Menopause and back pain: causes, treatments, and exercises for relief

Can menopause cause back pain? The short answer is: It can be a factor.

The same hormone changes that cause the menopause symptoms you may expect — hot flashes, mood swings, insomnia — may also contribute to new aches and pains in your back. But there are steps you can take to help ease back pain in menopause. 

Here, learn more about what causes back pain in menopause, and how to prevent and treat it — especially with exercises from our Hinge Health physical therapists.

What causes back pain during menopause?

Shifting hormones — specifically estrogen — likely play a role. Estrogen is a sex hormone that affects many body systems, including your musculoskeletal system. Estrogen helps maintain bone structure by:

• Slowing natural bone breakdown

• Improving muscle mass

• Increasing collagen in connective tissues and joints

• Preventing inflammation

Research shows estrogen can decrease stiffness in muscles, tendons, and ligaments, leading to better joint performance and fewer injuries. Enter perimenopause — the time leading up to menopause. (Menopause officially means that it’s been a year since your last period.) Perimenopause usually begins in the mid-to-late 40s and lasts an average of four years. During this transition, hormone levels fluctuate and estrogen drops. Lower levels of estrogen can lead to body changes that contribute to back pain, including:

• Bone loss. Estrogen helps keep bones strong — including bones in the spine. “As estrogen levels decline, there are significant changes to bone mineral density, which can lead to conditions like osteopenia and osteoporosis,” explains Dr. Bullis. These conditions can affect your spine, making it more susceptible to pain and stiffness, and may raise your risk of vertebral fractures.

• Joint changes. Estrogen plays a protective role in joint health. Loss of estrogen can lead to changes in cartilage and more joint inflammation. It may also contribute to osteoarthritis and an increased risk of degenerative disc disease, which may contribute to back pain. 

• Decreased muscle mass. Your muscles and other soft tissues (tendons and ligaments) have estrogen receptors. Lower estrogen can cause lower muscle mass. “When estrogen levels decrease, some people notice changes in muscle strength or recovery," says Dr. Bullis.

• Weight changes. Changes in hormones and metabolism during menopause can affect how your body stores energy and where you carry weight. Some people notice a shift in fat distribution from the hips to the midsection, which can contribute to back pain.

Musculoskeletal syndrome of menopause (MSM) is the name for the constellation of musculoskeletal signs and symptoms associated with the loss of estrogen in the menopause transition. Until recently, many MSM symptoms were considered separately and not recognized as part of a wider, connected syndrome.

More causes of back pain

There are many other factors that can affect back pain and stiffness during perimenopause or menopause. Other factors include:

• Age-related changes to the spine

• Inflammation related to your diet, stress, or other factors

• A sedentary lifestyle

• Poor sleep

• Mood disorders

• Overuse or repetitive movements

• Genetic predispositions

Symptoms of menopause-related back pain

Back pain can range from a dull ache to shooting, burning, or stabbing pain. It may come on suddenly or develop gradually. Some signs of back pain and associated discomforts include:

• Persistent stiffness anywhere from the base of your neck to the tailbone

• Sharp, localized pain anywhere in your back

• Pain that gets worse with bending, twisting, lifting, standing, or walking

• Backache after staying in one position for a long time

• Muscle spasms with standing  

Joint pain in general is also more common in menopause. If your back pain is linked to menopause, you may also experience pain in other joints — including your hands, feet, knees, hips, elbows, shoulder, and neck.

Physical therapy for back pain in menopause

When your back aches, you’re more likely to avoid movement. But in most cases, being active can help you feel better. “Consistent exercise can play a crucial role in managing back pain during menopause,” says Dr. Bullis. Regular physical activity can help:

• Keep bones strong

• Decrease joint pain and stiffness

• Maintain and build muscle mass and strength

• Decrease fat storage and improve metabolism

• Promote better sleep and improve mood, which can alleviate other menopause symptoms that impact back pain

You can exercise on your own to ease menopause-related back pain, but working with a physical therapist (PT) can be helpful, too. Physical therapists can assess you, rule out any serious causes of your pain, help you modify your activities, empower you with tools and tips to help you hurt less, and personalize your exercise program.

