Menopausal hormone therapy use fell 82% since 1999, as ‘negative perceptions’ persist

Key takeaways:

• Menopausal hormone therapy use prevalence fell from 26.9% in 1999 to 4.7% in 2020 for women of all age groups.
• Black and Hispanic women had consistently lower prevalence of hormone therapy use vs. white women.

Hormone therapy use markedly declined among postmenopausal women of all ages, races and ethnicities in the U.S. during the past 2 decades, according to findings published in JAMA Health Forum.

Additionally, researchers reported that the most substantial absolute and relative declines were observed among women aged 52 to 65 years.

“A gap in the current conversation on menopausal hormone therapy use is an understanding of recent trends in, and prevalence of, menopausal hormone therapy use,” wrote Lin Yang, PhD, an epidemiologist in the department of cancer epidemiology and prevention research at Alberta Health Services – Cancer Care Alberta, and Adetunji T. Toriola, MD, PhD, MPH, professor in the department of surgery and the Siteman Cancer Center at Washington University School of Medicine. “To our knowledge, the most recent study on menopausal hormone therapy prevalence using a nationally representative sample was based on self-reported data up to 2010; hence, there are not recent menopausal hormone therapy use data captured by prescriptions to understand contemporary patterns in the U.S.”

Hormone therapy use by age, race

Yang and colleagues conducted a serial cross-sectional analysis evaluating menopausal hormone therapy (HT) use trends with data from 13,048 postmenopausal women in the U.S. across 10 cycles of the National Health and Nutrition Examination Survey (1999-2020). Researchers assessed menopausal HT use prevalence based on prescription medication data collected during NHANES interviews.

Overall, most participants were white (71.7%), had a family income-to-poverty ratio above 1.3 (73.6%), had more than a high school education (59.6%), had private insurance (61.4%), had overweight (26.8%) or obesity (40.6%) and were never smokers (59.8%).

From 1999 to 2020, menopausal HT use prevalence declined for women of all age groups from 26.9% in 1999 to 4.7% in 2020, an 82% decrease. Menopausal HT use was highest for women aged 52 to 65 years until 2002 then, since 2005, use was highest for women younger than 52 years.

Menopausal HT use declined by 23.5% for women younger than 52 years, 31.4% for women aged 52 years to younger than 65 years and 10.6% for women aged 65 years or older. From 1999 to 2020, menopausal HT use prevalence declined from 13.8% to 2.6% for Hispanic women, 11.9% to 0.5% for Black women, 31.4% to 5.8% for white women and 13.5% to 2.8% for women of other races or ethnicities. White women consistently had the highest menopausal HT use prevalence compared with all other races or ethnicities.

Estrogen-only menopausal HT accounted for more than 50% of use for most study periods. Menopausal HT use prevalence varied by family income-to-poverty ratio, health insurance coverage for all races and ethnicities, weight, smoking status for white women and educational attainment for Black and Hispanic women.

“Discussions and policy on menopausal HT use need to take into consideration sociodemographic factors such as age, race and ethnicity, income and education,” the researchers wrote.

Need for awareness, education

In an accompanying editorial, Tara K. Iyer, MD, MSCP, menopause practitioner in the department of medicine at the Menopause and Midlife Clinic at Brigham and Women’s Hospital at Harvard Medical School, and JoAnn E. Manson, MD, DrPH, MSCP, professor of medicine at Harvard Medical School and chief of preventive medicine at Brigham and Women’s Hospital, noted that these findings provide “valuable insights” into U.S. menopausal HT use trends, “highlighting major sustained declines and important disparities in treatment practices.”

The sharp decline in HT use is likely a consequence of findings from the landmark Women’s Health Initiative (WHI) trial published in 2002, Iyer and Manson wrote, which suggested HT may increase CVD and cancer risk, though later analyses demonstrated the risk depended on factors including age and time since menopause onset.

“The data revealed a marked decline in menopausal HT use since the early 2000s, likely influenced by the publication of the initial WHI trial results and subsequent widespread negative perceptions regarding hormone therapy,” Iyer and Manson wrote. “This decline, especially notable among women aged 52 to 65 years, underscores the need for increased awareness and clinician education about current evidence-based practices in menopause management.”