Is Menopause Causing Your Hip Pain?

When we think of menopause symptoms, the most common culprits first come to mind: hot flashes, night sweats, mood swings. But for many midlife women entering the menopause transition, joint pain—especially in the hips—can be an uncomfortable reality. 

Here’s what two menopause healthcare providers want you to know about menopausal hip pain.

What is menopausal hip pain?

For many women, generalized joint and muscle pain can arise during midlife, and during the menopause transition, says Judy Gardiner, a Menopause Society-certified nurse practitioner and medical director of the Midlife Women’s Health Clinic in Stratford, Ont. That includes hip pain, which can often present as a literal pain in the butt—usually laterally, or on the side of the hip. It can also show up in the form of morning stiffness, achiness or even new injuries.

Dr. Alison Shea, an ob-gyn and menopause specialist at Hamilton, Ont.’s McMaster University, estimates anywhere from 60 to 80 percent of menopausal people will experience some degree of joint or muscle pain. She points to a 2024 landmark research paper by American orthopedic surgeon Dr. Vonda Wright, which coins this constellation of symptoms as the musculoskeletal syndrome of menopause: “More than 70 percent [of] will experience musculoskeletal symptoms and 25 percent will be disabled by them through the transition from perimenopause to postmenopause,” she writes.   

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When menopause is responsible for these joint pains, it’s because of the chaotic fluctuations of hormones occurring in the body—particularly the drop in both estrogen and progesterone that comes with the late stages of perimenopause. “We know that estrogen has a nice effect on the musculoskeletal system,” says Gardiner; it particularly impacts the production of collagen in the body. Meanwhile, Shea notes, progesterone has anti-inflammatory properties. As these hormones decrease, tendons and ligaments stiffen and inflammation increases, leading to more aches and pains. Women also lose bone density during the menopause transition, which can increase joint pain.

How do you know if menopause is causing your hip pain?

It’s crucial to rule out any other causes first, stresses Gardiner. Because musculoskeletal pain is common in midlife—and has numerous other causes, like osteoarthritis, bursitis or even a vitamin D deficiency—she suggests a diagnosis of exclusion. That means talking to your doctor about your symptoms so that they can run tests—like blood work or an X-ray, for instance—to ensure no other ailments are leading to the hip pain. Treatment for the pain will vary depending on the cause.

How do you treat menopausal hip pain?

If other causes have been ruled out, hip pain caused by hormonal shifts can be treated in various ways. Depending on your personal history, Gardiner says a primary care provider can refer you to the appropriate specialists who can help, like physiotherapists. 

Though she cautions that it isn’t a cure-all, Gardiner also says menopause hormone therapy (MHT) can provide modest improvements in pain. This is an off-label use for MHT, meaning it isn’t approved by Health Canada as a treatment for hip pain specifically. But the small improvement in pain, Gardiner says, is often enough to get women well enough to incorporate other lifestyle changes that can help manage joint and muscle pain overall. “If we can improve you enough that now you’re going to start hitting the gym, you’re going to start looking at your nourishment in a different way, and you’re going to start working on your sleep, that’s our goal,” says Gardiner. Shea agrees, adding that she’s seeing plenty of new research into the relationship between joint pain and menopause.

Regular exercise is paramount in managing pain. Squats and deadlifts—mainstays in strength training—are great for working quads, hamstrings and glutes, says Gardiner. Other exercises like clamshells (lying on your side with your knees bent and stacked, lift your top knee toward the ceiling with your feet together) and monster walks (in a slight squat, step sideways with your legs spread apart) can target the sides of your glutes and hips, which aren’t often triggered in everyday movement.

For milder pain, Shea says over-the-counter pain killers like NSAIDs like ibuprofen or aspirin can help alleviate symptoms. Anti-inflammatory diets, whether plant-based or the Mediterranean diet, can also help in managing pain.

How can you approach your doctor about hip pain?

When Gardiner began her menopause transition in 2022, she felt like she wasn’t being heard by her primary care providers—so much so that she worked to become certified by the Menopause Society to help other women avoid a similar experience. That’s why, she stresses, it’s so key to advocate for yourself in the doctor’s office. 

Come with specifics: when the pain started, how it presents (for instance, what aggravates the pain and what makes it feel better) and how severe it is. This will help your primary care provider narrow down potential causes to explore and what testing to order, Gardiner says. And if you don’t feel your primary care provider can offer the kind of specialized treatment you need, don’t feel afraid to ask for a referral to someone who can.

Shea recommends using the Menopause Foundation of Canada’s symptom tracker, which includes musculoskeletal pain. Coming to an appointment armed with a list of your symptoms can help your doctor better understand your menopausal experience.