How Many Women Use HRT? What the 2026 Data Actually Shows

About 3.6% of adult women seen in U.S. outpatient care were using hormone therapy in April 2026. Among women aged 45–54, the rate was about 1 in 15. The best nationally representative estimate is 4.7% of postmenopausal women, but that survey ended in March 2020. There is no single official 2026 national rate.

So when you search how many women use HRT, you get five different answers and almost no explanation for why they disagree. Here is the reason: they are not measuring the same thing. One counts postmenopausal women. One counts women with a hormone order in a month. One counts women who filled at least 180 days of systemic prescriptions in a year. Change the denominator or the definition of “use,” and the answer swings from about 1 in 59 to roughly 1 in 7.

We pulled seven major datasets, recorded what each one actually counts, and lined them up under the same four labels: population, therapy scope, event measured, and end date. That is the only honest way to compare them. It also reveals why the “nobody takes hormones anymore” story is now out of date without pretending there is one perfect 2026 national percentage.

Best for

• Women weighing HRT who want to know whether women their age actually use it
• Women already taking HRT who feel like the only person in their circle
• Anyone who has been told “nobody takes that anymore” and wants the number, source, and date

Not for you if

You need a personal answer about whether HRT is right for you. A prevalence figure knows nothing about your symptoms, age, time since menopause, uterus status, medical history, or goals. Start with HRT benefits and risks and a clinician who can assess your situation. We will say that more than once because it matters more than any percentage on this page.

At a glance

Your question	Best current answer	The qualifier that changes what it means
Most current large U.S. health-system figure	3.6%	Adult women with a U.S. outpatient encounter, April 2026
Women aged 45–54	About 1 in 15	Epic’s all-hormone outpatient measure; Truveta’s estrogen-only measure is about 1 in 20
Best nationally representative U.S. estimate	4.7%	Postmenopausal women; survey data ended in March 2020
Sustained annual systemic HRT use	1.7%	Women 40+ with at least 180 covered prescription days in 2023
England, women 40+	8.8 to 14.2 per 100	NHS prescribing rate varied by deprivation group in 2025/26
One official 2026 U.S. national rate	Does not exist	We will not create one by averaging incompatible datasets

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What do the seven major HRT-use datasets actually count?

The seven figures do not compete for one crown because each answers a different question. Their spread comes mostly from four variables: who enters the denominator, which hormone products count, whether “use” means an order or a filled prescription, and when data collection ended. Read those columns before you read the headline number.

The HRT Index Denominator Ledger

Source	Headline figure	Population	Therapy scope	What counts as “use”	Data through	What it can honestly answer
Epic Research, July 2026	1.7% → 3.6%	163,348,471 women ages 18–79 with a U.S. outpatient encounter; specific exclusions applied	Estrogen, progestin, combinations, testosterone-containing products, and multiple routes	An eligible hormone order or dispense in an active outpatient month	April 2026	How hormone use changed among women receiving outpatient care
Epic Research, November 2025	29.3 → 50.4 per 1,000	Women ages 50–65 with an encounter and an active prescription	Broad HRT medication list; some prescriptions may have nonmenopause uses	A new or renewed qualifying prescription in a quarter	Q3 2025	How quarterly prescribing changed in a narrower 50–65 healthcare cohort
Truveta, April 2026	11.5 → 23.5 per 1,000	Women 18+ with available prescription data	Estrogen-based products only	Evidence of an estrogen-based prescription	February 2026	Current estrogen-prescribing trends, including age and route differences
JAMA Health Forum / NHANES, September 2024	26.9% → 4.7%	13,048 U.S. postmenopausal women; nationally representative	Prescription menopausal hormone therapy	Current prescription medication reported during a household interview	March 2020	The best nationally representative prevalence estimate for postmenopausal U.S. women
AARP Public Policy Institute / NORC MEPS, April 2025	5% treated; 2.1 million women	U.S. women ages 45–64	Any recorded menopause treatment, not HRT alone	Treatment for menopause in the survey period	Pooled 2016–2021	How many midlife women received any menopause treatment—not HRT prevalence
Mayo Clinic Proceedings, June 2026	4.4% → 1.7%	Women 40+ in a large U.S. claims database	Systemic menopausal hormone therapy	At least 180 days of filled prescriptions in one year	2023	Sustained annual systemic use under a strict claims definition
NHSBSA inequalities analysis, August 2026	2 million women; 8.8–14.2 per 100	Women 40+ in England	NHS HRT prescriptions captured by the report	Receipt of an NHS HRT prescription	2025/26	England’s prescribing level and geographic/deprivation variation

Source: Epic July 2026, Epic November 2025, Truveta April 2026, JAMA Health Forum / NHANES, AARP Public Policy Institute / NORC, Mayo Clinic, and NHSBSA.

How to use this table:

• Want one nationally representative U.S. percentage? Use 4.7% and attach “postmenopausal women, data through March 2020.”
• Want to know what is happening now? Use Epic and Truveta, but attach “women represented in participating health-system data,” not “all U.S. women.”
• Want sustained annual systemic use? Use 1.7% and attach “at least 180 covered prescription days in 2023.”
• Want a single official 2026 U.S. prevalence rate? There is not one. Anyone offering one has either mislabeled a health-system figure or blended datasets that should remain separate.

