Lower back pain is not the first symptom that comes to mind with fibroids — but it is surprisingly common, particularly with posterior fibroids (those on the back wall of the uterus) and large fibroid burdens. It is also frequently attributed to other causes — posture, muscle strain, disc problems — before fibroids are considered.
Why Fibroids Cause Back Pain
Posterior subserosal fibroids — growing on the back surface of the uterus — can press directly against the sacral nerves and the muscles of the lower back. The sacral nerve roots (S1–S4) pass close to the posterior uterus. Pressure on these nerves from a fibroid sitting against them can cause pain that radiates through the lower back, buttocks, and sometimes down the back of the legs — a pattern that closely resembles sciatica.
Large fibroids of any type can cause back pain by shifting the centre of gravity and altering posture. A heavy, enlarged uterus shifts weight forward, which the lumbar spine compensates for by increasing its curve — putting chronic strain on the lower back muscles and facet joints.
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How To Tell If Your Back Pain Is Fibroid-Related
Fibroid-related back pain tends to: be in the lower back specifically (lumbar or sacral region), worsen before and during periods, be associated with other pelvic symptoms, not respond well to physiotherapy or postural work, and — crucially — improve or resolve when fibroid treatment is undertaken. If you have lower back pain that has not responded to conventional treatment and you have known fibroids, it is worth specifically discussing the posterior position of your fibroids with your gynaecologist.
What Helps
Heat on the lower back. Anti-inflammatory pain relief taken consistently during periods rather than reactively. Yoga and Pilates focusing on the posterior chain — but modified to avoid poses that compress or strain the pelvic structures during symptomatic periods. Reducing systemic inflammation through dietary changes has a broad effect on pain sensitivity that includes lower back pain.
Definitive improvement in fibroid-related back pain typically requires treating the fibroids themselves. For women with posterior subserosal fibroids causing significant back pain, this is worth including explicitly in the treatment priority conversation with a gynaecologist.
