Part of Greater trochanteric pain syndrome
Gluteal tendinopathy and the menopause
Warning signs, and when to get help
Is gluteal tendinopathy linked to the menopause?
They are linked in timing. Nobody has shown that one causes the other.
The association itself is not in doubt. Pain over the bony point at the side of the hip is described as most common in mid-life and more common in women than in men (Grimaldi and colleagues, 2015). Here are the numbers. In a cross-sectional study of 3,026 community-dwelling adults aged 50 to 79, tenderness over the greater trochanter in people with hip pain, without signs of hip osteoarthritis or widespread muscle tenderness, was reported on one side in 15.0% of the women and on both sides in a further 8.5%, against 6.6% and 1.9% of the men (Segal and colleagues, 2007). Added together that is 23.5% of the women and 8.5% of the men, which is the pair of figures you will see quoted, including in the Cambridge University Hospitals leaflet.
Read those figures carefully, because they are the ones most often stretched. They describe an age band. They do not compare women before the menopause with women after it, and they do not measure hormone levels, so age, sex and menopause status are all tangled together.
Who was in that cohort counts for as much. Those 3,026 people had been recruited for a study of knee osteoarthritis, as people who either had it or were at high risk of it, and in the same paper osteoarthritis in the knee on the same side came with about three and a half times the odds of outer hip pain. This is not a general population rate, and the trial team who went on to test hormone therapy describe the figure the same way, as a prevalence in women at risk of knee osteoarthritis (Ganderton and colleagues, 2016). A difference that large between women and men in their fifties and sixties tells you something real is going on. It does not tell you what.
So this page takes the same line as our menopause and joints pages take about joints in general. An association is not a cause, and treating it as one leads people to wait for a hormone answer instead of starting the treatment that works. Joint pain in the menopause covers the general picture, and the greater trochanteric pain syndrome program is the treatment for the hip.
Why would estrogen matter to a tendon?
The proposed mechanism is collagen. Tendon is largely collagen, estrogen is thought to influence how it is produced and turned over, and the suggestion is that less estrogen leaves tendon less able to cope.
The clearest statement about how firm that ground is comes from the researchers who went on to test it. Setting out their trial, they described the current knowledge of what female sex hormones do to tendon as limited, and the literature as limited, inconsistent and generally of poor quality, and noted that at that point no study had looked at the effect of menopausal hormone therapy on the gluteal tendons at all (Ganderton and colleagues, 2016).
So the mechanism is plausible and under-researched, and it is not something to build a treatment decision on. The broader account of estrogen and musculoskeletal symptoms belongs on the menopause and joints section, not here, and frozen shoulder and the menopause does the same job as this page for a different part of the body.
Does hormone therapy help outer hip tendon pain?
One randomized trial has asked that question in this condition. Here is what it did.
Researchers recruited 132 postmenopausal women with greater trochanteric pain syndrome, 12 of whom were lost to follow-up, and built a trial with two treatments crossed against each other (McMillan and colleagues, 2022). Every woman was given a cream to rub on the skin, either menopausal hormone therapy or an identical placebo. Every woman was also given an exercise program, either one designed to load the gluteal tendons or a sham program designed not to. And every woman in all four groups was given education on avoiding positions that compress the gluteal tendons and on managing daily load.
The published protocol describes the cream, the two exercise programs and the education content in full (Ganderton and colleagues, 2016). The measure was the VISA-G, a questionnaire about hip pain and function, taken at the start, at 12 weeks and at 52 weeks.
All four groups improved, at 12 weeks and still at 52 weeks. Whatever else the trial shows, it shows a year of improvement in postmenopausal women with this condition.
Between the two exercise programs there was no difference on any outcome, which is the result people skip past and the most interesting one in the paper, because the sham program had been built not to load the tendons. What all four groups had in common was the education about compression and load.
