Back and Pelvic Pain in Women: Periods, Pregnancy, Menopause and When to Worry

Every month, a day or two before your period, your lower back starts to ache and the heaviness spreads into your hips and thighs. Or you are seven months pregnant and turning over in bed feels like your pelvis is being pulled apart. Or your baby is now six months old, you lift them dozens of times a day, and your back has not felt right since delivery. Or the periods have stopped, and in their place have come stiff knees, aching fingers and a back that complains after an hour in the kitchen.

Back and pelvic pain follows many women through every stage of life, and it often gets brushed aside as “normal for women”. Some of it is common and manageable. Some of it is a sign of a gynaecological condition that deserves proper attention. In this guide, our pain specialists explain how periods, pregnancy, the months after delivery and menopause affect your back and pelvis, when the pain may be coming from the womb or ovaries rather than the spine, what genuinely helps, and whether you should see a gynaecologist or a pain specialist first.

Why do women get back and pelvic pain so often?

The lower back, the pelvis and the organs inside it share nerve supply. Pain from the womb, ovaries or bladder can be felt in the lower back, the buttocks or the tops of the thighs, a pattern doctors call referred pain. So the place that hurts is not always the place that is the problem.

On top of that, hormones change ligaments, muscles and bones at different stages of life. Pregnancy loosens the joints of the pelvis. Breastfeeding and the years after menopause affect bone density. Low iron from heavy periods, low vitamin D and B12 levels and an underactive thyroid, all common in Indian women, add to tiredness and body aches linked to hypothyroidism. And many women carry a heavy daily load: housework, office hours, commuting on a two-wheeler, and caring for children and elders, often with little time to rest or exercise.

Back pain during periods: what is normal?

Before and during a period, the lining of the womb releases chemicals called prostaglandins. These make the womb muscle contract to shed the lining, and they also make nearby nerves more sensitive. The result is the familiar cramping in the lower tummy, often with a dull ache across the lower back and down the thighs. Doctors call this primary dysmenorrhoea, and it is very common in teenagers and young women.

Typical period-related back pain:

• Starts shortly before or at the start of bleeding and eases within two or three days.
• Is a dull, central or band-like ache rather than a sharp pain on one side.
• Responds to warmth, gentle movement and simple pain relief taken as advised by your doctor.
• Does not stop you from going to college or work most months.

Women with PCOD or PCOS may have irregular cycles with heavier, more uncomfortable periods when they do come. Weight gain and insulin resistance that often go with PCOS also load the lower back, which is one reason we look at how extra weight affects the back and knees as part of the overall picture.

When back pain may be gynaecological: endometriosis, adenomyosis and fibroids

Period pain that is getting worse year by year, or back pain that clearly follows your cycle but is severe, is not something to simply tolerate. Three conditions are worth knowing about.

Endometriosis

In endometriosis, tissue similar to the lining of the womb grows outside it, on the ovaries, the ligaments behind the womb, the bowel or the lining of the pelvis. This tissue reacts to monthly hormones, causing inflammation and scarring. It can cause deep low back pain, pain that starts days before the period, pain during or after sex, painful bowel movements or passing urine during periods, and difficulty conceiving. Diagnosis is often delayed for years because the pain is dismissed. A gynaecologist will examine you and may order an ultrasound or MRI; sometimes a keyhole procedure (laparoscopy) is needed to confirm it. Treatment may include hormonal medicines, pain management and, for some women, surgery.

Adenomyosis

Here the lining tissue grows into the muscle wall of the womb itself. It is more common in women in their late thirties and forties, especially after childbirth. The womb becomes bulky and tender, with heavy, painful periods and a dragging ache in the lower back and pelvis.

Fibroids

Fibroids are non-cancerous growths of the womb muscle and are very common. Many cause no trouble at all. Larger fibroids, or those on the back wall of the womb, can press on the spine area, nerves or bladder, causing a heavy, pressing backache, frequent urination, constipation, a swollen tummy and heavy bleeding. The heavy bleeding can in turn cause iron deficiency, which makes muscles tire and ache more easily.

Other gynaecological causes include pelvic infection (pelvic inflammatory disease), which usually brings fever, unusual discharge and lower tummy pain, and ovarian cysts. Not all one-sided low back pain is gynaecological either: a kidney stone can feel like back pain, and so can a problem in the facet joints or the sacroiliac (SI) joint.

