Lower Back and Pelvic Pain in Females – Explained

Lower back pain is a common health concern for adults of both genders. Alone, it’s usually caused by musculoskeletal injuries. However, when it’s accompanied by pelvic pain in women, lower back pain can point to various gynecological or urinary issues. Distinguishing between the two is crucial to receiving proper treatment and alleviating your symptoms. 

Read on to learn more about the issues that can cause lower back and pelvic pain in females, including the available treatment options. 

Table of Contents

What Gynecological Problems Cause Lower Back Pain?

The gynecological problems that can cause lower back pain include endometriosis, PMS, PMDD, and dysmenorrhea.  

Endometriosis 

Endometriosis is a chronic gynecological disorder that occurs when the uterine lining, known as the endometrium, forms outside the uterus. It impacts an estimated 10% of the world’s women and reproductive-age girls. One of the most common symptoms of endometriosis is painful menstrual cramps that can move into the lower back or stomach. 

Other symptoms of this condition include:

  • Painful intercourse
  • Fatigue
  • Nausea 
  • Constipation or diarrhea during menstruation
  • Bloating
  • Irregular and/or heavy menstruation
  • Bleeding between periods
  • Infertility
  • Depression and anxiety

Endometriosis can be treated by removing the endometrial tissue through excision and/or ablation. Patients looking to avoid surgery can consider pain medications and hormone therapy, though these aren’t permanent fixes. 

PMS

PMS stands for premenstrual syndrome, a collection of symptoms that occur before a woman’s period, usually in a consistent pattern. Some of the most common symptoms of PMS include fatigue, irritability, moodiness, disrupted sleep, cravings, appetite changes, cramping, and bloating. Some women also experience lower back pain with PMS.

PMS-related lower back pain is generally muscular and triggered by hormonal fluctuations. The back pain tends to be more intense in women who experience heavy periods. 

PMDD

PMDD is a form of PMS that stands for premenstrual dysphoric disorder. It involves significantly more severe symptoms than typical PMS, potentially involving panic attacks, depression, and suicidal thoughts. Like PMS, PMDD can also cause muscular lower back pain in some women. 

Dysmenorrhea

Dysmenorrhea is menstruation-related pain, which typically develops in the lower abdomen and back. Usually, this pain is mild and subsides within a few days, but it can be severe. 

There are two types of dysmenorrhea: primary and secondary. Primary is the most common and occurs with menstrual periods, but isn’t caused by an underlying medical condition. Secondary dysmenorrhea involves an infection or condition of the reproductive organs that trigger painful periods. 

Dysmenorrhea can typically be treated with non-invasive methods, including pain medication, hormone therapy, birth control pills, heat therapy, massage, and/or lifestyle adjustments. In severe cases, surgery may be necessary to resolve the patient’s symptoms. 

What Does It Mean When Your Lower Back and Pelvic Area Hurts?

When the lower back and pelvic area hurts, it typically means that the muscles of the uterus are contracting before menstruation. This occurs as a result of prostaglandins, chemicals produced that the uterus produces to stimulate contractions. These contractions help the uterus release the endometrium for menstruation, which is why more prostaglandins are produced before a woman’s period. 

Besides menstruation, other possible causes of lower back and pelvic pain in women include:

  • Endometriosis, as discussed above
  • Pelvic inflammatory disease

Pelvic inflammatory disease, or PID, can develop when the female reproductive organs become infected. This usually results from sexually-transmitted bacteria and can cause pain in the pelvic, lower abdomen, and lower back. PID can usually be treated with antibiotics to clear up the infection. 

  • Fibroids

Fibroids are non-cancerous growths consisting of uterine muscle tissue. Though 70 to 80% of women are estimated to develop fibroids at some point in life, not everyone is symptomatic. In rare cases, fibroids push against nerves and muscles within the lower back, causing pain. 

There are many treatment approaches to symptomatic uterine fibroids, including medications or minimally-invasive procedures to remove them. 

  • Irritable bowel syndrome 

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that causes abdominal pain, irregular bowel movements, bloating, and gas. Approximately 28 to 81% of IBS patients experience back pain, which is thought to be referred pain (pain that originates in a different region of the body). 

IBS can be managed with lifestyle adjustments, mainly including dietary changes, as well as medications and probiotic supplements. 

  • Interstitial cystitis

Interstitial cystitis is a chronic bladder condition that develops when the bladder wall is inflamed or irritated. This can make the bladder stiffen and scar. The symptoms of this disorder can vary, but the most common include chronic pain in the pelvis, perineum, urethra, lower abdomen, and lower back.

Treatment options for interstitial cystitis include lifestyle changes, bladder training, medications, physical therapy, and, for severe cases, bladder surgery.  

  • Pelvic congestion syndrome

Pelvic congestion syndrome, or PCS, is a possible cause of chronic pelvic pain in women. It’s usually caused by issues with the pelvic veins, such as enlarged or varicose veins. Along with pelvic pain, women with PCS may experience lower back pain.  

PCS can be treated with gonadotropin-releasing hormone medications, progestin hormone drugs, and procedures to cut off or remove the damaged veins. 

