Contraindicated Hormone Therapy Prescribing Climbs in Primary Care

Hormone therapy prescribing for women with documented contraindications is rising quickly in primary care, even as funding to build safer prescribing support has dried up, according to Arina Chesnokova, MD, MPH, assistant professor of obstetrics and gynecology at the University of Pennsylvania.

At The Menopause Society 2026 Annual Meeting, held October 20-24 in San Diego, California, Chesnokova presented an electronic health record study of outpatient family medicine, internal medicine, and general obstetrics and gynecology (OB/GYN) encounters among women aged 45 to 60 years in the University of Pennsylvania Health System. Adjusted for annual encounter volume, prescribing of hormone therapy or combined contraception to women with a contraindication rose from 3.2 per 10,000 encounters in 2022 to 14.8 in 2025 and 23.1 through April 2026 (IRR per year, 1.64; 95% CI, 1.54-1.75).¹

"The raw numbers are still really small," Chesnokova said, noting that breast cancer and blood clots accounted for most contraindications.² "There's more kind of prescriptions being written, true, but there's also more prescriptions being written that are inappropriate....This isn't a benign engagement necessarily." The increase comes amid growing attention to hormone therapy, including FDA labeling changes that removed several boxed warnings, although the study did not examine causes.³

For clinicians unsure about menopause management, she says it is okay not to know. Rather than "scrounge something together," she urges them to refer to a trusted source of evidence-based care, even if patients must wait.

Chesnokova also discusses how lost funding from an Agency for Healthcare Research and Quality (AHRQ) learning health system grant slowed her team's rollout of a primary care menopause pathway. AHRQ has halted more than 100 research grants and issued few new ones since 2025.⁴ "Menopause comes for everybody," she said. She still plans to test the pathway and share it with other health systems.

Watch the video to hear more from Chesnokova on safe prescribing and what comes next for this work.

References

1. Chesnokova A, Bayes B, Blady S, Hamm R. Patterns of menopause diagnosis and prescribing in a large academic health system. Poster presented at: The Menopause Society 2026 Annual Meeting; October 20-24, 2026; San Diego, CA. Abstract P-19.
2. The 2022 Hormone Therapy Position Statement of The North American Menopause Society Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794. doi:10.1097/GME.0000000000002028
3. Jennings S. FDA removes boxed warnings on cardiovascular, cancer, and dementia risks from select menopausal hormone therapy labels. Patient Care Online. February 12, 2026. Accessed November 12, 2026. https://www.patientcareonline.com/view/fda-removes-boxed-warnings-cardiovascular-cancer-dementia-risks-from-select-menopausal-hormone-therapy-labels
4. Allen A. Trump has quietly throttled an agency devoted to the safety of American healthcare. KFF Health News. July 29, 2026. Accessed November 12, 2026. https://kffhealthnews.org/news/ahrq-funding-grants-trump-healthcare-safety-research-agency-hobbled/