By Brittany Cordeiro / Mayo Clinic News Network
JACKSONVILLE, Fla. — Hormone therapy use among women in the U.S. remains low, even though it’s an effective treatment for many menopause symptoms, according to a new Mayo Clinic study published in Mayo Clinic Proceedings.
Menopause affects more than 1 million women each year in the U.S., and up to 75% experience symptoms such as hot flashes and night sweats that can last for years. Yet researchers found that use of menopausal hormone therapy has steadily declined over time.
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The study found that hormone therapy use dropped from 4.4% in 2007 to 1.7% in 2023. Even among women most likely to benefit — those ages 50 to 59 — only about 3.5% were using hormone therapy in 2023.
“We have strong evidence that hormone therapy is safe and effective for many women, but that hasn’t translated into how it’s used in clinical practice,” says Stephanie Faubion, M.D., director of Mayo Clinic’s Center for Women’s Health and study author.
Researchers expected hormone therapy use to rebound in recent years as awareness of menopause has increased. Instead, rates remain at their lowest level since the early 2000s, following concerns raised after the Women’s Health Initiative trial.
The new study analyzed nationwide trends in hormone therapy use among women 40 and older between 2007 and 2023 using a large U.S. health database. Hormone therapy use was defined as having at least 180 days of filled prescriptions within a given year.
In addition to the overall decline, researchers found differences across racial and ethnic groups. Use was consistently higher among white women compared with Black, Hispanic and Asian American women. Oral therapies remained the most common, although both oral and transdermal treatments declined over time.
Despite growing public conversation about menopause, the findings suggest that increased awareness has not translated into greater use of the effective treatment.
Researchers say several factors may have contributed to the findings, including ongoing misconceptions about risks, limited menopause training among clinicians, and patient concerns or lack of awareness.
“The abundance of misinformation around hormone therapy is one reason some women are not getting treatment,” says Dr. Faubion. “Many are seeking care for symptoms but aren’t receiving therapies that could help.”
Hormone therapy is not appropriate for every patient. However, for many women — particularly those younger than 60 or within 10 years of menopause — it remains a safe and effective option for symptom relief. Even low-dose vaginal estrogen, which has a favorable safety profile, remains underused.
Untreated menopause symptoms can affect sleep, mood and overall quality of life. Some women may seek care from multiple specialists without a clear diagnosis or treatment plan. Symptoms also may affect workplace productivity.
Researchers say the next step is to better understand and address the barriers preventing women from receiving appropriate care.
“Despite increased attention on menopause, we still have a long way to go,” says Dr. Faubion. “Improving education for both patients and clinicians will be key to closing this gap.”
