Does Menopausal Hormone Therapy, Exercise, or Both Improve Pain and Function in Postmenopausal Women With Greater Trochanteric Pain Syndrome? A 2 × 2 Factorial Randomized Clinical Trial.

Greater trochanteric pain syndrome, a persistent form of hip pain, is especially common after menopause, and researchers have wondered whether the drop in estrogen at menopause plays a role in tendon health. This trial asked whether menopausal hormone therapy, a specific hip exercise program, or the combination could improve pain and function compared with placebo cream and sham exercise, with everyone also receiving education on avoiding positions that compress the tendon and on managing activity load. All groups improved over the 12 weeks of treatment and at the 52-week follow-up, and the tendon-specific exercise did not outperform sham exercise on any measure. When the results were broken down by body mass index, women with a body mass index under 25 who received hormone therapy showed better scores on the main pain and function measure than those on placebo, at baseline, 12 weeks, and 52 weeks.

This body mass index-dependent pattern is an unusual and limiting complication, and the trial does not establish that hormone therapy helps across the wider population of affected women.

If you have ongoing pain around the outer hip, sometimes called greater trochanteric pain syndrome, you may know it's common after menopause and can be stubborn to treat. This study looked at whether menopausal hormone therapy, a targeted hip exercise program, or both could ease that pain and improve function, compared with a placebo cream and a sham exercise routine, alongside advice on protecting the tendon from compression and pacing activity. Everyone in the study got better over the following year, including those doing the sham exercise and using the placebo cream, so the specific exercise program didn't show a clear advantage over the generic one.

Hormone therapy did seem to make a difference, but only for women with a body mass index under 25, a measure of body size, where it outperformed placebo at every time point checked. For women outside that weight range, the results don't show hormone therapy provided extra benefit.

This complicates the picture and means the findings don't tell us hormone therapy would help all postmenopausal women with this kind of hip pain.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This was a two-by-two factorial randomised controlled trial in 132 postmenopausal women with greater trochanteric pain syndrome (12 lost to follow-up), comparing menopausal hormone therapy versus placebo cream, crossed with tendon-specific versus sham exercise, all combined with education on load management and avoiding tendon compression. The primary outcome was the VISA-G score, assessed at baseline, 12 weeks, and 52 weeks, alongside secondary outcomes and Global Rating of Change. All groups improved significantly from baseline to both follow-up points (p<.001), and there was no significant difference between exercise groups on any VISA-G comparison (mean differences ranging from 0.10 to -3.08, all p>.3), indicating the sham exercise performed comparably to the tendon-specific protocol.

A significant interaction between hormone cream and body mass index prompted stratified analysis; among women with body mass index under 25, the hormone therapy groups showed significantly better VISA-G scores than placebo at baseline (mean difference -11.20), 12 weeks (mean difference -20.72), and 52 weeks (mean difference -16.71), with corresponding secondary outcome improvements. The baseline difference within this subgroup raises questions about randomisation balance in the stratified analysis, and the body mass index-dependent effect limits generalisability. No safety data were reported in the abstract.