Menopausal hormone fluctuations are associated with intervertebral disc degeneration, facet joint osteoarthritis, ligamentum flavum hypertrophy, sarcopenia, sympathetic innervation alterations, and systemic inflammation, but most findings are correlational rather than causal, and evidence supports exercise and parathyroid hormone as more promising therapeutic options than hormone replacement therapy or bisphosphonates for menopausal low back pain.
Key Findings
Background
Low back pain disproportionately impacts postmenopausal women relative to age-matched men, suggesting a role for sex-specific biological factors.
Annual costs of LBP in the United States are estimated at $90–134.5 billion.
The disparity between postmenopausal women and age-matched men implicates hormonal imbalance during menopause as a contributor to LBP pathophysiology.
The review used a literature search followed by screening of titles, abstracts, and full texts of original clinical studies, preclinical research using human or animal samples, and relevant reviews.
Rigour and reproducibility were evaluated using the ARRIVE Guidelines and the Modified Downs & Black Checklist.
Results
Menopause is associated with changes in intervertebral discs, including intervertebral disc degeneration.
Hormonal fluctuations during menopause are linked to intervertebral disc degeneration.
The specific mechanisms underlying this association remain poorly understood.
Most findings regarding intervertebral disc changes are correlational rather than causal.
Results
Menopause is associated with facet joint osteoarthritis.
Menopausal hormone fluctuations were identified as associated with facet joint osteoarthritis.
This association was noted among multiple spinal tissue changes linked to menopause.
Causal mechanisms have not been established.
Results
Menopause is associated with ligamentum flavum hypertrophy.
Ligamentum flavum hypertrophy was identified as one of the spinal tissue changes associated with menopausal hormonal changes.
Specific mechanisms linking hormonal fluctuations to ligamentum flavum hypertrophy remain poorly understood.
The finding is correlational rather than causal.
Results
Menopause is associated with sarcopenia, which contributes to spine health deterioration in older females.
Sarcopenia (skeletal muscle loss) was identified as a menopause-associated change affecting spinal health.
Hormonal imbalance during menopause may contribute to skeletal muscle changes.
Sarcopenia was listed among multiple systemic and structural changes associated with menopause.
Results
Menopause is associated with sympathetic innervation alterations that may affect spine health.
Sympathetic innervation alterations were identified as a menopause-associated change relevant to LBP pathophysiology.
The mechanisms underlying this association remain poorly understood.
This was identified as one of several critical windows for future research.
Results
Menopause is associated with systemic inflammation and changes in the gut microbiome that may affect spine health.
Systemic inflammation was identified among the menopause-associated changes contributing to LBP.
Changes in the gut microbiome were also noted as a systemic process associated with menopause and spine health.
These systemic associations are correlational rather than causally established.
Results
Evidence supporting hormone replacement therapy (HRT) for menopausal low back pain remains inconclusive.
HRT was characterized as 'less promising' as a therapeutic option for menopause-related LBP.
Evidence supporting HRT for LBP was described as 'inconclusive.'
Bisphosphonates were also identified as 'less promising' alongside HRT.
Results
Exercise and parathyroid hormone show more consistent benefits for menopausal low back pain than hormone replacement therapy or bisphosphonates.
Exercise was identified as a 'promising therapeutic option' for menopausal LBP with 'more consistent benefits.'
Parathyroid hormone was also described as a promising treatment with more consistent benefits.
These treatments were contrasted with HRT and bisphosphonates, which were characterized as 'less promising.'
The authors described exercise and parathyroid hormone treatments as showing 'more consistent benefits' compared to hormonal interventions.
Discussion
Most findings on menopause and spine health are correlational rather than causal, and future studies should focus on causal mechanisms.
The review explicitly states that 'most findings are correlational rather than causal.'
Future studies should 'focus on causal mechanisms and adhere to rigour guidelines to improve translational potential.'
The review highlights 'critical windows for research to uncover mechanisms and inform improved, targeted treatments for menopause related LBP.'
Rigour guidelines such as ARRIVE Guidelines and the Modified Downs & Black Checklist were used to evaluate included studies, suggesting variable quality in the existing literature.
What This Means
This research suggests that women going through menopause are at higher risk for low back pain than men of the same age, likely because of hormonal changes that affect multiple structures in the spine. The review found associations between menopause and damage to spinal discs, arthritis in the small joints of the spine, thickening of spinal ligaments, muscle loss, changes in nerve function, increased inflammation, and shifts in gut bacteria. All of these factors together may help explain why postmenopausal women experience more back pain, and why low back pain costs the U.S. healthcare system an estimated $90 to $134.5 billion every year.
When it comes to treating this type of back pain, the research suggests that exercise and a hormone called parathyroid hormone show the most consistent benefits. In contrast, hormone replacement therapy (HRT) — which many people might assume would help since menopause involves hormone loss — did not show convincing evidence of benefit for low back pain. Bone-strengthening drugs called bisphosphonates were also found to be less promising than exercise-based approaches.
This research suggests that there are significant gaps in scientific understanding of exactly how menopause causes spine problems, since most of the existing studies show associations but cannot prove cause and effect. The authors call for better-designed studies that follow strict scientific guidelines to uncover the underlying mechanisms and develop more targeted treatments specifically for postmenopausal women with low back pain. This is an important area for future research given how common and costly this condition is.
Julia Chagas, G. Gilmer, Gwendolyn Sowa, Nam N. Vo. (2026). Impact of Menopause and Associated Hormonal Changes on Spine Health in Older Females: A Review. Cells. https://doi.org/10.3390/cells15020148