The four labels every HRT statistic needs

Before trusting a percentage, make it pass this four-part test:

1. Population: all women, postmenopausal women, women with outpatient visits, insured women, or women in one age band?
2. Therapy scope: systemic estrogen, all systemic HRT, local vaginal estrogen, progestogen-only therapy, or every qualifying hormone product?
3. Event measured: prescription written, prescription active, prescription filled, medication reported, or at least 180 days of coverage?
4. End date: 2020, 2023, February 2026, April 2026, or a pooled multi-year period?

If a page gives you a number without those four labels, it has not told you enough to interpret the number.

The calculations we refuse to make

This is the part that separates a real answer from a stat blizzard. We could make the page look tidier by doing any of the following. Every one would be wrong.

• We will not average NHANES, Mayo, Epic, and Truveta. Averaging a household survey, a claims database, and two electronic-health-record datasets produces a number that describes nothing.
• We will not divide the FDA’s “about 2 million women ages 46–65” by its “about 41 million women ages 45–64.” Those age bands do not match. The ratio would look precise and mean nothing.
• We will not add U.S. and England counts or extrapolate a worldwide total. The health systems, data rules, populations, and treatment definitions differ.
• We will not treat a prescription written, a prescription filled, and a medication taken for six months as the same event. They sit on different points of the treatment chain.
• We will not convert symptom prevalence into “women who should be on HRT.” Symptoms do not establish candidacy. That is a clinical judgment, not arithmetic.

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How many women use HRT in the United States right now?

The most current large U.S. health-system estimate is 3.6% of adult women seen in outpatient care in April 2026, up from 1.7% in January 2017. It is not a whole-population prevalence rate. It describes women active in outpatient care and uses age—not confirmed menopause status—to define the groups being compared.

Epic Research analyzed 163,348,471 adult women with eligible U.S. outpatient encounters. Women with a history of breast cancer, a current pregnancy, or evidence of gender-affirming care were excluded for this menopause-focused analysis. The study counted qualifying hormone orders and dispenses by month. Epic Research, July 2026

What “3.6%” is actually a percentage of

The denominator is women with an eligible outpatient encounter—not every adult woman in the country. That matters because healthcare use changed over the study period, especially during the COVID-19 disruption, and because the population excludes several groups. Epic explicitly warns that apparent trends may partly reflect changes in who presents for care.

That does not make the number weak. It makes it a current health-system utilization measure rather than a census-style national prevalence estimate. It is the best recent answer to “is hormone use rising among women receiving outpatient care?” It is not the correct answer to “exactly what percentage of every U.S. woman is taking HRT today?”

Why another current dataset says “about 1 in 20”

Truveta reported that 49.0 per 1,000 women ages 45–54 had evidence of an estrogen-based HRT prescription in February 2026—about 1 in 20. Its overall rate was 23.5 per 1,000 women, or about 2.4%. Truveta, April 2026

That is lower than Epic’s 3.6% because the study designs differ. Truveta focused on estrogen-based products and women with available prescription data. Epic used a broader hormone definition and a different outpatient denominator. Neither figure cancels the other. They answer different questions.

The regulator’s headcount

If percentages feel abstract, the FDA supplied a useful scale check in its November 2025 utilization statement: approximately 41 million U.S. women were ages 45–64 in the 2020 Census, while approximately 2 million women ages 46–65 received a prescription for systemic estrogen alone or estrogen plus progestogen in 2020. FDA utilization statement

Notice what we did not do: divide one number by the other. The age bands are different. But “about 2 million women” is a real agency-supplied headcount for systemic therapy in 2020, and the FDA’s own conclusion was that menopausal hormone therapy may be under-utilized among women likely to benefit.

That is not the same as saying every untreated woman should receive HRT. It means a low prevalence figure cannot be treated as proof that the treatment is clinically marginal.

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How many women my age use HRT?

Use is highest around ages 45–54 in the newest U.S. datasets. Epic measured about 68 per 1,000 women in that group in April 2026—roughly 1 in 15—while Truveta measured 49 per 1,000 for estrogen-based therapy in February 2026, roughly 1 in 20. Rates decline after the peak age band.

Age group	Best current estimate	Source and date	What it counts
18–44	7.2 per 1,000	Truveta, February 2026	Estrogen-based prescriptions; one combined age group
35–44	Roughly doubled since 2017; exact endpoint not separately published in the text summary	Epic, April 2026	All qualifying hormone therapy in outpatient care
45–54	68 per 1,000 (about 1 in 15); 49 per 1,000 (about 1 in 20)	Epic April 2026; Truveta February 2026	Epic: broader HT definition; Truveta: estrogen-based only
55–64	41.6 per 1,000 (about 1 in 24) by Truveta; Epic reports roughly doubled use since 2017	Truveta February 2026; Epic April 2026	Estrogen-based versus broader HT definitions
65–74	22.1 per 1,000 (about 1 in 45)	Truveta, February 2026	Estrogen-based prescriptions
75+	15.1 per 1,000 (about 1 in 66)	Truveta, February 2026	Estrogen-based prescriptions

If you are 45 to 54: you are in the fastest-rising group

Epic’s rate for this band increased from about 24 per 1,000 women in 2017 to about 68 per 1,000 in April 2026. That is close to a tripling and was the steepest age-group rise in the study. Truveta independently found a 184.2% increase in estrogen-based prescribing for the same age band from 2018 to February 2026.

If you are here and feel like you are doing something unusual, the data says the opposite. You are in the age group driving the largest recent increase in measured U.S. hormone use.

If you are 55 to 64: common, rising, past the peak

Truveta measured 41.6 estrogen-based prescriptions per 1,000 women in February 2026—about 1 in 24. Epic found that broader hormone use in this age group roughly doubled from 2017 to 2026.

