Hip Pain in Women: Common Causes and Non-Surgical Care

It often starts quietly. A dull ache on the outer side of the hip when you turn over in bed at night. A catch in the groin when you get up from the floor after rolling chapatis, or when you climb the stairs to the terrace to dry clothes. Some women notice it after a pregnancy, others around menopause, and many simply assume it is “age” and carry on with a painkiller.

Hip pain is not one condition. The word “hip” covers a ball-and-socket joint deep in the groin, a set of strong buttock tendons on the outer side, the sacroiliac joints at the back of the pelvis and nerves coming down from the lower back. In this guide, our pain specialists explain why women are more prone to certain hip problems, how the exact spot of your pain points to the cause, which other conditions can masquerade as hip pain, and how most of it can be treated without surgery.

Why do women get hip pain more often than men?

Several things about a woman’s body and life stages put extra load on the hip.

• A wider pelvis. The female pelvis is built for childbirth, so the thigh bone angles in more sharply towards the knee. This increases the pull of the gluteal tendons over the bony point on the outer hip, called the greater trochanter.
• Menopause. Falling oestrogen affects tendons, which become less elastic and slower to repair, and it speeds up bone loss. This is one reason outer hip tendon pain peaks in women between their mid-forties and sixties.
• Pregnancy and the postpartum months. The hormone relaxin loosens pelvic ligaments, the centre of gravity shifts forward, and weight rises quickly. Afterwards, carrying a baby on one hip and nursing in awkward positions keeps the strain going.
• Thinner bones. Women are more likely to develop osteoporosis, which raises the risk of hip fractures after even a simple fall. Low vitamin D and B12 levels, very common in Bengaluru despite all our sunshine, add to bone and muscle aches.
• Autoimmune conditions. Inflammatory arthritis is more common in women, and it can involve the hips along with other joints. Our guide to pain in many joints explains how doctors tell these apart.

Where exactly does your hip hurt? What each area suggests

When a patient says “my hip hurts”, the first thing we ask is to point with one finger. The location narrows down the cause more than almost anything else.

Pain on the outer side of the hip

This is the most common hip complaint we see in women. The doctor’s term is greater trochanteric pain syndrome. It used to be blamed on an inflamed fluid sac (bursa), but we now know it is mainly a gluteal tendinopathy: the tendons of the buttock muscles that attach to the outer hip become irritated and weak, with the bursa sometimes joining in. Typical clues are tenderness when you press on the bony point, pain lying on that side at night, pain climbing stairs or getting out of a car, and a sharp twinge when you sit with your legs crossed. Read the full guide on trochanteric bursitis and outer hip pain.

Pain in the groin

The hip joint itself sits deep in the front, so true joint pain is usually felt in the groin, sometimes spreading to the front of the thigh or even the knee. The main causes are:

• Hip osteoarthritis: gradual wear of the joint cartilage, with stiffness after rest, difficulty cutting toenails or wearing footwear, and a shortened stride. Many people manage well for years, as we explain in hip osteoarthritis: living well without a hip replacement.
• Avascular necrosis: loss of blood supply to the ball of the hip, seen with long courses of steroid tablets, heavy alcohol use, lupus or sickle cell disease. Early on the X-ray can look normal, so a deep groin ache in someone with these risks needs an MRI. See early signs of avascular necrosis.
• Labral problems: the labrum is a rim of cartilage around the socket. A tear or pinching (often with a slightly unusual hip shape) causes sharp groin pain with deep bending or twisting, sometimes with a click or a catching feeling. It is more common in active younger women, dancers and yoga lovers.

Pain in the buttock

Pain deep in the buttock is very often not from the hip joint. A tight, irritated buttock muscle can press on the sciatic nerve, as in piriformis syndrome, which flares with long sitting in traffic or on a hard chair. The sacroiliac joint, where the spine meets the pelvis, is another frequent source, especially after childbirth: see facet joint and SI joint pain. And a nerve pinched in the lower back can send pain into the buttock and down the leg, which is sciatica.

Pain or burning in the front of the thigh

Ache in the front of the thigh may be referred from the hip joint or from upper lumbar nerves, sometimes linked with lumbar spondylosis. A burning or numb patch on the outer front of the thigh, without much true pain, can be meralgia paraesthetica, where a skin nerve is squeezed near the hip bone. In women it is often triggered by a tight saree petticoat string or waistband, pregnancy or weight gain, and it usually eases once the pressure is removed.

What else can cause hip or groin pain in women?

• Pelvic girdle pain in pregnancy. Pain over the pubic bone, the back of the pelvis or both hips, worse turning in bed or standing on one leg to wear a saree. It usually settles after delivery with the right support. Leg pain in pregnancy can also be nerve-related, as described in sciatica in pregnancy. Rarely, a condition called transient osteoporosis of the hip causes severe groin pain late in pregnancy and needs an MRI.
• The lower back. A surprising number of “hip” pains are referred from the spine. Our guide to the common causes of lower back pain covers the usual suspects.
• Gynaecological causes. Endometriosis, ovarian cysts and pelvic infections can cause pain in the groin, hip or buttock. Clues include pain that follows your monthly cycle, painful periods or intercourse, abnormal bleeding or discharge. These need assessment by a gynaecologist, so please do not assume it is a joint problem.
• Stress fracture. Women who run, train hard or diet strictly, especially with irregular periods or low vitamin D, can develop a small crack in the neck of the thigh bone. Groin pain builds with activity and eases with rest. An X-ray may be normal at first, so an MRI is often needed, and running should stop until it is checked. Our guide on sports injuries covers safe return to activity.
• Hip fracture after a fall. In older women with fragile bones, even slipping in the bathroom can break the hip. This is an emergency. Some people can still shuffle on an impacted fracture, so groin pain after any fall needs an X-ray. Afterwards, recovery is helped by good nutrition and rehabilitation, as described in fracture healing.
• Inflammatory arthritis. Hip or buttock pain with long morning stiffness that eases with movement may point to an inflammatory condition such as ankylosing spondylitis, which is often missed in women.

