexibility of ligaments, which can cause pain.”

Weight gain and back pain

One study found that women with a waist circumference greater than 88 cm (34.6 inches), were twice as likely to experience lower back pain as those without it. ⁵ Women tend to gain about 1.5 pounds per year through their 50s, often around the abdomen. ⁶

Menopause symptoms and back pain

A 2019 study found that the women who are most affected by menopause symptoms like hot flashes are also more likely to have chronic pain, including lower back pain. ⁷

Another small study of women ages 50 to 65 found that musculoskeletal pain, including back pain, was linked to higher levels of anxiety and insomnia. Additionally, women with menopause insomnia experienced more musculoskeletal pain alongside symptoms like night sweats. ⁸

Sleep deprivation and chronic stress can also lead to increased inflammation, which contributes to muscle, joint, tendon, ligament, and neural pain, says Alaniz.

Lifestyle Changes for Menopause Back Pain

Exercises for back pain

If you’re experiencing menopause back pain, movement could be your first line of defense. But not just any movement will do: Strength training is the holy grail for preventing low back pain in perimenopause and menopause.

To target menopause back pain, make sure your strength training plan includes exercises focused on the core and glute muscles that support and stabilize the spine.

• Core exercises: Exercises that target deep core muscles, like the transversus abdominis, lumbar multifidus, glute med and min, deep hip rotators, and the pelvic floor, all play a role in stabilizing the lower parts of the spine. ⁹ Recent studies show that Pilates is an especially effective core exercise treatment for low back pain. ^{10 11}
• Glute exercises: The glute muscles are just as important as muscles in the core for menopause back pain because they stabilize the hips, provide spinal support, and reduce strain in the low back, says Magee. She suggests using pelvic tilts and glute bridges to strengthen this area. “Slow and controlled movements are key,” she says.

As declining estrogen ushers in muscle and bone strength deficits, you have to work harder to maintain and build muscles that support your skeletal structure, including in the lower back. “Building muscle post-menopause requires progressive overload,” Magee says. Progressive overload requires persistent and incremental increases in workout volume or intensity by increasing the number of exercise repetitions performed or increasing the weight used during an exercise.

Choose weights that allow 8 to 15 reps, with the final reps feeling a bit difficult, advises Sam Pare, a chiropractic physician. As you get stronger, slowly increase the weight for each exercise, sticking to this 2-for-2 rule: Once you’re able to comfortably perform two additional reps of an exercise beyond your goal during your last set of the exercise, for at least two weeks in a row, you’re ready to increase the weight. ¹²

Perfect your posture

When back muscles weaken due to declining estrogen, it’s harder to keep your body in alignment. That leads to slouching, increased pressure on the spine, and pain.

• Proper posture: When standing, maintain equal weight between your heels and the balls of your feet with your pelvis in a neutral position rather than in the common butt-tucked-under posterior pelvic tilt.
• How to improve your posture: Attach a lumbar roll to your office chair to promote proper alignment while sitting, and incorporate scapular squeezes, rows, planks, and chest stretches into your workouts. ¹³ For a more targeted approach, seek out a licensed physical therapist who can teach you the correct exercises you need to stay in alignment.

Adjust your diet

An anti-inflammatory diet can reduce chronic back pain from inflammation. ¹⁴ In the ideal perimenopause diet, women should swap processed foods, saturated fats, sugars, and fried foods for:

• Antioxidant-rich foods: blueberries, strawberries, cherries, spinach, broccoli
• Omega-3 fatty acids: salmon and other fish, chia seeds, flaxseed, walnuts, olive oil, grass-fed butter
• Cruciferous vegetables: broccoli, cabbage, cauliflower, kale, Brussels sprouts
• Whole grains: brown rice, oats, and quinoa
• Fermented foods: kefir, kombucha, kimchi, and sauerkraut

Reduce stress and prioritize sleep

Sleep deprivation and stress during menopause increase inflammation, contributing to muscle, joint, tendon, and pain in the back, says Alaniz. What’s more, poor sleep reduces your brain’s ability to suppress pain signals.

To get better rest:

• Stick to a consistent sleep schedule: Go to sleep and wake up at the same time every day.
• Kick tech out of the bedroom: Avoid watching TV or scrolling on a phone or tablet at least 30 minutes before you shut your eyes.
• Limit caffeine and alcohol: An afternoon cup of coffee or tea might make it more difficult to fall asleep, while alcohol’s effects may rouse you from your slumber. ¹⁵
• Treat menopause symptoms: If hot flashes, night sweats, and increased urges to pee wake you up at night, talk to your doctor about treating your menopause symptoms with hormone replacement therapy (HRT) or other medications.

To reduce stress:

• Consider an 8-week mindfulness-based stress reduction (MBSR) course.¹⁶ MBSR is a structured program that teaches destressing tools, including mindfulness-based meditation. In one study, 78 percent of women who practiced this type of meditation felt that they were able to cope with life’s challenges better, and 89 percent said their menopausal symptoms improved. ¹⁷

Treatments for Menopause Back Pain

While lifestyle changes can go a long way in reducing menopausal low back pain, more treatments may be warranted.

Use heat and ice

For back pain that has been going on for at least six weeks, both heat and ice can be soothing, says Magee. “I advise patients to choose whichever one feels the best for them.” Apply ice every two to four hours for no more than 20 minutes each time. With heat, apply three times a day for no more than 20 minutes each time. ¹⁸

Hormone replacement therapy (HRT) for menopause back pain

Systemic estrogen HRT from a pill, patch, or gel can protect against bone loss and stave off lumbar disc degeneration. ¹⁹

Consult with your doctor to weigh the benefits and risks of HRT for not only back pain but also other menopause-related symptoms.

Other medications for menopause back pain

• Over-the-counter pain relievers: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen can temporarily reduce inflammation and pain.
• Muscle relaxants: If your back muscles are spasming, a prescription muscle relaxant may be warranted for short-term help.
• Antidepressants: Antidepressants are sometimes used to treat chronic low back pain, regardless of mental health status. ²⁰
• Topical pain relievers: Both topical lidocaine and topical capsaicin can help manage chronic lower back pain. While both are available OTC, prescription 5 percent lidocaine patches may provide the most relief. ²¹

Supplements and alternative remedies for menopause back pain

• Magnesium: Current evidence suggests that magnesium supplementation can help relieve chronic back pain. ²² “Magnesium is known to relax muscles and lessen pain,” Magee says. Ask your doctor for proper dosing.
• Acupuncture: Studies suggest that acupuncture can offer relief for chronic pain sufferers. ²³ “Acupuncture can address inflammation, modulate pain signals, and improve energy,” Alaniz says.
• Chiropractic: A 2018 study found that people who received chiropractic care in addition to medications, self-care, and physical therapy reported less intense pain, improved movement, a need for less pain medication, and higher satisfaction with treatment than their counterparts who did not receive chiropractic care in addition to other remedies. ²⁴

Physical therapy

Physical therapy is that physical therapists are trained to use a whole-body evaluation approach to treat menopause back pain. A well-trained physical therapist can connect pain in one part of the body to potential issues in other areas. If, for example, you come in for low back pain, your physical therapist will assess how it is impacting your hips, neck, and other areas, then suggest targeted treatment. ²⁵

About the author

Lauren Ramakrishna is a freelance writer who covers health. Her work has appeared on digital sites by Good Housekeeping, Redbook, and Woman's Day, among others.

About the reviewer

Carol Lynn, MD is a board-certified OB/GYN who specializes in menopause management. She is a member of the American Board of OB/GYN (ABOG) and the North American Menopause Society (NAMS).