Hip pain

It's the ache on the outside of your hip when you lie on that side at night. The stab going up stairs. The stiffness after sitting through a long meeting. New hip pain in midlife — especially on the outside, not deep in the groin — is one of the most under-named midlife hormone patterns, and it responds to specific loading, not rest.

Same underlying story as frozen shoulder and plantar fasciitis: estrogen-influenced tendon loss meeting a life that sits more.

Gluteal tendons lose some of their load tolerance. Estrogen supports the collagen quality and repair rate of tendons. In peri, the tendons at the greater trochanter (side of hip) become less tolerant of compression and prolonged loading. That's the classic 'hurts on the side, hurts at night, hurts on stairs' pattern.

The stabilisers weaken faster than the movers. Glute medius and minimus (the deep side-hip stabilisers) atrophy faster than the big prime-mover muscles when we sit more and lift less. The bigger muscles compensate, the tendon takes the load, and pain follows.

It's usually not the joint itself. Deep groin pain that's worse rotating the leg is a joint (hip osteoarthritis) conversation. Outside-of-hip, tender-to-lie-on pain is almost always tendon and bursa. The distinction matters because the fix is different.

Rest isn't the treatment. Weeks of avoiding steps and side sleeping make the tendon less tolerant, not more. Progressive isometric and heavy-slow-resistance loading is what actually works — the opposite of the instinct to protect it.

The evidence-based sequence is boring, unglamorous and works.

Isometric holds first, twice a day. Side-lying leg raises held at 30 degrees for 45 seconds, or wall-side hip pushes for 45 seconds, 3 rounds. Two weeks of this alone drops pain in most people. Not exciting. Highly effective.

Progress to heavy-slow strength. Once isometrics are pain-free, move to slow (3 seconds down, 3 seconds up) step-ups, hip abductions with a band, and single-leg glute bridges. Twice a week, six weeks minimum. This is the fix.

Stop crossing your legs and lying on the sore side. Both compress the tendon exactly where it is inflamed. Sleep with a pillow between the knees. Uncross at your desk. Small, cheap, real.

See a pelvic-aware physio, not a GP first. A physio who works with midlife people will get you on the right loading program in one visit. GPs often go to imaging and rest — worth naming this pattern by name (gluteal tendinopathy / GTPS) if you go that route.

MHT protects tendons over the long run. Estrogen therapy is associated with lower rates of frozen shoulder, tendinopathy and tendon rupture in observational data. Worth raising if this is one of several midlife tendon issues, not a first-line for pain alone.