Hip Pain in Women: Common Causes and When to See a Specialist

Hip pain is a common problem in women of all ages — but the cause is not always straightforward. While arthritis often gets the blame, many women have pain from a range of conditions involving the bones, cartilage, tendons, muscles, and even the lower back. Understanding the underlying cause is the first step toward effective treatment — and the single most useful clue is where the pain is.

Where is your pain? (it matters)

• Groin / front of the hip — most often the hip joint itself: arthritis, dysplasia, impingement, or a labral tear.
• Outer / side of the hip — usually the abductor tendons and trochanteric bursa.
• Buttock / radiating down the leg — frequently referred from the lower back or SI joint, not the hip at all.

Hip arthritis

One of the most common causes of hip pain in women over about 50 is osteoarthritis. Arthritis develops when the smooth cartilage lining the hip gradually wears away, leaving pain, stiffness, and lost motion. Women with hip arthritis often notice:

Hip dysplasia

Many women develop arthritis because they were born with a subtle difference in the shape of the hip. Hip dysplasia means the socket doesn't fully cover the ball, which overloads the cartilage over time. It's more frequently diagnosed in women, and mild dysplasia can go unnoticed for decades before symptoms appear. Common features include groin pain, mechanical clicking or catching, symptoms that worsen with activity, and arthritis that arrives earlier than expected.

Femoroacetabular impingement (FAI)

Impingement (FAI) is when extra bone around the ball or socket causes the two to pinch against each other during motion. Typical symptoms are deep groin pain, pain with squatting, difficulty sitting for long periods, limited hip flexibility, and mechanical catching. FAI frequently contributes to labral tears and can accelerate cartilage damage over time.

Labral tears

The labrum is a ring of cartilage around the rim of the socket that helps stabilize the joint. Women with a labral tear often describe clicking, catching, or locking, sharp groin pain, and pain with twisting or pivoting. Labral tears can come from injury, from FAI or dysplasia, or from generalized hypermobility — which brings us to one of the most overlooked causes of all.

Hypermobility: an overlooked cause

One of the most under-recognized causes of hip pain in women is generalized joint hypermobility. Women are naturally more flexible than men, and some have significant ligament laxity that allows excessive motion around the hip. That flexibility can be an asset in dance, gymnastics, yoga, and cheerleading — but excessive motion places extra stress on the muscles, tendons, and labrum. Symptoms often include:

Greater trochanteric pain: bursitis & abductor tendons

Pain on the outside of the hip is usually irritation of the gluteal (abductor) tendons or the bursa over the greater trochanter. It's one of the most common hip complaints in women. Symptoms include:

Many cases historically called “bursitis” are actually partial tears or degeneration of the abductor tendons — which is why a strengthening program matters and a single injection often isn't enough. I cover this in depth in hip bursitis (trochanteric & iliopsoas).

Iliopsoas tendinitis & internal snapping hip

Pain in the front of the hip and groin may come from the iliopsoas — the main hip flexor — whose tendon runs across the front of the joint. Women may notice front-of-groin pain, a snapping sensation, and pain getting out of a car or climbing stairs. It's particularly common in active women and those with underlying hypermobility. See iliopsoas bursitis for more on how this is evaluated and treated.

Avascular necrosis (AVN)

Less common but important to recognize, avascular necrosis occurs when the blood supply to the femoral head is compromised, which can lead to collapse of the bone and destruction of the joint. Risk factors include steroid use, autoimmune disease, heavy alcohol use, and prior trauma. Early diagnosis is critical — treatment options narrow once the bone collapses, so new, unexplained groin pain in a woman with these risk factors deserves prompt imaging.

Low back problems can mimic hip pain

Not all “hip” pain comes from the hip. Lumbar spine conditions — disc herniations, spinal stenosis, and nerve compression — can produce symptoms in the buttock, the outer hip, the thigh, and even the groin. Hip and back problems also frequently coexist. Distinguishing the two is one of the most important parts of the evaluation, because treating the wrong source is a common reason women don't get better.

A note on causes more common in women

Pulling it together, several of these occur more often in women:

• Hip dysplasia — more frequently diagnosed in women; drives earlier arthritis.
• Hypermobility — natural ligament laxity causing instability and labral pathology.
• Greater trochanteric pain — outer-hip tendon/bursa problems.
• Inflammatory arthritis — such as rheumatoid arthritis.
• Bone health — in older women, osteoporosis-related stress fractures can present as new hip or groin pain.

When should you see a hip specialist?

It's worth getting evaluated if your hip pain:

A thorough history, physical examination, and the right imaging — usually starting with an AP pelvis X-ray, which shows both hips at once — can identify the source of pain and guide treatment. The good news is that many causes respond well to physical therapy, activity modification, and injections — with surgery reserved for when it's truly needed. If it does turn out to be hip arthritis, it helps to know the signs it may be time to consider treatment.

From Dr. Harb

Most hip pain in women is not an emergency and not an automatic path to surgery — but it does deserve an accurate diagnosis. The location of your pain, a careful exam, and the right imaging usually make the picture clear, and the great majority of causes are managed without an operation.