Managing menopausal symptoms effectively remains a major health priority for aging women. Recently, researchers analyzed real-world utilization patterns of systemic hormone therapy among eligible women diagnosed with menopause. Overall, the investigation evaluated treatment initiation rates, preferred drug formulations, and overall therapy duration.
Key Predictors of Systemic Hormone Therapy Initiation
In this large cohort study of 318,621 women, only 21.7% initiated treatment within one year of diagnosis. However, several specific patient characteristics significantly increased the likelihood of starting treatment. Specifically, younger age, prior hysterectomy, and concurrent local hormone therapy strongly predicted earlier initiation. Conversely, clinicians less frequently prescribed therapy to patients with obesity or diabetes. Furthermore, Black women demonstrated significantly lower initiation rates compared to other demographic groups.
Formulation Patterns and Discontinuation Rates
Among patients who began treatment, combined estrogen plus progestogen was the most common initial prescription at 52.5%. Additionally, estrogen-alone regimens accounted for 32.4% of initial choices, while progestogen-alone options represented 15.1%. Nevertheless, treatment persistence remained low across all cohorts. The median duration for the first treatment episode was only 6.6 months. Consequently, merely 38.8% of patients continued therapy at the 12-month mark. Moreover, Black and Hispanic identities predicted significantly faster treatment discontinuation. In contrast, a history of prior hysterectomy or local hormone use reduced discontinuation risk.
Clinical Implications for Menopause Management
These findings highlight critical gaps in long-term symptom management and treatment persistence. Therefore, clinicians must address early drop-out rates and eliminate demographic disparities in care. Additionally, improved clinical coding and patient education will ensure consistent and equitable treatment delivery.
Frequently Asked Questions
Q1: What percentage of menopausal women initiate systemic hormone therapy?
Approximately 21.7% of women initiate treatment within one year of receiving a menopause-related diagnosis.
Q2: What is the median duration of the initial treatment episode?
The median duration for the first treatment episode is 6.6 months, with under 39% continuing at 12 months.
Q3: Which factors lower the risk of early treatment discontinuation?
Prior hysterectomy and concurrent use of local hormone therapy significantly lower the risk of early discontinuation.
References
- Sriprasert I et al. Initiation and Duration of Systemic Hormone Therapy for Menopausal Symptoms. Obstet Gynecol. 2026 Jul 27. doi: 10.1097/AOG.0000000000006386. PMID: 42492961.
- Taylor S, Davis SR. Is it time to revisit the recommendations for initiation of menopausal hormone therapy? Lancet Diabetes Endocrinol. 2025 Jan;13(1):69-74.
- The NAMS 2022 Hormone Therapy Position Statement Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022 Jul 1;29(7):767-794.