Pain over the bony point of the hip, worse lying on that side at night, worse getting out of a car or climbing stairs. It is extremely common in women aged 40 to 60, it is usually not bursitis despite what it gets called, and the treatment most people are given is often the opposite of what helps.

Where we stand: Menova is an independent publication. We sell no treatments, we are not your doctor, and this is general education, not a diagnosis.

What it usually is

Gluteal tendinopathy — degeneration and irritation of the tendons of the gluteus medius and minimus where they attach to the outer hip. The umbrella term is greater trochanteric pain syndrome.

For decades this was labelled "trochanteric bursitis," implying an inflamed bursa. Imaging studies changed that: the tendon is the primary problem in the large majority of cases, and inflammation is not the main driver.

That correction matters, because it changes the treatment. Tendons respond to progressive load. Bursitis implies rest and anti-inflammatories.

The pattern

  • Pain over the bony point on the outside of the hip, sometimes running down the outer thigh
  • Worse lying on that side at night — this is the most characteristic feature, and it is why sleep suffers
  • Worse lying on the other side too, if the top leg falls across the body
  • Worse on stairs, standing on one leg, getting out of a car, and after sitting cross-legged
  • Tender to press on the bony point
  • Not usually groin pain — groin pain points at the hip joint instead

Why midlife women

The demographics are striking: it is several times more common in women than men, with a clear peak around the menopausal years.

  • Anatomy. A wider pelvis changes the angle of pull on these tendons and increases compression against the bone
  • Connective tissue changes. Tendons are collagen-rich, and midlife tendinopathies cluster for this reason — the same pattern as frozen shoulder and plantar fasciitis; see frozen shoulder in midlife and heel pain and plantar fasciitis
  • Loss of gluteal strength, which is near-universal with sedentary work
  • Sudden increases in walking or running, including the new fitness habit that seemed like a good idea

What actually helps

Progressive strengthening. The core of treatment. Gluteal strengthening — starting isometric, building to loaded work — has the best evidence, better than injection at longer follow-up in trials. It takes months, not weeks.

Stop compressing the tendon. This is the part nobody explains, and it is what makes the difference in the first fortnight:

  • Do not sleep on the painful side. If you must, a pillow under that hip
  • Sleep with a pillow between your knees so the top leg does not fall across the body — this single change resolves a lot of night pain
  • Do not stand with your weight hanging on one hip ("hip hitching") — a habitual posture worth noticing
  • Do not sit cross-legged, or with knees together and feet apart
  • Avoid deep hip stretches and foam rolling over the painful point. The classic ITB stretch and rolling the outer hip compress the tendon against the bone. They feel productive and make it worse. This is the most common self-inflicted mistake here
  • Avoid low chairs and deep squats early on

Load management. Reduce hill walking and long walks temporarily. Do not stop moving.

Physiotherapy. Worth it, because the exercise progression is specific and getting it wrong wastes months.

Corticosteroid injection gives short-term relief and performs worse than exercise at longer follow-up. Repeated injections risk tendon damage. Reasonable as a bridge to enable rehabilitation, poor as the whole plan.

Time. Three to six months of consistent work is normal. Stopping at week four because it has not resolved is why this becomes a two-year problem.

What else it could be

  • Hip joint osteoarthritis — groin pain, stiffness, reduced rotation, difficulty with socks and shoes
  • Referred pain from the lumbar spine — see back pain in midlife
  • Stress fracture of the femoral neck — worsening pain with activity, pain at rest, groin pain. This matters in midlife women with osteoporosis risk factors, low body weight, or a recent training increase; see bone health in menopause
  • Inflammatory arthritis, particularly with morning stiffness over an hour — see autoimmune conditions and menopause
  • Polymyalgia rheumatica — sudden shoulder and hip girdle pain and stiffness, typically over 50, with very different treatment
  • Meralgia paraesthetica — burning and numbness over the outer thigh, a nerve problem rather than a tendon one

Our wider guide is menopause joint pain.

Get it assessed if

  • Pain in the groin rather than the outer hip
  • Worsening pain that is present at rest, or night pain not related to lying on it
  • You cannot weight-bear
  • Pain after a fall, at any age with osteoporosis risk factors
  • Fever, or feeling unwell
  • Numbness, tingling or weakness in the leg
  • No improvement after three months of doing the exercises properly

Does HRT help?

No established evidence that hormone therapy treats gluteal tendinopathy, and it should not be started for it.

The clustering of tendon problems around menopause is suggestive and is an area of research interest rather than a demonstrated treatment. Data from the Women's Health Initiative and later analyses suggest hormone therapy may reduce joint pain generally — see HRT risks and benefits.

What will help regardless: strength training, which protects tendon, muscle and bone at once — see strength training in menopause and starting from zero.

Why the night pain matters more than it sounds

Being woken every time you roll over, for months, produces the same downstream effects as any other broken sleep: worse mood, lower pain threshold, and less capacity for everything else — and it is easily attributed to menopause when it is a mechanical problem with a mechanical fix.

The pillow-between-the-knees change costs nothing and is often noticeable within a week. Start there — see perimenopause sleep problems.

How to raise it

"I've had pain over the outer point of my right hip for four months, worst lying on that side at night and on stairs. No groin pain, no numbness. I've read this is usually gluteal tendinopathy rather than bursitis — could I have a physiotherapy referral for progressive loading?"

Naming the tendon rather than the bursa changes the treatment you are offered.

Our free printable visit prep sheet gives you a page for it, and the free 2-minute Menova self-check organizes your wider symptom picture — no account, not a diagnosis, and your answers never leave your device.

This article is general education, not medical advice or a diagnosis. Hip pain that is present at rest, prevents weight-bearing, follows a fall, or comes with fever should be assessed promptly by a licensed clinician.

Sources: NIAMS — Bursitis and Tendinitis, AAOS OrthoInfo — Hip Bursitis, The Menopause Society, and NHS — Hip Pain.