There is a wrinkle worth knowing: the stricter Mayo claims analysis still showed sustained annual systemic use falling from 7.1% to 3.5% among women ages 55–59 between 2007 and 2023. That is not a contradiction. New prescription activity can rise before a measure requiring at least 180 filled days in a year catches up.

If you are under 45: uncommon does not mean inappropriate

Use is lower below 45 because most women in that range have not reached natural menopause. The datasets do not tell us why each prescription was written, so they cannot separate ordinary perimenopause care from primary ovarian insufficiency, early menopause, or surgical menopause.

For women with premature or early menopause, The Menopause Society states that hormone therapy can generally be used until at least the mean age of menopause unless there is a contraindication. In that situation, treatment may be recommended because of younger age, not despite it. The Menopause Society 2022 position statement

Not sure where you are in the transition? Start with the perimenopause symptoms checklist.

If you are 65 or older: check what the statistic includes

Truveta measured 22.1 estrogen-based prescriptions per 1,000 women ages 65–74 and 15.1 per 1,000 among women 75 and older. Those counts can include systemic and local vaginal routes.

That distinction matters. Low-dose vaginal estrogen is used for vaginal and urinary symptoms and generally has minimal systemic absorption, while systemic HRT circulates throughout the body. “Any estrogen-based prescription in the seventies” and “systemic HRT use in the seventies” are not the same statistic. Our vaginal estrogen guide explains the practical difference.

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Does the number settle your own decision? No. It narrows the next question.

Population data can tell you whether use is common, rising, or unusually low. It cannot tell you whether systemic therapy, local treatment, a nonhormonal option, or an in-person evaluation fits your history.

Get your personalized starting-point plan with Find My HRT Path.

About 90 seconds. No email required. The tool also flags when online care is not the right place to start.

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Why does every website give a different number for HRT use?

Because the pages are counting different women, different products, different events, and different years. “4.7% of postmenopausal women,” “3.6% of women in outpatient care,” and “1.7% with 180 prescription days” are not competing estimates of one population. Attach the denominator, therapy scope, event, and end date, and the apparent contradictions disappear.

Variable 1: who is in the denominator?

This is the biggest source of confusion, and it is usually invisible.

“4.7% of postmenopausal women,” “3.6% of adult women seen in outpatient care,” and “5% of women ages 45–64 treated for menopause in any way” describe three different populations. Postmenopausal women skew older. Outpatient data include younger adults. A 45–64 band includes women at different points before, during, and after menopause.

Same country. Similar topic. Different denominator. Different answer.

Variable 2: which products count?

Epic’s broad hormone definition includes estrogen, progestin, combinations, testosterone-containing products, and multiple routes. Truveta counts estrogen-based products. Mayo’s strict measure is systemic therapy. Other studies include or exclude local vaginal estrogen depending on their drug list and purpose.

That changes the result because non-oral routes are growing quickly. Epic found transdermal use increased from 0.33% to 1.17% and vaginal use from 0.45% to 1.26% between 2017 and April 2026. Truveta found patch dispensing more than tripled and vaginal cream dispensing increased more than fourfold from 2018 to February 2026.

A dataset that includes local vaginal products can therefore report a materially higher rate than one limited to systemic therapy, particularly in older age groups. The exact size of that difference cannot be assumed without a direct head-to-head analysis.

Variable 3: what does “use” mean?

A prescription can be:

• written or ordered
• active in a medical record
• filled at a pharmacy
• reported by a participant
• covered for at least 180 days in a year

Those are different points in the same chain. The farther along the chain a study requires a woman to travel, the lower the percentage will usually be.

Mayo’s 1.7% is especially strict because it requires at least 180 filled prescription days for systemic therapy in a year. Epic’s 3.6% is a monthly health-record measure. You cannot subtract one from the other and call the difference “women who quit.” The populations, years, therapy scopes, and events all differ.

Variable 4: when did the data stop?

The “4–5%” figure on many pages comes from a strong nationally representative NHANES analysis published in JAMA Health Forum in September 2024. It is excellent data. Its last survey cycle ended in March 2020. JAMA Health Forum

Epic found its utilization series remained around 1.8% to 1.9% through 2022 and then rose sharply from 2023. That means a nationally representative number ending in 2020 cannot describe the later acceleration. It is not wrong. It is a 2020 answer being reused as though it were a 2026 answer.

The numbers we checked and did not use

Circulating claim	What the source check found
“Only 4–5% of women use HRT.”	The 4.7% figure is nationally representative for postmenopausal women through March 2020, not all women today.
“About 40% of postmenopausal women used HRT before 2002.”	The nationally representative NHANES estimate was 26.9% in 1999–2000. Higher figures may describe narrower subgroups or a different definition.
“Only 7.2% of eligible women use HRT.”	We could not trace this to a primary prevalence measurement with a defined denominator. Not used.
“About 70 million U.S. women could benefit and go without.”	We did not find this figure in the JAMA NHANES analysis commonly cited beside it. Not used.

One more limitation—ours included

Every dataset on this page measures one point on a chain: prescription written → prescription active → prescription filled → medication taken → treatment sustained. None measures the entire chain in one nationally representative 2026 cohort.

Mayo comes closest to a sustained-use measure because it requires at least 180 filled prescription days in a year. That is still not proof of how every dose was taken, why a woman stopped, whether she switched routes, or whether treatment met her goals.

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Is HRT use going up or down right now?

