The link between menopause and gluteal tendinopathy – what you can do about it
- Alison Gould
- Apr 22
- 6 min read
Learn why women are more prone to developing gluteal tendinopathy during any stage of the menopause, how to avoid this, and what the best treatment approach for gluteal tendinopathy is if you're currently in the peri-menopause or beyond.
Remember, if you need help with an injury, you're welcome to consult our team of sports physios via video call.
The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in our articles. Read more (opens in new window).
In this article:
Alison has also made a video about this:
Some of the links in this article are to pages where you can buy products or brands discussed or mentioned here. We earn a small commission on the sale of these products at no extra cost to you.
Quick recap – How gluteal tendinopathy usually develops (without the menopause)
The gluteal muscles attach to the top of your femur (thigh bone) via tendons – gluteal tendinopathy is when these tendons become irritated or injured due to overuse.
Healthy tendons are made up of collagen fibres running in parallel bundles – this structure is what makes them so strong and resilient.
Physical activity (like walking and running) naturally causes tiny amounts of damage to your tendons – this is completely normal and part of how tendons get stronger. Given enough recovery time, your body repairs this micro-damage and replaces it with new, more robust collagen fibres.
Gluteal tendinopathy develops when your body isn't given enough time to recover and repair these small injuries between sessions, or when you suddenly increase your activity load too quickly (for example, running a long race without building up to it or walking a lot more than usual).
How the menopause affects gluteal tendinopathy
So, what role does the menopause play in gluteal tendinopathy, or any other tendinopathy, for that matter?
The menopause – and the perimenopause stage leading up to it – causes a significant drop in oestrogen levels. This matters for your tendons because oestrogen plays an important role in collagen production, which is the process your body uses to repair and strengthen tendon fibres after exercise.
💡 When oestrogen levels fall, this repair process slows down.
That means if you continue with the same exercise routine as before – or increase your physical activity very quickly (e.g. doing lots of intense gardening several days in a row) – your tendons may not have fully recovered from the previous session before you load them again. Over time, this is exactly how a tendinopathy develops.
How to avoid gluteal tendinopathy during menopause
It’s not all doom and gloom. It's not that exercise becomes dangerous during the menopause or that you can never do a certain activity again – your tendons simply need a little more recovery time and gradual increase in activity than they used to need.
💡 In fact, regular exercise has been shown to help women both physically (maintaining stronger bones, cartilage, muscles, tendons, etc.) and mentally throughout all the stages of the menopause.
Step one is to start listening to your body and accepting the annoying fact that you might have to make adjustments to how you previously approached your daily tasks and exercise, for example:
When spring comes, not trying to revamp the whole garden in one day, but rather breaking it up into smaller periods and spreading it out over the week.
Noticing when your body is telling you it is feeling tired, fatigued, or still sore from a previous exercise session and adapting your schedule accordingly – opt for tasks or exercise that don't work your legs so hard.
Planning ahead – if you know you have a holiday coming up where you will likely walk a lot more than normal, start building up your walking volume well in advance.
Getting into the habit of exercising regularly (especially doing strength training) means that, when you do suddenly want to do something out of the ordinary, your body is prepared for it.
We're concentrating on the physical factors in this article, but factors like nutrition and sleep also play an important role.
Best treatment for gluteal tendinopathy during menopause
The main treatment approach remains the same as for all cases of gluteal tendinopathy, but you do have to tweak it a bit. There are three elements worth highlighting.
Strength training
If you have overdone it and already have gluteal tendinopathy, the best treatment – as with any tendinopathy – is strength training for the tendons and the associated muscles. Strength training stimulates the tendons to produce new, healthy collagen fibres.
💡 You will just have to be more careful about how you approach this – more gradual progression and more recovery time – and your treatment plan should be adjusted according to how your body responds.
For instance, the latest research has shown that fewer repetitions performed slowly and with heavier weight produces better results than high volumes of fast repetitions with little or no weight. But what counts as "heavy" for your painful tendon may be a lot lighter than you expect, so it's important to first establish what your tendon's current strength and tolerance is.
It's also important to allow enough recovery time between rehab sessions. We teach our patients to monitor their 24-hour pain and symptom response and use that to find the right training schedule.
👉 You can find more information about specific exercises for gluteal tendinopathy (and what to avoid) in this article.
Supplements
Research has shown that hydrolysed collagen and Vitamin C-enriched gelatine can increase the gains from strength exercises for injured tendons. But don't take these supplements simultaneously.
Here's our article with much detail about various tendon repair supplements.
Hormone replacement therapy (HRT) and gluteal tendinopathy
Very few studies have looked at the effect HRT might have on recovery from tendonitis or tendinopathy, so we can't say for certain what it would be.
One study reported that when they scanned the Achilles tendons of 53 active women, they found that those on HRT had less tendon abnormality than those not on HRT. The problem with this study is that we don't really know whether other lifestyle factors might have influenced these results.
For example, a randomised controlled trial looking at HRT as part of treatment for gluteal tendinopathy found that women with a BMI under 25 had significantly better outcomes when using HRT compared with those who didn't – but this benefit wasn't seen in women with a higher BMI. But the exercises these researchers used were also not what we would typically prescribe, so that might have influenced the results.
These results highlight the importance of not approaching treatment for gluteal tendinopathy as one-size-fits-all. Every person's case is slightly different, which is why we spend a significant amount of time during our video consultations getting to grips with our patients' full situation and all the factors that might be contributing.
💡 HRT might benefit some women, but it is not right for everyone – you can also recover without it. We suggest that you discuss it with your doctor to understand if it is an option you would like to try.
How we can help via video call
Need help with an 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.
About the Author
Alison Gould is a chartered physiotherapist and holds an MSc in Sports and Exercise Medicine. You can follow her on LinkedIn, Facebook, Instagram or Twitter.