Menopause Hormone Therapy Gaps Raise Questions for Primary Care

Black and Hispanic women were more likely to discontinue systemic hormone therapy (HT) earlier than other women following natural menopause, according to a large retrospective study presented at The Menopause Society 2026 Annual Meeting in San Diego, highlighting persistent disparities in menopause treatment.

The study, led by Intira Sriprasert, MD, PhD, of the University of Southern California, analyzed insurance claims data for 318,621 women aged 45 to 60 years between 2009 and 2022 to evaluate systemic HT initiation and treatment persistence.

Among women who initiated treatment, Black race was associated with a 53% higher adjusted hazard of discontinuation (adjusted hazard ratio [aHR], 1.53; 95% CI, 1.35-1.74), while Hispanic ethnicity was associated with a 45% higher adjusted hazard (aHR, 1.45; 95% CI, 1.15-1.81).

Black women were also less likely to initiate systemic HT (adjusted odds ratio, 0.78; 95% CI, 0.68-0.89).

Although the analysis did not evaluate the underlying reasons for these disparities, Sriprasert identified several potential contributors, including access to care, patient-clinician interactions, underlying medical conditions, and patient perceptions of menopause treatment.

The findings also precede recent changes to federal hormone therapy labeling. In November 2025, the FDA initiated removal of certain boxed warning statements for menopausal HT, followed by approval of labeling changes for an initial six products in February 2026. The changes removed boxed warning language concerning cardiovascular disease, breast cancer, and probable dementia, while retaining other relevant safety information.

In an interview with Patient Care Online, Sriprasert discussed how the regulatory changes might influence future prescribing patterns and emphasized the importance of individualized treatment decisions.

For primary care physicians, she recommended initiating menopause discussions before symptoms become disruptive, explaining available treatment options, and providing ongoing follow-up to address concerns and adverse effects.

Sriprasert has no relevant disclosures.

References

1. Sriprasert I, Huang Y, Shoupe D, et al. Patterns of systemic hormone therapy initiation following natural menopause. Abstract S-8. Presented at: The Menopause Society 2026 Annual Meeting; October 2026; San Diego, CA.
2. Richard-Davis G, Ajmera M, Shiozawa A, et al. Health disparities in vasomotor symptom prevalence and treatment discontinuation in women of menopausal age: a commercial claims analysis. J Womens Health (Larchmt). 2025;34(2):176-186. doi:10.1089/jwh.2024.0079
3. US Food and Drug Administration. FDA approves labeling changes to menopausal hormone therapy products. Published February 12, 2026. Accessed October 30, 2026. https://www.fda.gov/news-events/press-announcements/fda-approves-labeling-changes-menopausal-hormone-therapy-products