Up in the newest U.S. health-system datasets. Epic measured a rise from 1.7% to 3.6% between January 2017 and April 2026, with acceleration after 2022. Truveta measured estrogen-based prescribing rising 104.8% from January 2018 to February 2026. The strict Mayo sustained-use measure was still falling through 2023.

That last sentence matters. The answer depends on which end of the treatment chain you measure.

• New and active prescribing: rising quickly in Epic and Truveta.
• At least 180 filled days of systemic therapy in a year: still lower in 2023 than in 2007 in the Mayo claims analysis.

Both can be true if more women are starting now while sustained-use data lag behind—or if some starts do not continue. No current study lets us separate those explanations cleanly.

The FDA label change did not start the increase

You will see the rise attributed to the FDA’s action on menopausal hormone therapy warnings. The timeline does not support that as the original cause.

Epic’s increase accelerated in 2023. The FDA requested class-wide labeling changes on November 10, 2025, then approved updated labeling for six products on February 12, 2026. FDA request · FDA February 2026 approvals

The label change did not start the car. It may have released a brake.

Rising public attention, more menopause-focused care, changing clinical interpretation, and more women entering their late forties are plausible contributors. The utilization studies are descriptive. They do not prove why the increase began.

What is changing in what gets prescribed?

The route mix is shifting toward patches, gels, and vaginal products.

• Epic: transdermal use grew about 3.5-fold, from 0.33% to 1.17%; vaginal use nearly tripled, from 0.45% to 1.26%.
• Truveta: patch dispensing increased from 6.2 to 19.9 per 1,000; vaginal cream dispensing increased from 2.8 to 14.3 per 1,000; oral estrogen dispensing declined from 10.4 to 8.6 per 1,000.

That is not merely “more HRT.” It is a change in how therapy is delivered—and another reason an old percentage cannot be lifted into a current answer without its product definition.

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How many women used HRT before 2002—and what happened after?

In nationally representative NHANES data, menopausal hormone therapy use among U.S. postmenopausal women was 26.9% in 1999–2000 and 4.7% in the 2017–March 2020 cycle—an 82.5% relative decline. The fall followed the 2002 Women’s Health Initiative results and the public interpretation that followed them. Menopause did not change. Prescribing did.

Why we use 26.9%, not 40%

You will see “40%” on several statistics pages. The nationally representative NHANES estimate for current use in 1999–2000 was 26.9%, with a 95% confidence interval of 22.6% to 31.7%. The 2001–2002 cycle measured 29.5%. JAMA Health Forum

Higher figures can describe a narrower subgroup, a different year, or lifetime rather than current use. One narrow subgroup was genuinely striking: a 2013 peer-reviewed analysis stated that more than 90% of women ages 50–59 who had undergone hysterectomy used estrogen therapy in the 1990s. That is not the national rate for all postmenopausal women. It is a high-use subgroup cited in a separate analysis.

Who stopped—and who was never equally represented

NHANES found the largest decline among women ages 52 to under 65, whose prevalence fell 31.4 percentage points between the first and final survey cycles.

It also found racial disparities throughout the period. In 2017–March 2020, measured prevalence was 5.8% among non-Hispanic White women, 2.6% among Hispanic women, and 0.5% among non-Hispanic Black women. The estimates have wide uncertainty in some subgroups, but the overall disparity pattern was persistent. JAMA Health Forum

The MEPS analysis of women ages 45–64 found another version of the gap: 6.3% of non-Hispanic White women were treated for menopause in any way, compared with 2.5% of non-Hispanic Black women and 2.7% of Hispanic women. AARP Public Policy Institute

Different methods. Different years. Same warning: a national average can hide who was offered care and who was not.

What this history does not prove

The historical decline does not, by itself, prove HRT is safe, unsafe, indicated, or contraindicated for an individual woman. Benefit and risk depend on age, time since menopause, symptoms, medical history, formulation, dose, and route.

The Menopause Society’s 2022 position statement says the benefit-risk ratio is generally favorable for most healthy symptomatic women younger than 60 or within 10 years of menopause onset, while emphasizing individualized decision-making. That is a clinical framework—not a popularity contest. The Menopause Society

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The number of women on HRT was shaped by a study most of them never read.

And by a conversation many never got to have. Yours does not have to end at a percentage.

Use Find My HRT Path to get the questions that belong in your next consult.

It maps symptoms, age, uterus status, risk history, insurance, and state—and flags situations that need an in-person starting point.

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Does a low HRT usage rate mean HRT is dangerous?

No. A utilization rate measures what a health system prescribed under particular cultural, regulatory, training, insurance, and access conditions. It does not measure whether the treatment is safe for you. The FDA’s 2025 utilization review explicitly said menopausal hormone therapy may be under-utilized among women likely to benefit.

Here is the trap. You see 4%. Your brain fills in: If 96% of women are not doing this, they must know something.

That inference does not follow. The data show use varies sharply by year, clinician specialty, race, geography, age, product definition, and healthcare setting. A low number may reflect clinical contraindications for some women. It may also reflect whether HRT was offered, which route was considered, whether a woman wanted treatment, whether she could access a prescriber, and whether a prescription was filled.

The “90,000 deaths” estimate—and the dispute attached to it

In 2013, researchers led by Philip Sarrel published a model estimating that between 18,601 and 91,610 women ages 50–59 who had undergone hysterectomy may have died prematurely over the decade after 2002 because estrogen therapy was avoided. Original analysis

You will often see the top of that range—“90,000 deaths”—presented as a settled body count. It was not.

