Back pain in menopause and perimenopause: the back itself, thin bones, fractures and what helps

Common at every stage, and usually the back itselfStrong evidence

The NHS says back pain "usually improves within a few weeks but can sometimes last longer or keep coming back", and "Very rarely, back pain can be a sign of a serious problem such as a broken bone, cancer or an infection". In 11,332 Norwegian women aged 40 to 69, 30% had low back pain that had lasted at least 3 months; 32.9% of 210 healthy Italian women past the menopause had low back pain, and 51% of 119 Australian women past the menopause had had upper back pain in the past month.

The NHS menopause page lists muscle aches and joint pains, and weakening bones, among menopause symptoms, but not back pain as such.

Sources 1, 2, 3, 4, 5

Does the menopause cause back pain? The studies disagreeMixed evidence

Pooled surveys of 93,021 women found back pain in 42% before the menopause, 57% in perimenopause and 59% after it (1.15 to 1.2 times as often), but the symptom checklists weren't designed for back pain and the figures weren't adjusted for age. In 292 Seattle women followed with diaries, back pain rose through the transition and early years after the menopause, unrelated to measured hormones and alongside stress, hot flushes, low mood, night waking and higher weight. The Study of Women's Health Across the Nation (SWAN) found aches in general higher after the menopause, but only a marginal link with seeing a clinician for back pain.

The most careful study, of 11,332 Norwegian women aged 40 to 69, found no link between long-lasting low back pain and being past the menopause, or the age at which it happened, once age was taken into account, followed over 11 years. So the surveys can't separate the menopause from age, weight, sleep and mood. Women report more back pain than men at every age, from childhood on, and the idea that the menopause explains the later gap is a hypothesis: a 2026 review says the findings are "correlational rather than causal".

Sources 6, 7, 8, 2, 9, 10, 11, 12

Disc and joint changes on scans are common, and don't explain the painStrong evidence

In 846 Chinese women, MRI (magnetic resonance imaging) scans showed more disc wear after the menopause, mostly in its first 15 years, and disc narrowing was more common in older Chinese women than men. Slipped vertebrae from wear were found in 8.4% of women and 2.7% of men in Copenhagen, unrelated to the age at menopause. But these changes are common in people without pain: worn discs in 37% of pain-free people at 20 and 96% at 80, and facet joint arthritis in 89% of people in their 60s, unrelated to back pain. That is why the National Institute for Health and Care Excellence (NICE) says don't routinely scan low back pain.

Sources 13, 14, 15, 16, 17, 18

The menopause matters most through boneStrong evidence

The NHS says "Women also lose bone rapidly in the first few years after the menopause", more so after an early menopause (before 45), removal of the ovaries, long-term high-dose steroid tablets or anti-oestrogen tablets after breast cancer, and that "Osteoporosis is not usually painful until a bone is broken, but broken bones in the spine are a common cause of long-term pain". In the UK about 1 in 2 women will have a fragility fracture in their lifetime, and there are about 86,000 spinal fractures a year, the UK osteoporosis guideline (NOGG) says. NICE says women under 60 are less likely to have a spinal fracture; the risk rises through the 60s and beyond.

Sources 19, 20, 21

Spinal fractures from thin bones: the pattern to knowStrong evidence

The Royal Osteoporosis Society lists "unexplained back pain and muscle spasms; height loss; a curved spine or change in posture" as signs, and says "Sometimes, spinal fractures don't cause the pain you'd expect from a broken bone". The NHS says "Sometimes a cough or sneeze can cause a broken rib or the partial collapse of one of the bones of the spine", and in one US population, 83% of diagnosed spinal fractures followed moderate or no injury. NOGG asks GPs to think of a spinal fracture in women past the menopause with sudden back pain, especially in the middle of the back, and risk factors for osteoporosis. The Royal Osteoporosis Society says: "spinal fractures caused by osteoporosis do not cause paralysis. They're what we call 'stable'".

