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Review papeR
DOI: 10.5114/pm.2015.54347
Prz Menopauzalny 2015; 14(3): 203-207
Corresponding author:
Mateusz Kozinoga, MSc, Rehasport Clinic, 30 Górecka St., 60-201 Poznań,
e-mail: mkozinoga@hotmail.com
Submitted: 06.10.2014
Accepted: 02.07.2015
Abstract
Low back pain is amassive problem in modern population, both in social and economic terms. It affects
large numbers of women, especially those aged 45-60. Going through aperimenopausal period is associated
with many symptoms, including low back pain.
This paper is areview of published research on the association between the perimenopausal age and low
back pain. PubMed databases were investigated. After the search was narrowed to “menopausal status, back
pain”, 35 studies were found. Seven studies, which suited our area of research best, were thoroughly analyzed.
All studies show increased pain when women enter this period of their life. There is no agreement among re-
searchers regarding which stage of menopause is the most burdensome.
Examples of possible treatments and physiotherapeutic methods targeting low back pain are also pre-
sented. Physiotherapeutic procedures used to treat low back pain include exercises in safe positions, balance
exercises, manual therapy, massage and physical measures.
Key words: menopause, low back pain.
Introduction
As their life expectancy increases, contemporary
women live athird of their life in menopause [1]. Chron-
ic pain is more prevalent in women than in men, and
it increases with age [2-4]. According to Whelan et al.,
even 80% of women suffer from various symptoms (in-
cluding pain) in the perimenopausal period (which is
usually defined as the age range of 45-55) [5].
Going from a premenopausal period to a post-
menopausal one is aresult of slower production of fe-
male hormones by ovaries. This process is gradual and
spread over time, and anatural part of aging. Numer-
ous symptoms associated with the perimenopausal
period have been identified. Physical ones can include
spine and joint pain, hot flashes, night sweats, chronic
tiredness; psychological symptoms can include irrita-
tion and anxiety, mood swings, depression and sleep
disorders. The analyzed studies showed an associa-
tion between the menopausal period and depression,
hot flashes and sleep disorders but little attention
was paid to pain (in spine and peripheral joints) as an
equally prevalent symptom associated with this period
of life [6].
This review focuses on the association between the
perimenopausal and post-menopausal periods of life
and low back pain (LBP). Additionally, it describes phy-
siotherapeutic procedures used to treat low back pain.
Spine pain, especially in the lumbar region, is ase-
rious health issue in the modern world. At some point
in life, 36.4% to 58% of people in European countries
and the United States experience LBP [7, 8]. This poses
a great medical and socio-economic challenge to such
extent that some researchers call it alifestyle disease. It
is the main cause of absence in the workplace, and the
second cause of visiting primary health care profession-
als. Spine pain has negative psychological consequences
as it impairs daily functioning of the affected person. It
also poses aserious socio-economic problem – it is costly
due to disability-related absence in the workplace [9].
The purpose of the paper is to review available stud-
ies on perimenopausal women with LBP. This review
can shed more light on the issue of pain in women who
undergo menopause.
Back pain in women in the
perimenopausal period
PubMed databases were investigated. After the
search was narrowed to “menopausal status, back
pain”, 35 studies were found.
Low back pain in women before and after menopause
Mateusz Kozinoga1,2, Marian Majchrzycki3, Sylwia Piotrowska4
1Spine Disorder Unit, Department of Pediatric Orthopedics, Poznan University of Medical Sciences, Poznan, Poland
2Rehasport Clinic Poznan, Poland
3Department of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, Poznan, Poland
4Department of Physiology, Poznan University of Medical Sciences, Poznan, Poland
M R/P M 14(3) 2015
204
The selected studies were analyzed to verify wheth-
er they described the perimenopausal period of life,
correlated back pain and menopausal status, divided
the study group into sub-groups depending on the
menopausal status (not all studies did).
Twenty-eight papers were excluded due to lack of
information about back pain and menopausal status.
Seven studies, which suited our area of research best,
were thoroughly analyzed.
Most studies [1, 10-12] divided women into five
groups:
1. Premenopausal women who had had aregular pe-
riod in the past three months.
2. Early perimenopausal women who had an irregular
period in the past three months.
3. Late perimenopausal women who had menstruated
irregularly in the last 12 months but not in the last
3 months.
4. Postmenopausal women who had not menstruated
in the last 12 months.
Aseparate group of women who have hormone re-
placement therapy.
All analyzed studies showed that women who are
experiencing or experienced menopause suffered from
increased joint and spine pain.