Women’s Health Initiative investigators formally disputed the calculation in the same journal. They argued that the estimate relied on an oversimplified extrapolation from a hazard ratio whose confidence interval included 1.0. The original authors replied and stood by their model.

We are showing you the dispute on purpose. The estimate is a peer-reviewed statistical model built on assumptions, not a registry count of identified deaths. It is legitimate evidence in an argument about potential harm from undertreatment. It is not a fact that should be repeated without the published rebuttal.

The honest version

A low usage rate is not evidence of danger. It is also not evidence that everyone should take HRT.

What the historical data prove is that prescribing fell dramatically after 2002. What the newest data prove is that measured use is rising again. What neither proves is whether one particular woman should start, continue, switch, or stop.

Popularity is not a clinical indication. In either direction.

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If HRT works for many women, why are so few receiving treatment?

The clearest documented bottleneck is what happens after women reach care. In a 2025 health-system analysis of 5,491 women with menopause-related outpatient encounters, only 17.1% had prescription treatment recorded. Provider specialty strongly predicted whether they received systemic estrogen, vaginal estrogen, or an SSRI. The finding was a conference poster, not a peer-reviewed paper.

That result was presented at The Menopause Society’s 2025 Annual Meeting. We label it as a conference presentation every time because it has not yet passed peer review. The Menopause Society press release

The treatment funnel

Step	Verified figure	What it does—and does not—mean
U.S. women ages 45–64	About 41 million	FDA-cited 2020 Census count; not a treatment denominator by itself
Moderate-to-severe vasomotor symptoms, ages 45–65	About 34%	FDA-cited symptom prevalence; symptoms do not automatically establish HRT candidacy
Women ages 45–64 treated for menopause in any way	2.1 million; 5% of the age group	MEPS pooled 2016–2021; not HRT-only prevalence
Women with a menopause-related outpatient encounter who had prescription treatment recorded	17.1%	2025 conference poster; not peer-reviewed
Among the treated group	34% systemic estrogen; 47% vaginal estrogen; 16% SSRIs	Prescription mix within that poster’s treated subgroup
Women ages 46–65 prescribed systemic estrogen alone or estrogen plus progestogen in 2020	About 2 million	FDA utilization estimate; age band differs from the 41-million count

Do not multiply these rows together. They come from different studies, populations, years, and methods. Read the table as a map of where information is lost—not as one measured cohort.

Which door a woman walks through changes what she is offered

In the conference analysis, 64.4% of menopause-related visits were with OB/GYN clinicians, 17.6% with internal medicine, 12.4% with family medicine, and 4.5% with endocrinology.

Women seen in OB/GYN were more likely to receive systemic estrogen. Internal medicine and family medicine were more likely to prescribe SSRIs. The researchers concluded that provider type and specialty significantly affected receipt and type of prescription treatment.

Read the result carefully:

Five out of six women in this health-system analysis had no prescription treatment recorded after a menopause-related visit. And among those who did, what they received depended heavily on which type of clinician they saw.

That does not prove every untreated woman was denied appropriate care. Some may not have wanted a prescription. Some may have had mild symptoms, contraindications, a nonprescription plan, or an incomplete record. But it does prove that “she reached care” and “she received prescription treatment” are not the same event.

What the regulator said

The FDA’s utilization assessment concluded that menopausal hormone therapy may be under-utilized among women likely to benefit. That is deliberately narrower than “the number is too low.” It raises under-use as a documented possibility without pretending every gap represents a missed prescription.

Mayo Clinic’s Stephanie Faubion made the same practical point when discussing the claims study: strong evidence that hormone therapy is safe and effective for many women has not fully translated into practice. Mayo Clinic

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If you have already been told no, the useful question is not “Can somebody prescribe it?”

It is: What was the actual reason—and does it still apply to the treatment route being considered?

See which starting point fits your situation with Find My HRT Path.

The tool does not override a clinician. It helps you separate an online-care fit from a situation that needs an in-person evaluation first.

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Do women in other countries use more HRT than women in the United States?

England reports higher measured HRT prescribing in its women-40+ population than the newest U.S. datasets report in their own populations. A record 2 million women ages 40 and older received NHS HRT prescriptions in 2025/26, with rates from 8.8 to 14.2 per 100 across deprivation groups. The U.S. and England figures are not directly comparable.

The NHSBSA release was published on August 5, 2026. It reported more than twice as many women receiving NHS HRT prescribing as in 2020/21. It also documented wide local and socioeconomic variation. NHSBSA media release

U.S. and England: what can be compared

Measure	United States	England
Most current headline figure	3.6% of adult women with outpatient encounters, April 2026	2 million women ages 40+ receiving NHS HRT prescribing, 2025/26
Core midlife age band	About 5–7 per 100 at ages 45–54, depending on dataset and product scope	NHSBSA publishes age-specific patterns, but they are not measured on the same basis as the U.S. rows
Direction	Epic flat through 2022, then sharply rising from 2023	More than doubled from 2020/21 to 2025/26
Social/geographic variation	Race and ethnicity gaps in NHANES and MEPS	8.8 to 14.2 per 100 across deprivation groups; 4 to 23 per 100 across local areas
Direct rate comparison valid?	No	No—age bands, systems, and measurement rules differ

The honest conclusion is not “England is exactly three times higher.” It is that England’s NHS data show higher measured prescribing in its defined women-40+ population and much wider local granularity than the available U.S. reports.

