Hip pain in women has a wide range of causes, from wear-and-tear joint changes to conditions tied directly to female anatomy and hormones. Where you feel the pain, whether it’s on the outer side of the hip, deep in the groin, or radiating toward the buttock, is one of the strongest clues to what’s behind it. Understanding that distinction can help you have a more productive conversation with a healthcare provider and know what to expect next.
Pain Location Narrows the List
Hip pain isn’t one problem. It’s a symptom that maps to very different structures depending on where you feel it. Pain on the outer (lateral) side of the hip most commonly points to soft tissue issues like tendon irritation or bursitis. Pain in the front of the hip or deep in the groin tends to involve the joint itself, including cartilage tears, arthritis, or stress fractures. Pain felt in the back of the hip or buttock often originates from the lower spine or from nerve compression deep in the gluteal muscles.
Many women describe their pain as simply “in the hip,” which can mean any of these locations. Paying attention to exactly where it hurts, what makes it worse (sitting, walking, lying on that side, climbing stairs), and whether it clicks or catches will help a provider zero in faster.
Greater Trochanteric Pain Syndrome
This is the single most common cause of lateral hip pain in adults, and it affects women far more than men. In a large community study of adults aged 50 to 70, 15% of women had it on one side and another 8.5% had it on both sides, compared with roughly 7% and 2% of men. The female-to-male ratio is about 4 to 1, with most cases appearing after age 50.
The condition used to be called trochanteric bursitis, as though a small fluid-filled sac was the main problem. It’s now understood as a broader syndrome involving irritation or degeneration of the gluteus medius tendon (the muscle that stabilizes your pelvis when you stand on one leg), along with possible bursitis and tightness of the iliotibial band on the outside of the thigh. It typically causes a deep ache on the outer hip that worsens when you lie on that side at night, climb stairs, or sit cross-legged.
Recovery depends on severity. Mild cases often improve in two to four weeks with rest and ice. Moderate cases typically take six to twelve weeks, with structured rehabilitation starting around week four. That rehab phase focuses on strengthening the hip stabilizers through exercises like clamshells, bridges, and targeted glute work, combined with stretching the IT band. Chronic or severe cases can take four to six months. The average overall recovery sits around six to eight weeks.
Hip Osteoarthritis
Osteoarthritis of the hip affects an estimated 7.2% of people globally, and it’s one of the leading causes of deep, aching groin pain in women over 50. The cartilage that cushions the ball-and-socket joint gradually wears down, leading to stiffness (especially first thing in the morning or after sitting), reduced range of motion, and pain that worsens with weight-bearing activity.
Unlike the sharp, sudden onset of an injury, osteoarthritis builds slowly. Early on you might notice it only after a long walk or a day on your feet. Over months or years it can become constant enough to affect sleep and daily function. Risk factors include age, excess body weight, previous hip injuries, and a family history of arthritis. Women are more susceptible after menopause, partly because declining estrogen levels accelerate cartilage breakdown.
Initial management focuses on low-impact exercise (swimming, cycling, walking on flat surfaces), maintaining a healthy weight, and physical therapy to strengthen the muscles around the joint. When the joint is severely damaged and quality of life is significantly affected, hip replacement becomes an option with high success rates and typical recovery periods of several months.
Hip Labral Tears
The labrum is a ring of tough cartilage that lines the rim of the hip socket, helping to keep the ball of the femur seated properly. When it tears, the hallmark symptom is a clicking or popping sensation with movement, often accompanied by a catching or locking feeling in the joint. You may also have a deep ache in the groin that gets worse during activities involving rotation, like pivoting, squatting, or getting in and out of a car.
Labral tears are common in active women, particularly those involved in sports that demand repetitive hip flexion and rotation (dance, running, yoga, soccer). They can also develop from structural variations in the hip joint that cause abnormal contact between the ball and socket during movement. Some tears respond well to physical therapy and activity modification, while others eventually require a minimally invasive surgical repair.
