{ "title": "The HRT Index HRT Use Evidence Map, 1999–2026", "version": "2026-07-31", "published_date": "2026-07-31", "last_verified": "2026-07-31", "canonical_page": "https://thehrtindex.com/research/how-many-women-use-hrt/", "description": "A definition-aware comparison of U.S., England, U.K., and Australian menopausal hormone therapy utilization estimates, preserving every source’s population, denominator, therapy scope, use definition, estimate, comparability rule, and principal limitation.", "comparability_rule": "Figures may be compared over time within a source when its method remains sufficiently stable. They must not be pooled, averaged, or treated as interchangeable across sources.", "methodology": "Structured evidence synthesis of official government statistics, peer-reviewed studies, and primary analyses from original healthcare-data producers. Source-specific populations and definitions were retained; estimates were not pooled.", "records": [ { "record_id": "nhanes-jama-us-1999-2020", "source_name": "NHANES / JAMA Health Forum", "source_class": "Nationally representative peer-reviewed serial cross-sectional study", "geography": "United States", "reference_period": "1999–2000 through 2017–March 2020", "publication_date": "2024", "population_and_denominator": "13,048 noninstitutionalized postmenopausal women across 10 nationally representative survey cycles", "age_range": "Postmenopausal women; age groups under 52, 52–under 65, and 65+", "use_definition": "Prescription menopausal hormone therapy reported as taken in the past month during household interviews; 86% of MHT containers were seen", "therapy_scope": "Medications classified as menopausal hormone therapy under the study’s NHANES medication rules", "published_estimate": "26.9% in 1999–2000; 4.7% in 2017–March 2020; highest published point estimate 29.5% in 2001–2002", "age_specific_result": "2017–March 2020: 9.4% under 52; 4.5% ages 52–under 65; 4.3% ages 65+", "within_source_trend": "Large decline across survey cycles; 26.9% to 4.7% between first and last cycles", "comparability_rule": "Compare cycles and subgroups only within this study; do not pool with claims, EHR, prescription, or administrative estimates", "nationally_representative": "Yes, for the U.S. civilian noninstitutionalized population under the study design", "principal_limitation": "Data end in March 2020; route was not recorded; 5.7% with missing menopause information were classified using age and smoking rules", "source_url": "https://doi.org/10.1001/jamahealthforum.2024.3128", "verified_date": "2026-07-31" }, { "record_id": "fda-systemic-mht-us-2020", "source_name": "U.S. Food and Drug Administration drug-utilization review", "source_class": "Federal regulatory drug-utilization statement", "geography": "United States", "reference_period": "2020", "publication_date": "2025-11-10", "population_and_denominator": "U.S. women aged 46–65 receiving outpatient prescriptions", "age_range": "46–65", "use_definition": "Received an outpatient prescription for systemic estrogen alone or combined estrogen plus progestogen", "therapy_scope": "Specified systemic estrogen-alone and estrogen-plus-progestogen therapies", "published_estimate": "Approximately 2 million women", "age_specific_result": "Not further broken down in the FDA statement", "within_source_trend": "No multi-year series published in the statement", "comparability_rule": "Quote only with year, age band, outpatient setting, and systemic-therapy definition", "nationally_representative": "Federal U.S. drug-utilization estimate; supporting downloadable utilization table not published with the statement", "principal_limitation": "No downloadable utilization table accompanies the statement; excludes other ages and therapies outside the stated definition; prescription does not prove dispensing or adherence", "source_url": "https://www.fda.gov/drugs/drug-alerts-and-statements/fda-requests-labeling-changes-related-safety-information-clarify-benefitrisk-considerations", "verified_date": "2026-07-31" }, { "record_id": "mayo-optumlabs-us-2007-2023", "source_name": "Mayo Clinic Proceedings / OptumLabs", "source_class": "Peer-reviewed observational claims study", "geography": "United States", "reference_period": "2007–2023", "publication_date": "June 2026", "population_and_denominator": "Women aged 40+ in a large national commercial-insurance and Medicare Advantage claims database", "age_range": "40+", "use_definition": "At least 180 days of filled systemic hormone-therapy prescriptions during a calendar year", "therapy_scope": "Systemic menopausal hormone therapy under the study’s claims definitions", "published_estimate": "4.4% in 2007; 1.7% in 2023; approximately 3.5% among ages 50–59 in 2023", "age_specific_result": "2023: approximately 3.4% ages 50–54 