A nearly sixfold gap inside one health system

NHSBSA reported rates from about 4 per 100 women ages 40+ in Newham to 23 per 100 in Brighton and Hove. That is nearly a sixfold local difference inside one national health service.

A gap that large cannot tell us which women should have received HRT. It does tell us that utilization is not explained by biology alone. Local prescribing culture, access, deprivation, patient preference, population mix, and clinical need may all contribute. The report cannot assign a clean percentage to each cause.

The same warning appears in both countries

U.S. data show utilization differences by race, age, clinician specialty, and year. England’s data show differences by deprivation and geography. These are not the same measures, and we will not collapse them into one claim.

But they point to the same practical warning: where a woman lives and which part of the healthcare system she reaches can change the treatment pathway she encounters. That is an editorial interpretation of the sourced patterns—not a measured causal effect.

Two things England’s numbers do not tell you

First, England is not the whole United Kingdom. Scotland, Wales, and Northern Ireland publish separately. “Two million women in the UK” would be an inaccurate relabeling of an England-only figure.

Second, NHSBSA’s inequalities analysis and annual HRT statistical collection use different methods. The annual collection counted 14.7 million dispensed items and 2.8 million identified patients in 2024/25. The 2025/26 inequalities report used a different analytical frame. Those figures should not be stitched into one time series without following NHSBSA’s methodology notes.

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How long do women stay on HRT?

We know far less about continuation than initiation. Mayo’s claims analysis required at least 180 filled prescription days in a year and found 1.7% of women 40+ met that definition in 2023. Monthly-order datasets report higher percentages, but they cannot tell us whether the same women stayed on treatment for six months, switched routes, or stopped.

That gap between measures is one of the most important unanswered questions on this page.

What the gap may mean

Put the measures beside each other:

• Mayo, 2023: 1.7% of women 40+ had at least 180 filled days of systemic HRT in the year; about 3.5% among women 50–59.
• Epic, April 2026: 3.6% of adult women in outpatient care had qualifying hormone use in an active month; 6.8% among women 45–54.

Different populations. Different years. Different products. Different events. This is not a clean subtraction.

But it identifies the missing measurement: Are the women behind the recent prescribing increase continuing treatment long enough to appear in a strict annual claims measure? We do not yet know. If the rise is durable, later sustained-use data should increase. If starts are short-lived, they may not.

The large clinical trial nobody has run

The AARP analysis highlighted a blunt evidence gap: a large clinical trial following women who start HRT in their forties and fifties for at least a decade has not been conducted.

Not “needs updating.” Not “had a small sample.” The specific large, long-duration clinical trial people assume exists does not.

That does not mean there is no long-term evidence. There are observational studies, trial follow-ups, product-specific data, and decades of clinical experience. It means the exact prospective trial design many people imagine has not supplied a simple answer.

That is not a gap in this page. It is a gap in the evidence, and you deserve to know it is there.

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What can these HRT statistics tell you about your own decision?

They can tell you whether use is rare, rising, concentrated in your age group, or measured differently across systems. They cannot tell you whether you are a candidate. Popularity does not override symptoms, age, time since menopause, uterus status, medical history, treatment route, or personal preference. A clinical decision remains individual.

We want to be blunt because the emotional pull runs in both directions.

If you are leaning toward HRT, a low number can feel like a warning. It is not a verdict.

If you have decided against HRT—or your symptoms do not bother you enough to treat—the rising numbers and “everyone is on it now” energy can feel like pressure. That is not a verdict either.

Not treating mild symptoms is a legitimate choice. Treating disruptive symptoms after an informed clinical discussion is also a legitimate choice. A prevalence percentage cannot make either decision for you.

The four things that actually change your answer

1. Your age and time since menopause. The Menopause Society says the benefit-risk ratio is generally favorable for most healthy symptomatic women younger than 60 or within 10 years of menopause onset.
2. Whether you have a uterus. With systemic estrogen, women with a uterus generally need endometrial protection, commonly with a progestogen or an approved alternative regimen.
3. Your medical history. Unexplained vaginal bleeding, certain cancers, prior blood clots, stroke, heart disease, and liver disease can change whether, how, or where treatment should be considered.
4. The symptom and treatment route. Hot flashes and night sweats may lead to a systemic discussion. Vaginal dryness, pain, and urinary symptoms may lead to local treatment instead. See vaginal estrogen and nonhormonal options.

When online care is not the right starting point

Some situations belong with an in-person clinician first:

• unexplained vaginal bleeding, especially after menopause
• a personal history of breast cancer, blood clots, stroke, or heart attack
• complex heart or liver disease
• symptoms that need a physical examination, imaging, or biopsy to sort out
• a new or rapidly changing symptom that has not been evaluated

A telehealth intake form is not the right first step for those. We would rather lose your click than have you skip the evaluation you need.

FDA-approved versus compounded—and what the data can prove

Compounded hormone preparations and FDA-approved products are different regulatory categories. Compounded drugs are not FDA-approved, and the FDA does not review them for safety, effectiveness, or quality before marketing in the way it reviews approved drugs. FDA compounding Q&A

The current prevalence studies do not provide a clean, separately reported national count of compounded menopausal hormone use. Some claims and EHR systems may undercapture compounded prescriptions or fail to distinguish them reliably. NHANES records reported prescription medicines but does not give this page a current compounded-versus-approved national split.

That means we cannot say every dataset contains only FDA-approved products. We also cannot add an invented compounded estimate on top of the published figures. The total is unmeasured.

We are flagging this as a data-integrity issue, not a recommendation. FDA-approved and compounded products are not interchangeable, and this site does not imply equivalence. Our HRT cost guide explains how care models and medication categories can affect what a woman pays.