According to Dugan et al. [10], 61% of women in the
study group of 2218 reported lumbar spine pain. Back
pain experienced at least once in two weeks prior to the
study was reported by 56% of 294 women in group 1
(premenopausal), 65% of 856 women in group 2 (early
perimenopausal), 59% of 137 women in group 3 (late
perimenopausal) and 61% of 152 women in group 4
(postmenopausal). Additionally, an association between
increased BMI and increased pain was observed, which
probably is aresult of increased mechanical loading of
the spine. Mitchell and Woods [12] divided their study
subjects into similar groups. In group 1 (late reproduc-
tive stage), of 196 women, 81.6% reported pain; in
group 2 (early transition stage), of 171 women, 77.8%
reported pain; in group 3 (late transition stage), of 106
women, 83% reported pain; in group 4 (early postmeno-
pause), of 67 women, 80.6% reported pain.
Along-term study by Szoeke et al. [11] established
that in the period of 8 years, the number of women
suffering from back pain grew from 44% to 59%. Most
women who took part in this study went from the
premenopausal to postmenopausal stage during the
study. The authors of the study also noticed adirect
association between increased BMI and increased
spine pain.
Astudy by Poomalar and Bupathy [1] on the Indian
female population divided 500 participants into 3 sub-
groups (perimenopausal, early postmenopausal and late
postmenopausal). Alow back pain incidence was as fol-
lows: 80% (n = 135), 76% (n = 133), and 79% (n = 232),
respectively.
AJapanese study by Manabe [13] of 2244 women
(group 1: 25-44 years, n = 719; group 2: 45-64 years,
n = 1,153; group 3: over 65 years, n = 372) showed
lumbar spine pain in 21%, 34% and 37% of study par-
ticipants, respectively. A study by Sievert [14] on the
Mexican female population is yet another paper show-
ing the risk of developing low back pain in women go-
ing through aperimenopausal period of life.
Athree-year study by Brennan Braden et al. [15]
examined 67,963 postmenopausal women aged 50-79
with chronic pain (low back pain, neck pain, headache,
joint pain or stiffness) and established that increased
BMI (≥ 30) was associated with the worsening of
pain. What is interesting is that when an opioid-using
group was compared to the group not using opioids, it
turned out that the former tended to have worse pain
scores (mean 41 vs. 72.6), worse physical functioning
(56.8 vs. 80.6), slightly higher BMI (29.5 vs. 27.3), were
more likely to be disabled (13.5% vs. 1.9%) and were
more likely to be diagnosed with depression (20.5%
vs. 11.1%).
There are disagreements in the literature about the
relationship between BMI and low back pain. Astudy of
Australian community-dwelling women from 2010 re-
ported adirect association between high BMI and both
high low back pain intensity and disability [16]. On the
other hand, a2010 study by Park et al. [17], in which
78 Korean women hospitalized due to spine pain were
observed, took alook at a relationship between BMI,
bone mineral density, age and the stage of postmeno-
pause. The results showed no association between BMI
and the incidence of back pain. This could be due to
asmall number of studied cases with BMI higher than
30 (3 women out of 78). The study also concluded that
compared to women with normal bone mineral density,
women with lower bone mineral density were signifi-
cantly older (p = 0.003) and had been postmenopausal
for alonger time (p = 0.031).
All these studies seem to unanimously suggest
an increased incidence of low back pain in perimeno-
pausal women comparing to other age groups. Table I
shows all of the discussed studies. None of them con-
tained any information about the treatment of pain
which would take into consideration perimenopause-
related factors (the risk of osteoporosis, hormonal im-
balance). These topics are legitimate topics for further
research.
On the other hand, Holte [18] concludes that the
menopausal period of life is not always associated with
negative symptoms. Norwegian women he studied re-
ported alower incidence of headaches during meno-
pause. Moreover, sleep disorders could be afactor in
spine pain. Resting can influence muscle tension and
tiredness, as aresult reducing the pain [19]. We have
not found any studies which would examine this issue
in depth.
M R/P M 14(3) 2015
205
Treating low back pain in perimenopausal
women
Physiotherapeutic procedures used to treat low
back pain include exercises, manual therapy, massage
and physical measures. Pharmacology is also used (e.g.
non-steroidal anti-inflammatory drugs) [20, 21].
According to Mishra et al. [22], the exercise program
for postmenopausal women should include endurance
(aerobic) exercises, strength exercises and balance ex-
ercises. Out of these, aerobics, weight bearing, and re-
sistance exercises are effective at increasing the bone
mineral density of the spine in postmenopausal women
[23]. This is an extremely desirable effect considering
the fact that bone mineral density tends to diminish at
this stage of woman’s life [24].
A meta-analysis by Hayden et al. [25] reviewed
available research on exercise therapy for low back pain
and concluded that the therapy is effective at slightly
decreasing pain. However, it should be noted that the
therapy was defined as “a series of specific move-
ments with the aim of training or developing the body
by aroutine practice or as physical training to promote
good physical health” [26]. This suggests anon-specific
character of exercises in the treatment of lumbar spine
pain. Nevertheless, recommending general physical
exercises is beneficial because they undoubtedly pro-
mote weight loss, which is important in perimenopau-
sal women who tend to be less physically active [24].
