Back Pain & Hormones

Dr. Jan Brynhildsen and colleagues from the Department of Obstetrics and Gynecology, Faculty of Health Sciences, University Hospital, Linkoping, Sweden, sent questionnaires to 1,324 women who were in menopause. This questionnaire included questions about current hormone replacement treatment, previous and current back problems, medical care for back problems, parity, exercise and smoking habits, and occupation.

The questionnaire was returned by 85 percent of the women. There was a significant positive association between current use of hormone replacement treatment and low back pain. Previous back problems during pregnancy was a strong risk factor for current back pain, whereas neither current smoking nor regular physical exercise was a risk factor (nor was exercise protective). Their conclusion was that women receiving hormone replacement treatment had a significantly higher prevalence of current back pain than non-users, which could not be explained by differences in occupation, smoking habits, or current physical activity. (Brynhildsen, J. Is hormone replacement therapy a risk factor for low back pain among postmenopausal women? Spine. 1998; 23:809-813.) They speculated that hormonal effects on joints and ligaments may be involved.

Others have also speculated that oral contraceptive pills are a risk factor for low back and pelvic pain among women. The theory proposes that estrogen steroid hormones affect joints and ligaments, leading to Pubic Symphysis weakening and low back pain. In our opinion, this is not theory, but fact. Estrogen negatively affects collagen growth with only one result emerging, and that result is not good. Many general practitioners, gynecologists, orthopedists, midwives, and physiotherapists (at least in Sweden) believe there is an association between the use of these estrogen pills and the development of back problems.

Approximately one-fourth of the active professionals in Sweden recommend that some women with back problems abandon their use of oral contraceptives. (Brynhildsen, J. Oral contraceptives and low back pain: Attitudes among physicians, midwives and physiotherapists. Acta. Obste. Gynecol. Scan. 1995; 74:714-717.)

Many believe the oral contraceptives increase the risk of back problems, just as what occurs during pregnancy. As many as 50 percent of all women experience back problems during pregnancy. Because back problems develop so early during pregnancy, they cannot be explained as related only to the increased mechanical stress from the weight gained in the front of the body; therefore, hormonal factors have been proposed as the cause. Sex hormones are thought to affect ligaments and increase flexibility in the pelvis. This increased flexibility, or laxity, then leads to the low back pain.

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