Lower back pain in females can stem from a woman’s reproductive anatomy or her spinal anatomy.

• Menopause and Hormonal issues
• Menstruation and Uterine dysfunction
• Endometriosis
• Postmenopausal Compression Fractures
• Spondylolisthesis
• Piriformis Syndrome
• SI Joint Dysfunction

Research suggests 60 to 80% of people experience low back pain during their lifetime with its prevalence being slightly more common in females than males across all age groups. Back pain in women increases significantly with age. Additionally, a middle-aged subject research comparison reported an increased incidence of low back pain in females versus males post menopause age.

Here are some possible lower back pain causes in females that men may worry less (or not at all) about.

Menopause and Hormonal Issues

Research suggests that chronic low back pain (LBP) is one of the most common musculoskeletal challenges women face during menopause.  Around 70% of perimenopausal women will experience symptoms tied to estrogen deficiency, with musculoskeletal pain reported in over half of women in perimenopause. Most studies demonstrate that increasing menopausal symptoms correlates to chronic back pain symptoms.

Menstruation or Uterine Dysfunction

Dysmenorrhea, a uterine dysfunction which is the origin of frequent and severe cramping for women during menstruation, also predisposes women to back pain. The condition is classified as either primary or secondary, and with both types, low back pain is a common symptom.

• Primary dysmenorrhea begins when a woman starts her period and perpetuates throughout her life. Its harsh and atypical uterine contractions can result in recurrent and severe menstrual cramping.
• Secondary dysmenorrhea usually begins later in life, and it’s caused by another condition such as endometriosis or pelvic inflammatory disease.

Endometriosis

Endometriosis is a chronic condition that can also be a cause of back pain in females.  The condition occurs when tissue that behaves like endometrial tissue grows outside of the uterus, in the pelvic cavity or other areas.  The displaced tissue responds to the body’s hormonal changes and can cause swelling, pain, spotting between periods, and bleeding.

Because the endometriosis growths bleed monthly like the uterine lining, without having a place for the blood to go, the excess fluid irritates and inflames surrounding tissue.  Consequently, the condition can result in heavy periods, chronic pain, and scar tissue build up.

Endometriosis symptoms may present at any menstrual cycle stage. Pelvic pain that radiates down the legs is common, and some females encounter gnawing and throbbing pain that can present from mild to very severe.

Symptoms include:

• Abdominal or lower back pain
• Pain upon walking or standing
• Pain upon ovulation
• Pain during voiding and urinary urgency
• Pelvic cavity inflammation
• Constipation
• Pain upon sexual intercourse
• Pain upon bowel movements and radiating rectal pain
• Pain caused by adhesions (scar tissue builds up) within the bladder, fallopian tubes, bowls, and ovaries
• State of being chronically tired

Endometriosis may initially be diagnosed by a doctor finding endometrial growths upon a pelvic exam and requesting imaging tests to assist in identification of endometrial cysts.

Postmenopausal Compression Fractures

Research studies suggest that in the United States, about 25% of women will experience vertebral compression fractures (VCFs) of the middle to lower spine  throughout their lifetime. The condition occurs more frequently with age, reaching 40% at age 80.

These small cracks in vertebrae can cause substantial disability and limit in function.

Osteoporosis is the most common cause of VCFs. Postmenopausal women have an increased risk of osteoporosis due to hormonal changes that decrease bone mineral density, predisposing bones to fracture.

Spondylolisthesis

This occurs when one vertebral body, the thick oval bone segment in front of the vertebra, slips against an adjacent vertebral body resulting in pain or mechanical symptoms. The pain can radiate through the spine to the hip, back, and into the legs. The condition can be present from birth, attributed to an unknown cause, or acquired. Some research suggests that childbirth and hysterectomies can put women at risk for spondylolisthesis.

Spondylolisthesis is most common in the lower lumbar spine, lower back, though it can also present in the cervical spine. It rarely occurs, except in trauma cases, in the thoracic spine. The thoracic spine is the longest section, and is located between the cervical and lumbar regions.

Intermittent and localized low back pain is typical for lumbar spondylolisthesis. The pain is exacerbated when the affected region is flexed or directly touched. 

Piriformis Syndrome

Sometimes back pain isn’t really back pain, it’s piriformis syndrome. Piriformis syndrome occurs when the piriformis muscle, a small muscle that extends from the lower spine to the top of the femur, involuntarily contracts and compresses or irritates the sciatic nerve. The piriformis muscle aids in helping to rotate and turn the leg and foot outward. It presents with symptoms consistent with sciatica although it’s not spinal in origin.

Piriformis syndrome typically presents with buttock/gluteal pain that shoots, aches, or burns along the leg’s back side, thigh, calf, and Also common is tingling in the sciatic nerve area and buttocks’ numbness. That’s why it’s so commonly mistaken for sciatica.

Causes can include:

• Buttock or hip injury
• Increased piriformis muscle development (commonly seen in athletes during pre-season training)
• Sitting for an extended time (big rig truck drivers, sedentary desk jobs workers, etc.)
• Abnormal anatomy in the piriformis muscle or sciatic nerve branching relative to the piriformis muscle

Research notes that 0.3% to 6% of all low back pain and/or sciatica cases may be due to piriformis syndrome. Given annual estimated new cases of sciatica and low back pain are 40 million annually, the occurrence of piriformis syndrome would be around 2.4 million yearly. In most cases the condition is present in middle-aged patient in a 1:6 ratio of male to female affected patients.

SI Joint Dysfunction

Here’s another case where back pain starts somewhere other than the back. Sacroiliac joint dysfunction is characterized by inflammation occurring in the sacroiliac joints, located at the connection of the pelvis and lower spine. The condition can present as lower back or buttock pain that can radiate down the legs. The pain may be exacerbated by extended time in stair climbing or standing.

Like piriformis syndrome, sacroiliac joint dysfunction can be challenging to diagnose, as it can be mistaken for other low back pain causes.

SI joint dysfunction causes:

• Pregnancy. During pregnancy, the increased weight and altered movement can cause additional stress and wear on joints.
• Joint Infection. In rare situations, the SI joints can be subject to infection.
• Arthritis. Sacroiliac joints can experience arthritis from normal wear and tear, also known as osteoarthritis.
• Traumatic Injury. The sacroiliac joints can be injured in from sudden impacts like a fall or car accident.

Source: Spine universe