The Hip Pain That Has Nothing to Do With Your Posture
- infomenopausehub
- May 16
- 6 min read
What gluteal tendinopathy actually is — and why declining oestrogen is so often part of the picture
By Anna Pattison — Former Registered Nurse, Clinical Myotherapist & Menopause Mentor — Menopause Hub
⚡ The Short Version
Outer hip pain that arrives in your late forties or fifties without a clear trigger, that has not fully responded to treatment, that is worse after sitting and first thing in the morning — this is a well-understood condition with a name. And for women in perimenopause and beyond, hormonal change is very often part of what is driving it. The positions you sit and sleep in matter enormously. So does knowing what is actually happening. |
You have had the outer hip pain for about eight months. It wakes you at night when you roll over. It is worst after sitting for a long time — that moment of standing up from a chair has become something you prepare yourself for. You have been told it is your IT band. You have been told it is bursitis. You have been given stretches.
The stretches have not helped. If anything, you suspect they have made it worse — but you are not sure, and nobody has explained why that might be.
You have not been told that this condition is significantly more common in women than men. You have not been told that the tendons involved contain oestrogen receptors. You have not been told that your hormonal status is clinically relevant to why this happened and how it will respond to treatment.
What nobody has told you is the part that changes everything. |
What gluteal tendinopathy actually is.
The gluteal tendons are the tendons of the gluteus medius and gluteus minimus muscles — two of the muscles that run along the outer hip. They attach at the bony prominence you can feel on the side of your hip, called the greater trochanter. When these tendons become overloaded and unable to repair themselves quickly enough, the result is gluteal tendinopathy: persistent outer hip pain that is often worse with sitting, standing from a chair, climbing stairs, and lying on the affected side.
This condition was previously called trochanteric bursitis. That name has been largely retired. More accurate imaging has consistently shown that in the majority of cases, it is the tendons themselves — not the bursa beneath them — that are the primary source of pain. The name matters because the treatment approach is different. Tendons respond to load. Bursae respond to rest and anti-inflammatory treatment. Most women have been managed for the wrong thing.
Why women get this so much more than men.
Women experience gluteal tendinopathy two to four times more often than men (Grimaldi & Fearon, 2015). Two things explain this — one anatomical, one hormonal.
The anatomical factor: women tend to have a wider pelvis relative to the distance between their hip joints. This changes the angle at which the gluteal tendons run, which means they experience more compressive force during ordinary daily movement — every step, every stair, every time you move from sitting to standing. They are working closer to their limit under normal load, with a smaller margin before symptoms develop.
The hormonal factor: oestrogen is actively involved in maintaining the quality of collagen in tendons and their ability to repair the small amounts of daily damage that accumulates with use. Research published in the Journal of Applied Physiology (Hansen et al., 2009) found that the higher a woman’s oestradiol level, the higher her rate of tendon collagen synthesis. As oestrogen declines in perimenopause, that repair process slows. Tendons that are already managing significant mechanical demand begin doing so with a progressively reduced ability to recover.
The two factors interact. Anatomical load plus declining hormonal support is a combination that explains why this condition clusters so strongly in postmenopausal women.
The GLoBE Trial — 2022 Cowan et al. compared menopausal hormone therapy alone, targeted exercise alone, and MHT combined with targeted exercise in postmenopausal women with gluteal tendinopathy. Both MHT and targeted exercise improved pain and function. Women who received both had the best outcomes. This trial is significant because it directly tested the hormonal dimension — and confirmed it matters. (American Journal of Sports Medicine, 50(2), 515–525.) |
The positions that drive the pain.
This is the piece of information most women with this condition have never been given — and it is the one that can produce the most immediate relief.
Gluteal tendinopathy is a compression injury as much as a load injury. Certain positions press the tendons directly against the bone they attach to, causing the tissue to be compressed from both sides. Every time this happens, the already-sensitised tendon is provoked. Repeated throughout the day and night, these positions keep the tissue in a state of ongoing irritation that makes recovery very slow.
The position that causes compression is called hip adduction — when the thigh crosses the midline of the body. This happens in more places than most people realise.
Crossing your legs when seated — in a chair or on the floor.
Sitting cross-legged.
Standing with your weight predominantly on one hip.
Lying on your side with the top knee dropping forward and down.
Carrying something on one hip in a way that causes you to lean into it.
The single most impactful thing you can do right now.
Stop crossing your legs — in any position. Keep your knees roughly hip-width apart when seated. When lying on your side, place a pillow between your knees to prevent the top knee from dropping forward. These changes reduce compressive load on the tendons and often produce noticeable relief within days. Most women are never told this. |
What actually helps.
Gluteal tendinopathy responds well to the right inputs — but not always to the inputs women are most commonly given. Rest alone allows the tissue to further decondition. Stretching that involves crossing the leg or pulling the knee across the body — a very common hip stretch — directly compresses the tendons and can worsen symptoms. Cortisone injections may reduce pain temporarily but do not address the underlying tendon quality.
What the evidence supports is a staged approach. The first step is reducing the positions and activities that are directly provoking the tissue. Then, isometric loading — where the muscle works without the joint moving — has a direct pain-relieving effect and begins to rehabilitate the tendon without aggravating it. Progressive loading follows: gradually increasing what the tendon is asked to do, from controlled holds through to functional strength movements. Resistance training two to three times a week sits alongside this as the foundation, driving collagen synthesis throughout the body and rebuilding the tissue quality that declining oestrogen has been eroding.
Adequate protein supports this process at a cellular level — collagen synthesis requires it, and most women are eating less than the evidence supports.
A conversation with your GP about menopausal hormone therapy is worth having — not instead of rehabilitation, but alongside it. The GLoBE trial made clear that both matter, and that women who address the hormonal dimension alongside the mechanical one do best.
Your hip did not give up. It was managing a significant mechanical demand in a lower-oestrogen environment — and nobody explained the combination. From here, your approach can change. |
Want the complete picture?
There are three free resources to take this further — at three depths, depending on what you need today. |
Audio bundle — 10-minute audio guide + Key Point Sheet + GP Conversation Card menopausehub.com.au/gluteal-audio Start with the 10-minute audio guide. It covers what is happening in the gluteal tendons, why falling oestrogen is part of the picture, and the positions to change first. You also get a one-page Key Point Sheet to keep, and a GP Conversation Card to take to your next appointment. |
Gluteal Tendinopathy Mini-Guide — focused, in-depth guide on this condition The gluteal tendinopathy mini-guide goes deeper. It covers the step-by-step exercise progression from the beginning, the exact positions to avoid and why, sleep strategies, protein targets, and word-for-word scripts for your GP and allied health conversations. |
Why Nobody Connected It To Your Hormones — the complete guide across all four conditions And if you want the whole picture across all four conditions, the full guide brings everything together. |
All three resources are free to access. |
This information is educational only and does not constitute personal medical advice. Always consult a qualified health professional about your individual circumstances. © Menopause Hub 2026.
References
Grimaldi A & Fearon A (2015). Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. Journal of Orthopaedic and Sports Physical Therapy, 45(11), 910–922.
Hansen M et al. (2009). Effect of estrogen on tendon collagen synthesis, tendon structural characteristics, and biomechanical properties in postmenopausal women. Journal of Applied Physiology, 106(4), 1385–1393.
Cowan RM, Ganderton CL, Cook J et al. (2022). GLoBE trial. American Journal of Sports Medicine, 50(2), 515–525.
Wright VJ, Schwartzman JD, Itinoche R & Wittstein J (2024). The musculoskeletal syndrome of menopause. Climacteric, 27(5), 466–472.
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