United States Menopausal Hormone Therapy Usage Trends: An Observational Study

To evaluate nationwide trends in systemic menopausal hormone therapy (HT) use in women aged 40 and older between 2007 and 2023.

This retrospective, population-based cohort study used de-identified medical and pharmacy claims data from the OptumLabs Data Warehouse, including commercially insured and Medicare Advantage women 40 years of age and older in the United States from 2007 to 2023. The annual rate of HT use was defined as the proportion of women in a year with at least 180 days of filled prescriptions. The prevalence of HT use was analyzed by 5-year age groups and calendar year. Prescriptions for HT were further stratified by formulation, dose, and route of administration.

Systemic HT use in women 40 years of age and older declined from 4.4% in 2007 to 1.7% in 2023. Oral HT was the most common route of administration. Among women aged 45-49, 50-54, and 55-59 years, HT use decreased from 2.9%, 5.8%, and 7.1% in 2007 to 1.5%, 3.4%, and 3.5% in 2023, respectively. Use of HT was consistently highest among White women.

Despite substantial evidence and established guidelines supporting the efficacy and safety of menopausal HT, particularly when started early in menopause, usage rates have declined and remain low, even among age groups most likely to experience bothersome menopause symptoms.