Stress Fractures
A stress fracture in the hip, most often in the femoral neck (the narrow section connecting the ball of the femur to the shaft), causes a deep groin or thigh pain that worsens with weight-bearing activity and eases with rest. It’s more common in women than men, and the key risk factors include high training volume, low bone mineral density, previous stress fractures, weakness in the gluteus medius, leg length differences, and certain structural hip variations.
Women who are underfueling relative to their activity level are at particular risk, especially when menstrual irregularities and low bone density are also present. This combination weakens bone faster than it can repair itself. MRI is the gold standard for diagnosis and can detect early bone stress changes within one to two days of symptom onset, well before a standard X-ray shows anything. If your hip pain came on gradually, gets worse with running or jumping, and eases when you stop, a stress fracture should be on the radar.
Pregnancy-Related Pelvic Girdle Pain
About one in five pregnant women develops pelvic girdle pain, which often presents as hip pain, low back pain, or both. The pelvis has three joints that normally move in sync. During pregnancy, hormonal changes loosen the ligaments that hold those joints together, and if the joints begin moving unevenly, the pelvis becomes less stable. As the baby grows, the added weight and shifts in posture put further strain on the system.
The pain typically shows up in the second or third trimester and can range from mild discomfort with certain movements (rolling over in bed, climbing stairs, standing on one leg) to severe, activity-limiting pain. Specialized physical therapy focusing on pelvic stability, supportive belts, and movement modifications are the primary treatments. For most women, the pain resolves within a few months after delivery, though a small percentage have lingering symptoms that need continued rehab.
Endometriosis and Referred Pelvic Pain
Endometriosis, a condition where tissue similar to the uterine lining grows outside the uterus, can cause hip and groin pain that seems completely unrelated to the reproductive system. When endometrial tissue grows near or around pelvic nerves, it can entrap those nerves and produce pain that follows specific nerve pathways into the hip, buttock, or thigh. This pain often follows a cyclical pattern, worsening around menstruation, though it can become constant over time.
This is widely underrecognized. Because the resulting pain follows nerve distribution patterns rather than typical gynecologic symptoms, it frequently gets attributed to orthopedic or spinal problems, delaying correct diagnosis. If you have hip pain that seems to flare with your menstrual cycle, or if standard imaging and orthopedic evaluations haven’t explained your symptoms, endometriosis-related nerve involvement is worth considering.
Posterior Hip Pain and the Spine Connection
Pain felt in the back of the hip or deep in the buttock often doesn’t originate in the hip joint at all. Lumbar spine problems, including disc herniations and degenerative changes in the lower vertebrae, commonly refer pain to the hip and buttock region. Deep gluteal syndrome, where the sciatic nerve gets compressed by muscles or other structures deep in the buttock, produces similar symptoms: a deep ache or burning sensation that may radiate down the back of the thigh.
The overlap between spine-referred pain and true hip joint pain is one of the main reasons hip pain can be tricky to diagnose. A key distinguishing feature is that spine-related hip pain often changes with back movements (bending forward, arching backward) or worsens with prolonged sitting, while true hip joint pain tends to worsen with weight-bearing and hip rotation specifically.
What Happens During Evaluation
Standard X-rays are the first-line imaging for hip pain and can reveal arthritis, fractures, and structural abnormalities. If X-rays look normal but symptoms persist, MRI provides a much more detailed view of soft tissues, including the labrum, tendons, and bone marrow, and can pick up stress fractures and early cartilage damage that X-rays miss entirely.
A physical exam matters just as much as imaging. Specific tests that reproduce your pain, such as resisted hip movements, single-leg stance, or positioning the hip in certain angles, help a provider distinguish between joint problems, tendon issues, and referred pain before ordering any scans. Arriving with a clear sense of where the pain is, what triggers it, and how long you’ve had it gives your provider the most useful starting information.