Hormones and Back Pain: Why Women's Musculoskeletal Health Is Different

Back pain affects men and women at broadly similar rates. But the mechanisms, patterns and experiences of back pain in women differ from those in men in ways that are clinically significant and frequently under-discussed in both clinical practice and public health information. Hormonal influence on musculoskeletal health is one of the most important and least acknowledged of these differences.

Oestrogen, progesterone and relaxin all have direct effects on connective tissue, including the ligaments, discs and joint capsules of the spine. Understanding these hormonal influences allows for more nuanced and effective management of back pain in women across the lifespan and explains phenomena that might otherwise appear puzzling: why back pain often fluctuates with the menstrual cycle, why pregnancy produces such significant spinal changes, and why perimenopause and menopause are associated with new or worsening musculoskeletal symptoms.

Oestrogen and Connective Tissue

Oestrogen has well-documented effects on connective tissue beyond the commonly known relationship with bone density. Oestrogen receptors are present in the ligaments, tendons and discs of the spine, and oestrogen influences the synthesis and maintenance of collagen in these structures.

During phases of the menstrual cycle when oestrogen levels are lower, particularly in the premenstrual and menstrual phases, connective tissue laxity increases and pain sensitivity rises. Many women who experience cyclical back pain report it is most significant in the days before menstruation, consistent with the reduced oestrogen levels and increased prostaglandin activity of this cycle phase.

At menopause, the sustained reduction in oestrogen is associated with measurable reduction in connective tissue integrity. Intervertebral disc degeneration accelerates in the postmenopausal period, and facet joint degeneration becomes significantly more prevalent.

Relaxin and Spinal Laxity

Relaxin, produced primarily during pregnancy, produces general ligamentous laxity throughout the body. The effect is not limited to the pelvis: the ligaments of the lumbar spine and sacroiliac joints also become more lax, increasing range of motion but reducing passive stability.

The result is that the active muscular stabilisation system must work harder during pregnancy to compensate for reduced passive ligamentous support while simultaneously accommodating a significant anterior shift in centre of gravity. This produces the very high rates of low back and pelvic girdle pain during pregnancy, affecting an estimated 50 to 70 percent of pregnant women.

Chiropractic Care for Hormonal Back Pain

At Clifton Chiro in Bristol, the hormonal dimension of women's back pain is considered in assessment and management. For women experiencing cyclical back pain, treatment accounts for variation in tissue laxity and pain sensitivity across the cycle. For pregnant patients, adapted techniques maintain safety while addressing genuine musculoskeletal demands. And for women in perimenopause, the changing connective tissue environment informs technique selection and exercise-based support.

References

1. Kiapour A et al. The role of ligamentous laxity in spinal stability. Spine. 2012.

2. Ostgaard HC, Andersson GB, Karlsson K. Prevalence of back pain in pregnancy. Spine. 1991.

3. Burger H et al. Effect of combined implants of oestradiol and testosterone on libido in postmenopausal women. BMJ. 1987.

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Tim Scott is the Principal Chiropractor at Clifton Chiro, with over 26 years of experience in healthcare.