Back and pelvic pain in pregnancy

During pregnancy, a hormone called relaxin loosens the ligaments of the pelvis so that the baby can pass through at birth. At the same time, your centre of gravity moves forward, the curve of your lower back deepens, and the tummy muscles stretch. Back pain is therefore very common, especially in the second half of pregnancy.

Pelvic girdle pain (symphysis pubis dysfunction)

Pelvic girdle pain is felt at the front over the pubic bone, at the back over one or both SI joints, in the buttocks, or in the inner thighs. It is typically worse when standing on one leg, climbing stairs, getting in and out of an auto or car, turning over in bed, or parting the legs. It can be very uncomfortable, but it does not harm the baby, and most women can still have a normal delivery.

What helps: an obstetric physiotherapist’s exercises for the deep tummy, pelvic floor and buttock muscles; keeping your knees together when getting out of bed or a vehicle; taking stairs one step at a time; sitting to dress; sleeping on your side with a pillow between the knees; and, for some women, a pelvic support belt. If pain shoots down the leg, read our guide to sciatica in pregnancy; pain deep in the buttock may also be from piriformis syndrome.

Always talk to your obstetrician before taking any medicine for pain in pregnancy, including over-the-counter tablets, gels or balms.

After delivery: lifting, feeding and the postpartum back

Pelvic girdle pain usually eases in the weeks after delivery as hormones settle, though for some women it lingers. Back pain in the months after birth is mostly mechanical. The tummy muscles have been stretched and sometimes separated (diastasis recti), the pelvic floor is weak, sleep is broken, and you are suddenly bending and lifting all day: picking the baby up from the floor bed, bathing them on your lap, carrying the bucket, lifting the pram into the car.

Many women worry that the epidural caused their backache. Research has not shown that an epidural causes long-term back pain; tenderness at the injection site usually fades within days. The more likely causes are the strain of late pregnancy and the physical demands of caring for a newborn. Some women also develop tailbone pain after a difficult delivery, which usually settles with time, a cushion with a cut-out and gentle care.

• Lift from a squat, not a stoop. Bend your knees, bring the baby close to your chest, then stand. The same rule applies to water buckets and a gas cylinder.
• Bring the baby to you while feeding. Use pillows to raise the baby to breast level instead of hunching forward, and support your back against the wall or a chair.
• Raise your work surfaces. Change nappies and bathe the baby at waist height where possible, not bent over the floor.
• Rebuild gradually. Gentle pelvic floor and deep core exercises can usually start soon after a normal delivery, and later after a caesarean, with your doctor’s guidance. Our programme of exercise for chronic low back pain shows how to progress safely.
• Eat for recovery. Breastfeeding draws on your calcium, iron and protein stores. Discuss supplements with your doctor and see how diet affects joint and muscle pain.

If a sudden twinge came on with one particular lift, it is often a back sprain or strain that settles in a few weeks with movement and care.

Menopause: bone loss, joint aches and a changing back

Oestrogen helps protect bones, joints and muscles. As it falls in the years around menopause, many women notice new aches in the hands, knees, shoulders and back, stiffness in the morning and poorer sleep with night sweats. Some of this is hormonal, but it is also the age when lumbar spondylosis and osteoarthritis become more common, so a proper examination matters. If several joints are swollen and stiff for more than half an hour each morning, it is worth checking whether it is osteoarthritis or rheumatoid arthritis.

Bone loss speeds up in the first years after menopause. Osteoporosis itself is painless, but it makes the vertebrae more likely to crack after a minor fall, a cough or even lifting a bag of rice. A sudden, sharp mid or lower back pain in a woman after menopause, sometimes with loss of height or a stooping posture, needs an X-ray and a bone density (DEXA) scan. Hip pain is common at this stage too, and our article on hip pain in women covers the usual causes.

Hormone therapy, calcium and vitamin D, and bone-strengthening medicines are decisions to make with your gynaecologist or physician. If you are already on hormone therapy or any bone medicine, please do not stop it on your own; discuss any concerns with the doctor who prescribed it. Any bleeding after menopause needs a gynaecologist’s review soon.

Gynaecologist or pain specialist: who should you see?

See a gynaecologist first if your pain clearly follows your cycle and is getting worse, if you have very heavy or irregular bleeding, pain during sex, bleeding between periods or after menopause, a lump or swelling in the tummy, or trouble conceiving. They can examine you, arrange a pelvic ultrasound and treat conditions like endometriosis, adenomyosis and fibroids. During pregnancy, your obstetrician should always be the first person to know about new pain.

