Nearly 80% of Women May Not Initiate Menopause Hormone Therapy: A Q&A With Intira Sriprasert, MD, PhD

Only 21.7% of more than 318 000 women initiated systemic hormone therapy (HT) within 12 months of a natural menopause diagnosis, and fewer than 1 in 5 women who started treatment remained on their initial treatment episode at 3 years, according to a late-breaking study presented at The Menopause Society 2026 Annual Meeting in San Diego.

The retrospective analysis of MarketScan Research Databases from 2009 to 2022 included 318,621 women aged 45 to 60 years who experienced natural menopause, of whom 69,203 initiated systemic HT within 12 months of diagnosis. Among women who initiated treatment, the median duration of the first HT episode was 202 days, and just 16.9% continued that episode at 36 months.

Investigators also identified significant racial and ethnic differences in treatment initiation and persistence. Black women were less likely to initiate HT than women in the reference group (adjusted odds ratio [aOR], 0.78; 95% CI, 0.68-0.89), while Black race (adjusted hazard ratio [aHR], 1.53; 95% CI, 1.35-1.74) and Hispanic ethnicity (aHR, 1.45; 95% CI, 1.15-1.81) were associated with earlier discontinuation.

Women with obesity (aOR, 0.78; 95% CI, 0.75-0.81) or diabetes (aOR, 0.69; 95% CI, 0.66-0.72) were also less likely to initiate systemic HT.

The findings raise questions about barriers to menopause treatment, reasons for early discontinuation, and opportunities for primary care physicians to improve treatment discussions and continuity of care.

Patient Care Online spoke with study author Intira Sriprasert, MD, PhD, of the University of Southern California, about the findings, potential contributors to treatment disparities, and how primary care physicians can help patients make informed decisions about menopause HT.

Patient Care Online: Can you provide an overview of the study and the key findings you presented at The Menopause Society 2026 Annual Meeting?

Intira Sriprasert, MD, PhD: Our study looked at insurance claims data across a diverse population in the United States. We studied more than 300,000 women aged 45 to 60 years who had a diagnosis code for menopause for the first time.

We explored how many of these women initiated hormone therapy and how long they remained on treatment.

What we found was that among more than 300,000 women, only approximately 22% had a prescription filled for hormone therapy.

Patient Care Online: Your study found that many women discontinued hormone therapy relatively early. What factors might explain why so many women stop treatment within the first 1 to 2 years?

Intira Sriprasert, MD, PhD: Among the 22% of women who initiated hormone therapy, only about 40% remained on treatment after the first year. After 2 years, that dropped to approximately 24%.

You can see that there was a dramatic decline. Only about one-fifth of women started therapy, and then treatment persistence dropped substantially within the first year or two.

The factors we found to be associated with discontinuation included Black race, Hispanic ethnicity, and underlying cardiometabolic conditions, such as hypertension, dyslipidemia, diabetes, and obesity.

Patient Care Online: What clinical and nonclinical barriers could be contributing to lower hormone therapy initiation and earlier discontinuation among Black and Hispanic women?

Intira Sriprasert, MD, PhD: To clarify, we did not investigate the specific reasons behind these differences.

However, when we consider the overall decision to initiate or remain on hormone therapy, potential clinical factors could include access to care, physician-patient interactions, and underlying medical conditions.

From a nonclinical perspective, factors could include patients' personal perceptions, knowledge, and attitudes toward hormone therapy during this stage of life.

Patient Care Online: How might the FDA's removal of boxed warnings for menopause hormone therapy affect treatment initiation and persistence going forward?

Intira Sriprasert, MD, PhD: That's a very interesting question, and it's something I would also like to know the answer to.

Unfortunately, our data only extended through 2021, so we cannot determine the impact of that change from our study.

Historically, after the FDA introduced boxed warnings for hormone therapy in 2003, utilization dropped dramatically. I would speculate that removing those warnings could gradually increase hormone therapy use.

However, the decision to use hormone therapy should be individualized for each patient. It should not mean that everyone should use it or that no one should use it.

Patient Care Online: Primary care physicians are often the first point of contact for women entering menopause. What can they do to help eligible patients make informed decisions about starting hormone therapy and support treatment continuation when appropriate?

Intira Sriprasert, MD, PhD: I would say the most important thing is to initiate the conversation with your patients, even before they reach this stage of life.

You can begin discussing the menopause transition when women are around 40 to 45 years old, so they know what to expect, what symptoms may occur, and what treatment options are available.

Once treatment is initiated, it's also important to follow up with patients, support their decisions, address concerns, and help manage any unwanted side effects.

Long-term treatment persistence, when appropriate, is important for achieving the best possible outcomes for patients.

Reference:

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, California.