Only One in Five Women Start Hormone Therapy After Menopause Diagnosis

This was an observational study of insurance claims, not a trial. The researchers used the Merative MarketScan databases from 2009 to 2022 and identified 318,621 women aged 45 to 60 with menopause-related claims and at least 12 months of continuous enrollment. They excluded women who had both ovaries removed, had breast or gynecologic cancers, or had medical reasons not to use hormone therapy. This article draws only on the study.

Systemic hormone therapy means hormones taken in a way that reaches the whole body, such as pills, rather than local treatments applied to one area. Of the women studied, 21.7% started it within a year of diagnosis.

Some women were more likely to start than others. Younger age was linked to starting (adjusted odds ratio 2.17). So were a prior hysterectomy (1.98) and use of local hormone treatment (3.25). Starting was less likely among women with obesity (0.78), diabetes (0.69) and women identified as Black (0.78). An odds ratio below 1 means lower odds of starting.

The first prescriptions varied. Estrogen plus a progestogen made up 52.5% of starting regimens. Estrogen alone was 32.4%, and progestogen alone was 15.1%.

Staying on treatment was the bigger problem. The median length of a first course was 6.6 months, meaning half of women stopped before that point. Only 38.8% were still using therapy at 12 months.

Stopping was not evenly spread. Black women (adjusted hazard ratio 1.52) and Hispanic women (1.43) were more likely to stop sooner. A hazard ratio above 1 means a higher rate of stopping at any given time. Women with a prior hysterectomy (0.75) or who also used local hormones (0.84) were less likely to stop.

Claims data also capture only what was coded. The authors say true use is probably even lower than they found because of underdocumentation in clinical coding.

The authors conclude that low persistence and racial disparities reveal gaps in longterm menopause management, and they call for targeted, equitable efforts to improve adherence and provide consistent, comprehensive care.

The study does not say whether stopping early was the right or wrong choice for any individual. Its point is that many women stop, and that the pattern differs by group. For women whose treatment did not suit them, the study's call for consistent care points toward ongoing contact with a clinician rather than a silent exit.

This is a different question from our October 15 report on menopause hormone therapy and weight loss with semaglutide. That finding was about an association with weight change in one group of women. This study looks at who starts and who continues treatment, and it does not examine weight or outcomes.

Next, watch for research that asks why women stop and whether the targeted interventions the authors call for improve persistence.

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