Why Menopause and Hip Pain Are Connected

It's a fair question: can menopause actually cause hip pain, or is this just "getting older"? The honest answer is both are involved, but there's a specific hormonal piece that explains why hip pain shows up for so many women specifically around perimenopause and menopause.

Estrogen plays a role in keeping collagen - the structural protein in tendons and connective tissue - healthy. As estrogen drops during perimenopause and menopause, tendons can become more prone to irritation and breakdown, and the body also naturally loses some muscle mass and strength around this time. Sports medicine specialists at Hospital for Special Surgery have pointed to this hormone-tendon connection as a reason lateral hip pain becomes so much more common in women at this stage of life, even in women who were never especially active.

Researchers in Australia have also been studying whether menopausal hormone therapy can directly improve tendon health in women with this kind of hip pain - an active area of ongoing research, not yet a settled answer, but a sign of how seriously the connection is being taken clinically.

Gluteal tendinopathy is a change in the tendons that attach your gluteal muscles - mainly the gluteus medius and gluteus minimus - to the bony point on the outside of your hip, called the greater trochanter. You'll also see it called greater trochanteric pain syndrome (GTPS), and it's sometimes lumped together with trochanteric bursitis, since the tendons and the nearby fluid-filled bursa sit right next to each other and often get irritated together.

It's different from hip osteoarthritis, which is wear on the joint cartilage deep inside the hip socket. Gluteal tendinopathy sits closer to the surface, right over that bony bump on the side. That distinction matters, because the two conditions are managed differently - and it's easy for either one to get mislabeled as "just arthritis" or "just getting older."

One underlying driver, beyond hormones, is reduced strength and stability in the hip muscles themselves - so weakness, not just wear, is often part of the picture, which is actually good news, because strength can be rebuilt.

Common gluteal tendinopathy symptoms include:

• Tenderness or aching directly over the bony point on the outer hip (not deep in the groin)
• Pain that increases when lying on the affected side at night
• Discomfort climbing stairs, getting out of a low chair or car, or standing on one leg
• A dull ache that can spread down the outer thigh, sometimes toward (but rarely past) the knee
• Pain after standing with your weight shifted onto one hip, or after crossing your legs for a long time
• Pain that builds gradually over weeks rather than appearing suddenly from an injury

Pain that runs all the way down to the foot is more often related to the lower back or sciatica than to the hip tendons themselves - worth mentioning to whoever you see about it.

This is one of the most consistent things reported with gluteal tendinopathy: pain that's tolerable during the day but flares up the moment you lie on that hip. The mechanism is straightforward - lying on the affected side puts direct, sustained compression on the irritated tendons, right where they wrap around the greater trochanter. Even lying on the opposite side can sometimes pull the top leg down and across the body, stretching the same tendons if that leg isn't supported.

A few things some women find helpful to try:

• A firm pillow between the knees and ankles when side-sleeping, to keep the top leg more level with the hip instead of dropping forward
• Sleeping with a small pillow or folded towel under the waist for extra support if on your back
• Avoiding sleeping directly on the painful side for a stretch of weeks while things settle, if switching sides is realistic for you
• A softer mattress topper if your current mattress is very firm, since firmer surfaces increase direct pressure on the trochanter

Gluteal tendinopathy treatment is generally built around managing load on the tendon and gradually rebuilding hip strength, rather than rest alone - complete rest can actually let the surrounding muscles weaken further. A physiotherapist can build a specific plan, but the general approach usually includes:

• Load management first: temporarily reducing activities that compress the tendon - deep stretching of that hip, crossing legs, standing with weight shifted to one side
• Guided strengthening: progressive exercises for the gluteus medius and minimus, since weaker hip muscles are linked to this condition
• Gradual return to activity: walking and exercise are usually still encouraged, just adjusted in the short term
• Sleep position changes: the pillow and mattress adjustments above
• A medical conversation about further options if symptoms persist, including anti-inflammatory approaches or other interventions a doctor may discuss with you

Because the tendon and gluteal-strength picture is so specific, a physiotherapy assessment tends to get better results than generic hip stretches found online - it's genuinely worth the appointment. For pillow positioning diagrams to try tonight, see the 2am rescue tool.

Hip pain often isn't the only ache that shows up. Joint pain more broadly - sometimes called menopause arthralgia - is commonly reported in the knees, shoulders, hands, and lower back during perimenopause and menopause, alongside general morning stiffness. The same estrogen-and-connective-tissue link that affects the gluteal tendons is thought to play a role across other joints too, though the hip is one of the most frequently reported sites specifically because of its role bearing body weight during sleep and daily movement.

Most hip pain in perimenopause and menopause is manageable and not an emergency, but it's worth booking an appointment rather than waiting it out if:

• Pain is severe or getting worse week over week, not better
• Pain started suddenly after a fall, twist, or other injury
• You can't put weight on the leg
• There's visible swelling, redness, warmth, or fever alongside the pain
• It hasn't improved after a few weeks of rest and gentle activity changes

A doctor or physiotherapist can confirm whether this is gluteal tendinopathy, hip osteoarthritis, referred lower-back pain, or something else - and each of those is managed differently, so getting the right diagnosis is worth the appointment.