NOGG says "The majority of vertebral fractures do not currently come to medical attention". The figures come from older women, mostly in their 70s: in a large trial, about 1 in 4 new spinal fractures seen on X-rays had been diagnosed, X-ray reports missed 34% in another study, and spinal fractures showed on X-rays in 18% to 26% of European women aged 50 and over. In 7,223 women aged 65 and over, a new spinal fracture raised the odds of more back pain about 2.4 times, even if it never came to medical attention.

Sources 22, 19, 23, 20, 21, 24, 25, 26, 27

Other causes to knowEmerging evidence

Fragility fractures of the base of the spine (the sacrum) or pelvis mostly affect women in their late 70s and 80s with osteoporosis, causing low back or buttock pain after little or no injury; plain X-rays missed 11 of 16 in one series, and MRI is the most sensitive test. Sacroiliac joint pain is common but hasn't been linked to the menopause.

A kidney infection causes pain in the side or back just under the ribs with a high temperature, and the NHS says urine infections can become more common around the menopause. The British Heart Foundation lists pain spreading to the upper back among heart attack signs. Rarely, back pain comes from a cancer, more likely with a past cancer, and NICE asks GPs to offer blood tests for myeloma in people 60 and over with persistent bone pain. Bleeding after the menopause isn't a back problem, but needs a GP whatever your back is doing.

Sources 28, 29, 30, 31, 32, 5, 33, 34, 35

When a scan or test helpsStrong evidence

For ordinary back pain, NICE says don't routinely scan. With sudden back pain and risk factors for osteoporosis, 4 cm or more of height loss, a curved upper back or long-term steroids, NOGG asks for the spine to be checked with side-view X-rays or a DXA (dual-energy X-ray absorptiometry) spine image, and NICE suggests considering a spine check at a DXA bone density scan for women from 60, and under 60 with unexplained back or rib pain or a changed shape. A suspected fracture of the sacrum needs an MRI. The Royal Osteoporosis Society says "You do not usually need to have a spine X-ray before you start exercise".

Sources 18, 20, 21, 36, 30

How it usually goesMixed evidence

After a new episode of back pain, pain fell on average from 52 to 23 out of 100 by 6 weeks and to 6 by a year, more slowly once it had lasted (from 51 to 23 over a year), and NHS inform says most problems should have improved within 6 weeks.

After a spinal fracture, the Royal Osteoporosis Society says the bone takes 6 to 12 weeks to heal and keeps its new shape, and the pain usually gets better as it heals, though some people have pain for longer. The figures come from people in their 70s: 40% of one group still had pain of 4 out of 10 or more at a year, and another improved only 10% to 15% by 3 months. In women in their 70s, 19.2% with a new spinal fracture had another within a year, which is why a bone check matters. No one can promise a timescale.

Sources 37, 38, 39, 40, 41, 42, 43

Staying active and exercise help back painStrong evidence

Across 249 trials, exercise therapy eased long-lasting low back pain by about 15 points out of 100 against no treatment or usual care, with mostly minor side effects such as muscle soreness. NICE suggests a group exercise programme, says don't offer belts or corsets, suggests anti-inflammatory tablets taking into account your age and other risks, and advises against paracetamol on its own and against opioids for long-lasting low back pain. The NHS says "stay active and try to continue with your daily activities" and "do not stay in bed for long periods of time", and NHS inform says "any activity is better than none".

Sources 1, 44, 18, 38

Trials in women after the menopause are smallEmerging evidence

Pilates trials of 22 to 128 women past the menopause with low back pain reported benefits, one of them with implausibly large effects, and 2 years of extra activity in 210 healthy women didn't change back pain more than in the comparison group. Nothing suggests women around the menopause need a different exercise approach from other adults.

Sources 45, 46, 47, 3

With thin bones, exercise is safe and recommended: how, not whetherStrong evidence

The UK consensus on exercise for osteoporosis, which NOGG supports, recommends strength training on 2 or 3 days a week at "the maximum that can be lifted 8-12 times (building up to three sets for each exercise)", about 50 moderate impacts on most days if you have no spinal fractures and impact up to brisk walking if you do, back-muscle exercises "repeated 3-5 times and held for 3-5 s at least twice a week", and balance work at least twice a week. It asks for "'how to' rather than 'don't do'", and across 62 trials, 5.8% of people who exercised broke a bone against 9.6% who didn't.

