A woman with a hand pressed to her lower back.

The nerves supplying the lower back and the pelvis run close together, and the brain is not good at telling them apart. Pain from the uterus, the ovaries or a kidney can be felt squarely in the lower back, and pain from a disc or a joint can be felt low in the pelvis.

That is why the useful first question is not “how bad is it” but “where is it actually coming from”. The answer decides whether you need a spine surgeon, a gynaecologist, or your own doctor.

Signs that need emergency care

Go to an emergency department if back pain comes with any of these:

Numbness around the groin, buttocks or inner thighs
Loss of bladder or bowel control, or sudden difficulty passing urine
Weakness in both legs, or legs that feel as though they are giving way
A foot that has started to drop

Together these can mean cauda equina syndrome, where the nerve roots at the base of the spine are compressed. It is rare, and it needs decompression within hours rather than days.

Call 995

Spinal, gynaecological or urinary?

Most causes fall into one of three groups, and they behave differently.

	Spine and joints	Gynaecological	Kidney or bladder
Typical causes	Sacroiliac joint, slipped disc, wear and narrowing, osteoporotic fracture	Endometriosis, fibroids, pelvic infection, period pain	Stones, kidney infection
What the pain does	Changes with position and movement; often worse on sitting, standing or bending	Follows your cycle, or comes with pelvic pain	Sudden and intense, often one side, in waves
Other clues	Pain or numbness down a leg; stiffness in the morning	Heavy or painful periods, pain during sex, bleeding between periods	Fever, burning on passing urine, blood in the urine, nausea
Who treats it	This clinic	A gynaecologist	Your doctor, or a urologist

The groups overlap, and more than one can be true at once — a woman with endometriosis can also have a sacroiliac joint problem. That is worth saying because it explains why treating one and finding no improvement does not mean the pain was imagined.

What follows covers the spinal side. For the causes, nerve levels and treatment of lower back pain in general, that page goes into more detail.

Lower back pain in women: the spinal causes

Sacroiliac joint dysfunction. The joints between the base of the spine and the pelvis. A wider pelvis and more elastic ligaments make these joints more likely to become painful, and pregnancy and childbirth add to that. Pain sits to one side, just below the belt line, and hurts on standing from a chair or turning in bed.
Slipped disc and sciatica. A bulging or herniated disc pressing on a nerve root, giving back pain with pain, numbness or weakness down one leg — see sciatica.
Wear and narrowing. Facet joint arthritis and spinal stenosis, more common from the forties onwards, causing stiffness, aching and leg symptoms on walking.
Osteoporosis after menopause. Falling oestrogen speeds bone loss, and thinned vertebrae can fracture under very little load — sometimes a cough or a lift. Sudden back pain in a post-menopausal woman deserves an X-ray rather than a wait.

The causes that need a different doctor

These are common, and they are not treated here. Saying so plainly is more useful than implying otherwise:

Endometriosis. Tissue like the womb lining growing outside it, causing pelvic and low back pain that often tracks with your cycle.
Fibroids. Non-cancerous growths in the womb that can press on nearby structures and cause a dull, persistent ache.
Pelvic inflammatory disease. Infection of the reproductive organs, with lower abdominal and back pain, often with fever or abnormal discharge.
Period pain. The chemicals that make the womb contract can refer pain into the lower back and thighs.
Kidney stones and infections. Sudden severe one-sided back or flank pain, often with fever or urinary symptoms. Kidney infection needs treating the same day.
Pregnancy-related back pain. Common, and usually managed with your obstetric team and a physiotherapist.

If your pain follows your cycle, start with a gynaecologist. If it comes with fever or urinary symptoms, start with your own doctor. If it changes with movement and position, or travels down a leg, that is the spine, and that is what we assess.

When to book rather than wait

Pain lasting more than a few weeks without improving
Pain, numbness or weakness down a leg
Pain after a fall or an accident, particularly with osteoporosis
Pain that wakes you at night, or is worse lying flat
Pain with a history of osteoporosis or cancer

What happens at the appointment

The history. Where the pain is, what changes it, whether it tracks with your cycle, previous pregnancies, and what you have already tried.
The examination. Movement, reflexes, strength and sensation, and specific tests for the sacroiliac joints and nerve roots.
Imaging, only if it will change something. X-rays for alignment or a suspected fracture, MRI where nerve compression is likely. Most back pain does not need a scan at the first visit.
A plan, and honesty about the source. If the examination points to the pelvis rather than the spine, we will say so and point you to the right specialist.

Who you would see here

Spinal causes are assessed by Dr Mathew Tung, neurosurgeon, and Dr Lim Heng Hing, orthopaedic spine surgeon. Either is a sound first appointment — having both in one clinic means the recommendation is not shaped by which one you happened to book. Bone health and fracture care sit with the orthopaedic surgeons.

Female lower back pain: what is spinal, and what is not