Lower Back Pain in Women: Common Causes

Is back pain different in women?

Mostly not. The most common cause of lower back pain in anyone is non-specific back pain, which comes from the muscles, joints and other tissues of the back, and usually settles within weeks. See our guide to lower back pain. But some causes only affect women, or are more common in women, and it’s worth knowing them.

Causes linked to periods and the pelvis

• Period pain. Cramping pain from the uterus often spreads to the lower back and thighs, usually starting just before or at the start of a period.
• Endometriosis. Tissue similar to the lining of the uterus grows elsewhere in the pelvis. Lower back pain, especially around periods, is common, along with pelvic pain, painful periods and pain with sex. See endometriosis symptoms.
• Adenomyosis. The lining grows into the muscle wall of the uterus, causing heavy, painful periods that can also be felt in the back. See endometriosis vs adenomyosis.
• Ovarian cysts and other pelvic problems can sometimes cause one-sided lower back or pelvic pain.

Pregnancy

Back pain and pelvic girdle pain are very common in pregnancy. Pelvic girdle pain affects about one in five pregnant women, causing pain at the back of the pelvis, around the buttocks or at the front over the pubic bone. See pelvic girdle pain and sciatica in pregnancy.

New back pain in pregnancy with tightening, bleeding, fluid loss or fever needs urgent advice from your maternity team.

After menopause

Bone density falls after menopause, which makes osteoporosis more likely. A vertebral fracture can cause sudden back pain, sometimes after only a minor strain, cough or fall. Height loss or a more rounded upper back can also be signs. Sudden severe back pain in an older woman should be checked.

Kidney and bladder problems

Kidney infections and kidney stones cause pain in the flank, which is the side of the back just below the ribs. Kidney infection usually comes with fever, feeling unwell, and burning or frequent urination. Kidney stones cause severe pain that comes in waves and may spread to the groin. Both need prompt medical care.

Lower back and hip pain together

Pain in the lower back and hips can come from the sacroiliac joints, the hip joints themselves, or the back referring pain into the buttock. See sacroiliac joint pain and hip pain.

When to see a doctor

• Back pain that’s severe, not improving or keeps coming back
• Back pain linked to your periods, or with pain during sex
• Pain with fever, burning when you wee, or blood in your urine
• Back pain in pregnancy that worries you
• Sudden back pain after menopause, especially after a minor fall

Numbness around the groin, new bladder or bowel problems, or worsening leg weakness need emergency care. See back pain red flags.

References

1. Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356-2367.
2. Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020;382(13):1244-1256.
3. Iacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update. 2015;21(6):762-78.
4. Wu WH, Meijer OG, Uegaki K, et al. Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. Eur Spine J. 2004;13(7):575-89.
5. Chapron C, Vannuccini S, Santulli P, et al. Diagnosing adenomyosis: an integrated clinical and imaging approach. Hum Reprod Update. 2020;26(3):392-411.
6. healthdirect. Back pain.