and 3.5% ages 55–59; article summary describes about 3.5% ages 50–59", "within_source_trend": "4.4% in 2007 to 1.7% in 2023", "comparability_rule": "Compare years and age groups within the same claims source under the 180-day threshold", "nationally_representative": "No; commercially insured and Medicare Advantage population", "principal_limitation": "The insured population is not all U.S. women; the strict threshold excludes shorter or intermittent use", "source_url": "https://doi.org/10.1016/j.mayocp.2025.12.021", "verified_date": "2026-07-31" }, { "record_id": "epic-cosmos-us-2017-2026", "source_name": "Epic Research / Cosmos", "source_class": "Primary EHR data-producer analysis; dual-team study; not a peer-reviewed journal article", "geography": "United States", "reference_period": "January 2017–April 2026", "publication_date": "2026-07-30", "population_and_denominator": "163,348,471 women aged 18–79 seen in U.S. outpatient care; specified exclusions included breast-cancer history, current pregnancy, and evidence of gender-affirming care", "age_range": "18–79", "use_definition": "Qualifying hormone-therapy orders or dispenses in a month", "therapy_scope": "Estrogen, progestin, combinations, and testosterone-containing products; contraceptives and antineoplastics excluded", "published_estimate": "1.7% in January 2017; 3.6% in April 2026; 68 per 1,000 among ages 45–54", "age_specific_result": "Ages 45–54: approximately 24 per 1,000 in 2017 to 68 per 1,000 in April 2026", "within_source_trend": "Relatively flat near 1.8%–1.9% through 2022, then rising more sharply from 2023", "comparability_rule": "Compare monthly trends, age groups, routes, and product compositions only within Epic’s method", "nationally_representative": "No; denominator is women using outpatient care in participating data systems", "principal_limitation": "Outpatient-care denominator is not all U.S. women; menopause approximated with age bands; primary EHR analysis rather than peer-reviewed journal publication", "source_url": "https://www.epicresearch.org/articles/hormone-therapy-use-nearly-doubled-since-2017-led-by-women-in-their-late-40s-and-early-50s/", "verified_date": "2026-07-31" }, { "record_id": "truveta-estrogen-us-2018-2026", "source_name": "Truveta Research", "source_class": "Primary prescription/EHR data-producer analysis; preliminary and not peer reviewed", "geography": "United States", "reference_period": "January 2018–February 2026", "publication_date": "2026-04-09", "population_and_denominator": "Women aged 18+ with available prescription data; separate route analysis used women with dispensing data and an encounter requirement", "age_range": "18+", "use_definition": "At least one estrogen-based HRT prescription in the month; route results use pharmacy dispensing records", "therapy_scope": "Estrogen-based HRT products", "published_estimate": "11.5 per 1,000 in January 2018; 23.5 per 1,000 (2.35%) in February 2026; 49.0 per 1,000 among ages 45–54", "age_specific_result": "February 2026: 49.0 per 1,000 ages 45–54; 41.6 per 1,000 ages 55–64", "within_source_trend": "Overall prescribing increased 104.8% from January 2018 to February 2026; oral dispensing declined 16.5% while patch and vaginal-cream dispensing rose", "comparability_rule": "Compare prescribing trends within the prescription cohort and route trends within the separate dispensing cohort", "nationally_representative": "No; proprietary data subset with data-availability requirements", "principal_limitation": "Estrogen-based products only; menopause not confirmed; findings preliminary and not peer reviewed; prescribing and dispensing cohorts differ", "source_url": "https://www.truveta.com/blog/research/estrogen-based-hormone-replacement-therapy/", "verified_date": "2026-07-31" }, { "record_id": "nhsbsa-england-2015-2025", "source_name": "NHS Business Services Authority official statistics", "source_class": "Official administrative statistic", "geography": "England", "reference_period": "2015/16–2024/25", "publication_date": "2025-10-23", "population_and_denominator": "Estimated identified patients dispensed primary-care medicines on the HRT Prescription Prepayment Certificate drug list", "age_range": "All ages", "use_definition": "At least one included HRT-list item prescribed in primary care and dispensed in the community", "therapy_scope": "Drugs appearing on the England HRT PPC drug list", "published_estimate": "1,028,430 estimated identified patients in 2015/16; 2,804,440 in 2024/25; 14,725,133 items in 2024/25", "age_specific_result": "2024/25: 646,619 estimated identified patients ages 50–54, the largest single five-year age band", "within_source_trend": "Estimated identified-patient count rose in every financial year except 2020/21; 6.4% increase from 2023/24 to 