The cream's effect depended on body size. A significant interaction between the cream and body mass index led the authors to analyze the results by body mass index, and among the women with a body mass index below 25 the hormone therapy groups had significantly better hip scores than the placebo groups at every time point. Every time point includes the start, before a single application of either cream, so part of that difference was already there when the trial began. The authors concluded that cream of either kind, combined with either exercise program plus education, reduced pain and improved function, and that for women with a body mass index below 25, hormone therapy with either exercise plus education did better than placebo.
What the trial does not tell you matters as much.
It cannot separate the cream from the education, because there was no group that received neither. It cannot tell you whether hormone therapy prevents this condition, because everyone in it already had it. The body mass index result is a subgroup finding that came out of an interaction in the data, not from the comparison the trial was designed around, so treat it as a lead and not a conclusion, and the trial reported no such advantage in the groups with a higher body mass index. It also measured one hip questionnaire over a year. It measured none of the other reasons hormone therapy is prescribed, and none of its risks.
Put plainly: this trial is a reason the question is legitimate, not an argument for taking anything. Hormone therapy is prescribed on your whole health by someone who knows your history, and that conversation belongs with your own doctor or menopause clinic. Nothing on this site advises for or against it. Never stop or change a prescribed medicine on your own.
What about supplements, collagen and vitamin D?
No supplement has been shown to treat gluteal tendinopathy. This page names none, doses none and recommends none.
Nothing you can buy appears in what these sources recommend. The 2025 gluteal tendinopathy masterclass, written specifically to take apart the myths that have grown up around it, sums up contemporary management as education, load management, progressive exercise and attention to general health, and argues against the anti-inflammatory model that produced the rest-it-and-settle-it advice in the first place (Grimaldi, Ganderton and Nasser, 2025). That is its own summary of what it recommends, taken from the abstract, which is as much of it as we can read. The Cambridge University Hospitals leaflet, which we can read in full, names no supplement either.
Two things do belong in the conversation. If you are asking about vitamin D because of your bones and not your tendon, that is a real question with a real answer, and it is one for your doctor, who can decide whether testing or treatment applies to you. Eating well, sleeping and keeping your weight in a range you are comfortable with all help tissue tolerate load. That is a general health point and not a treatment for this tendon. Muscle and bone loss in the menopause covers the bone side, and osteoporosis is the program if low bone density is already in your notes.
What does work
Loading the hip, gradually, for months rather than weeks. That is the treatment with the evidence behind it, and it was tested in women at this stage of life.
In the LEAP trial, 204 adults aged 35 to 70 with the tendon problem confirmed on MRI were randomized to 14 physio sessions of education and exercise over 8 weeks, a single steroid injection, or one session of advice and a wait and see approach. At 8 weeks the education and exercise group had more people rating themselves improved than either of the others, and at a year it still had better overall improvement than the injection group (Mellor and colleagues, 2018). A 2024 review of 6 trials in 733 people recommends exercise as the first treatment for this condition, while noting how few trials there are (Kjeldsen and colleagues, 2024).
The education half gets missed. It means cutting down on the positions that squeeze the tendon against the bone: sitting with the legs crossed, standing with your weight hung on one hip, lying on the sore side. The hormone therapy trial gave that education to every group, and both of its exercise arms improved. People underestimate the timescale too. The Cambridge University Hospitals leaflet says the best results come from at least 12 weeks of exercise, so this is a season of work and not a fortnight.
Start with the holds. The isometric clamshell loads the muscles at the side of the hip with the leg going nowhere, and standing hip abduction is the standing progression once the early work is comfortable. The parent program stages the whole thing and sets the numbers for this condition, which are lower than the general starting doses on the individual exercise pages, so take the lower figure. Your physio will adjust this.
If you have high blood pressure, breathe steadily through every hold and never hold your breath. If you have had a hip replacement or other hip surgery, follow the program from your surgical team and physio instead.
