Perimenopause Hip Pain: Why the Side of Your Hip Hurts at Night
Written by Cathy — Founder, Vibrance Way | 14th October 2026 · 11 min read · Fact-checked against primary sources, peer-reviewed research only
My perimenopause hip pain came and went, a dull ache on the outside of my left hip that showed up at night. I couldn't sleep on my left side, and I brushed it off, sure I'd just slept too long in one position. But the next day the same uncomfortable ache was still there, and it made driving difficult. After three days it stopped, and then, not long after, it came back.
A quick, honest note before we go further. I'm not a doctor, physiotherapist or any kind of licensed clinician. I'm a 43-year-old woman in perimenopause who reads the primary research obsessively, tries things on herself and tells you what she finds, including what didn't work. Please treat this guide to perimenopause hip pain as a well-researched starting point for a conversation with your own clinician, not a diagnosis. |
Key Takeaways
A 2007 study of 3,026 adults aged 50 to 79 found pain on the outside of the hip (greater trochanteric pain syndrome) in 23.5% of women, compared with 8.5% of men.
In a 2017 study, pain within 30 seconds of standing on the sore leg identified MRI-confirmed tendinopathy with 100% specificity.
In the 2018 LEAP trial in the BMJ, 77% of people improved at 8 weeks with education plus exercise, compared with 58% after a steroid injection and 29% who waited.
A 2022 trial found hormone therapy cream helped hip tendon pain only in women with a BMI under 25, so it is a possible add-on, not a standalone fix.
Every group that improved in these trials was taught to avoid positions that squash the tendon.
The short answer: Perimenopause hip pain on the outside of the hip is usually gluteal tendinopathy. Falling estrogen may weaken the tendons there. Lying on that side squashes the tendon, so it hurts at night. Education and targeted exercise work better than a steroid injection long term.
What Is Perimenopause Hip Pain, Really?
I assumed my hip was "wearing out." I was wrong about where the pain was coming from. Most perimenopause hip pain on the outer side isn't the joint at all. It comes from tendons.
Your gluteus medius and minimus muscles hold your pelvis level when you walk. Their tendons attach to a bony bump on the side of your thigh bone. That bump is called the greater trochanter. When those tendons get irritated, the outside of your hip aches.
Doctors call this greater trochanteric pain syndrome. Many people still know it as hip bursitis. Segal studied it in a 2007 paper in the Archives of Physical Medicine and Rehabilitation. It affected 23.5% of women aged 50 to 79. Only 8.5% of men had it. Women had more than three times the odds.
It also clusters in midlife. Mellor's team wrote the LEAP trial protocol. They describe it as most common in women aged 40 to 60. That is perimenopause, almost exactly.
After months of this on-and-off pain, I started searching for answers.
What this means practically: Pain outside the hip, not the groin? Ask your clinician about gluteal tendinopathy by name. 🟢 Strong evidence (RCT/meta-analysis) |
Why Estrogen Loss Affects Your Hip Tendons
This is the part that made the timing make sense to me. Tendons are mostly collagen, which estrogen helps maintain. When estrogen becomes erratic and then falls, tendons may lose resilience.
A 2026 systematic review in the Muscles, Ligaments and Tendons Journal by Tidd and Shrestha pooled 19 studies. It found estrogen deficiency was linked to altered collagen turnover, reduced tendon elasticity and weaker healing. In the authors' words: "Estrogen signaling influences tendon structure and function across molecular, biomechanical, and clinical domains." — Tidd, Muscles, Ligaments and Tendons Journal, 2026
That review mixes human, animal and laboratory studies, though. Ganderton and colleagues in BMC Women's Health, who designed the main hormone trial, called the human evidence limited and inconsistent. Estrogen is a strong suspect, not a proven cause.
What we do know is that hip tendons don't suffer alone. A 2024 paper in Climacteric by Wright and colleagues named the "musculoskeletal syndrome of menopause." It reported that more than 70% of women have musculoskeletal symptoms across the transition, and about a quarter are disabled by them. If your hip flares at the same time as your other joints, my piece on why perimenopause makes your joints ache covers the wider picture.
I started logging my hip pain alongside my cycle. The worst weeks lined up with my most irregular, low-estrogen stretches.
What this means practically: Treat a new tendon pain in your 40s as a signal to protect and strengthen that tissue, not just to rest it. 🟡 Emerging evidence (small studies, n<200) |
Why Your Hip Hurts at Night When You Lie on Your Side
This is the symptom that sends most of us searching at 3am. The explanation is mechanical.
The LEAP trial protocol in BMC Musculoskeletal Disorders by Mellor notes that "the pain experienced in side lying often creates significant sleep disturbance." — Mellor, BMC Musculoskeletal Disorders, 2016. The same researchers explain why: when your thigh is pulled across your body's midline (a position called hip adduction), the gluteal tendons are pressed hard against the bone. Lying on the sore side squashes them directly. Lying on the other side can let your top knee drop across your body into that same squashed position.
The same thing happens when you cross your legs, stand with your weight hanging into one hip, or sit in a low, soft sofa. The protocol even warns that common iliotibial band (ITB) and piriformis stretches put the hip into that high-compression position, so the researchers left them out of their exercise programme.