2024/25", "comparability_rule": "Compare financial years, age bands, deprivation groups, and ICB rates only within NHSBSA’s method", "nationally_representative": "Official England administrative view within its defined primary-care/community-dispensing scope", "principal_limitation": "Not restricted by gender, age, or menopause indication; patient identification not complete; excludes private, hospital, prison, unfilled, and specified OTC use; net direction versus women using HRT for menopause is unknown", "source_url": "https://www.nhsbsa.nhs.uk/statistical-collections/hormone-replacement-therapy-england/hormone-replacement-therapy-england-april-2015-june-2025", "verified_date": "2026-07-31" }, { "record_id": "ahrq-meps-us-2001-2008", "source_name": "AHRQ Medical Expenditure Panel Survey Statistical Brief #347", "source_class": "Federal nationally representative survey statistical brief", "geography": "United States", "reference_period": "2001–2008", "publication_date": "November 2011", "population_and_denominator": "U.S. civilian noninstitutionalized women aged 18+", "age_range": "18+", "use_definition": "Obtained at least one outpatient prescription drug in the brief’s HRT therapeutic class during the year", "therapy_scope": "Broad legacy HRT therapeutic class used by the brief", "published_estimate": "17.9 million in 2001; 5.8 million in 2008", "age_specific_result": "Age breakdowns are available in the source brief", "within_source_trend": "67.6% decline from 2001 to 2008 based on published endpoints; AHRQ reports a rounded 68% decline", "comparability_rule": "Compare annual headcounts, prescriptions, expenditures, and subgroups within MEPS only", "nationally_representative": "Yes, for the U.S. civilian noninstitutionalized population under MEPS methods", "principal_limitation": "Series ends in 2008 and uses a broad legacy therapeutic-class definition; not directly continuous with newer FDA, claims, or EHR measures", "source_url": "https://meps.ahrq.gov/data_files/publications/st347/stat347.shtml", "verified_date": "2026-07-31" }, { "record_id": "bjgp-uk-primary-care-2010-2021", "source_name": "BJGP Open U.K. primary-care study", "source_class": "Peer-reviewed descriptive database study", "geography": "United Kingdom", "reference_period": "2010–2021", "publication_date": "2022", "population_and_denominator": "Women with recorded menopause and/or women aged 50+ in a U.K. primary-care database", "age_range": "Recorded menopause and/or age 50+", "use_definition": "HRT prescribing prevalence; incidence measured first HRT prescriptions", "therapy_scope": "HRT prescriptions under the study’s primary-care coding and medication definitions", "published_estimate": "Prescribing prevalence 7.89% in 2010 and 6.86% in 2020; first-prescription incidence 5.01 to 18.16 per 1,000 person-years from 2010 to 2021", "age_specific_result": "Subgroup detail available in the source article", "within_source_trend": "Prevalence declined while first-prescription incidence increased; these are different measures", "comparability_rule": "Compare prevalence with prevalence and incidence with incidence within the study; do not treat either as a national headcount", "nationally_representative": "No; U.K. primary-care database sample", "principal_limitation": "Database sample, not a U.K.-wide absolute count; prevalence and incidence answer different questions", "source_url": "https://doi.org/10.3399/BJGPO.2022.0126", "verified_date": "2026-07-31" }, { "record_id": "pbs-australia-2014-2023", "source_name": "Australian and New Zealand Journal of Obstetrics and Gynaecology / PBS", "source_class": "Peer-reviewed dispensing trend study", "geography": "Australia", "reference_period": "2014–2023", "publication_date": "2026", "population_and_denominator": "10% random sample of Pharmaceutical Benefits Scheme data for women aged 45–64", "age_range": "45–64", "use_definition": "Government-subsidised menopausal hormone therapy dispensing", "therapy_scope": "MHT products captured through the PBS sample", "published_estimate": "Overall prevalence showed no statistically significant annual change (relative annual change 0.42%); transdermal +5.89% per year, IUD +10.22% per year, vaginal −1.47% per year", "age_specific_result": "Study population restricted to ages 45–64", "within_source_trend": "Route mix changed despite statistically stable overall prevalence", "comparability_rule": "Compare route trends only within the PBS sample", "nationally_representative": "10% random PBS sample within government-subsidised dispensing scope", "principal_limitation": "Reports trend rather than a single current national level; excludes non-subsidised private supply and does not confirm menopause indication", "source_url": "https://doi.org/10.1111/ajo.70135", "verified_date": "2026-07-31" } ] }