How is the cause of hip pain diagnosed?

A good diagnosis starts with your story: when the pain began, what makes it worse, your periods, pregnancies, menopause, medicines (especially any past steroid courses) and falls. Then comes a careful examination. We press on the outer hip, test hip rotation in the groin, check the SI joint, watch you stand on one leg and walk, and examine the lower back and nerves, because the hip and spine so often overlap.

• X-ray of the pelvis and hips shows arthritis, joint space and bone shape.
• MRI when needed, to look for avascular necrosis, stress fracture, labral tears or tendon damage that an X-ray cannot see. An ultrasound can also show the gluteal tendons.
• Bone density (DEXA) scan after menopause or if there has been a fracture.
• Blood tests: vitamin D, B12, thyroid, calcium, blood sugar and inflammatory markers such as ESR and CRP, plus specific tests if inflammatory arthritis is suspected.

With our in-house laboratory and radiology at our facilities, most of this can be done on the same visit. As always, we read the scan alongside you, not on its own.

How Dr Heal treats hip pain without surgery

Our hip pain treatment is built around the cause we find, not a single standard package. A typical plan includes:

1. Pinpoint the source. A full examination of hip, pelvis and spine, with imaging and blood tests only where they will change the plan. If something like a gynaecological cause is suspected, we tell you and help you get the right review.
2. Help damaged tissue repair, without steroids. For stubborn gluteal tendon pain, an irritated SI joint or an arthritic hip, we may use our own regenerative injection, prepared by Dr Heal Pharma. It contains no steroids, painkillers or antibiotics and is meant to encourage healing rather than simply mask pain. That matters because repeated steroid shots near tendons can weaken them, as explained in steroid side effects. Learn more about regenerative medicine.
3. Look after bones and hormones. Through functional medicine and clinical nutrition, we correct vitamin D and calcium, check thyroid and blood sugar, support you through menopause-related changes, and help with weight that loads the hips and knees. Food choices matter too: see diet and arthritis pain.
4. Guided strengthening. Gluteal and core strengthening that starts gently and builds week by week. For tendon pain, the right kind of loading is the treatment, and rest alone rarely fixes it.
5. Follow up until you move freely. We check your walking, stairs and sleep, adjust the plan, and say honestly if a joint has reached the stage where surgery is the better choice.

If other joints are also involved, our joint pain and arthritis treatment and back pain treatment work alongside the hip plan. You can also meet our pain specialists.

What you can do at home for hip pain

• Change how you sleep. Avoid lying on the painful hip. Sleep on your back or on the other side with a pillow between your knees so the top leg does not drop across and stretch the sore tendons. Poor sleep makes any pain feel worse, as we explain in sleep and chronic pain.
• Uncross your legs. Sit with both feet flat and knees slightly apart, and avoid standing with your weight hitched onto one hip, especially while carrying a child.
• Adapt floor sitting. Cross-legged sitting and deep squats load a painful hip heavily. For now, sit on a low stool or firm cushion while cooking or doing pooja, use a western toilet or a commode chair, and get up from the floor using a support.
• Take the stairs smartly. Lead with the good leg going up and the sore leg going down, and use the railing.
• Keep walking, little and often. Short, regular walks on level ground are better than one long walk. If buttock pain travels down your leg, try the gentle sciatica exercises and stop anything that makes it spread.
• Do not rely on painkillers. Needing them every day is a sign to look for the cause. Read why painkillers are not the answer.

Frequently asked questions

Why do women get more hip pain than men?

A wider pelvis increases strain on the outer hip tendons, falling oestrogen around menopause affects tendons and bone, pregnancy loosens pelvic ligaments, and women are more likely to have osteoporosis and low vitamin D.

How can I tell if my pain is from the hip or the back?

Hip joint pain is usually in the groin and worse with rotating the leg, such as putting on socks. Back-related pain is more often in the buttock, may travel below the knee with tingling, and changes with bending or sitting. Often both are involved, so an examination of both is needed.

Should I sleep on the side that hurts?

No. Lying on the painful side presses on the irritated tendons. Sleep on your back or the other side with a pillow between your knees, and try a softer layer on a hard mattress.

Can ovarian or period problems cause hip pain?

Yes. Endometriosis, ovarian cysts and pelvic infections can cause groin, hip or buttock pain, often linked to the menstrual cycle. If your pain follows your periods or comes with abnormal bleeding, see a gynaecologist as well.

Will I need a hip replacement?

Most women with hip pain do not. Outer hip tendon pain, SI joint and piriformis problems almost always settle without surgery, and many people with hip arthritis live well for years with the right care. Replacement is considered when a badly damaged joint stays disabling despite proper treatment.

Where can I get hip pain treated without surgery in Bengaluru?

Dr Heal Pain Cure Hospital treats hip pain without surgery at its HSR Layout and Banashankari branches. Both are open 24 hours, and women come to us from all over Karnataka.

This article is for general information and is not a substitute for a medical consultation. Please see a doctor for advice about your own symptoms.