Peer, Social, and Structural Influences on Hormone Therapy Use in Menopause: A U.S. Population Survey

To describe treatment patterns for perimenopause and menopause symptoms, including hormone therapy (HT), nonhormonal medications, and supplements and to examine peer, social, and structural correlates of HT use in a nationally representative sample of U.S. women.

In February 2025, a cross-sectional online survey was conducted through YouGov (n = 1,500 women). Eligible participants were women who reported being told by a healthcare professional (HCP) they were in perimenopause or menopause, or who were within the midlife age range associated with these stages (45-54 years). Participants reported symptom burden, treatment use, peer influences, and perceived barriers to care. Multivariable logistic regression was used to identify demographic and sociocultural predictors of HT use.

Approximately half of the respondents reported vasomotor symptoms, yet only 7.2% reported current HT use. Marked disparities by education and income were observed: women with a 4-year college degree or higher had more than twofold higher odds of HT use, and those with household incomes >$100,000 had twice the odds compared with those earning <$20,000 (p < 0.001). Peer influence was independently associated with treatment choice: women whose peers used HT had 3.4-fold higher odds of HT use, whereas peer use of mind-body approaches was associated with 63% lower likelihood of HT use.

In a nationally representative sample of U.S. women with substantial symptom burden, reported HT use was low. Treatment decisions were strongly shaped by sociodemographic disparities and peer influence, suggesting opportunities for targeted risk communication and equitable access to evidence-based menopause care.