If you’re in your 40s or 50s and suddenly dealing with hip or shoulder pain, especially things like gluteal tendon pain or rotator cuff issues, you’re not alone. And honestly, sometimes these changes can begin in mid to late 30s for some women. Many women I see in my clinic don’t expect it: they come in for hip pain at night that makes sleep impossible, or a shoulder that felt fine yesterday but now creaks and aches trying to reach overhead.
The good news? There are explanations and tools that help.
Musculoskeletal Pain Really Does Increase During Perimenopause and Menopause
A large systematic review and meta-analysis of 93,021 women found that:
- About 40% of premenopausal women report muscle or joint pain.
- That increases to 57% in perimenopausal women.
- And 59% in postmenopausal women.
Women in perimenopause have a 35% higher risk of pain compared to premenopausal peers.
This isn’t just “getting older”, it’s a biological shift that changes how tissues respond to load, recover, and feel pain.
How Hormones Influence Tendons and Muscles
Research shows that estrogen isn’t just about hot flashes and bone health, but it also affects soft tissues:
- Estrogen decline leads to reduced collagen production and tendon thickness, which can make tendons more susceptible to pathology and injury.
- Tendons are less elastic and recover more slowly, meaning everyday activities can lead to tendon irritation and pain.
This helps explain why we see more tendon problems around menopause, especially in women who were previously active and didn’t struggle with pain before.
Why I See So Many Women with Gluteal Tendinopathy and Rotator Cuff Pain
Even though most large studies lump pain together as “muscle or joint pain,” specific conditions like gluteal tendinopathy (often diagnosed as greater trochanteric pain syndrome) and shoulder conditions including rotator cuff issues or shoulder arthralgia are common in the perimenopausal and menopausal population in clinical practice.
Here’s what research suggests:
Gluteal Tendinopathy / Greater Trochanteric Pain Syndrome (GTPS)
In clinical studies, GTPS (which involves pain around the greater trochanter where the gluteus medius/minimus tendons attach) is most commonly diagnosed in postmenopausal women between about 45–63 years old, and prevalence estimates suggest up to 23.5% in middle-aged women.
This fits the pattern we see in practice: women transitioning through menopause often present with:
- Lateral hip pain that wakes them at night
- Pain with side-lying, stairs, or walking
- Deep aching that doesn’t resolve with generic stretching or rest
That tendon pain isn’t random, but it lines up with hormonal influences on tendon health and changes in tissue resilience as estrogen levels decline.
Shoulder Pain & Rotator Cuff Conditions
While fewer large population studies break out rotator cuff tear rates by menopausal status, there’s evidence that:
- Rotator cuff full-thickness tears are more common in postmenopausal women (8.9% vs 3.1% in premenopausal women), suggesting structural tendon changes with age and hormonal shifts.
- Shoulder pain is the third most common musculoskeletal complaint overall and has a significant prevalence in middle-aged women.
Plus, other research points to increased shoulder synovitis and arthralgia during perimenopause.
As estrogen declines, tendons like the rotator cuff become less robust, making them more prone to degenerative changes and women feel that change as pain long before imaging catches it.
What This Means in the Clinic & How Physical Therapy Helps
From a clinical standpoint, many women don’t just report “general pain”. Tthey come in with very specific pain patterns:
- Hip/groin or lateral thigh pain that keeps them awake at night, makes side-lying uncomfortable, and limits walking or fitness activity
- Shoulder pain that started without a clear injury and worsens with reaching, lifting, or overhead movement
- Pain that sometimes migrates or doesn’t respond to rest or generic stretching
These aren’t “normal aches”; instead, they reflect changes in tissue health, load tolerance, and nervous system sensitivity, often compounded by hormonal transitions.
Here’s Where Physical Therapy Makes a Real Difference
- Targeted Load Management
Through careful assessment, physical therapy can:
- Identify which tissues are irritated
- Adjust movement patterns and load to calm pain pathways
- Progressively expose tendon and muscle tissue to the right kind of stress to increase tolerance
This is different from just “stretching more”. It’s about strategically loading tissue to help it adapt.
- Strength & Neuromuscular Control
We work on:
- Strength around the gluteal muscles to offload irritated hip tendons
- Scapular and rotator cuff strength to support shoulder mechanics
- Movement quality to prevent compensations that perpetuate pain
- Pain Science Education
Understanding that pain isn’t just about tissue “damage” but about nervous system output helps women move with less fear and more confidence. - Contextual Lifestyle Integration
Hormonal shifts affect sleep, mood, energy levels, and recovery all can influence pain. Physical Therapy doesn’t treat these in isolation, but alongside movement strategies that fit your life.
Bottom Line: Pain During Perimenopause Isn’t “All in Your Head” And It Is Treatable
The research clearly shows that musculoskeletal pain increases around perimenopause and menopause. The mechanisms include changes in soft tissues influenced by hormonal shifts, which can make tendons like those in the hip and shoulder more vulnerable.
Your personal story of pain, whether it’s gluteal tendinopathy keeping you up at night or shoulder pain limiting your workouts, fits the pattern seen in what physical therapists have seen for years in the clinic and we now have the research to support these patterns.
And while hormones are part of the story, movement-based solutions delivered through thoughtful physical therapy are a powerful part of regaining strength, resilience, function, and comfort.
References
Kruse, C., McKechnie, T., Dworsky-Fried, J., Sardar, A., Hacker, G., Rattansi, S., Fang, E., Sprague, S., Shea, A. K., & Bhandari, M. (2026). Musculoskeletal manifestations of perimenopause: A systematic review and meta-analysis of 93,021 women. JBJS Open Access, 11(1), e25.00254. https://doi.org/10.2106/JBJS.OA.25.00254
Grimaldi, A., Fearon, A., Gluteal Tendinopathy Study Group, & Vicenzino, B. (2015). The prevalence of gluteal tendinopathy in women: A cross-sectional study. British Journal of Sports Medicine, 49(10), 648–653. https://doi.org/10.1136/bjsports-2014-093470
Fearon, A. M., Cook, J. L., Scarvell, J. M., Neeman, T., Cormick, W., Smith, P. N., & Purdam, C. R. (2014). Greater trochanteric pain syndrome negatively affects work, physical activity and quality of life: A case control study. Journal of Arthroplasty, 29(2), 383–386. https://doi.org/10.1016/j.arth.2013.07.016
Hansen, M., Couppé, C., Hansen, C. S., Skovgaard, D., Kovanen, V., Larsen, J. O., Aagaard, P., & Magnusson, S. P. (2009). Impact of oral contraceptive use and menstrual phases on patellar tendon morphology, biochemical composition, and biomechanical properties in female athletes. Journal of Applied Physiology, 106(2), 593–600. https://doi.org/10.1152/japplphysiol.90933.2008
Abate, M., Schiavone, C., Salini, V., & Andia, I. (2013). Occurrence of tendon pathologies in metabolic disorders. Rheumatology, 52(4), 599–608. https://doi.org/10.1093/rheumatology/kes395
Yamamoto, A., Takagishi, K., Osawa, T., Yanagawa, T., Nakajima, D., Shitara, H., & Kobayashi, T. (2010). Prevalence and risk factors of a rotator cuff tear in the general population. Journal of Shoulder and Elbow Surgery, 19(1), 116–120. https://doi.org/10.1016/j.jse.2009.04.006
Chung, S. W., Kim, J. Y., Kim, M. H., Kim, S. H., & Oh, J. H. (2013). Gender-specific risk factors for rotator cuff tears: A population-based study. Journal of Shoulder and Elbow Surgery, 22(9), 1258–1265. https://doi.org/10.1016/j.jse.2013.01.018