Premenstrual Period and Lumbar Disc Herniation:
Connection to Low Back Pain and Sciatica

Fluctuating levels of gonadal steroids during the menstrual period cause physiological and psychological changes, leading to premenstrual syndrome. One common complaint during this time is low back pain and radiculopathy in patients with lumbar disc protrusion.

Laboratory studies have highlighted a potential connection between low-grade inflammation and premenstrual symptoms.

The premenstrual period is associated with low-grade inflammation, marked by increased levels of systemic inflammation markers. This inflammation explains the physical and psychological symptoms experienced during this time, including pain.

In cases of disc herniation, inflammatory mediators contribute to disc degeneration and pain, and similar mediators are involved in the low-grade inflammation during the premenstrual period, leading to increased low back pain and radicular pain.

Elevated estrogen and progesterone levels during the menstrual cycle increase capillary permeability and peripheral vasodilation, leading to edema. Similarly, in disc protrusion, compressed nerve root sites show increased vascular permeability, edema, and inflammation.

The parallel between these processes suggests that menstrual cycle-induced changes may worsen nerve root compression in disc protrusion by promoting edema in the degenerated disc region.

During the premenstrual period, there are alterations in emotional state that can affect the way pain is perceived. It is widely recognized that changes in emotional well-being, such as anxiety and depression, may contribute to the severity of low back and radicular pain experienced by individuals with disc protrusion.

The pain assessment criteria revealed noteworthy disparities between the premenstrual and normal periods, underscoring the significance of incorporating these variances into treatment approaches.

It is advisable to refer patients who report premenstrual syndrome to gynecologists and psychiatrists to ensure comprehensive care. Evaluating premenstrual syndrome can contribute to mitigating the likelihood of unsuccessful back surgery.