Most lower back pain in women is mechanical. It comes from the moving parts of the low back: the muscles and ligaments, the small joints at the back of the spine, the sacroiliac joints where the spine meets the pelvis, or a disc. On top of those, hormonal change, pregnancy and gynaecological conditions add causes specific to women that are often missed. Working out which group your pain belongs to is the first useful step.
The mechanical causes, the same in women and in men
These explain most low back pain at any age.
Muscle and ligament strain. The commonest cause by far. It follows lifting, twisting, a new workout or a long stretch of sitting. The pain is dull and spread across the low back rather than in one spot, and worse with movement.
Facet joint irritation. The facet joints are the small paired joints at the back of each spinal level that let you bend and twist. When they are irritated, pain is worse leaning backwards or standing a long time, and easier sitting or leaning forward.
Disc problems. A disc is the cushion between two vertebrae. It can bulge and press on a nerve root, sending pain down the leg instead of keeping it in the back. Our page on back pain and lumbar radiculopathy explains that pattern, and if the pain is sharp and travelling, read what sciatica actually feels like.
The sacroiliac joint. These two joints join the base of the spine to the pelvis. Pain sits low, often on one side, sometimes reaching the buttock or groin. Because it often arrives with hip pain, see lower back and hip pain and our sacroiliac joint pain page.
Osteoarthritis and canal narrowing. With age the spinal joints wear, and the canal carrying the nerves can narrow. That brings stiffness worse in the morning, and sometimes leg heaviness on walking that eases when you sit or bend forward.
What causes lower back pain in females that men do not get
This is the group most often left out of a back pain assessment.
Pregnancy and the months after birth. Weight shifts forward, ligaments soften, and the pelvic joints take more load. Some women develop pelvic girdle pain, which is pain across the back of the pelvis or the pubic area, worse turning in bed or on stairs. Afterwards, the abdominal and pelvic floor muscles that support the low back take months to regain strength, so pain can appear long after delivery.
Periods and hormonal causes. Many women get low back ache before and during a period. Endometriosis, a condition where tissue like the lining of the womb grows outside it, commonly refers pain into the lower back and is frequently diagnosed years later than it could have been. If your back pain follows a monthly pattern, say so to your doctor plainly, and read our post on lower back pain around your period.
Perimenopause and menopause. As estrogen falls, bone density and the connective tissue around joints both change. Osteoporosis, which is thinning of the bone, raises the risk of a vertebral compression fracture, a small collapse in one of the spinal bones. Those can cause sudden back pain with little or no injury, which is why new, sudden back pain after 50 is worth assessing rather than waiting out.
Fibroids and ovarian cysts. Growths in or on the womb or ovaries can press on nearby structures and produce a low, heavy pressure or ache in the back and pelvis, sometimes with changes in your periods or bladder habits.
Kidney infection and kidney stones. These give pain higher up, in the flank, usually on one side, often with fever, nausea or burning when passing urine. This needs a family doctor or urgent care, not a pain clinic.
Lower back pain right side, or pain in lower left back: does the side matter?
Less than most people expect. The same structures sit on both sides of your spine: the same muscles, facet joints, discs and sacroiliac joints. A one-sided strain or facet joint is ordinary, and the side alone rarely changes the diagnosis.
What it does change is what else belongs on the list, because the kidneys, bowel and ovaries sit close to the low back. One-sided pain with abdominal, urinary or bowel symptoms, or with fever, is a different assessment from one-sided pain that is clearly worse when you move. Mention those extra symptoms early.
What your pain pattern may be pointing to
The pattern is often more useful than the exact spot:
- Worse leaning backwards or standing a long time: facet joints.
- Worse sitting or bending forward: a disc.
- Worse standing on one leg or turning in bed: the sacroiliac joint or pelvis.
- Travels below the knee, with pins and needles or numbness: a nerve root.
- Follows your monthly cycle: a hormonal or gynaecological cause.
- Worse at night, not eased by any position: have this assessed, not managed at home.
- Sudden, with no real injury, and you are over 50: have this assessed promptly.
What helps lower back pain
For most mechanical back pain, staying active helps more than resting. Gentle movement, walking and a return to normal activity are the mainstays. Physiotherapy adds targeted strengthening, and after pregnancy that means the deep abdominal and pelvic floor muscles. Where the cause is hormonal or gynaecological, treating the cause matters more than treating the back.
When pain has lasted months and has not responded, an interventional pain clinic adds tools that work from the inside. Image-guided injections place medication precisely using X-ray or ultrasound guidance. Diagnostic blocks numb one structure at a time to identify which is responsible. If a block confirms a facet or sacroiliac source, radiofrequency ablation can interrupt the nerves carrying that signal. For nerve root pain, epidural steroid injections are an option.
Warning signs that need urgent medical care
Get medical help the same day, or go to an emergency department, if you have:
- numbness in the groin or saddle area, with any change in bladder or bowel control
- weakness in both legs, or legs that are giving way
- back pain with a fever
- sudden severe back pain after a minor strain, if you have osteoporosis or are over 50
- unexplained weight loss alongside new back pain
- new severe back pain and a history of cancer
- one-sided flank pain with fever, or blood in your urine
Frequently asked questions
How do I know if my lower back pain is serious?
Look at what comes with it rather than how much it hurts. Fever, saddle numbness, bladder or bowel changes, weakness in both legs, unexplained weight loss, or sudden pain after minimal injury when you have osteoporosis all need prompt assessment. Severe lower back pain that eases when you change position is usually mechanical.
Why is my lower back pain worse on one side?
Usually because one muscle, facet joint or sacroiliac joint is carrying more of the strain, which is common and not in itself concerning. It matters more when urinary, bowel or abdominal symptoms or fever come with it, because the kidneys, bowel and ovaries sit near the low back.
Can endometriosis cause lower back pain?
Yes. Endometriosis commonly refers pain into the low back and pelvis, and that pain often follows a cyclical pattern. Because it is frequently diagnosed late, tell your doctor if your back pain tracks your cycle, even when it feels muscular.
What are the most common lower back pain symptoms in women?
A dull ache across the low back, stiffness worse in the morning, pain that builds with sitting or standing too long, and sometimes ache into the buttock or hip. Pain travelling below the knee, or pain with pelvic or urinary symptoms, points somewhere more specific.
This article is general information, not medical advice. It cannot diagnose your pain. If your symptoms are new, worsening, or worrying you, speak with your family doctor or contact us for an assessment.
Talk to us about your lower back pain
If your low back pain has lasted months and physiotherapy or medication has not settled it, our physicians in Toronto can assess which structure is responsible and discuss the options. Most services are covered by OHIP with a physician referral, and you can also refer yourself.
Ask your family doctor to send a physician referral, or refer yourself directly using our online form.