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Causes of Pelvic Pain

Possible causes of pelvic pain in women include:

  • Endometriosis
  • Pelvic inflammatory disease
  • Menstrual cramps
  • Mittelschmerz (mild, one-sided abdominal pain that occurs with ovulation)
  • Adenomyosis (when tissue from the uterine lining grows into the uterine wall)
  • Ovarian cysts (fluid-filled sacs that develop on or in the ovaries)
  • Uterine fibroids (growths that develop in the uterus, consisting of muscle and connective tissue)
  • Ovarian cancer

Pregnancy-Related Pain

The physiological changes and stress (both physical and mental) associated with pregnancy can contribute to lower back and pelvic pain. Here’s how:

  • The body releases various hormones during pregnancy that loosen ligaments in the pelvis. This, along with weight gain and a shifting center of gravity, can lead to pelvic pain. Pelvic pain during pregnancy is sometimes referred to as pelvic girdle pain (PGP) or symphysis pubis dysfunction (SPD). 
  • Increased pressure on the pelvis and lower back during pregnancy can cause inflammation and nerve irritation. 
  • Normal contractions during pregnancy (called Braxton Hicks contractions) are usually painless, but can cause some pelvic or back discomfort. 

Certain pregnancy complications can also cause pelvic or lower back pain, including:

  • Miscarriage
  • Ectopic pregnancy (when a fertilized egg develops outside the uterus)
  • Preterm labor (when labor begins before 37 weeks)

When Should I Be Worried About Lower Pelvic Pain?

Women should be worried about lower pelvic pain if it’s severe, worsens when you move or touch the area, or makes it difficult to go to the bathroom. If you experience these symptoms with lower pelvic pain, seek emergency medical care. 


Lower Back Pain and Spine Issues

Lower back pain in women can also be caused by spine issues, such as:

  • Osteoarthritis, also known as “wear and tear” arthritis, causes the cartilage in the facet joints of the spine to degenerate.
  • A herniated disc occurs when one of the spinal discs becomes damaged, potentially causing it to impinge on nearby spinal nerves.
  • Degenerative disc disease is a condition that develops when the spinal discs gradually weaken and thin, usually as a result of the aging process. This can lead to lower back pain, stiffness, and neurological symptoms. 
  • Spinal stenosis involves the abnormal narrowing of the spinal canal. It can be present at birth or develop as a result of age-related spinal changes. When the spinal canal is too narrow, it can press on spinal nerves. 
  • Spondylolisthesis occurs when a vertebra slips out of its usual position, leading to spinal misalignment. Many people with spondylolisthesis experience lower back pain and radiating pain. 

Lower back pain caused by spinal issues, rather than gynecological or urinary issues, tends to trigger neurological symptoms, rather than pelvic pain. Neurological symptoms can include numbness, weakness, tingling, or a pins-and-needles sensation that radiates through the hips and legs. 

Relationship Between Pelvic and Lower Back Pain

Pelvic and lower back pain have a close, interconnected relationship. In some cases, pelvic pain influences lower back pain and vice versa. 

The pelvis and the lower back pain have some shared structures, like the sacroiliac joint. This joint links the lumbar spine to the pelvis, and sacroiliac discomfort can radiate to both regions. 

The pelvic floor is another anatomical structure that can contribute to both pelvic and lower back pain. Weakness or tension in the pelvic floor muscles compromise their ability to support the pelvic organs. This (often referred to as pelvic floor dysfunction) can trigger nerve irritation and inflammation, leading to pelvic pain that can radiate to the lower back. 

Treatment Options for Pelvic and Lower Back Pain

Treatment options for pelvic and lower back pain include:

  • Home remedies like heat/cold therapy, rest, and gentle stretches
  • Lifestyle adjustments, like low-impact exercise, nutritional improvement, and good posture 
  • Physical therapy
  • Pain medications, either over-the-counter or prescription
  • Steroid injections, particularly for spinal conditions
  • Acupuncture, massage therapy, aromatherapy, and other alternative remedies
  • Chiropractic care

Lower Back Surgery

Lower back surgery may be required for lower back pain that doesn’t resolve after several months of conservative treatment. For the spinal issues above, lower back surgery may involve:

  • Laminectomy, a decompression procedure to remove some or all of the lamina (the roof of the spine)
  • Discectomy, a procedure to remove some or all of a damaged spinal disc
  • Foraminotomy, a procedure to widen the foramina, the spinal openings that nerves and blood vessels pass through
  • Spinal fusion, a procedure that uses bone graft material to permanently fuse at least two vertebrae and stabilize the spine

The TOPS System is a mechanical implant device that stabilizes the spine without the need for fusion. It preserves the motion of the spine while offering relief from low back pain in patients with spinal stenosis or spondylolisthesis. 

If you’re struggling with persistent lower back pain, schedule an appointment with a spinal specialist in your area to learn about your treatment options. 

When to Seek Medical Advice for Lower Back and Pelvic Pain

It’s time to seek medical advice for lower back and pelvic pain if you experience:

  • Sudden, severe, or constant pain
  • Pain that lasts longer than a week
  • Pain after a traumatic event, like an car accident
  • Pain that gets progressively worse
  • Pelvic pain with changes in your menstrual cycle
  • Pain accompanied by other symptoms, like:
    • Fever
    • Nausea
    • Vomiting
    • Dizziness
    • Changes in bowel or bladder function
    • Numbness, weakness, or tingling in the extremities
    • Unexplained weight loss
    • Changes in skin color

If you experience any of these concerning symptoms, contact your doctor right away or seek emergency medical care.