If night waking was already a problem before your hip joined in, read why you wake at 3am in perimenopause. |
A firm pillow between my knees, plus a folded towel under my waist, was the first thing that let me sleep through on my "good" side.
What this means practically: Sleep on your back or your pain-free side with a pillow between your knees, and stop doing ITB stretches. 🔵 Expert consensus (clinical agreement, limited RCT) |
Gluteal Tendinopathy or Hip Arthritis? The 30-Second Test
Hip arthritis usually hurts in the groin or front of the hip. Gluteal tendinopathy hurts on the outer side, over that bony point.
A 2017 study in the British Journal of Sports Medicine by Grimaldi compared simple clinical tests against MRI in 65 people with outer hip pain. Pain that came on within 30 seconds of standing on the affected leg had 100% specificity for MRI-confirmed tendinopathy. And if pressing on the bony point wasn't tender, tendinopathy was unlikely. The sample was small, so treat this as a strong clue rather than a diagnosis.
Segal also found outer hip pain travels with other problems: 2.79 times the odds with low back pain, and 3.47 times with same-side knee osteoarthritis.
See a clinician promptly for hip pain after a fall (bone density drops in perimenopause, as I explain in the silent bone loss nobody warns you about), pain with fever, pain that is severe at rest regardless of position, or unexplained weight loss.
I tried the single-leg stance against my kitchen counter for safety. The ache arrived at about 20 seconds, which is what finally got me to book a physio.
What this means practically: Stand on the sore leg for 30 seconds, holding a counter for balance. If the outer hip hurts, mention it to your clinician. 🟡 Emerging evidence (small studies, n<200) |
Cortisone Injection or Exercise for Hip Pain?
Almost every friend I asked about "hip bursitis" had been offered a cortisone injection. The best trial we have suggests that isn't the strongest first move.
The 2018 LEAP trial in the BMJ by Mellor randomised 204 people with gluteal tendinopathy, 167 of them women, with an average age of 54.8. They got either education plus exercise, a single steroid injection, or a wait-and-see approach. At 8 weeks, 77% of the education-and-exercise group reported improvement, compared with 58% after injection and 29% of those who waited. At 52 weeks, the figures were 78%, 57% and 52%. The authors concluded: "These results support EDX as an effective management approach for gluteal tendinopathy." — Mellor, BMJ, 2018 (EDX is their abbreviation for education plus exercise.)
The injection did help in the short term, and pain scores at one year were similar for both active treatments. But on overall improvement, education plus exercise beat the injection at both time points. The programme combined advice on avoiding tendon compression with progressive strengthening for the hip muscles.
I asked my physio for a loading programme before agreeing to an injection. Week three was the turning point for me.
What this means practically: Ask for a physiotherapist-led education and progressive strengthening programme first, and treat an injection as a short-term option, not the plan. 🟢 Strong evidence (RCT/meta-analysis) |
What Helps Perimenopause Hip Pain Day to Day
Education turns out to be powerful on its own. I found that the most reassuring part of the research.
A 2018 trial in the Journal of Women's Health by Ganderton tested 94 postmenopausal women. Everyone learned how to avoid squashing the tendon. Half did targeted hip exercises. Half did sham exercises. Both groups improved at 12 weeks and 52 weeks. There was no difference between them.
Daily habits seem to do much of the work. Here is the compression principle in daily life:
Don't cross your legs when sitting.
Don't stand with your weight hanging into one hip.
Choose higher, firmer chairs over low, sinking sofas.
Sleep on your back or your pain-free side.
Put a pillow between your knees when lying on your side.
Skip ITB and piriformis stretches for now.
Keep walking, but break long walks into shorter ones while it settles.
Strength still matters for the long run. Midlife muscle loss makes the hip muscles work harder. My guide to why you're losing strength in perimenopause explains how to rebuild it. And if your old workouts suddenly hurt, read why your old workout stopped working.
Uncrossing my legs was the hardest habit to break. I put a sticky note on my desk for two weeks.
What this means practically: Change two habits this week. Start with crossed legs and sleep position. Keep going for eight weeks. 🔵 Expert consensus (clinical agreement, limited RCT) |
Does HRT Help Hip Tendon Pain?
The honest answer: maybe, for some women.
The 2022 GLoBE trial in the American Journal of Sports Medicine by Cowan randomised 132 postmenopausal women with outer hip pain to hormone therapy cream or placebo cream, and to targeted or sham exercise. Everyone also got education on avoiding tendon compression. All groups improved. Overall, the hormone cream didn't separate from placebo, but in women with a BMI under 25, those using it had better pain and function scores at 12 and 52 weeks.
That is a subgroup finding, and the groups weren't perfectly matched at the start, so it needs confirming. One untested idea is that a higher BMI reduces how much hormone is absorbed through the skin. If you're already weighing HRT for hot flushes, sleep or bone health, start with the HRT evidence that changed everything. Hip tendons could be one more factor in that conversation.
I raised this with my doctor as a "bonus" question. We agreed the tendon argument alone wasn't enough to start HRT.