What to change is sustained, repeated, end-of-range or loaded rounding of the spine, such as sit-ups and toe touches. The Royal Osteoporosis Society says "It is how you lift rather than how much you lift that matters", "There is not a specific weight that is safe or unsafe", and "Moving around and bending forward is generally safe and won't cause a spinal fracture".

Sources 48, 20, 36, 49

Heavier training and back-muscle work for boneEmerging evidence

In the Australian LIFTMOR trial, 101 women with low bone mass (average age 65) did 8 months of twice-weekly supervised heavy lifting and impact: spine bone density rose 2.9% against a 1.2% loss, with one minor back spasm, and the upper back's curve improved. A similar trial of 115 women found the same direction, and a small trial of 40 women aged 45 to 60, around the menopause, found heavy strength and impact training was feasible. None of these trials measured back pain, and the heavy lifting was supervised throughout.

Back-muscle training raised back strength (26% against 11% in 80 women with osteoporosis), and in a small 10-year follow-up of 50 women, those who had strengthened their backs had fewer spinal fractures. Posture training reduced the upper back's curve by about 3 degrees in 6 months in older adults.

Sources 50, 51, 52, 53, 54, 55, 56, 57

After a spinal fracture: gentle back exercises from the startMixed evidence

A Cochrane review of 9 trials (749 people) found exercise after a spinal fracture improved walking speed a little, but its effect on pain is uncertain; an international panel strongly recommends combined strength and balance training. The Royal Osteoporosis Society's exercises for back pain after spinal fractures are done "at least once a day", held "three to five seconds" and repeated "up to 10 times", starting "as soon as you feel ready. You don't need to wait until your bones are fully healed". It advises waiting until the bone has healed, which can take up to 3 months, before building up strength work, and NOGG recommends back-muscle strengthening after a spinal fracture, starting lying down while it hurts.

Sources 58, 59, 40, 36, 20

Fracture treatments: what helps, and what doesn'tStrong evidence

For a spinal fracture, NOGG advises pain relief by mouth, the weakest that works for the shortest time, and says routine bracing "cannot be recommended"; in a trial of 284 women aged 65 to 85, a rigid brace was no better than a soft one. Cement injections into the bone (vertebroplasty) were 0.7 points better than a sham procedure on a 0 to 10 scale at a month, not a clinically important difference, and NICE keeps them for severe ongoing pain from a recent fracture. NOGG recommends bone medicines and follow-up through a fracture liaison service after a new spinal fracture.

Sources 20, 60, 61, 62, 39

HRT protects bone while it's taken, but isn't a back pain treatmentMixed evidence

NICE says fragility fracture risk is lower while taking HRT, and the benefit fades once it stops. In the Women's Health Initiative, oestrogen alone cut diagnosed spinal fractures by about a third, and oestrogen plus progestin cut fractures overall by about a quarter, in women aged 50 to 79. NOGG lists HRT as a first-line option for women aged 60 or under at high fracture risk and low risk of its harms.

Back pain is different. In 6,007 Norwegian women followed for 11 years, those taking HRT were about 1.3 times as likely to develop long-lasting low back pain (from about 20% to 26%); in US women aged 65 and over, 52.7% of current users had back pain against 43.4% of never users. These studies of women taking HRT in the 1990s can't show that HRT caused it, as women with more symptoms are more likely to take it. The only trial was in 48 women before the menopause. A 2026 review calls the evidence for HRT for back pain "inconclusive". HRT is a decision about your menopause symptoms and bones, made with a GP, who the NHS says "will help you decide".

Sources 63, 64, 65, 20, 66, 67, 68, 69, 12, 70

Flares, getting up and sleep (written steps)

Our 3D figure can't show these. They come from the NHS, NHS inform and the Royal Osteoporosis Society.

