# U.S. Menopause Racial Disparities Evidence Matrix, 2026

**Version:** 1.0  
**Rows:** 66  
**Last verified:** August 1, 2026  
**Creator:** The HRT Index Editorial Team  
**Publisher:** The HRT Index

## Purpose

This dataset normalizes original U.S. evidence on menopause racial disparities into a row-level matrix. It keeps symptom frequency, duration, severity, menopause timing, clinical documentation, prescribing, current MHT use and history of MHT use separate rather than treating them as one outcome.

## Scope

Included evidence covers:

- vasomotor-symptom frequency and duration;
- symptom severity;
- natural and surgical final menstrual-period timing;
- everyday discrimination as an observed correlate of vasomotor symptoms;
- VHA documentation and hormone-therapy prescribing;
- nationally representative current MHT prevalence;
- insurance and self-reported history of MHT use.

Version 1.0 is U.S.-only. Non-U.S. studies may be discussed in future releases only if the dataset and schema scope are updated explicitly.

## Source hierarchy

The original peer-reviewed article is the quantitative source. Publisher or PubMed records are used to verify publication identity, dates and DOI metadata. Narrative reviews and consumer summaries are not substituted for primary estimates.

## Inclusion criteria

1. Original quantitative U.S. research.
2. A defined menopause-related outcome or directly relevant structural correlate.
3. A traceable primary-source publication.
4. A stated population, comparator, estimate and method sufficient for accurate quotation.

## Exclusion criteria

- narrative reviews as quantitative rows;
- consumer summaries where the original study was available;
- unsourced or irreproducible statistics;
- estimates without a defined population, comparator or outcome;
- general postmenopausal health differences without a direct menopause-experience or care measure;
- causal or biological claims about race unsupported by the design;
- non-U.S. estimates in the Version 1.0 core matrix.

## Extraction rules

- One estimate is stored per row.
- Source race and ethnicity terminology is preserved.
- Confidence intervals retain the source's stated level, including the 97.5% intervals in Kochersberger et al.
- Odds ratios remain odds ratios; they are not converted into percentage-point gaps.
- Observed and model-predicted medians are separate.
- Natural, surgical and overall menopause timing are separate.
- Current MHT use is separate from self-reported history of ever using female hormones for menopause.
- Every derived figure is labeled as an HRT Index calculation.
- Every row carries a limitation.
- No pooled effect is calculated because the studies use incompatible populations, outcomes, periods and methods.

## Original calculations

### Frequent-VMS duration

`absolute difference = group median - non-Hispanic White median`

`relative difference = ((group median - White median) / White median) × 100`

Using Avis et al.'s published unadjusted medians:

- African American: 10.1 versus 6.5 years = **3.6 years longer, or 55.4% higher**.
- Hispanic: 8.9 versus 6.5 = **2.4 years longer, or 36.9% higher**.
- Chinese: 5.4 versus 6.5 = **1.1 years shorter, or 16.9% lower**.
- Japanese: 4.8 versus 6.5 = **1.7 years shorter, or 26.2% lower**.

These are arithmetic comparisons of published medians. They are not risk ratios, causal effects, prevalence estimates or individual forecasts.

### Gold et al. 2013 natural-FMP timing

- Unadjusted: 52.17 minus 52.88 = **-0.71 years**, or **-8.52 months**.
- Covariate-adjusted: 52.59 minus 52.85 = **-0.26 years**, or **-3.12 months**.

The adjusted arithmetic difference does not override the study's conclusion that it did not detect a significant adjusted racial or ethnic difference overall.

### Reeves et al. 2023 selection-adjusted timing

- Natural FMP: 51.4 minus 52.0 = **-0.6 years**.
- Surgical FMP: 47.1 minus 48.9 = **-1.8 years**.

These calculations remain separate from the paper's reported **1.2-year overall Black-White timing difference**.

### Yang and Toriola 2024 current-MHT trends

`relative decline = ((later prevalence - earlier prevalence) / earlier prevalence) × 100`

The White-to-Black point-estimate ratio is the White prevalence divided by the Black prevalence. No confidence interval is calculated because the source did not provide covariance information or an interval for the derived ratio.

## Source-specific integrity rules

- **Gold 2006:** OR 1.63 remains an odds ratio; the authors noted odds ratios can overstate relative risks when the outcome is common.
- **Reeves 2023:** the pre-selection-correction HR 0.98 is described as Black-White menopause timing, not relabeled as a natural-FMP-specific estimate; the surgical HR 3.21 uses White natural menopause as its reference.
- **Kochersberger 2024:** Table 4 values are labeled as adjusted for a ZIP-code neighborhood-affluence score, not as a complete adjustment for socioeconomic status. Table 3 reports Indigenous/First Nations painful-sex OR 1.77 and Table 4 reports 1.74; the abstract contains an inconsistent 1.39 rendering. The selected commercial-platform sample and author-company relationships travel with the estimate.
- **Blanken 2022:** documented symptoms required qualifying codes at two or more VA encounters. The outcome is not symptom prevalence.
- **Yang 2024:** current-use estimates end in March 2020.
- **Chesnokova 2026:** the outcome is self-reported history of ever using female hormones for menopause, not current 2026 use. The sample was restricted, cross-sectional and affected by substantial missingness in medical-history variables used for eligibility.

## Limitations

This is an evidence map, not a meta-analysis or formal certainty grade. It does not establish causation, determine clinical appropriateness, prove undertreatment or predict any individual's symptoms, menopause timing or treatment needs. Several sources use historical data. Publication year is not data year.

Race and ethnicity are social classifications, not stand-alone biological mechanisms. Observed differences may reflect structural inequity, discrimination, material conditions, health history, care access, communication, documentation, measurement, cohort selection and other pathways.

## Change control

Material estimates are never silently replaced. A changed headline figure requires a new version-history entry stating the old value, new value, reason and source. The visible verification date advances only after affected rows are rechecked against their primary sources.