Moreover, Hayden et al. also concluded that the most
effective exercise therapy strategy for chronic LBP was
supervised and individually-tailored, high-dose stretch-
Tab. I. Summary of reviewed literature
Study Number
of participants
Group specific therapy/
Study groups
Comparison between
groups
Outcomes, conclusions
Dugan et al.
[10]
2218 women Group 1: Premenopausal
(294 women)
Group 2: Early perimenopausal
(856 women)
Group 3: Late perimenopausal
(137 women)
Group 4: Postmenopausal
(152 women)
Premenopausal women were
least affected by symptoms.
The biggest increase in pain
symptoms was observed
in early perimenopausal
women.
Aches and pain are significantly
and independently related with
the postmenopausal status.
Mitchell et al.
[12]
540 women Group 1: Late reproductive
stage (196 women)
Group 2: Early transition stage
(171 women)
Group 3: Late transition stage
(106 women)
Group 4: Early postmenopause
(67 women)
The most severe pain symp-
toms in the low back were
observed in groups 3 and 1.
Back pain increased in severity
as women progressed through
the menopausal transition
stages.
Szoeke et al.
[11]
438 women Australian-born women, aged
45-55 years and menstruating
at baseline
In the period of 8 years, the
number of women suffering
from back pain grew from 44%
to 59%. Apositive association
between increased BMI and in-
creased spine pain was observed.
Poomalar et al.
[1]
500 women Group 1: In menopause transi-
tion (135 women)
Group 2: Early post menopause
(133 women)
Group 3: Late post menopause
(232 women)
The highest incidence of
low back pain was observed
in the menopause transi-
tion group. The smallest
incidence rate, on the other
hand, was observed in the
early postmenopausal group.
The menopause-related symp-
toms have anegative effect
on the quality of life of the
perimenopausal and postmeno-
pausal women.
Manabe et
al. [13]
2244 women Group 1: Younger women,
25-44 years (n = 719)
Group 2: Middle-aged women,
45-64 years (n = 1153)
Group 3: Older women,
over 65 years (n = 372)
The spine pain incidence in-
creased with age, the largest
increase observed in group 3.
It can be assumed that there are
some differences in the primary
factors causing LBP between
the middle and the upper age
groups, with changes in the
condition of the lumbar spine
occurring gradually.
Brennan
Braden et al.
[15]
67 963 women Postmenopausal women aged
50-79 with chronic pain.
Increased BMI (≥ 30) is associ-
ated with the worsening of pain.
Park et al.
[17]
78 women Korean women hospitalized
due to spine pain.
No association between BMI and
the incidence of back pain.
M R/P M 14(3) 2015
206
ing and muscle strengthening exercise programs with
home practice [25].
The American Pain Society and American College of
Physicians stated that there is good evidence that spe-
cific physical exercises recommended by aphysiothera-
pist have amoderate positive effect in low back pain.
These organizations also pointed out that there is no
good evidence for physical therapies (transcutaneous
electrical nerve stimulation, ultrasounds) for low back
pain and so they do not recommend their use [27].
Study by Cherkin et al. [28] compared the effects
of physical therapy, chiropractic manipulation and pro-
vision of an educational booklet on low back pain. It
concluded that physical therapy and chiropractic ma-
nipulation were similarly effective in terms of symp-
toms, functioning, satisfaction with care, disability,
recurrences of back pain, and subsequent visits for
back pain. There was no significant difference between
achiropractor or aphysical therapist with regard to the
length of the therapy, which lasted for about 2.5 hours.
Meade et al. [29] also points out to the benefits of
manual therapy for low back pain.
A2010 report by Bronfort et al. on the scientific evi-
dence for manual treatment of pain (including low back
pain) in Great Britain concluded that spinal manipula-
tion and mobilization are effective in adults for acute,
subacute, and chronic low back pain. It was also noted
that as an alternative technique, massage is effective in
adults for chronic low back [30].
Suggested specific physiotherapeutic procedures
for low back pain for perimenopausal women:
• exercises in safe positions (with aminimal risk of wors-
ening the pain): supine position – exercises strength-
ening the floor of the pelvis, the transversus abdominis
and multifidus muscles, as they are the most important
stabilizers of the lower parts of the spine,
• balance exercises,
• manual therapy.
Conclusions
The perimenopausal stage of life is associated with
an increased incidence of low back pain. Increased BMI
(≥ 30) is one of the factors increasing the prevalence
of pain. Suggested forms of treatment include physi-
otherapeutic procedures such as physical exercises,
massage, and manual therapy. Further studies are nec-
essary in the area of treatment of pain and association
between insomnia and low back pain.
Disclosure
Authors report no conflict of interest.
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