Back pain during menopause: oestrogen and your bones

Back pain during menopause links to falling oestrogen, which affects not only your bones but also your spinal discs and ligaments. In an MRI study of 1,566 women and 1,382 men, discs degenerated noticeably faster in women after menopause. The effect was largest in the first fifteen years afterwards.

That makes it one of the few menopause symptoms with hard imaging behind it. And it explains why back pain surfaces for so many women in exactly this period.

What it does not explain is every back pain. More on that shortly.

What does oestrogen do to your back?

Oestrogen receptors sit in your spinal discs, your facet joints and the cartilage around them. When oestrogen falls, the water content and elasticity of those tissues change. At the same time bone loss in your vertebrae accelerates, especially in the first years after your final period.

Lou and colleagues published that MRI finding in 2017 in the journal Menopause. Postmenopausal women had more severe degeneration than age-matched men and than premenopausal women.

The difference was clearest in the first fifteen years after menopause, and narrowed after that.

One caveat matters: degeneration on an MRI is not the same as pain. Many people have visible wear without symptoms, and the reverse happens too.

So this research is useful as an explanation, and unsuitable as a diagnosis.

Take two women aged 55 with back pain and the same MRI result: wear at two levels.

The first has had nagging pain for months that eases once she moves. The second had sudden severe pain last week after a simple movement, and has lost a centimetre in height.

Same image, different story.

For the first, ordinary wear fits. For the second, that height loss should be raised quickly. My point: the scan does not decide, your story does.

Is it your back or your bones?

Those are two different things that often get mixed up. Ordinary back pain usually comes from muscles, ligaments and discs. Osteoporosis itself does not hurt, until a vertebra collapses, and then the pain is sudden and severe.

The right-hand column is not a diagnosis. These are the points your GP wants to hear.

If you recognise something there, do not wait it out.

What can be checked?

For persistent back pain your GP looks first at your history and physical examination, not at blood values. Blood testing here mainly serves to rule out other explanations, such as inflammation, vitamin D deficiency or a thyroid problem.

For your bones it is mostly your risk profile and sometimes a DEXA scan. The Dutch Gezondheidsraad and RIVM emphasise adequate vitamin D, calcium and physical activity in women over fifty.

Your vitamin D value is the one most often measured. A deficiency is not unusual in the Netherlands in winter, certainly in women who spend little time outdoors.

We will say plainly that blood testing rarely explains your back pain. It rules things out, which is a different job.

What there is to know about your bones is in osteoporosis after menopause.

What helps with back pain during menopause?

Movement remains the best supported approach, even though it feels counterintuitive when you are in pain. Strength training does double duty here: it loads your bones, which is favourable after menopause, and it strengthens the muscles around your spine.

Training twice a week does more than walking gently every day. That is one of the few pieces of menopause advice where the evidence is reasonably consistent.

Prolonged sitting is the other side of the same coin. If you do desk work, standing up every half hour beats an expensive chair.

Muscle preservation plays a part too, and it deserves its own read: preserving muscle after 50.

If joint pain runs alongside it, joint pain during menopause follows on.

When should you see your GP?

Go for back pain lasting more than six weeks, pain radiating into your leg, weakness or numbness, and pain that wakes you at night. Sudden severe back pain without a clear cause is also a reason to make contact.

Bring how long it has been going on, what makes it worse and what you have already tried.

What I notice most here: women do not mention their back pain when they come in about menopause symptoms. They treat it as a separate problem. Often there is more of a link than they expect.

The broader picture of what changes in this period is in our article on hot flashes. To include your vitamin D and thyroid at the same time, those sit in the menopause blood test.

References

• Lou C, Chen H, Mei L, et al. Association between menopause and lumbar disc degeneration: an MRI study of 1,566 women and 1,382 men. Menopause, 2017. PMID 28609385.
• Gezondheidsraad, advice on vitamin D and calcium.
• RIVM, information on physical activity and health.
• Thuisarts.nl, back pain.

Lunara Health provides blood testing and explanation, not diagnosis. Your results are reviewed by a BIG-registered doctor. Always involve your GP if you have symptoms, and do not use this article to treat yourself.