Hormone therapy for menopause is widely underused, and racial and metabolic disparities are making it worse. A large retrospective study published in Obstetrics & Gynecology analyzed insurance claims from over 318,000 women aged 45–60 and found that only 21.7% initiated systemic hormone therapy (HT) within a year of their menopause diagnosis. Among those who did start treatment, the median duration was just 6.6 months — and by the five-year mark, only 9.1% remained on therapy.

The most common formulation was estrogen plus progestogen (52.5%), and prior hysterectomy was the strongest predictor of both initiating HT and sticking with it. Meanwhile, cardiometabolic conditions like obesity, diabetes, and hypertension were associated with lower odds of starting treatment — even though vasomotor symptoms affect up to 75% of menopausal women.

By the Numbers:

• Only 21.7% of women initiated systemic HT within a year of diagnosis
• Median treatment duration: 6.6 months
• 38.8% remained on HT at 12 months; just 9.1% at 5 years
• Black women were 52% more likely to discontinue HT than White women (aHR 1.52)
• Hispanic women were 43% more likely to discontinue (aHR 1.43)

Why it matters: Menopausal vasomotor symptoms significantly impact quality of life, yet most women aren't receiving or sustaining effective treatment. The stark racial and metabolic disparities highlighted here point to systemic gaps in menopause care that demand targeted, equitable clinical interventions.