If you have fallen in the past year, feel unsteady on your feet, or take medicines that make you dizzy, keep a hand on a kitchen counter or the back of a sturdy chair for the whole of the standing exercises, practice only when someone else is at home, and ask your doctor or physio about a falls check. If you live alone, that rule still stands, so plan around it rather than ignoring it. Do the exercises that ask for someone to be at home at your physio appointments or in a class instead, keep to the seated and supported work when you are on your own, and ask your physio which of the standing exercises you may do alone. Keep your phone in a pocket rather than in another room, so you can reach it from the floor, and ask about an alarm you wear.
If you do fall and cannot get up, or you think you may have hurt your head, neck, back or hip, stay where you are, keep warm and call emergency services, or get someone to call for you. Do not let anyone haul you up first.
Exercises to avoid with outer hip pain covers the ones that commonly make it worse, the outer hip stretches in particular. If you want the general strength picture for this stage of life instead of the hip on its own, the menopause strength plan is the page.
Why does so much hurt at once at this age?
Because more than one thing usually is going on, and naming them beats catastrophizing about them. Aching joints, stiffness, muscle and bone changes and a new musculoskeletal complaint can all turn up within the same couple of years, and a hip tendon is often simply the loudest of them.
That whole subject belongs to the menopause and joints section, which covers what else turns up at this stage, what is known about muscle and bone, and how to train on a bad day. For the hip itself, the thing to check is whether it is only the tendon: pain in the groin with a hip that has become stiff points toward the joint instead, and hip osteoarthritis is the program for that.
When to see a physio or doctor, and where the hormone questions go
Book a routine appointment with a doctor or physio if outer hip pain is stopping you sleeping or doing what you normally do, or if it has not improved after 2 weeks of looking after it at home (NHS). If you have been doing a program properly for 6 to 8 weeks and nothing has changed, ask for the diagnosis to be rechecked rather than doing more of the same, and whether a scan would change anything covers what imaging does and does not settle.
Keep the two conversations separate, because they go to different people. The hip goes to a physio, who can confirm what is producing the pain and set the load. Hormone treatment goes to your doctor or menopause clinic, who decide it on your whole health. Mentioning your stage of life to the physio is still worth doing, so they have the full picture.
Some signs need help faster, from an emergency visit to a doctor within a few days. They are listed under the warning signs below, each with its own timing.
Related exercise programs
Warning signs
Get emergency help now
- Emergency: you have had a fall or an injury and now have severe hip pain, or you cannot walk or put weight on the leg. Call emergency services or go to an emergency department. This can be a sign of a broken hip (hip fracture).
- Emergency: tingling or loss of feeling in the hip or leg after a fall or injury. Call emergency services or go to an emergency department.
- Emergency: pain, tingling, numbness or weakness in both legs, numbness or altered feeling around your genitals or bottom, or new trouble peeing or controlling your bladder or bowels. The same applies if you lose feeling in one leg. Call emergency services or go to an emergency department straight away. These can be signs of pressure on the nerves at the base of the spine (cauda equina syndrome).
Get help today
- Same day: the hip is hot and swollen, the skin around it has changed color, or you have hip pain with a high temperature or feel hot, cold or shivery. Get medical help the same day, and go to an emergency department if you feel very unwell. A joint infection needs treatment quickly. If you have a very high or very low temperature, shivering you cannot control, you are breathing very fast or finding it hard to breathe, you are confused or your speech is slurred, your skin, lips or tongue look blue, gray, pale or blotchy (on brown or black skin this can be easier to see on the palms of the hands or soles of the feet), or you have a rash that does not fade when you press it, call emergency services, as this can be sepsis.
- Same day: severe hip pain that came on suddenly without a fall, or pain that is getting worse quickly over a few days. Get medical advice the same day.
- Same day: new hip or groin pain after a fall, even a small one, if you are older, have low bone density (osteoporosis) or have taken steroid tablets for a long time, even if you can still walk. Get medical advice the same day. A broken hip is not always obvious at first.
- Same day: a leg or foot that is getting weaker, for example your foot drags, catches on the ground or slaps down when you walk (foot drop). Get medical advice the same day. If the weakness is getting worse by the hour, go to an emergency department.
