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CHICAGO -- The use of hormone therapy for menopause in the U.S. has remained low since 2007 when it first dropped, according to an analysis of insurance claims data.

The prevalence of hormone therapy use among women over 40 was 4.6% in 2007, and declined consistently to a low of 1.8% in 2023, reported Stephanie Faubion MD, MBA, of the Mayo Clinic in Jacksonville, Florida, at the Menopause Society annual meeting.

Use of hormone therapy was consistently highest among women ages 50 to 64, but still fell over the study period from 6% to 3.6% in those ages 50-54, from 7.3% to 3.8% in those ages 55-59, and from 7.5% to 2.9% in those ages 60-64.

The prevalence of hormone therapy use was once around 40%, but that was before researchers on the , a long-running randomized trial of health outcomes in postmenopausal women, that they were halting the trial's estrogen-progestin arm, and later its estrogen-only component, because of adverse events. Concerns about breast cancer and cardiovascular risks also prompted a rapid drop in use.

"Despite reiterating the relative safety [of hormone therapy] -- and we know it's efficacious -- we have not moved the needle at all," said Faubion, who is also the medical director of the Menopause Society.

Later reinterpretations of the WHI findings and other research showed that the outcomes were more nuanced, with minimal risks for healthy women initiating hormone therapy for menopause symptoms before age 60.

"We've seen sort of the culture shift in the last few years, and menopause is having more than a moment -- menopause is having a lot of moments," Faubion said. "And in the last few years, we started to talk about it more. So our working hypothesis was that hormone therapy usage rates would have rebounded somewhat since the last publications."

However, experts said, both providers and patients may still be hesitant to initiate treatment so many years later, or they may lack a good understanding of it.

Monica Christmas, MD, director of the Center for Integrated Women's Health at University of Chicago Medicine and associate medical director of the Menopause Society, told MedPage Today that she wasn't surprised by the overall results, "but I do think with more attention being called to menopause, women feeling more empowered about talking to a provider about their menopause symptoms," that treatment will naturally improve.

"And I think that with good education, people won't be as scared of hormone therapy as they've been the last few years," she added.

Still, Christmas noted that a lack of insurance coverage for hormone therapy can be prohibitive to treatment. "You've got all these providers like myself who aren't afraid to prescribe it -- I prescribe it all the time," she said. "My biggest angst is that many times insurance companies don't cover it."

The researchers also compared oral to transdermal hormone therapy use, and conjugated estrogen to estradiol, in a secondary analysis. While the predominant route of administration was oral, and estradiol was the primary formulation of estrogen, use in all of these categories declined or remained low.

Faubion noted that the analysis did not account for rates of , which would be outside the insurance claims process, but added that even if many women were using compounded hormones, the change in overall use would likely not be drastic. "Even if you add a percentage point or two, it's still low," she said.

Christmas explained that compounded hormones, or "bioidentical hormones," are often marketed as safer than approved hormone therapies, further confusing patients. "And that's absolutely not true," she said. "In fact, in many cases, it could be more harmful because it doesn't have to undergo the stringent testing policies that other drugs that are FDA-approved have to go through."

For this analysis, the researchers used de-identified claims data from OptumLabs Data Warehouse, which included medical and pharmacy claims for women ages 40 and older with commercial insurance or Medicare Advantage plans.

The annual study population increased from about 2 million in 2007 to 4.5 million in 2023. The average age rose from 53 years to 66 years over this time frame.

The annual rate of hormone therapy use was defined as the proportion of women in a year's study population who had at least 180 days of a filled prescription for a systemic estrogen-containing menopausal hormone therapy.

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