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How the menopause can predispose you to gluteal tendinopathy

Many women (and medical practitioners) don’t realise that women who are going through the menopause are at a higher-than-normal risk of developing gluteal tendinopathy, which is one of the typical causes of greater trochanteric pain syndrome, also known as outside hip pain or lateral hip pain. This article explains how the menopause can cause gluteal tendinopathy, how to avoid this during menopause, and what the best treatment approach for gluteal tendinopathy is. Remember, if you need more help with an injury, you're welcome to consult our team of sports physios online via video call.



In this article:

The anatomy of the gluteal tendons


One of the most common causes of pain round the outside (lateral side) of the hip is gluteal tendinopathy, which is when the tendons that attach your gluteal muscles to the top of your femur, where it protrudes from your hip socket, get injured or irritated due to overuse.


More often than not, it is the gluteus medius tendon that is the culprit, but it can also be the gluteus maximus (your main buttock muscle) or the gluteus minimus.


If you were to look at a healthy tendon under a microscope, you would see that it consists of many collagen fibres running parallel to each other. Zoom out a bit, and you would see that these fibres are grouped in bundles, also in parallel.


This is what makes a tendon so strong and resilient. We all know that it is easy to snap a single piece of thread. But put ten pieces of thread together in parallel, and this is not so easy anymore.


How we develop gluteal tendinopathy


When we exercise, our tendon fibres (as well as our muscles, joints, and bones) sustain micro-damage, which is quite normal. The natural processes in our bodies then repair that micro-damage by removing the damaged tissue and, in the case of tendons, replacing this with healthy new collagen fibres that are more robust than the previous ones, so that the tendon is now a bit stronger than before the exercise session.


That is why over a period of time, our muscles can get bigger, our collagen fibres get stronger in our tendons, or even our cartilage in our joints gets nice and healthy thanks to that repeated cycle of micro-damage and repair.


We develop gluteal tendinopathy when we don’t allow our bodies enough time to repair the tendon fibres properly between exercise sessions or if we suddenly overload our tendons in a major way, such as running a marathon on a whim without training for it.


The menopause and gluteal tendinopathy


So, what role does the menopause play in gluteal tendinopathy, or any other tendinopathy, for that matter?


The stages of the menopause

For some women the perimenopause can start as early as in their late 30s, but normally it's around about the mid-40s, and it can last up to 10 years. During this stage your hormone levels (predominantly oestrogen and progesterone) start to drop.


This is the time where you are starting to get some symptoms of the menopause, and those common symptoms may have nothing to do with tendons whatsoever. These are typically hot flushes, not being able to sleep properly, and maybe putting on a little bit of weight around your waist.


We then move on to the actual menopause, which is when your body stabilises at a new lower "normal" hormone level. It's defined as having not had a menstrual cycle or a period for 12 months. So, once you've hit that 12 months, you're then known to have gone through menopause.


Hormones and gluteal tendinopathy

Oestrogen plays an important part in the process of collagen replacement in our tendons, which means that once the perimenopause starts, the cycle of NORMAL tendon repair takes a little bit longer than previously.

So, if you continue with exactly the same exercise regime as previously, or even ramp it up or start with new types of exercise that your body isn’t used to, you run the risk of exercising with tendons that haven’t fully recovered yet from previous exercise, which can then develop into a tendinopathy.



How to avoid gluteal tendinopathy during menopause


However, it’s not all doom and gloom. If women are aware of the role of the menopause in how tendons get repaired after exercise, we can mitigate against developing a tendinopathy.


We can start listening to our bodies while realising that what we can do at this stage in our lives compared to what we could do previously might need a little bit more thought.


We might need to realise that a harder session would necessitate a longer recovery time. And to do that, we can listen to the signs and symptoms that we might be having in our body. Do we feel tired and fatigued? Do we have niggles anywhere? Can we rest a little bit longer in between?


This doesn’t mean that we can’t do any other exercise in between training sessions. According to the ‘relative rest’ approach, it means that we can switch over to cross-training that doesn't put so much pressure on that gluteal tendon. It could be things like cycling or gentle walking on the flat, or it could be doing high interval intensity training (HIIT) exercises for the upper body that don't necessarily involve your lower limbs.


It's about looking at whether we experience pain (anything more than a niggle) during exercise and in the 24 hours following an exercise session.


So, for women who have started or gone through the menopause, it's really important that we start planning ahead and start thinking about what exercise sessions we are going to put into our week. How can we better schedule it to allow enough recovery?


Best treatment for gluteal tendinopathy during menopause


If you have overdone it and you already have gluteal tendinopathy, the best treatment, as with any tendinopathy, is strength training for the tendons and the associated muscles. But you will just have to be more careful with how you approach this and your treatment plan should be adjusted according to how your body responds.


For instance, the latest research has shown that doing fewer repetitions of an exercise, slowly and with high weight, produces better results than high volumes of fast repetitions with little or no weight. But what is "heavy" for your painful tendon may be a lot lighter than what you think, so it's important to first establish what your tendon's current strength and tolerance is.


It's also important that you allow enough recovery time between rehab sessions. We teach our patients to monitor their 24 hour pain/symptoms response and use that to find the perfect schedule for training. You can find more information about exercises for gluteal tendinopathy in this article.


How we can help via video call

Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.


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References:

  1. Grimaldi, A. and A. Fearon (2015). "Gluteal tendinopathy: integrating pathomechanics and clinical features in its management." Journal of Orthopaedic & Sports Physical Therapy 45(11): 910-922.

  2. Grimaldi, A., et al. (2015). "Gluteal tendinopathy: a review of mechanisms, assessment and management." Sports Medicine 45(8): 1107-1119.

  3. Leblanc D, Schneider M, Angele P, et al. The effect of estrogen on tendon and ligament metabolism and function. The Journal of steroid biochemistry and molecular biology 2017;172:106-16.

  4. Mellor, R., et al. (2018). "Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial." British Journal of Sports Medicine 52(22): 1464-1472.

  5. Oliva F, Piccirilli E, Berardi AC, et al. Hormones and tendinopathies: the current evidence. British medical bulletin 2016;117(1):39-58.