The secret cause of back pain every woman needs to know about…and how to cure it without drugs or surgery

Plus five pill-free ways to get immediate relief (that work for men, too)!

We tend to chalk up aches and pains as an inevitable part of growing older. That’s true with back pain, too. But new research shows that women who develop lower back pain in middle age can actually lay the blame on something other than age.

The surprising culprit? Menopause.

That’s right, the harbinger of hot flashes can also cause disc degeneration in the lower back, according to a new study.

Researchers looked at data from both women and men. They found that after menopause, women were much more likely to have severe disc degeneration than men of the same age. They also had it worse than pre- and perimenopausal women.

The worst time for back damage, according to the study, is in the first 15 years after menopause’s onset. That makes sense, as this is a stage in a woman’s life where hormone levels endure a seismic shift. Plummeting estrogen levels lead to all the common symptoms we think of when we think “menopause.”

And, according to the authors of the study, the lack of estrogen might be to blame for the rise in disc degeneration as well.

Hormones to the rescue 

The logical solution, if hormonal shifts are at the root of all these problems, would be to replace the hormones. To get them back into the balance women had before menopause. Which is why some doctors have put their menopausal patients on hormone replacement therapy (HRT).

It would make sense that HRT delays or prevents the degeneration of the discs that lead to back pain. If estrogen drops cause the pain, replenishing the hormone seems like a sensible next step. Especially in the first 15 years after menopause—the “sweet spot” for HRT.

But as with anything health-related, it’s not quite as simple as taking a “magic pill.” There’s a flip-side to HRT.

The hormone replacement controversy 

As you probably know, hormone replacement therapy is hugely controversial—and with good reason.

While synthetic hormone replacement is a boost to pharmaceutical companies’ bottom line, it’s a disaster from a public health perspective. In fact, in the early 2000s, the National Institutes of Health determined that one type of hormone replacement therapy (Prempro) caused breast cancer in otherwise healthy women. The effect was so clearly devastating that the study investigating the connection was halted early to avoid putting more women at risk. Understandably, that turned a lot of people off of hormone replacement completely.

The fact is, there’s a safer way to replace the hormones lost during menopause. A more tailored approach is available, known as bioidentical hormone replacement therapy (BHRT). BHRT is designed to precisely match the amounts and types of hormones your body would naturally produce.

I’ve prescribed it to my patients for years, with great success. I’ve seen it restore health and vitality to women who feel their youth slipping away. It’s addressed their complaints about hot flashes, vaginal dryness, and other symptoms of menopause. And the study I just told you about suggests it may help with back pain too.

In my eyes, it’s far safer than synthetic hormone replacement. Still, it does come with a few caveats…

Treat the individual, not the numbers 

Outsmarting our hormonal system requires a very delicate balancing act that most people get wrong—especially when they try to do it themselves.

That’s why I tailor all my treatments to the individual, not a standard set of numbers.

Before a patient gets a prescription for BHRT, they should undergo blood tests to observe overall hormone levels. That way, you can be clear about what actually needs to be replaced (and how much) rather than taking an arbitrary standard dosage.

Testing begins with a measurement of “total estrogens.” There are three types of estrogen in a woman’s body—estradiol, estrone, and estriol. They’re all different, and keeping them in balance is essential.

Balance is especially important when it comes to estradiol and estrone. In the simplest terms:

  • Estradiol is important during reproductive years, as it’s required for sexual and reproductive function, as well as organ and tissue health. It is the strongest, most active type of estrogen and may protect against cancer.
  • Estrone is a weaker form of estrogen and is prevalent in menopausal years. High levels are often indicative of cancer in the ovaries or adrenal glands.
  • Estriol is a metabolite of estradiol and is highest only during pregnancy. High levels reflect fetal health. It’s the weakest but most abundant of the three.

A safe and effective BHRT plan addresses all three estrogens. The goal isn’t to get to a defined level for each. What you want is a healthy ratio.

Ideally, estradiol and estrone should be in a one-to-one ratio. Higher amounts of estradiol can also be healthy. But you never want estrone to be the dominant estrogen. Which is something that often occurs in women on conventional HRT—even those estradiol patches that conventional gynecologists recommend. Why? Because they convert to estrone.

Women should also get tested for the hormones progesterone and free testosterone. Yes, women need testosterone too. These hormones are especially important for balancing estrogen and restoring sex drive.

Typically after analyzing hormone levels, doctors can prescribe a customized cream, catered to each patient. Throughout treatment, additional, follow-up blood tests should be standard to ensure things are staying in balance. If anything is off, you can quickly address it and make the changes your body needs.

A less tailored alternative to BHRT, which I’ve also been recommending for years, is dehydroepiandrosterone, better known as DHEA. DHEA is a vital hormone made by the adrenal glands. In the body, it converts to testosterone and estrogen.

The problem is, as you get older, the body produces less DHEA and, consequently, fewer hormones. So taking DHEA can spur your body to make its own reproductive hormones.

DHEA is also a natural anti-inflammatory, which can help with the menopausal back pain I told you about earlier. (Plus, as a side benefit, DHEA boosts libido.) I usually recommend 5 to 25 mg of this hormone per day.

Hormone replacement isn’t for everyone 

Now as much as I like BHRT, I’ll be the first to admit that it’s not for everyone. No one who has had an estrogen-related cancer should use hormone replacement therapy of any sort. Nor should those people with genetic markers for estrogen-related cancers (BRCA, the breast cancer gene, for instance).

