Common around the menopause, but usually a specific, treatable causeMixed evidence
The NHS lists muscle aches and joint pains among the symptoms of perimenopause and the menopause, and NICE lists joint and muscle pain; neither names the hip. No study has compared hip pain before and after the last period with age taken into account, and a review of hormone supplements and tendons found the results "contradictory and inconsistent". NHS inform says hormone changes "may also influence" outer hip tendon pain. So most hip pain at this age has a specific cause, the same as at other ages, and those causes are treatable.
Sources 1, 2, 3, 4
The outer hip tendons: the classic midlife causeStrong evidence
Greater trochanteric pain syndrome is pain over the bony point on the outside of the hip, usually from the gluteal tendons rather than the fluid-filled sac (the bursa), which is why it's often called hip bursitis. NHS inform says it's "more common in females and in those aged between 40 and 60 years old but can affect any age", and an NHS trust leaflet says the same. In 3,026 US adults aged 50 to 79 with, or at risk of, knee arthritis, it affected one hip in 15.0% of women and 6.6% of men, with no rise between 50 and 79; that group wasn't a general population sample. In Dutch general practice, 1.8 people per 1,000 a year were newly diagnosed, 79.9% of them women, with an average age of 55.
It hurts to lie on that side, climb stairs, stand on one leg (getting dressed), cross your legs, or get in and out of a car or bed. In the main trial of outer hip pain, the LEAP trial, 117 of the 167 women were perimenopausal or past the menopause.
Sources 4, 5, 6, 7, 8, 9
Hip arthritis, and what X-rays do and don't showMixed evidence
New hip arthritis was commoner in women than in men in a meta-analysis (men's rate about two thirds of women's), though the difference in how many people have it at any one time was clear only for the knee and hand. NICE diagnoses osteoarthritis from your symptoms from 45, without imaging, when activity brings on joint pain and morning stiffness lasts 30 minutes or less: typically groin, front of thigh or buttock pain, stiff after rest and worse walking, with socks and shoes getting harder.
Scans and pain often disagree. In US cohorts, only 15.6% of frequently painful hips showed arthritis on X-ray, and only 20.7% of hips with arthritis on X-ray were frequently painful. Gluteal tendon changes showed on MRI (magnetic resonance imaging) in all 16 women with outer hip pain and in 88% of 17 women without hip pain, a small study. A scan result on its own doesn't explain your pain.
Sources 10, 11, 12, 13
Your bones change fastest around the last periodStrong evidence
In the Study of Women's Health Across the Nation (SWAN), 862 US women lost 9.1% of the bone density at the top of the thigh bone over 10 years, 5.8% of it between a year before and two years after the final period, and 10.6% at the spine. The NHS says women "lose bone rapidly in the first few years after the menopause", more so after an early menopause (before 45) or removal of the ovaries, and that osteoporosis "is not usually painful until a bone is broken".
About 1 in 2 women over 50 will break a bone because of osteoporosis in their lifetime, the Royal Osteoporosis Society and the UK osteoporosis guideline (NOGG) say. A broken hip is mostly a later-life event: of 65,133 people aged 60 and over who broke a hip in England in 2024, 69.0% were women and the average age was 82.4. NICE asks GPs to assess fracture risk in women past the menopause who have broken a bone in a minor fall or take long-term steroid tablets, and to consider it from 65, or earlier with risk factors such as 2 or more falls in a year, a parent's broken hip, smoking, more than 14 units of alcohol a week, an untreated early menopause or breast cancer tablets called aromatase inhibitors.
Sources 14, 15, 16, 17, 18, 19
Pain felt in the hip that starts elsewhereEmerging evidence
NHS inform says hip problems can come from the back "even though you don't feel pain in your back", often as pins and needles or a sharp, hot or burning pain. The two often go together: in a US spine centre, 20.2% of people referred with low back pain had outer hip tendon pain instead, and about half of 273 people seen for worn spine problems had it too, more often women.
A femoral hernia is a small, grape-sized lump in the groin at the top of the thigh: the NHS says "Femoral hernias mainly happen in women over 50 years old. They can happen to anyone". Polymyalgia rheumatica stiffens both hips and shoulders for more than 45 minutes every morning, mostly in people over 65; it's very rare under 50. Rarely, bone pain that is constant or worse at night, with weight loss or a lump, comes from a cancer, and very low vitamin D can soften the bones (osteomalacia), with pain in the back, pelvis or legs and weak thigh muscles.
Sources 20, 21, 22, 23, 24, 25, 26, 27
When a scan or test helpsStrong evidence
The outer hip tendons and hip arthritis are diagnosed by examination; NICE doesn't routinely use imaging for osteoarthritis unless something doesn't fit, and the LEAP trial used MRI to confirm the diagnosis for research, not for everyday care. After a fall, X-rays come first, and a broken hip needs urgent care.
A DXA (dual-energy X-ray absorptiometry) bone density scan is part of a fracture risk assessment: NICE offers it after a broken hip or spine from thin bones, or another major fragility fracture, such as the wrist or shoulder, in the last 2 years, and considers it when the 10-year risk of a major fracture is 10% or more. It measures bone, not pain. Blood tests answer specific questions, such as inflammation markers when polymyalgia rheumatica is suspected and vitamin D and calcium when osteomalacia is. An MRI helps when hip or groin pain hasn't settled and the X-ray is normal, or before surgery for a tendon tear.
Sources 11, 9, 28, 19, 15, 25, 27
How it usually goesStrong evidence
The outer hip is slow but usually improves. NHS inform says it "can often take 6 to 12 months of rehabilitation to settle", with flare-ups, and an NHS trust expects improvement after 8 to 12 weeks of the right exercises and small changes, with some people taking up to a year. In Dutch general practice, at least 36% still had pain after a year. Hip arthritis changes slowly, over years; exercise eases it a little while you keep it up.
Bone loss slows from about 2 years after the last period but doesn't stop, and HRT's protection for bone fades once it's stopped. The NHS says menopause symptoms usually last 7 to 9 years, sometimes longer. No one can promise a timescale.
Sources 4, 5, 7, 9, 11, 14, 2, 1