What this means practically: Ask whether hormone therapy suits you for your overall symptoms, and see any hip benefit as a possible extra alongside education and exercise. 🟡 Emerging evidence (small studies, n<200) |
Frequently Asked Questions About Perimenopause Hip Pain: Why the Side of Your Hip Hurts at Night
Can perimenopause cause hip pain?
Perimenopause doesn't directly cause hip pain, but it coincides with the peak years for gluteal tendinopathy, which is most common in women aged 40 to 60. Falling estrogen may weaken tendon collagen and slow healing. The evidence is strongest for tendon pain on the outside of the hip.
Why does my hip hurt at night when I lie on my side?
Lying on the sore side presses the gluteal tendons directly against the bone. Lying on the other side lets your top leg drop across your body, which also compresses them. A pillow between your knees, or sleeping on your back, reduces that pressure.
Is hip bursitis the same as gluteal tendinopathy?
They are closely related, and the terms are often used interchangeably. Research now shows that most outer hip pain comes from irritated gluteal tendons rather than an inflamed bursa. The umbrella term is greater trochanteric pain syndrome.
Is a cortisone injection or exercise better for hip bursitis?
In the 2018 LEAP trial, education plus exercise led to improvement in 77% of people at 8 weeks, versus 58% after an injection. At one year, 78% had improved with education and exercise versus 57% with the injection. An injection can ease pain in the short term, but it isn't the strongest long-term option.
Does HRT help hip pain in menopause?
A 2022 trial found hormone therapy cream improved hip tendon pain only in women with a BMI under 25. It is not proven as a standalone treatment. It may be a reasonable add-on if you're already considering HRT for other symptoms.
How long does gluteal tendinopathy take to heal?
In the LEAP trial, most people doing education plus exercise had improved by 8 weeks, and it held at one year. Tendons adapt slowly, so plan on two to three months.
The Bottom Line
Perimenopause Hip Pain: Why the Side of Your Hip Hurts at Night - hip pain on the outside of the hip is most often gluteal tendinopathy, a tendon problem that peaks in women aged 40 to 60 and may be made worse by falling estrogen. The best evidence says to stop squashing the tendon, especially in bed and when sitting, and to build hip strength gradually. A cortisone injection can buy short-term relief, but education plus exercise did better over a year, and hormone therapy is a possible extra for some women. At Vibrance Way I'll keep tracking the tendon research.
If you take one thing from this, uncross your legs tonight and put a pillow between your knees. It's the cheapest experiment in this whole article.
From the Vibrance Way Perimenopause Series
Perimenopause Joint Pain
🔗Perimenopause Joint Pain: Why Your Joints Ache and What Actually Helps
Perimenopause Muscle Loss:
🔗Perimenopause Muscle Loss: Why You're Losing Strength and What to Do
Perimenopause Exercise
🔗Perimenopause Exercise: Why Your Old Workout Stopped Working
Perimenopause Protein
Perimenopause Frozen Shoulder
Perimenopause Bone Loss
HRT in Perimenopause
References
Segal, N. A., et al. Greater trochanteric pain syndrome: epidemiology and associated factors. Archives of Physical Medicine and Rehabilitation. 2007. https://doi.org/10.1016/j.apmr.2007.04.014
Mellor, R., et al. 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. https://doi.org/10.1136/bmj.k1662
Mellor, R., et al. Exercise and load modification versus corticosteroid injection versus 'wait and see' for persistent gluteus medius/minimus tendinopathy (the LEAP trial): a protocol for a randomised clinical trial. BMC Musculoskeletal Disorders. 2016. https://doi.org/10.1186/s12891-016-1043-6
Grimaldi, A., et al. Utility of clinical tests to diagnose MRI-confirmed gluteal tendinopathy in patients presenting with lateral hip pain. British Journal of Sports Medicine. 2017. https://pubmed.ncbi.nlm.nih.gov/27633027/
Ganderton, C., et al. Gluteal loading versus sham exercises to improve pain and dysfunction in postmenopausal women with greater trochanteric pain syndrome: a randomized controlled trial. Journal of Women's Health. 2018. https://doi.org/10.1089/jwh.2017.6729
Cowan, R. M., et al. Does menopausal hormone therapy, exercise, or both improve pain and function in postmenopausal women with greater trochanteric pain syndrome? A 2x2 factorial randomized clinical trial. The American Journal of Sports Medicine. 2022. https://doi.org/10.1177/03635465211061142
Wright, V. J., Schwartzman, J. D., Itinoche, R., Wittstein, J. The musculoskeletal syndrome of menopause. Climacteric. 2024. https://doi.org/10.1080/13697137.2024.2380363
Tidd, M., Shrestha, M. Postmenopausal estrogen deficiency and tendon degeneration: a systematic review. Muscles, Ligaments and Tendons Journal. 2026. https://www.ejcrim.com/index.php/mltj/article/view/6292
Ganderton, C., et al. 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 (protocol). BMC Women's Health. 2016. https://doi.org/10.1186/s12905-016-0311-9
Side-of-hip pain that wakes you at night is often a tendon problem, and it's very common in perimenopause. | Vibrance Way
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