- Same day: a child or teenager has sudden pain in the hip, thigh or knee, is limping, or cannot put weight on one leg. Get an urgent appointment with a doctor the same day. If they have a high temperature or seem very unwell, go to an emergency department. This page is for adults, and hip pain in children has different causes.
- Same day: hip pain at night or at rest that does not ease when you change position, and keeps getting worse. If you are being treated for cancer now, contact your cancer team the same day.
Book an appointment
- Within a day or two: hip pain at night or at rest that does not ease when you change position, and keeps getting worse. If you have had cancer, now or in the past, or are losing weight without trying, see your doctor sooner, within a day or two, and mention it. This applies even if the pain is not getting worse.
- Within a few days: hip pain at night or at rest that does not ease when you change position, and keeps getting worse. See your doctor within a few days.
- Within a few days: new pain in the groin or buttock, and you take steroid tablets long term, or have in the past, or you regularly drink a lot of alcohol. This can be a sign of a problem with the blood supply to the top of the thighbone (avascular necrosis). Book an appointment with your doctor within a few days and mention the steroids or alcohol.
- Within 2 weeks: pain that spreads down the leg below the knee, especially with numbness or tingling in the leg or foot. The pain may be coming from your lower back rather than the hip tendons. Book an appointment with a doctor or physio.
- Within 2 weeks: the pain is mostly in the groin rather than on the outside of the hip, or the hip is stiff and hard to bend, for example when you put on socks. This points more toward the hip joint itself, such as hip osteoarthritis. Book an appointment with a doctor or physio so the cause can be checked.
Common questions
Is gluteal tendinopathy caused by the menopause?
Nobody has shown that. The overlap is in who gets it and when: the condition is most common in mid-life and affects women more than men (Grimaldi and colleagues, 2015), and in a cross-sectional study of 3,026 adults aged 50 to 79 recruited for a knee osteoarthritis study it was found in 23.5% of the women against 8.5% of the men (Segal and colleagues, 2007). That study measured an age band, not menopause status, so age and hormones cannot be pulled apart in it, and its cohort was selected for knee problems, not drawn from the general population. Falling estrogen is a proposed explanation, not a demonstrated one, and the protocol for the hormone therapy trial in this condition described the literature on female sex hormones and tendon as limited, inconsistent and generally of poor quality (Ganderton and colleagues, 2016).
Will HRT help my hip tendon pain?
One randomized trial has tested that question in this exact condition and the answer it gives is partial. In 132 postmenopausal women with greater trochanteric pain syndrome, a hormone therapy cream or an identical placebo was combined with either tendon-specific or sham exercise, and every group also received education on avoiding tendon compression and on managing load. All groups improved over 12 and 52 weeks. For women with a body mass index below 25, the hormone therapy groups had significantly better hip scores than the placebo groups at every time point, baseline included, which means part of that gap was there before anyone used the cream; and the finding came out of an analysis by body mass index, not from the trial's main comparison (McMillan and colleagues, 2022). Whether hormone treatment suits you is a prescribing decision for your own doctor or menopause clinic, and nothing on this site advises for or against it.
Why does this happen to women at this age?
The pattern is clear and the reason is not. Mid-life and female sex are both associated with this condition (Grimaldi and colleagues, 2015; Segal and colleagues, 2007). The proposed mechanism is that estrogen influences collagen in tendon, so that less of it leaves tendon less able to cope, and the trial team who put that to the test described the underlying science as thin before they started (Ganderton and colleagues, 2016). Load matters too, and it is the part you can change: the muscles at the side of the hip hold the pelvis level every time you stand on one leg, and what they can tolerate is trainable at any age.
Do collagen, vitamin D or any supplements help tendon pain?