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If you decide to look into HRT, where should you start?

Start with a clinician who can assess your history and treats menopause routinely. For some women, that is their current OB/GYN or primary-care clinician. For others, it is a menopause specialist or a telehealth service. The right starting point depends on clinical complexity, insurance, state availability, medication route, and whether an examination is needed.

Start with your own clinician—genuinely

If you already have a clinician who handles menopause confidently, that is usually the simplest path. You have an existing relationship, your records may already be available, and insurance may be easier to navigate.

Three questions can turn a vague appointment into a useful one:

1. “Am I a candidate for systemic hormone therapy—and if not, what specifically rules me out?”
2. “If systemic therapy is not right for me, is local vaginal treatment appropriate for my symptoms?”
3. “If you do not prescribe menopausal hormone therapy, can you refer me to someone who does?”

That last question matters. “This clinician does not provide this care” and “this treatment is medically wrong for you” are different answers. They can feel identical from the exam-room chair unless you ask for the reason.

What menopause-focused telehealth can change

Telehealth does not make a prescription automatic, and it does not remove the need for clinical screening. What it can change is access to a clinician who works with menopause routinely, a structured intake, route-specific treatment discussions, follow-up, and—depending on the provider—insurance or cash-pay logistics.

It is a poor starting point when your situation requires an examination, imaging, biopsy, urgent workup, or coordinated management of complex disease. It can be a practical starting point when the clinical question is appropriate for remote evaluation and the service operates in your state.

Because provider pricing, insurance participation, laboratory policies, and state availability change quickly, this statistics page does not embed a fast-staling provider sales table. Use the HRT cost guide for current cost pathways or Find My HRT Path to identify which care model fits before you compare programs.

That is the next step this page earns: not “buy HRT,” but find the right clinical starting point.

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How did we verify these HRT numbers?

Every headline figure on this page traces to a named source with a publication date, population, therapy scope, use definition, and end date. When two sources disagree, we preserve both and show why. When a circulating statistic does not trace to a defensible primary measurement, we exclude it instead of laundering it through repetition.

This is The HRT Index Verification Standard applied to prevalence research: read the original source, record what it measured, separate medical and commercial facts, identify the denominator, and re-check on a fixed schedule.

What we actually verified

Claim set	Verification method	Verified
Epic 2026 headline percentage, age-band figure, route trends, exclusions, and limitations	Read Epic Research’s full study summary and data definitions	August 10, 2026
Epic 2025 50–65 quarterly rate	Confirmed that 50.4 per 1,000 applies to Q3 2025, not Q4; Q4 update reports an 86% increase without the same printed endpoint	August 10, 2026
Truveta overall, age-band, and route figures	Read the published methods and results through February 2026	August 10, 2026
NHANES national prevalence, sample, confidence interval, race/ethnicity findings, and end date	Read the full JAMA Health Forum article	August 10, 2026
Mayo strict-use definition and trend	Confirmed the ≥180-day definition and 4.4% to 1.7% trend in the journal-linked Mayo release	August 10, 2026
FDA utilization counts, under-use language, and label-change timeline	Read the FDA request, utilization statement, and February 2026 approval notice	August 10, 2026
17.1% treatment finding and specialty distribution	Read The Menopause Society release; labeled as a conference poster, not peer-reviewed	August 10, 2026
England 2025/26 headline and local variation	Checked NHSBSA’s August 2026 release and kept it separate from the annual collection	August 10, 2026
Compounded-drug regulatory language	Checked FDA’s current compounding Q&A; removed the unsupported claim that every dataset contains only FDA-approved products	August 10, 2026

When we will check again

Element	Refresh cadence	What would trigger a change
Epic headline percentage and age bands	Monthly	A newer Cosmos update or revised methods
Truveta rates	Quarterly	A new research post or longer follow-up
NHSBSA England figures	At each release	New inequalities or annual publication
NHANES national estimate	Annually	A post-2020 nationally representative cycle
Mayo sustained-use measure	Annually	Later claims year or revised definition
17.1% conference finding	Quarterly	Peer-reviewed publication, correction, or fuller methods
FDA regulatory language	Quarterly	Additional label approvals or revised agency guidance
Internal care-path links	Monthly	Pricing, provider, coverage, or state-availability changes on linked pages

Found a number we got wrong? Tell us. We publish corrections and would rather hear it than leave a bad figure live.

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Frequently asked questions

How many women use HRT?

About 3.6% of adult women seen in U.S. outpatient care were using hormone therapy in April 2026. Among women ages 45–54, Epic measured about 1 in 15. The best nationally representative estimate is 4.7% of postmenopausal women, but that survey ended in March 2020.

What percentage of women take HRT?

It depends on which women and which definition you count. Nationally representative postmenopausal prevalence was 4.7% through March 2020. Current outpatient hormone use was 3.6% in April 2026. Sustained annual systemic use under a ≥180-day definition was 1.7% in 2023.

Is there an official 2026 national HRT usage rate for the United States?

No. The newest nationally representative survey ended in March 2020. The 2026 figures come from large health-system datasets, which are more current but do not represent every U.S. woman in the way NHANES does.

How many women ages 45–54 use HRT?

Epic measured about 68 per 1,000 women—roughly 1 in 15—in April 2026 using a broad hormone definition in outpatient care. Truveta measured 49 per 1,000—roughly 1 in 20—in February 2026 using an estrogen-based prescription definition.

