March 12, 2026

Back pain is common and can affect anyone. For women, back pain may be related to different factors, from anatomy and hormones to lifestyle. Johns Hopkins urogynecologist Shannon Lamb, M.D., and pelvic floor physical therapists Mary Austin and Madeline Urban help bring to light some common causes of back pain in women and share some tips on how to prevent and address them.

While back pain can affect anyone, women may get it due to factors that are unique to the female sex, such as anatomy, menstrual cycle and pregnancy, as well as factors that have to do with lifestyle and societal norms. This article focuses on back pain causes that are unique to or more prevalent in women than men and is not meant to cover every possible cause of back pain.

“Often, back pain in women is multifactorial, meaning more than one condition can be contributing to it. So treating just one condition may not completely resolve it; it is important to take a holistic approach,” says Lamb.

Orthopaedic Issues

The most common causes of back pain often have to do with the spine. The bones and tissues making up the spine can get injured, misshapen or deteriorate with age. Some spine conditions affect women more than men. The reasons for this are largely unknown, but many experts consider anatomical differences and childbirth to be contributing factors for some of these conditions.

• Osteoarthritis: According to 2022 Centers for Disease Control (CDC) data, arthritis was diagnosed in 21.5% of women, compared to 16.1% of men. Osteoarthritis can affect various joints in the body and is often found in the spine, causing back pain. Osteoarthritis may also lead to spinal stenosis (narrowing of the spinal canal), which puts pressure on the nerves.
• Spondylolisthesis refers to vertebrae that slide out of alignment. According to the American Academy of Orthopaedic Surgeons (AAOS), women are eight times more likely than men to develop this condition due to age-related wear and tear in the spine.
• Scoliosis: According to AAOS, idiopathic (without a cause) scoliosis that is severe enough to require treatment occurs 10 times more often in girls than in boys. While scoliosis does not always cause back pain, it can contribute to bad posture. Scoliosis may worsen over time, approximately one degree of rotation per year, so it is important to see an expert for evaluation.
• Sacroiliac joint dysfunction and misalignment, which can cause back pain, are more common in women. These conditions are commonly caused by hypermobility of the joint during pregnancy, or by not enough movement and exercise, which can lead to joint stiffness.
• Coccydynia (tailbone pain) is five times more likely to develop in women than in men.

Pelvic Anatomy

Compared to men, women typically have a wider pelvis and a smaller sacroiliac joint (where the spine and the pelvis connect). While these factors alone do not cause back pain, they affect how the weight is distributed from the upper body to the pelvis through the spine. In women, the muscles around the lower back may need to work harder to keep the spine stable, which over time can lead to lower back strain and pain.

The width of the pelvis may also have to do with piriformis syndrome, a condition where the piriformis muscle in the buttock compresses the sciatic nerve. Women tend to develop this condition more often than men, but the exact causes are unknown.

Pelvic floor muscles play an important role in supporting the lower back. Some of these muscles attach near the tailbone, so they can directly influence how the lower back moves. Weak pelvic floor muscles can affect core strength and can cause other muscles to compensate, causing imbalances and pain.

What you can do about it: While these anatomical features may seem like disadvantages, they don’t have to be. Physical therapy can help address imbalances, improve skeletal alignment, and strengthen muscles in all the right places.

Pelvic floor therapy can be especially helpful to women who experience pelvic floor dysfunction in addition to back pain — a phenomenon common in pregnancy and postpartum.

“Physical therapy alongside regular exercise with the focus on weight bearing and strength can be beneficial for most people experiencing back pain,” advises Austin. “Anyone can make an appointment with an orthopaedic physical therapist, even pregnant women. But if you have symptoms that point to a pelvic floor issue, then a pelvic floor therapist can help.”

Hormones

Women’s bodies go through monthly hormonal changes related to menstruation. There are also major events such as pregnancy and menopause that bring on hormonal shifts. Fluctuation of hormone levels in the body can not only affect the structure of the spine by influencing ligament laxity and bone density, but can also change how women experience pain.

Different hormones have different effects on the body. Here are some of the key hormones that have been linked to back pain:

• Estrogen: Estrogen plays an important role in maintaining bone density and overall bone health. When estrogen levels drop — such as during menopause — women can experience bone loss, leading to osteoporosis. Weaker bones in the spine can increase the chance of compression fractures, which are a known source of chronic back pain. Moreover, in some women, estrogen has a pain reliever effect, so when its levels change, pain sensitivity can increase, potentially increasing back discomfort.
• Progesterone: Progesterone can cause fluid retention and swelling around soft tissues, including those supporting the spine. This swelling can irritate surrounding nerves and muscles, contributing to back discomfort or stiffness. During phases of the menstrual cycle, these changes may also worsen existing back pain or contribute to new discomfort.
• Relaxin: Relaxin is known for its role during pregnancy, as it helps loosen the ligaments to prepare the body for childbirth. This means that the structures supporting the spine and pelvis become temporarily looser and weaker. This reduced stability can shift the body’s mechanics, leading to additional strain and lower back pain. Read more about pregnancy and back pain.
• Prostaglandins: Although not technically hormones, these hormone-like compounds have a strong connection to pain and inflammation. Prostaglandins are produced during a woman’s period to help the uterus contract and shed its lining. However, in some cases the body makes too much of them, which causes moderate to severe cramps and other symptoms (dysmenorrhea) associated with the premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PDD). The pain from the cramps can radiate to the lower back.