No supplement has been shown to treat this condition, and this page names none and recommends none. The sources that set out how to manage gluteal tendinopathy, including the 2025 masterclass written specifically to deal with the myths around it, build their recommendations on education, load management, progressive exercise and general health rather than on anything you can buy (Grimaldi, Ganderton and Nasser, 2025). If you are wondering about vitamin D because of your bones and not your tendon, that is a reasonable question for your doctor, who can decide whether testing or treatment applies to you, and bone is covered on the menopause pages rather than here.
Does the exercise program still work after the menopause?
Yes, and this is the part of the page to take away with you. The hormone therapy trial was conducted entirely in postmenopausal women, and every group in it improved on hip pain and function over 12 and 52 weeks while receiving exercise and education (McMillan and colleagues, 2022). The LEAP trial, in 204 adults aged 35 to 70 with the tendon problem confirmed on MRI, found education plus exercise beat a steroid injection and beat waiting at 8 weeks, with better overall improvement than the injection a year later (Mellor and colleagues, 2018). A 2024 review of 6 trials in 733 people recommends exercise as the first treatment for this condition (Kjeldsen and colleagues, 2024).
Is it worth asking my doctor about hormone treatment for this?
It is a fair question to raise, and the hip should not be the thing that decides it. Hormone therapy is prescribed on the whole picture, which includes your symptoms, your history and your own risks, and that conversation belongs with your doctor or menopause clinic. What you can usefully bring is the fact that a randomized trial has looked at this condition specifically, so the question is not a novel one. Never stop or change a prescribed medicine on your own. Meanwhile the loading program does not wait for that decision and is worth starting either way.
References
- McMillan R, Ganderton CL, Cook J, Semciw AI, Long DM, Pizzari T. Does Menopausal Hormone Therapy, Exercise, or Both Improve Pain and Function in Postmenopausal Women With Greater Trochanteric Pain Syndrome? A 2 x 2 Factorial Randomized Clinical Trial. American Journal of Sports Medicine. 2022;50(2):515-525. https://doi.org/10.1177/03635465211061142
- Ganderton C, Semciw A, Cook J, Pizzari T. Does menopausal hormone therapy (MHT), exercise or a combination of both, improve pain and function in post-menopausal women with greater trochanteric pain syndrome (GTPS)? A randomised controlled trial. BMC Women's Health. 2016;16:32. https://doi.org/10.1186/s12905-016-0311-9
- Segal NA, Felson DT, Torner JC, Zhu Y, Curtis JR, Niu J, Nevitt MC. Greater trochanteric pain syndrome: epidemiology and associated factors. Archives of Physical Medicine and Rehabilitation. 2007;88(8):988-992. https://www.archives-pmr.org/article/S0003-9993(07)00302-4/abstract
- Grimaldi A, Mellor R, Hodges P, Bennell K, Wajswelner H, Vicenzino B. Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management. Sports Medicine. 2015;45(8):1107-1119. https://doi.org/10.1007/s40279-015-0336-5
- Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, Wajswelner H, Vicenzino B. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ. 2018;361:k1662. https://doi.org/10.1136/bmj.k1662
- Kjeldsen T, Hvidt KJ, Bohn MB, Mygind-Klavsen B, Lind M, Semciw AI, Mechlenburg I. Exercise compared to a control condition or other conservative treatment options in patients with Greater Trochanteric Pain Syndrome: a systematic review and meta-analysis of randomized controlled trials. Physiotherapy. 2024;123:69-80. https://doi.org/10.1016/j.physio.2024.01.001
- Grimaldi A, Ganderton C, Nasser A. Gluteal tendinopathy masterclass: Refuting the myths and engaging with the evidence. Musculoskeletal Science and Practice. 2025;76:103253. https://doi.org/10.1016/j.msksp.2025.103253
- Cambridge University Hospitals NHS Foundation Trust. Gluteal tendinopathy. Patient information. Approved 14 January 2025. https://www.cuh.nhs.uk/patient-information/gluteal-tendinopathy/
- NHS. Hip pain in adults. Page last reviewed 20 November 2025. https://www.nhs.uk/symptoms/hip-pain/
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-17.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.