For these women, risks of HRT far outweigh the benefits. These women already have much higher risk of developing breast cancer, and adding more estrogen to the mix can be like throwing fuel on a fire.

If you’re at risk for estrogen-related cancer—or aren’t interested in hormone therapy—the good news is you still have options for combatting menopausal back pain. I’ll tell you about them in the sidebar on page 3. But first, a quick reminder…

What NOT to do for back pain 

First things first: If you’re suffering from back pain, do not to turn to non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or acetaminophen. Research shows that not only do NSAIDs have terrible side effects, they’re also ineffective.

A new review published in the Annals of the Rheumatic Diseases looked at how effective NSAIDs are for back pain. And it found that for every six patients who take them, only one experiences real pain relief.

That’s right in line with a study from the Lancet where participants who took placebos actually recovered from back pain faster than those taking acetaminophen.

So now we know that five out of six people taking NSAIDs are wasting their money. And setting themselves up for a boatload of risks and side effects. Think hearing loss, asthma, ulcers, liver failure, heart disease, and stroke.

Honestly, NSAIDs are such atrocious drugs I can’t believe they’re still on the market. But just because they’re on the shelf of every drug store (and grocery store, and corner store…) doesn’t mean you should buy them out of convenience. Especially when there are an array of natural, risk-free methods to combat back pain.

The bottom line is, you don’t have to suffer with menopause-related back pain. And you don’t have to take risky drugs to treat it either. By getting your hormones in balance, you can improve not only back pain, but other menopause symptoms as well.

And even if hormone replacement isn’t for you, you’ve got plenty of drug-free options to choose from. Experiment to see which is the most conducive to your body and lifestyle.



5 pill-free ways to relieve back pain 

When you ask a conventional doctor for drug-free help with back pain, you can be sure he or she will recommend physical therapy (PT). And that can be effective. But it’s far from the only choice.

Whether your back pain is menopause-related or not, there are several other drug-free remedies that can help you get the relief you need.

Yoga: According to a new study, chronic low-back pain sufferers find just as much relief from yoga as they do from PT. Other studies have shown yoga helps pain and improves function while also reducing reliance on pain medication.

Yoga’s effectiveness is good news on several levels. First, it’s generally less expensive and more accessible than physical therapy. Secondly, yoga has additional benefits for people who practice it long-term, including helping to retain gray matter in the brain, which typically deteriorates with age. More gray matter means better brain function and a higher pain tolerance.

Massage: Another favorite for back pain sufferers, with the science to back it up. A new study examined the results of 10 massage sessions on people with back pain. Twelve weeks after the massages, 75 percent of people in the study had meaningful improvement in pain and disability.

Even more telling: At 24 weeks, those results persisted in half the patients. The results were even better for people over age 49 than for younger participants.

Walking: No matter how much you want to just lie in bed and do nothing when you have back pain, it’s essential to keep moving. Even light to moderate walking can help. According to a new study, aerobic walking training strengthened muscles and improved functioning in people with chronic low back pain.

Acupuncture: Acupuncture has a centuries-old history of helping with a wide variety of ailments. A recent study highlighted its pain-relief benefits. After just eight weekly acupuncture sessions, back pain sufferers saw significant improvements in pain severity. Plus, they said pain no longer interfered with their lives as much. And they saw improvements in depression, too—which is a common companion to chronic pain.

Chiropractic adjustment: Mainstream docs often sneer at chiropractic treatments. But even they’ll have to pay attention to this recent study proving its merits.

A systematic review published in JAMA concluded that the majority of studies on chiropractic found significant improvements in pain and function. Of the 26 random clinical trials in the study, 15 reported significant improvements in pain and 12 reported significant improvements in function. No groups reported serious adverse events.

Most insurance plans cover these types of treatment methods. Be sure to check with your insurance provider to determine the best option for you.

You may also locate a provider near you by visiting The American College for Advancement in Medicine (ACAM) at



“Loss of estrogen a risk factor for disc degeneration and lower back pain” ScienceDaily. Retrieved from

“Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial.” BMJ 2012;345:e6409

“Analgesic Use and the Risk of Hearing Loss in Women,” Am J Epidemiol 2012; 176 (6): 544-554

“Acetaminophen use and risk of asthma, rhinoconjunctivitis, and eczema in adolescents: International Study of Asthma and Allergies in Childhood Phase Three.” Am J Respir Crit Care Med. 2011; 183(2): 171-178

“Primer: managing NSAID-induced ulcer complications–balancing gastrointestinal and cardiovascular risks”Nature Clinical Practice Gastroenterology & Hepatology (2006) 3, 563-573

“Non-steroidal anti-inflammatory drugs and the risk of atrial fibrillation: a population-based follow-up study.” BMJ Open. 2014 Apr 8;4(4):e004059.

“Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomized trials,” The Lancet 2013; 382: 769-779

Anderson, Pauline. “Yoga as Good as Physical Therapy for Back Pain.” (29 September 2016). Medscape. Medscape. Retrieved from:

“Real-world massage therapy produces meaningful effectiveness signal for primary care patients with chronic low back pain: results of a repeated measures cohort study.” Pain Med. 2017 Mar 14. doi: 10.1093/pm/pnw347. [Epub ahead of print]

“Acupuncture therapy in a group setting for chronic pain.” Pain Med. 2017 Jun 8. doi: 10.1093/pm/pnx134. [Epub ahead of print]

“Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain: systematic review and meta-analysis.” JAMA. 2017;317(14):1451-1460.