Why Women Are More Prone to Hip Pain

Lateral hip pain, often caused by gluteal tendinopathy or trochanteric bursitis, is significantly more common in women than men. Research suggests that women are two to four times more likely to develop this condition, especially during pregnancy and menopause. This gender disparity isn’t just a coincidence — it’s the result of biomechanical, anatomical, and hormonal differences that make women more susceptible to issues affecting the hip tendons and bursa. As PTs from the best physical therapy in austin can share, there are a few key components that cause this:

How Estrogen Affects Tendon Health

One of the biggest reasons women experience more hip tendinopathy and bursitis than men is the influence of estrogen on connective tissues. A woman’s hormones actually fluctuate daily. However, through specific time periods and events in a woman’s life, hormones are either at an all time high or an all time low. Each hormone plays a very specific role in supporting the body, and for women one of the most important hormones is estrogen.

Estrogen Helps Maintain Tendon Strength and Flexibility

Estrogen plays a crucial role in:

Collagen production – Collagen is the main protein that gives tendons and ligaments their strength and elasticity.
Tendon metabolism – Estrogen helps regulate how tendons repair and adapt to stress.
Inflammation control – Estrogen has anti-inflammatory properties, which help prevent excessive swelling in tendons and bursae.

But during pregnancy and menopause, estrogen levels drop, leading to:

Reduced collagen production, making tendons more prone to microtears.
Slower tendon healing, increasing the likelihood of chronic pain.
Increased inflammation, contributing to bursitis and tendinopathy.

This means that as estrogen declines, tendons become weaker, stiffer, and more prone to injury — especially in areas like the gluteal tendons, which stabilize the hip joint. That is why it is important to consult with a medical professional if you are going through either pregnancy or menopause as they can help direct you to what can boost estrogen levels to prevent damage. It is also encouraged to seek physical therapy so that you can train your hips to be stronger.

The Biomechanical and Anatomical Differences That Increase Risk

In addition to hormonal influences, women’s skeletal structure and movement patterns contribute to their increased likelihood of developing lateral hip pain. In fact, a recent study found that 24% of women complained of hip pain as affected by their body’s structures versus only 9% of men who complained of hip pain.

Wider Hips and the Q-Angle Effect

One major factor is the wider pelvis that women have compared to men. This increases what’s called the Q-angle — the angle at which the femur (thigh bone) meets the pelvis. It should be noted that this is something natural. Women are born with a pelvis that is wider than a man’s and it is not something that happens over time.

A wider Q-angle leads to:

Increased stress on the gluteal tendons, causing more tension and friction where they attach to the hip bone.
A higher likelihood of hip instability, requiring the gluteal muscles to work harder to maintain balance.
Greater mechanical load on the trochanteric bursa, increasing the risk of bursitis.

Gluteal Muscle Function and Weakness

Women, particularly as they age, tend to have weaker gluteus medius and minimus muscles, which are responsible for stabilizing the hip.

In men, the gluteal tendons are thicker and stronger, providing better support.
In women, gluteal tendons are thinner and more vulnerable to overload and degeneration.

As a result, the tendons in women are more prone to developing microscopic tears, leading to tendinopathy and pain. There might seem to be a lot of big, fancy words in there but the takeaway is this: the way women’s hips work automatically puts them at more risk for hip pain. Your hips provide support to your entire body, but unfortunately that puts a large amount of strain on them which they may not be able to handle over time.

How Pregnancy and Menopause Specifically Affect the Hip

Pregnancy: The Impact of Relaxin and Postural Changes

During pregnancy, the body produces relaxin, a hormone that helps loosen ligaments and tendons to prepare for childbirth.

However, relaxin doesn’t just affect the pelvis — it also weakens the gluteal tendons, making them more susceptible to:

Overuse injuries due to the extra weight of pregnancy.
Excessive stretching, which alters the way forces are transmitted through the hip.
Increased friction on the bursa, contributing to bursitis.

Additionally, the growing belly shifts the center of gravity forward, which:

Increases stress on the lower back and hips.
Causes weaker glute activation, leading to poor hip control.
Forces the gluteal tendons to absorb more strain, leading to irritation and pain.

