Hip Pain and Menopause: Why It Is Not Just About Getting Older (And What Actually Helps)

I was bent nearly 90 degrees just to walk ten steps. Every chair was a negotiation. Getting in and out of a car was an event. A surgeon told me he wanted to operate but could not guarantee any relief from the pain.

I did not have surgery. I learned to manage this condition. And ten years later I am still pain free.

What I had was gluteal tendinopathy. What made it worse was everything the wellness world told me to do about it, including stretching. Here is what the research now tells us and what I wish I had known at the time.

What Is Gluteal Tendinopathy?

Gluteal tendinopathy is an injury to the tendons that attach the gluteal muscles to the top of the femur at the greater trochanter. It produces deep, localized pain in the outer hip and buttock that is aggravated by prolonged sitting, crossing the legs, walking uphill, and yes, yoga.

It is one of the most common causes of hip pain in women over 40, and it is frequently misdiagnosed as bursitis. That distinction matters because the treatments are not the same. Corticosteroid injections, commonly used for bursitis, do not address tendon damage and can actually weaken the tendon further with repeated use. [1]

Why Menopause Makes You More Vulnerable

This is where the research has expanded significantly in recent years, and it is information every perimenopausal and postmenopausal woman deserves to have.

Estrogen is not just a reproductive hormone. It plays a critical role in maintaining tendon and connective tissue health. Research funded by the National Institutes of Health found that the transition through menopause is a significant risk factor for tendinopathies, and that estrogen is vital for maintaining the extracellular matrix of tendon tissue. [2] When estrogen levels decline, collagen synthesis decreases, tendon integrity is compromised, and the tissue becomes less resilient and more susceptible to injury.

A randomized controlled trial published in PubMed examined 132 postmenopausal women with gluteal tendinopathy and found that menopausal hormone therapy combined with tendon-specific exercise produced better outcomes than exercise alone, particularly in women with a healthy body mass index. [3]

This does not mean hormone therapy is the answer for everyone. It means that the hormonal context of menopause is a real and clinically relevant factor in gluteal tendinopathy, not just background noise, and that treatment approaches need to account for it.

Why Stretching Is Making It Worse

Here is the part that goes against everything yoga culture teaches.

When we feel tightness and pain, we stretch. It is instinctive. In the case of gluteal tendinopathy, it is also counterproductive.

The tightness associated with this condition is not a flexibility problem. The tendons have lost strength and resilience. They are already operating under excessive load. Stretching an already compromised tendon adds tensile stress to tissue that cannot handle it. It may feel temporarily satisfying, like a release, but it is loading an injured structure in the way most likely to aggravate it.

Pigeon pose. Garland pose. Cow face pose. These are among the most commonly recommended hip openers in yoga. For someone with gluteal tendinopathy, performed passively with the goal of releasing the glutes, they can make things significantly worse.

The key is not avoiding these poses entirely. It is understanding how to use them. Pressing the mat away, activating the glutes rather than releasing them, turning a stretch into a strengthening opportunity, changes everything. The pose becomes a tool for rebuilding rather than a source of further damage.

What the Research Says About Treatment

The clinical consensus is clear. Education and progressive loading are the primary recommended approach for gluteal tendinopathy. [1] Rest alone does not work. Passive stretching does not work. What works is rebuilding the strength and load capacity of the tendon and the entire gluteal system around it.

This means glute strengthening as a foundation. Bridges, single-leg variations, controlled hip hinging. Isometric holds early in recovery, when the tendon needs load without compression. Eccentric loading as the tendon rebuilds capacity.

It also means understanding compression avoidance. Sitting with the legs crossed, sitting on low surfaces, forward-folding with straight legs, all of these positions compress the tendon against the bone. Reducing compressive load while rebuilding strength is the clinical framework that consistently produces results. [3]

What I Changed and What Happened

When I stopped trying to stretch my way out of the pain and started strengthening instead, things began to shift. It was not overnight. Tendon healing takes time, weeks to months depending on severity. But the trajectory changed completely once I stopped doing the things that were aggravating the tissue and started doing the things that rebuilt it.

This is the principle behind everything I teach. Pain is most often a strength problem. Your body is not asking you to go deeper. It is asking you to get stronger.

If you are dealing with outer hip pain, especially if you are in perimenopause or postmenopause, have your hormonal context evaluated. Work with a physiotherapist who understands tendinopathy. Modify your yoga practice to emphasize activation over passive release. And give the tissue the time it needs to heal.

If you want to start right now, download my free No More Hip Pain guide. It gives you Stage One of my Hip Strength program and the same activation-first approach I use with every student dealing with this.

You do not have to live with this pain. But you do have to approach it differently than you have been told.

About Vikky Santana

Vikky Santana is a yoga teacher with 38 years of practice, 16 years teaching and over 13,000 teaching hours. She specializes in yoga for women over 50 with chronic pain, physical limitations, and injury histories. She is the founder of Vikky Santana Yoga at vikkysantana.com.

Download the free No More Hip Pain guide.

References

1. National Institutes of Health. Treatment of Proximal Hamstring Tendinopathy with Individualized Physiotherapy: A Clinical Commentary. PMC. 2024.

2. National Institutes of Health. The Impact of Genistein Supplementation on Tendon Functional Properties and Gene Expression in Estrogen-Deficient Rats. PMC. 2020.

3. PubMed. Does Menopausal Hormone Therapy, Exercise, or Both Improve Pain and Function in Postmenopausal Women With Greater Trochanteric Pain Syndrome? A Randomized Controlled Trial. 2022.