See a pain specialist if the pain changes with movement, posture or lifting; if it travels down the leg; if it is in the SI joint, hip or tailbone; if it has lasted more than a few weeks after delivery; or if a gynaecologist has found nothing to explain it. Many women have both: a gynaecological condition plus a strained back or SI joint. In that case, the two doctors work best together. Long-standing pelvic pain can also make the nervous system more sensitive, so pain spreads and lingers, as explained in how stress and low mood make pain worse and fibromyalgia.

How Dr Heal can help

We do not replace your gynaecologist or obstetrician. Our role is to find and treat the musculoskeletal and metabolic side of the problem, and to guide you to the right specialist when the cause lies elsewhere.

1. A careful history and examination. We ask about your cycle, pregnancies, deliveries and menopause, and examine the spine, SI joints, hips and pelvic muscles to locate the real source of pain. Our pain specialists are available 24 hours.
2. Tests under one roof. Our in-house laboratory and radiology, described on our facilities page, can check haemoglobin and iron, vitamin D and B12, thyroid, blood sugar and inflammation markers, along with X-rays and scans when needed. We coordinate with your gynaecologist for pelvic imaging and hormonal care.
3. Steroid-free care for back, SI joint and hip pain. When an injection is right for a joint or soft-tissue problem, we use a regenerative preparation from Dr Heal Pharma that contains no steroids, painkillers or antibiotics, which matters for women already worried about bone thinning. See our back pain treatment, hip pain treatment and joint pain and arthritis treatment pages.
4. Functional medicine and clinical nutrition. Through functional medicine, we help with iron, bone health, weight, insulin resistance, sleep and stress, which all shape how much your back and joints hurt.
5. Guided rehabilitation. A step-by-step programme for the core, pelvic floor, hips and back, similar to the approach in our guide to physiotherapy for low back pain, with follow-up until you can lift, work and move with confidence.

What you can do at home

• Use warmth. A hot water bag on the lower back or tummy eases period cramps and muscle spasm. Avoid very hot bags directly on the skin, and be careful with heat on the tummy during pregnancy.
• Keep moving. Walking, gentle yoga stretches and swimming help with period pain and back pain alike. Bed rest usually makes back pain worse.
• Keep a pain diary. Note the day of your cycle, what you were doing and where it hurt. This one habit helps any doctor tell gynaecological pain from mechanical pain.
• Build bone strength. Weight-bearing exercise, sunlight, and enough calcium and protein matter more after 40. Our daily habits for a healthy spine are a good start.
• Follow a short self-care plan for a flare of ordinary back pain, such as our two-week home plan for lower back pain.
• Do not rely on painkillers every month. Needing strong tablets for several days each cycle is a reason to see a gynaecologist, not to increase the dose. Read why painkillers are not the answer for long-term pain.

Frequently asked questions

Why does my lower back hurt during my period?

Prostaglandins released by the womb lining make the womb cramp and sensitise nearby nerves, and the pain is often felt in the lower back and thighs. Mild to moderate pain that settles in two or three days is common. Severe or worsening pain should be checked by a gynaecologist.

Can endometriosis or fibroids cause back pain?

Yes. Endometriosis can cause deep low back pain that worsens around periods, often with pain during sex or bowel movements. Large fibroids can press on surrounding structures and cause a heavy backache with heavy periods. A gynaecologist can confirm either with examination and scans.

Is pelvic girdle pain in pregnancy harmful to the baby?

No. It is caused by loosened ligaments and changed posture, and it does not harm the baby. Physiotherapy, a support belt and simple changes to how you move usually help, and it often improves after delivery.

Did my epidural cause my back pain after delivery?

Studies have not found that epidurals cause long-term back pain. Soreness at the injection site usually fades within days. Ongoing back pain after delivery is more often due to weak core muscles and the lifting, carrying and feeding postures of early motherhood.

Why do my joints ache more after menopause?

Falling oestrogen affects joints, muscles and bone, and this is also the age when osteoarthritis becomes more common. Sudden sharp back pain after menopause should be checked for an osteoporotic fracture. Discuss hormone or bone treatment with your doctor, and do not stop prescribed medicines on your own.

Where can I get back and pelvic pain checked in Bengaluru?

Dr Heal Pain Cure Hospital assesses back, SI joint and hip pain in women at its HSR Layout and Banashankari branches, with blood tests and imaging under one roof. Both are open 24 hours, and we coordinate with your gynaecologist when needed.

This article is for general information and is not a substitute for a medical consultation. Please see a doctor for advice about your own symptoms, and always consult your obstetrician about pain during pregnancy.