• 1. In a flare, keep moving, take an anti-inflammatory such as ibuprofen if it suits you, use ice for pain and swelling and heat for stiffness or spasm, and don't stay in bed for long (the NHS). NHS inform suggests ice for up to 15 minutes, with a few hours between, and no ice or heat if you have problems with circulation or feeling.
• 2. Getting out of bed: roll onto the side you find most comfortable, push yourself up with your arms, and carefully bring your legs towards the floor as you sit up and stand (NHS inform).
• 3. Sleep: experts no longer recommend a very firm "orthopaedic" mattress for back pain, and pillows can support your leg when you lie on your side. On bad mornings, take your painkiller half an hour before getting up, except ibuprofen and similar anti-inflammatories, which shouldn't be taken on an empty stomach (the Royal Osteoporosis Society).
• 4. Sitting: change position regularly, and take regular breaks from a desk to reduce stiffness (NHS inform and the Royal Osteoporosis Society).

Sources 1, 38, 73

Lifting and bending with thin bones (written steps)

These come from the Health and Safety Executive (HSE), the Royal Osteoporosis Society and the UK consensus.

• 1. Plan the lift, keep the load close to your waist, stand with your feet apart and one leg a little forward, bend slightly at your back, hips and knees rather than stooping or squatting fully, turn with your feet rather than twisting, and "Put down, then adjust" (the HSE).
• 2. The HSE's guideline weights for women are about 13 to 16 kg held close to the body between mid-shin and shoulder height, 7 kg from the floor or above the shoulder, and less at arm's length, and they are not "safe limits".
• 3. "Think straight": keep your upper back straight and your neck in line with your spine, tighten your tummy muscles, and move slowly and smoothly; twisting should be safe if it's smooth and comfortable (the Royal Osteoporosis Society).
• 4. Bending forward is "generally safe and won't cause a spinal fracture", but avoid sustained, repeated or loaded rounding of your back, such as toe touches and sit-ups (the Royal Osteoporosis Society and the UK consensus).
• 5. Put a weight down if you feel the strain in your back; it's how you lift rather than how much you lift that matters (the Royal Osteoporosis Society).

Sources 74, 75, 49, 76, 36, 48

Gardening, shopping, housework and the car (written steps)

These come from the Royal Osteoporosis Society, written for people after a broken bone, the NHS and Acas.

• 1. Gardening: "Do a little gardening often, rather than too much at once", take breaks every 10 to 15 minutes, use a padded kneeling stool and raised beds, and a hose rather than a heavy watering can.
• 2. Shopping: use a supermarket trolley rather than a basket, a shopping trolley on wheels rather than bags, and ask for help with packing and carrying.
• 3. Housework: a lightweight vacuum cleaner in short sessions, a long-handled dustpan and brush, a lighter bucket and a perching stool at the sink.
• 4. The car: plan breaks to stretch and move, set your seat up well with a back support if it helps, and don't twist to reach into the back seat.
• 5. If you fall: take your time, roll onto your side, get onto your hands and knees, and use something stable to stand up slowly (the NHS).
• 6. At work: you don't need to be free of pain to return (NHS inform), and Acas asks employers to consider changes for menopause symptoms.

Sources 77, 73, 78, 79

Your bones, HRT and bleeding after the menopause (written steps)

These come from the NHS and NICE.

• 1. For your bones: strength exercise and weight-bearing exercise such as walking or dancing, calcium-rich food, a daily 10 microgram vitamin D supplement, no smoking and less alcohol (the NHS).
• 2. Ask your GP about bone health if you had an early menopause, take steroid or breast cancer tablets, or have broken a bone easily.
• 3. Talk to your GP about your menopause symptoms and the options, including HRT. The NHS says HRT tablets slightly raise the risk of blood clots and stroke, while patches, gels and sprays don't raise the clot risk, and NICE says the same about clots.
• 4. See a GP about any vaginal bleeding after your periods have stopped for more than 12 months, even if it happened once or was only spotting (the NHS).

Sources 80, 19, 70, 63, 5