What you can do about it: Talk to your doctor if you are experiencing back pain or other symptoms to see if they could be related to a hormonal imbalance. Your doctor may recommend lifestyle changes related to diet, sleep, exercise and daily habits to help regulate hormones naturally. In some cases, the doctor may prescribe supplements, birth control or hormone therapy to tackle the imbalance.

Women experiencing menopause can sometimes benefit from hormone replacement therapy to help reduce symptoms and preserve bone density.

Breast Size

Large breasts have been linked to chronic upper back, shoulder and neck pain because they pull on the spine and can shift the center of gravity. When women develop excessive breast tissue, it is called macromastia.

What you can do about it: Finding a comfortable, supportive bra can help, although some bras can cause further issues as the straps dig into the shoulders, creating visible grooves. Talk to your doctor if you feel like your breast size has been contributing to back pain.  Some women consider breast reduction surgery to address these symptoms.

Gynecologic Conditions

Many women develop gynecologic conditions that can have back pain as a symptom. Back pain is often caused by abnormal tissue growth or enlarged tissues that compress nerves and trigger inflammation in the back. Most of these conditions also cause pelvic pain, which can radiate to the lower back.

• Endometriosis is a chronic condition in which the tissue that lines the uterus grows outside the uterus.
• Adenomyosis is a condition where tissue that normally lines the uterus grows into the muscular wall of the uterus, enlarging the uterus.
• Ovarian cysts are very common and usually harmless fluid-filled sacs that can develop in the ovaries.
• Uterine fibroids are non-cancerous growths in the uterus. In severe cases, they can cause the uterus to enlarge, causing misalignment in the pelvis and the spine.
• Pelvic congestion syndrome is a condition where the veins in the pelvic area, often around the ovaries, are swollen and enlarged.

What you can do about it: If you experience back pain along with other pelvic symptoms, talk to your gynecologist to diagnose the issue and discuss your treatment options. The options vary from medications and lifestyle changes to procedures such as ablation and surgery. Endometriosis and adenomyosis are chronic conditions that require lifetime monitoring and management. Fibroids and cysts can often be removed but can come back, so regular checkups with your gynecologist are important.

Getting evaluated by a pelvic floor therapist can also be a good idea. “Because these conditions often co-exist with increased tension in the pelvic floor muscles, treatments such as pelvic floor therapy can be really helpful,” says Urban.

However, be aware that although back pain may improve after treating a gynecologic condition, it may not go away completely until other causes are addressed. “While things like endometriosis and fibroids can cause back pain, it is pretty uncommon that it is the sole source,” adds Lamb. “Almost none of my patients with pre-existing back pain get complete back pain relief after surgeries such as hysterectomy or prolapse surgery; they usually also have an underlying musculoskeletal condition that causes it and requires treatment.”

Lifestyle Factors

Certain lifestyle factors have been linked to back pain in both men and women. They include:

• Poor posture
• Prolonged sitting and overall sedentary lifestyle that lacks physical activity during leisure time
• A job that has to do with repetitive motions involving the back
• Improper mechanics when performing daily tasks or activities
• Participating in high-intensity sports
• Sleeping on your stomach
• High levels of stress
• Having anxiety or depression
• Being overweight or obese
• Smoking

However, women can be at greater risk for some of these factors than men. Research shows that women globally spend two hours more than men per day on domestic work and unpaid care, including childcare. Domestic work can be strenuous and can require a lot of repetitive tasks that involve bending and twisting. Childcare can also be physically demanding, especially with younger children who often need to be carried in a car seat, as well as lifted in and out of chairs and cribs. One study found that 66% of the surveyed parents, a majority of whom were women, experienced pain related to childcare in the lower and upper back, neck and shoulders.

Another lifestyle factor is wearing high-heeled shoes. According to one study, wearing high-heeled shoes for more than 3.5 hours can cause pain in the feet and lower back.

What you can do about it: Lifestyle change is an area where you can make a difference both for back pain and your overall health. Some things to consider:

• Pay attention to and practice good posture and form during work and leisure. Posture is especially important for pregnant women whose center of gravity is shifting. Wearing supportive braces can help maintain good posture during pregnancy as well as day to day.
• Talk to a physical therapist if you feel like your daily routine is causing back pain — they can help you identify problem areas, learn proper techniques and strengthen the right muscles.
• If you sit a lot, set reminders to take standing breaks. See other tips to avoid neck and back pain if you work from home — most of these also apply to an office job.
• Look into your sleep habits and your bedroom setup. Waking up in pain? Maybe it’s time for a new mattress or a better pillow. Getting good sleep is important in other ways, too. “Chronic sleep deprivation and undiagnosed sleep apnea can exacerbate pain (or even cause it),” warns Lamb.
• Maintain a healthy weight and a healthy diet.
• Participate in some form of physical activity daily.
• Find ways to manage stress.
• Quit smoking.
• Take breaks when performing repetitive or strenuous activities.

Read about more ways to treat back pain without surgery.

Medically reviewed by Shannon Lamb, M.D., Mary Austin, P.T., D.P.T., and Madeline Urban, P.T., D.P.T.