Chart of Female Back Pain

Women experience back pain more than men, according to extensive clinical research. A combination of factors including anatomy, hormones, and pregnancy contribute to this phenomenon, widely known as the “gender pain bias”. 

‌Below, we’ll explore the causes and treatments of female back pain. 

Table of Contents

Back Pain Conditions That Affect Mainly Women

Back pain conditions that affect mainly women include endometriosis, spinal osteoarthritis, spinal osteoporosis, degenerative spondylolisthesis, and piriformis syndrome. 


Endometriosis occurs when tissue similar to the endometrium (the lining of the uterus) grows outside the uterus. Affecting an estimated 190 million women and girls of reproductive age across the globe, endometriosis is a prevalent gynecological disorder. 

Lower back pain is one of the most common endometriosis symptoms. It occurs when the abnormal tissue grows in or close to the back, often triggering nerve compression or inflammation. 

Spinal Osteoarthritis

Osteoarthritis is more likely to affect women than men, as osteoarthritis rates significantly increase in women aged 50 and older. This may be due to a combination of factors, including the hormonal fluctuations that occur around menopause and female anatomy, which can increase stress on certain joints. 

When osteoarthritis affects the spine, it can trigger back pain from increased inflammation, bone spurs, and resulting nerve irritation. 

Spinal Osteoporosis

Osteoporosis, a disease that causes weakened bones, is four times more prevalent among women than men. This is because the menopause-related decline in estrogen can directly compromise women’s bone density. Spinal osteoporosis causes the vertebrae to weaken, potentially causing compression fractures. 

Along with back pain, spinal osteoporosis can cause kyphosis (stooped posture) and loss of height.  

Degenerative Spondylolisthesis

Spondylolisthesis occurs when a vertebra slips out of its proper position, falling over the vertebra below. With degenerative spondylolisthesis, this slip results from degenerative spinal changes, like weakened or damaged spinal discs, bone spur formation, and thickened spinal ligaments.

Degenerative spondylolisthesis is more prevalent in women than men, and tends to occur after age 50. Symptoms include back pain, stiffness, muscle spasms, and radiating neurological symptoms. 

Piriformis Syndrome

Piriformis syndrome is a condition that develops when the piriformis muscle presses on the sciatic nerve. The piriformis muscle is flat and pear-shaped, extending from the lower back to the buttocks and top of the thighs. With piriformis syndrome, you may experience pain in the lower back and gluteal area, along with tingling and numbness in the buttocks, hip, and upper thighs. 

Though uncommon, piriformis syndrome occurs in women more than men. This is likely due to female anatomical features, along with hormonal fluctuations associated with menstruation, pregnancy, and menopause. 

The Anatomy of Back Pain in Women

The anatomy of back pain in women clarifies the areas of the back that are associated with specific conditions. 

  • Lower Back:
    • Spinal conditions
    • Impinged nerves
    • Sciatica
    • Menstrual pain
    • Endometriosis
    • Pregnancy
    • Pelvic inflammatory disease
    • Fibroids
  • Sacrum/Tailbone
    • Menstrual pain
    • Pregnancy and recent childbirth
    • Sacroiliac joint dysfunction
    • Coccydynia
    • Pelvic inflammatory disease
    • Fibroids
  • Mid-Back:
    • Spinal conditions
    • Poor posture
    • Muscle fatigue
  • Upper Back and Neck:
    • Spinal conditions
    • Poor posture
    • Poor sleeping position
    • Stress
    • Muscle fatigue

How Does Anatomy Contribute to Back Pain in Women?

Certain anatomical factors may contribute to back pain in women, including:

  • A wider pelvis can compromise the alignment and balance of impact on the lumbar spine. 
  • Smaller sacroiliac joints may increase strain on the joint and increase the risk of sacroiliac joint dysfunction. 

The Main Causes of Back Pain in Women

The main causes of back pain in women include premenstrual syndrome, painful menstruation, back muscle strain, endometriosis, and spinal conditions. 

  • Premenstrual syndrome, or PMS, is a combination of physical and emotional symptoms that occur before or during a menstrual cycle. Lower back pain is a very common PMS symptom, resulting from hormonal fluctuations and the release of prostaglandins. Prostaglandins are chemicals that trigger uterine contractions and can cause pain that radiates to the lower back. 
Chart of Female Back Pain
  • Painful menstruation, also known as dysmenorrhea, can cause heavy uterine contractions from an excess of prostaglandins. Radiating pain from these contractions can affect the lower back. 50 to 90% of reproductive-age women worldwide experience dysmenorrhea, making it a prevalent cause of female back pain.  
  • Back muscle strains can result from heavy lifting, poor posture, repeated movements, and overuse. They’re one of the most common causes of back pain in both women and men. Thankfully, most back muscle strains go away with rest, home care, and over-the-counter medications, although severe cases require professional medical treatment. 
  • Endometriosis can cause back pain from inflammation and spinal nerve impingement. Additionally, nerves supplying the uterus also supply the lower back, so pain from the uterus can radiate to the lower back. 
  • Spinal conditions like spinal stenosis, herniated discs, spondylolisthesis, osteoarthritis, and degenerative disc disease can trigger chronic back pain in women. These conditions require prompt medical attention to prevent worsened symptoms and lasting tissue damage.

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Chronic Back Pain Conditions in Women and Their Solutions

Chronic back pain conditions in women include endometriosis, spondylolisthesis, spinal stenosis, osteoarthritis, and osteoporosis. Their solutions include:

  • Endometriosis-related back pain can be treated with:
    • Pain medications like NSAIDs and other analgesics
    • Hormone therapy to optimize hormone levels and potentially reduce endometriosis growth
    • Physical therapy to strengthen the pelvic floor muscles, reduce muscle tension, and improve relaxation
    • Lifestyle changes like mindfulness meditation, improving sleep quality, and breathing techniques
  • Osteoarthritis can be treated with:
    • Anti-inflammatory medications and corticosteroid injections to reduce swelling in the spine and temporarily alleviate back pain
    • Low-impact exercise to improve mobility
    • Physical therapy to improve posture and muscular support for the spine
    • Surgery, in severe cases, to remove bone spurs and/or repair spinal joint damage
  • Osteoporosis can be treated with:
    • Hormone therapy to increase estrogen, preventing further bone loss and fractures
    • Physical therapy to strengthen the body and reduce the risk of falls
    • Medications like bisphosphonates to curb bone loss and lower fracture risk
    • Lifestyle adjustments to improve bone density, like quitting smoking and limiting alcohol intake 
    • Fall prevention measures, like wearing supportive footwear and adding traction to slippery surfaces in your home
  • Spondylolisthesis can be treated with:
    • Back bracing to stabilize the spine
    • Physical therapy to strengthen the core and back muscles, which support the spine
    • Activity modifications to reduce strain on the slipped vertebra
    • Surgery with spinal fusion or non-fusion spinal implants to restore spinal stability and resolve nerve impingement, in severe spondylolisthesis cases
  • Spinal stenosis can be treated with:
    • Physical therapy to reduce the impact on the spine with daily movements
    • Lifestyle changes to reduce inflammation and limit stress on the spine
    • Pain medications for symptom management
    • Low-impact exercise to retain mobility and spinal range of motion
    • Surgery with spinal decompression and stabilization to create more space in the spinal canal

If you’re struggling with female back pain, contact your physician for a complete evaluation and diagnosis.