Back Pain During Perimenopause: Why It Happens and What Helps
Back pain is a surprisingly common perimenopause symptom. Learn why falling estrogen affects your spine, when to see a doctor, and practical strategies to reduce pain.
Why Perimenopause Triggers Back Pain
Back pain in perimenopause is more common than most women expect. The main driver is falling estrogen. Estrogen plays a protective role in spinal disc health, keeping cartilage resilient and supporting the ligaments that hold vertebrae in alignment. As estrogen drops, discs can lose hydration and elasticity, making the lower back more vulnerable to strain. Muscle tension also increases when the nervous system becomes more reactive to fluctuating hormones, which adds another layer of discomfort.
What the Pain Can Feel Like
Perimenopausal back pain most often settles in the lower back, though mid-back and sacral aching are also reported. Many women notice it is worse in the morning, easing off as they move around. Others find it flares before or during a period when prostaglandins increase muscle tension. A dull, persistent ache is the most typical description, but sharp twinges on movement are also possible. Some women also experience hip pain alongside back pain because the two areas share ligaments and muscle groups.
When to Get Checked
Most perimenopausal back pain is mechanical and responds well to self-management. See your doctor if you have pain that radiates down one leg (suggesting nerve involvement), pain that wakes you repeatedly at night, unexplained weight loss alongside back pain, or significant weakness or numbness in your legs. These symptoms need investigation to rule out disc problems, osteoporotic fractures, or other causes not related to hormone changes.
Movement and Exercise Strategies
Staying active is the single most evidence-backed approach to back pain. Gentle walking for 20 to 30 minutes most days keeps spinal discs nourished and reduces muscle stiffness. Strength training two or three times a week builds the muscles that support the spine, particularly the glutes, deep abdominals, and back extensors. Pilates and yoga both offer targeted core strengthening with low injury risk. Avoid long periods of sitting without a break. Setting a timer to stand and move every 45 minutes makes a noticeable difference over time. You can log your workouts in PeriPlan to see whether exercise frequency correlates with lower pain days.
Heat, Cold, and Supplements
Heat is generally more helpful than cold for muscular back pain. A heat pack applied to the lower back for 15 to 20 minutes relieves muscle guarding and improves blood flow. Magnesium glycinate (300 to 400 mg daily) is worth considering as magnesium supports muscle relaxation and is often deficient during perimenopause. Omega-3 fatty acids (2 to 3 g daily from fish oil) have mild anti-inflammatory effects that may reduce achiness over time. Topical anti-inflammatory gels can also provide short-term relief without systemic side effects.
Medical Options Worth Discussing
If back pain is persistent and significantly affecting your quality of life, talk to your doctor about hormone replacement therapy. HRT that restores estrogen levels often improves musculoskeletal pain as a secondary benefit, since it supports disc and ligament health. Physiotherapy with a practitioner experienced in women's health can provide targeted exercises and manual therapy. Non-steroidal anti-inflammatory drugs (NSAIDs) are a short-term option for acute flares but are not suitable for long-term daily use. Getting a bone density scan is also sensible if back pain is severe, as vertebral fractures from osteoporosis can mimic mechanical pain.
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