Hormones. From puberty to menopause, these powerful little messengers are almost single-handedly responsible for running the day-to-day operations of a woman’s body. Hormones travel through the bloodstream from one tissue to another, regulating and facilitating most all of the body’s processes. Growth, sleep/wake patterns, emotions, appetite, and reproductive health are just a handful of the functions that are governed solely by hormones. These chemicals are in a constant state of change, always adjusting to the body’s needs. Though these fluctuations are considered normal, and are actually imperative for optimal health, when hormone levels travel outside the normal thresholds, problems can arise. When hormones become unbalanced, women may experience abnormalities such as mood swings, changes in weight, depression, disturbances in sleep, and even pain. Most women who experience this type of pain are undergoing changes of a specific hormone- estrogen.
When we talk about female hormones, estrogen is usually the one that comes to mind first. It has its hand in countless reproductive functions and fluctuates with our body’s rhythm at highs and lows over a woman’s lifespan. Estrogen is not only responsible for reproduction, but in appropriate amounts, also has a starring role in skin health, cardiovascular health and bone strength. So how exactly are these estrogen levels connected to pain?
During menopause, when a woman is transitioning out of her reproductive years, estrogen levels naturally fall. Along with that drop comes an array of symptoms that can range from inconvenient to almost debilitating. For some women, these symptoms can be such a burden on their quality of life that they seek out treatment in the form of estrogen replacement to restore some balance in their bodies. While suppressing some of the dreadful side effects of menopause, one study showed that artificially elevated levels of estrogen (in this case hormone replacement therapy) had been found to be a direct cause of joint pain and arthritis, and women utilizing this therapy were at higher risk for developing spine and lower back pain. The risk with synthetically elevating estrogen levels is not only specific to menopause suffers alone, but also to some young women using oral contraceptives (which consist of a supplement of estrogen and progestin) are subjected to the same risks.
But what about estrogen levels that are raised naturally? Does the same risk apply? A perfect example of this is pregnancy. During the first trimester, there is a natural rapid increase in estrogen levels, and at least 50% of women experience some form of lower back pain during this time. It might seem logical to assume that this back pain during pregnancy is a direct result of mechanical changes and physically carrying extra weight that exerts stress on the lower back. However, back problems can develop so early in pregnancy that they cannot be explained as stemming solely from the physical changes of the body, and therefore hormonal factors have been identified as a probable cause. One study explains that estrogen hormones directly affect joints and ligaments, inducing flexibility of pelvic muscles, and sometimes resulting in low back pain.
The sea of hormones in the human body requires a delicate balance to operate at optimal therapeutic levels. In looking at estrogen, we can conclude that a surplus can put women at risk for developing spine pain, and for some that may serve as a deciding factor on whether or not to go forward with elective hormone replacement therapy. At the same time, we also need to look at the reasons why women are actually supplementing their estrogen. A classic example is osteoporosis, which is a severe weakening of the bones that occurs when estrogen levels drop too low (as in menopause, or other hormonal conditions). In this instance, the benefit of hormone replacement may outweigh the risk. It’s important to consider all factors and have a proper risk-benefit conversation with an experienced spine health professional. In any case, if you suspect a hormonal imbalance is contributing to your spine and back pain, consult with your doctor who can work with you to best restore natural balance to your body.