Menopause: The Effects of Estrogen Decline on Tendon Degeneration

Menopause marks a significant decline in estrogen, which results in:

Reduced tendon elasticity, making them stiffer and more prone to injury.
A slower repair process, meaning small tendon injuries accumulate over time.
A higher inflammatory response, increasing pain and discomfort.

Because the gluteal tendons already experience high levels of mechanical stress, these age-related changes accelerate tendon degeneration and increase the likelihood of chronic hip pain. This might sound scary, but even with age or pregnancy things can be done to help keep your hips strong such as physical therapy. The best part about PT is that it can be done preventatively too. If you hope to get pregnant in the future, you can start working with a physical therapist on exercises to strengthen your body. It works the same for aging too!

How Aging and Activity Levels Contribute

Loss of Muscle Mass (Sarcopenia) in Women

As women age, they experience sarcopenia, or the natural loss of muscle mass.

Women tend to lose muscle at a faster rate than men, partly due to hormonal differences.
Less muscle support means more strain on tendons, which can lead to chronic irritation and pain.
The gluteal tendons, responsible for hip stability, become overloaded, increasing the risk of lateral hip pain.

Differences in Physical Activity Between Men and Women

Physical activity plays a huge role in maintaining muscle and tendon health.

Women, especially postmenopausal women, tend to engage in less high-intensity resistance training than men.
Strength training is crucial for maintaining gluteal tendon integrity, and without it, tendons become weaker and more prone to injury.

Additionally, women are more likely to participate in activities that involve repetitive movements (such as long-distance walking or running), which can contribute to overuse injuries in the hip tendons. That is not to say that you should not walk or run — keep doing that! When you start to notice your hip bothering you during or after those activities, that is when it is time to contact a physical therapist to work on strengthening those muscles that may have lost some mass over time.

Why Men Are Less Affected

In contrast, men have several protective factors that make them less prone to lateral hip pain:

Stronger and thicker tendons – Due to higher testosterone levels, men naturally develop denser, more resilient tendons that resist overuse injuries.
A narrower pelvis and lower Q-angle – This means that the gluteal tendons experience less strain in daily activities.
Greater muscle mass and strength – Stronger glute and hip muscles provide better support and stability, reducing stress on tendons and bursae.
Less hormonal fluctuation – Without the drastic estrogen decline seen in menopause, men’s tendons remain more stable over time.

Of course, men still experience hip pain but it is often for different reasons. Even though a man and woman may experience the same type of pain, it must be treated accordingly because the cause of it is different in each person.

The Interplay of Hormones, Anatomy, and Lifestyle

Lateral hip pain in women is not the result of a single factor — it’s a complex interplay of:

Hormonal changes (estrogen decline weakens tendons and increases inflammation)
Biomechanical factors (wider hips and higher Q-angles put more stress on tendons)
Muscle loss with age (weaker glutes mean tendons absorb more force)
Lifestyle choices (less strength training and repetitive activities can lead to overuse injuries)

This combination makes women — especially those who are pregnant or menopausal — far more likely to develop chronic hip pain than men.

Women, especially during pregnancy and menopause, face a higher risk of lateral hip pain due to hormonal shifts, anatomical differences, and biomechanical factors. Again, as a recap the factors that affect this are due to:

Estrogen plays a key role in maintaining healthy tendons, and its decline leads to tendon weakening and inflammation.
A wider pelvis and higher Q-angle increase mechanical stress on the gluteal tendons.
Pregnancy-related hormones like relaxin further weaken the hip’s stabilizing structures.
Menopause accelerates tendon degeneration, making chronic hip pain more likely.

With all that being said…have you noticed your hips hurting? When you sit too long in a chair, do you feel uncomfortable? Do walks leave your hips aching afterwards?

If you answered yes to any of these questions, then you might have tendinopathy with hip bursitis. A physical therapist can help. Schedule a FREE discovery session today with our team at Move Empower Concierge Physical Therapy. One of our physical therapists will determine what is causing your pain, and they will create a customized treatment plan just for you. Stop letting hip pain keep you from doing what you love, contact us today!