A PT may recommend exercises to strengthen your low, mid-, upper back, and core muscles, as well as full-body strengthening to help decrease pain and reduce your risk of injury, says Dr. Bullis. They can make sure your plan includes gentle mobility and flexibility exercises, as well as weight-bearing movements to help improve bone health and prevent osteoporosis. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

More ways to treat or prevent back pain in menopause 

In addition to targeted exercise, there are many lifestyle changes and other treatment options that can help ease back pain or prevent it from getting worse. Talk to your health care provider to make sure these strategies are safe and appropriate for you.

1. Regular physical activity — including strength training, weight-bearing, and flexibility exercises — is key to reducing back pain during menopause, says Dr. Bullis. Strength training helps build and maintain muscle mass, which can support your spine and reduce the risk of back pain. Weight-bearing exercises, such as walking, jogging, or using an elliptical machine, can help maintain bone density. Flexibility exercises, like yoga or stretching, can improve your range of motion and reduce stiffness, making it easier to move without pain. Consistent physical activity not only helps manage back pain but also supports overall health and well-being.

2. Maintain a healthy diet. Diet alone can’t cure joint pain. But well-balanced meals can play an important role. 

• Protein is a building block for bones, muscles, and other tissues. When estrogen drops during perimenopause, it can speed up muscle loss. A higher protein diet may have muscle health benefits. Include lean sources of protein in your diet, such as lean meat, beans, lentils, nuts and seeds. 

• Anti-inflammatory foods can help reduce inflammation that contributes to back pain. These include fruits (such as strawberries and blueberries); green, leafy vegetables (spinach, kale); fatty fish (salmon and tuna); nuts (almonds and walnuts) and healthy fats (olive oil).

• Vitamin D helps maintain bone and muscle strength. Women 50 and older need 800 to 1,000 IU daily. One study suggests that vitamin D deficiency may be linked to disc issues and lower back pain after menopause. Your skin makes vitamin D from sunlight, but you may need more. You can get it from foods like fish and eggs, fortified cereals, milk, and orange juice, or from a supplement. Your provider can check your vitamin D levels.

• Calcium is a mineral that helps make your bones rigid and strong. Women 50 years and older should get 1,200 mg of calcium daily. Calcium can be found in dairy products, certain fish, vegetables, fruits, fortified foods, and supplements.

3. Maintain a healthy weight. Excess weight can put stress on your back. Managing your weight during perimenopause and menopause can be a struggle — and there are no easy answers. But taking steps to reduce your back pain through movement can lead to a more active lifestyle and help support your weight loss efforts. 

4. Other dietary supplements — such as fish oil (which contains omega-3 fatty acids) and others — may help ease inflammation and improve joint health. Your provider can help determine if a supplement is appropriate and safe for you..

5. Try cold or heat therapy. Ice can help reduce inflammation and swelling to provide temporary pain relief. Heat is most commonly used for muscles that feel stiff or sore.

6. Take steps to reduce stress. Stress can make back pain worse. Deep breathing, meditation and yoga, or taking a short walk can help keep stress levels in check. A bonus: Mind-body relaxation techniques have also been shown to help relieve the severity and frequency of hot flashes during perimenopause and menopause. 

7. Consider a dual energy X-ray absorptiometry (DEXA) scan. This X-ray test measures bone density, usually in your spine and hip. It provides important information about bone health, which is crucial for understanding and managing back pain, especially if osteoporosis or bone fractures are suspected. “It’s especially important if you have a family history of osteopenia or osteoporosis, so you can start treatment early if needed,” says Dr. Bullis. Talk to your provider to see if a DEXA scan is right for you.

8. Ask your provider about menopause hormone therapy (MHT). Low estrogen can play a role in low back pain and osteoarthritis in menopause. More research is needed, but some studies suggest that MHT could have benefits for musculoskeletal pain, including back pain, during menopause. There are many different types of MHT available. Talk to your healthcare provider to determine if MHT is right for you.

PT tip: Your body is resilient 

“Menopause can bring a host of changes, including back pain,” says Dr. Bullis. Working with a physical therapist to find exercises that are appropriate for you and your needs can make a big difference, she explains. “Remember that your body is resilient, and with the right guidance, you can find relief and stay active and healthy.

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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