Initiation and Duration of Systemic Hormone Therapy for Menopausal Symptoms

OBJECTIVE: To examine real-world patterns of systemic hormone therapy (HT) initiation and continuation among women with a diagnosis of menopause. METHODS: Using the Merative™ MarketScan® Research Databases (2009-2022), we identified women aged 45-60 years with menopause-related claims and at least 12 months of continuous enrollment. Patients with bilateral oophorectomy, breast or gynecologic cancers, or HT contraindications were excluded. Multivariable regression analyzed factors associated with HT initiation, formulation, and duration. RESULTS: Of 318,621 eligible women, 21.7% initiated systemic HT within 1 year. Predictors of HT initiation included younger age (adjusted odds ratio [aOR] 2.17; 95% CI, 2.12-2.23), prior hysterectomy (aOR 1.98; 95% CI, 1.77-2.21), and local hormone use (aOR 3.25; 95% CI, 3.05-3.47). Initiation was significantly lower among women with obesity (aOR 0.78; 95% CI, 0.75-0.81), diabetes (aOR 0.69; 95% CI, 0.66-0.72), and Black racial identification (aOR 0.78; 95% CI, 0.68-0.89). Initial formulations were estrogen plus progestogen (52.5%), estrogen-alone (32.4%), and progestogen-alone (15.1%). The median first-episode duration was 6.6 months; 38.8% of patients continued at 12 months. Black racial (adjusted hazard ratio [aHR] 1.52; 95% CI, 1.34-1.73) and Hispanic ethnic (aHR 1.43; 95% CI, 1.14-1.80) identities predicted faster discontinuation. Conversely, prior hysterectomy (aHR 0.75; 95% CI, 0.68-0.83) and concurrent local hormone use (aHR 0.84; 95% CI, 0.80-0.89) reduced discontinuation risk. CONCLUSION: Although one-fifth of women initiated systemic HT shortly after their diagnosis, low persistence and racial disparities among those who initiated reveal critical gaps in long-term menopause management. Furthermore, true real-world utilization is likely even lower due to underdocumentation in clinical coding. These findings underscore an urgent need for targeted, equitable interventions to improve treatment adherence and ensure consistent, comprehensive care for menopausal women.