Why Are So Many Peri- and Menopausal Women Experiencing Hip Pain?

If you talk to women in their 40s and 50s long enough, a pattern emerges: “My hip just started hurting out of nowhere.” “X-rays look fine, but I can’t sleep on my side anymore.” “Stretching helps a little, but it keeps coming back.”

Hip pain during peri- and menopause is incredibly common—and often misunderstood. While it’s frequently blamed on “aging,” the reality is far more nuanced. Hormonal shifts, particularly declining estrogen, play a significant role in how our joints, tendons, muscles, and connective tissue function. This is where physical therapy becomes not just helpful, but essential.

The Hormone–Hip Connection

Estrogen does much more than regulate reproductive health. It also plays a key role in:

• Maintaining collagen elasticity

• Supporting joint lubrication

• Regulating inflammation

• Preserving muscle mass and strength

• Protecting bone density

As estrogen levels fluctuate and decline during perimenopause and menopause, the musculoskeletal system becomes more vulnerable. Tissues may stiffen, recovery slows, and low-grade inflammation becomes more persistent. The hip—an area that relies heavily on coordinated muscle strength, tendon resilience, and joint mobility—is especially susceptible.

This is why many women experience:

• Lateral hip pain (often labeled as bursitis or gluteal tendinopathy)

• Deep aching in the groin or buttock

• Pain with walking, stairs, or getting out of the car

• Night pain when lying on one side

Often, imaging doesn’t reveal a dramatic structural problem—because the issue is functional, not catastrophic.

To further complicate matters; twenty-three years ago, intentionally skewed results from the billion-dollar Women’s Health Initiative (WHI) study falsely linked hormone replacement therapy (HRT) to an increased risk of breast cancer, stroke, and heart disease. Headlines erupted. Fear spread faster than facts. Prescriptions for HRT plummeted almost overnight. What followed was not caution—it was collapse.

An entire generation of people with ovaries was stripped of informed choice. Perimenopausal and menopausal symptoms were minimized, dismissed, or reframed as personal failure rather than physiological change. In the vacuum left by evidence-based care, a massive industry bloomed—one built on supplements, detoxes, creams, and “natural” solutions that promised relief while quietly profiting from untreated suffering. This was not just a medical misstep. It was a cultural one.

Hormone therapy—now widely recognized as safe and effective for many patients when appropriately prescribed—was demonized. And with it, the broader understanding of how estrogen loss affects the entire body was lost too.

The Musculoskeletal Fallout No One Talked About

While hot flashes and mood changes dominated the limited menopause conversation, a quieter epidemic unfolded in exam rooms and physical therapy clinics: persistent hip pain, tendon pain, joint stiffness, and unexplained loss of strength.

Estrogen is not optional to musculoskeletal health. It influences collagen turnover, tendon elasticity, joint lubrication, muscle protein synthesis, bone density, and pain modulation. When estrogen levels drop or fluctuate—as they do in perimenopause and menopause—tissues do not fail dramatically. They change subtly, until one day pain appears “out of nowhere.”

Hip pain is one of the most common manifestations, but other common complaints include frozen shoulder, achilles tendinopathy, plantar faciitis, etc.

Women are diagnosed with bursitis, tendonopathy, labral tears, early arthritis, or told their imaging is “normal” and sent on their way. Rarely is the hormonal context acknowledged. Rarely is the connection made between declining estrogen, tendon vulnerability, and altered load tolerance.

And almost never is the question asked: What does this body need now?

Reclaiming Choice, Reclaiming Care

The damage done by the WHI study extended far beyond hormone prescriptions. It shaped how pain in midlife women is interpreted, treated, and too often ignored.

Reclaiming that lost ground means restoring these truths:

• Hormone therapy is not dangerous by default

• Menopausal pain is not inevitable

• Strength, mobility, and resilience are still achievable

Physical therapy has a responsibility—and an opportunity—to be part of that correction. To validate symptoms. To educate without fear. And to help women rebuild trust in bodies that were never broken—just unsupported.

Physical Therapy in a Post-WHI World

Physical therapy often becomes the first place where these patterns are noticed—because PT lives in function, not lab values.

We see:

• Highly active women suddenly unable to tolerate walking or stairs

• Lateral hip pain mislabeled as inflammation rather than tendon overload

• Strength gains that plateau faster than expected

• Pain sensitivity that doesn’t match imaging findings

This is not weakness. It is not aging. It is physiology responding to a changed hormonal environment. Modern physical therapy recognizes that peri- and menopausal bodies require different loading strategies, longer recovery windows, and more intentional strength training—not less movement, not fear, and not dismissal. And critically, PT can coexist with hormone therapy. These are not competing approaches; they are complementary. Hormones influence tissue capacity. Physical therapy teaches those tissues how to tolerate load again.

How Physical Therapy Helps During Peri- and Menopause

Physical therapy for menopausal hip pain isn’t about aggressive stretching or generic strengthening. It’s about strategic loading, education, and restoring confidence in movement.

Key components often include:

1. Targeted Strength Training Gluteal and deep hip stabilizer weakness is common during hormonal transition. Progressive, well-dosed strength work helps tendons tolerate load again and reduces pain over time.

2. Tendon-Specific Loading Many cases of lateral hip pain are tendon-related rather than bursitis. Tendons respond best to controlled loading—not rest.

3. Mobility Where It Matters Rather than forcing range of motion everywhere, PT focuses on restoring mobility where restrictions are contributing to overload elsewhere.

4. Nervous System Down-Regulation Hormonal changes can heighten pain sensitivity. Breathing strategies, pacing, and education help calm the system and improve pain tolerance.

5. Lifestyle & Load Management Education Sleep position, walking volume, gym routines, and even sudden increases in activity all matter. Small adjustments can significantly reduce symptoms.

The Takeaway

Hip pain during peri- and menopause is common—but it is not something women should simply “put up with.” Hormonal changes affect how tissues behave, how pain is processed, and how the body responds to stress. Physical therapy sits at the intersection of these systems, offering evidence-based, individualized care that addresses both symptoms and root causes. If you’re navigating this stage of life and noticing new or persistent hip pain, consider it a signal—not of decline, but of a body asking for a smarter approach.

And that’s exactly where physical therapy shines.