How Menopause Affects the Spine and Back

The hormonal changes of menopause — particularly the decline in oestrogen — have a direct impact on several structures involved in back pain:

• Bone density Oestrogen plays a key role in maintaining bone density. As levels fall during perimenopause and menopause, bone loss accelerates. In the spine, this can lead to reduced density in the vertebrae — increasing the risk of compression fractures, particularly in the thoracic spine, and contributing to postural changes like increased kyphosis (rounding of the upper back).
• Disc health The intervertebral discs — the cushioning structures between each vertebra — are partly maintained by oestrogen. Research suggests that oestrogen decline is associated with accelerated disc degeneration, reduced disc hydration and increased susceptibility to disc-related back pain.
• Joint inflammation Oestrogen has significant anti-inflammatory properties. Its decline is associated with increased systemic inflammation, which can manifest as greater joint pain and stiffness throughout the body — including the lumbar and thoracic spine and the sacroiliac joints.
• Muscle mass and support The accelerated muscle loss associated with menopause affects the muscles that support the spine — including the deep core, the erector spinae and the gluteal muscles. Reduced muscular support places greater demand on passive structures like joints and ligaments, increasing the likelihood of pain.
• Pain sensitivity Oestrogen influences how the nervous system processes pain signals. Lower oestrogen levels are associated with increased central sensitisation — meaning the nervous system becomes more reactive and pain thresholds lower. This can make existing back pain feel worse or make new pain develop more easily.
• Sleep disruption Night sweats, insomnia and disrupted sleep are common during menopause — and poor sleep is one of the strongest drivers of increased pain sensitivity. Many women find their back pain is significantly worse when they've slept poorly, which creates a difficult cycle.

Common Presentations We See

At Active Balance, we see several patterns of back pain that are particularly common in perimenopausal and menopausal women:

• Thoracic pain and stiffness — mid and upper back pain often related to postural changes, reduced bone density and increased joint sensitivity
• Lumbar pain — lower back pain that may be more persistent or harder to settle than it was previously
• Sacroiliac joint pain — particularly common during hormonal transitions due to changes in ligament laxity and pelvic stability
• Generalised spinal stiffness — a feeling of the whole spine being tighter and less mobile, often worst in the morning

What Actually Helps

The good news is that back pain during menopause responds well to the same evidence-based physiotherapy approaches that work at any stage of life — and some interventions are particularly well suited to this phase:

• Strength training Progressive resistance training is arguably the most important intervention. Building and maintaining the muscles that support the spine — core, glutes, hip stabilisers — reduces load on passive structures and significantly improves pain and function. The research is clear that strength training is safe and beneficial for women in midlife and beyond.
• Manual therapy and hands-on treatment Joint mobilisation, soft tissue therapy, dry needling and myofascial release can all help reduce pain, improve mobility and settle acute flare-ups — creating the window needed to engage effectively with rehabilitation.
• Clinical Pilates and exercise classes Physio-led exercise that builds deep core control, spinal mobility and hip strength is particularly valuable. Our Clinical Pilates and Move Well classes are designed to be progressive and individually tailored — making them excellent for women managing menopause-related back pain.
• Sleep and stress management Addressing sleep quality and stress levels — whether through lifestyle changes, relaxation strategies, massage or other means — has a meaningful impact on pain sensitivity and recovery.
• Load management and education Understanding what's driving your back pain, how hormonal changes are contributing, and what you can do about it is one of the most empowering parts of treatment. Knowledge reduces fear, and reduced fear genuinely reduces pain.

When to Get Assessed

If you're experiencing back pain during perimenopause or menopause — whether it's new, worsening or just more persistent than before — it's worth getting a proper assessment. A physiotherapist can identify the contributing factors, rule out anything that needs medical attention, and put together a plan that addresses the whole picture.



Book online or call us on (08) 7123 4148. Our team understands the specific musculoskeletal challenges of menopause and would love to help.