Is HRT use increasing?

Yes in the newest prescribing and outpatient-use data. Epic nearly doubled from 1.7% in 2017 to 3.6% in April 2026, with acceleration after 2022. Truveta’s estrogen-based prescribing rate increased 104.8% from 2018 to February 2026.

How many women used HRT before 2002?

Nationally representative NHANES prevalence among postmenopausal U.S. women was 26.9% in 1999–2000 and 29.5% in 2001–2002. It fell sharply after the Women’s Health Initiative results and reached 4.7% in the 2017–March 2020 survey cycle.

Why do websites give different HRT percentages?

They count different populations, products, events, and years. A monthly hormone order among women in outpatient care is not the same as a self-reported current prescription among postmenopausal women or 180 filled prescription days of systemic therapy.

Does vaginal estrogen count as HRT in these statistics?

Sometimes. Epic includes vaginal products in its broader hormone-use measure. Mayo’s strict claims analysis is systemic only. Truveta reports estrogen-based prescribing and also breaks out dispensing by route. Always check whether a number includes local vaginal treatment.

How many women take HRT in the UK?

The current figure cited on this page is for England, not the whole UK: 2 million women ages 40+ received NHS HRT prescribing in 2025/26. Scotland, Wales, and Northern Ireland report separately.

Do more women in England take HRT than in the United States?

England’s measured prescribing rate is higher in its defined women-40+ NHS population than the headline rates in the newest U.S. datasets. A precise “times higher” comparison is not valid because the age bands, healthcare systems, product definitions, and measurement methods differ.

Is it normal to be the only person I know on HRT?

Yes. Even in the highest-use current U.S. age band, the measured rate is about 1 in 15 to 1 in 20, depending on the dataset. In a group of thirty women ages 45–54, that translates to roughly one or two measured users—not most of the room.

Am I too young to be on HRT?

Age alone does not answer that. Use is uncommon below 45 because most women have not reached natural menopause, but women with primary ovarian insufficiency, early menopause, or surgical menopause may be offered hormone therapy precisely because of their younger age.

Do more women take HRT after hysterectomy?

Historically, estrogen use was extremely high among women ages 50–59 who had undergone hysterectomy, with one published analysis citing rates above 90% in the 1990s. Current national datasets do not provide a clean, current hysterectomy-specific prevalence estimate. Hysterectomy status does change whether endometrial protection is needed with systemic estrogen.

Does HRT use differ by race in the United States?

Yes in multiple datasets. NHANES found lower measured use among Hispanic and non-Hispanic Black women than non-Hispanic White women across the study period. MEPS found menopause treatment rates of 6.3% for non-Hispanic White women, 2.5% for non-Hispanic Black women, and 2.7% for Hispanic women ages 45–64.

Does a low HRT usage rate mean it is unsafe?

No. Usage reflects clinical need and contraindications, but also prescribing patterns, healthcare access, public messaging, patient preference, insurance, geography, and the definition used by the dataset. Safety for one woman is a clinical question, not a prevalence calculation.

How many women who might benefit from HRT do not receive it?

No source can give a precise national 2026 number, and we will not invent one. The FDA says MHT may be under-utilized among women likely to benefit. A 2025 conference poster found prescription treatment recorded for only 17.1% of women in one health-system cohort with menopause-related outpatient encounters.

How long do women stay on HRT?

There is no current nationally representative 2026 continuation rate. Mayo’s strict claims analysis found 1.7% of women 40+ had at least 180 filled prescription days of systemic therapy in 2023. Monthly-order datasets cannot tell us how many of the recent starters continued for six months or longer.

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What should you do with all this?

If you came here worried you were doing something unusual: you are not. You are part of a minority, but a rapidly growing one—especially if you are in your late forties or early fifties.

If you came here worried the other way—that everybody is on HRT and you are missing out—that is not true either. Most women in every current dataset are not recorded as using it, and popularity would not make it right for everyone.

And if someone told you nobody takes hormones anymore, now you have the numbers, the denominators, and the dates. That conversation should go better next time.

Still not sure which HRT program is right for you? Take The HRT Index’s free 90-second matching quiz.

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Sources

1. Epic Research. Hormone Therapy Use Nearly Doubled Since 2017, Led by Women in Their Late 40s and Early 50s. July 30, 2026.
2. Epic Research. Hormone Replacement Therapy Prescriptions for Women Up 72% Since 2021. November 24, 2025; updated February 4, 2026.
3. Truveta Research. Estrogen-based hormone replacement therapy use is rising. April 9, 2026.
4. Yang L, Toriola AT. Menopausal Hormone Therapy Use Among Postmenopausal Women. JAMA Health Forum. 2024;5(9):e243128.
5. Carter B. Women in Menopause Often Go Untreated. AARP Public Policy Institute with NORC at the University of Chicago. April 17, 2025.
6. Mayo Clinic. Hormone therapy use for menopause declines despite proven benefits, study finds. June 2026.
7. NHS Business Services Authority. Record 2 million women receive NHS HRT prescribing in England. August 5, 2026.
8. NHS Business Services Authority. Hormone Replacement Therapy—England, April 2015 to June 2025. October 23, 2025.
9. U.S. Food and Drug Administration. FDA Requests Labeling Changes Related to Safety Information to Clarify the Benefit/Risk Considerations for Menopausal Hormone Therapies. November 10, 2025; updated February 12, 2026.
10. U.S. Food and Drug Administration. FDA Approves Labeling Changes to Menopausal Hormone Therapy Products. February 12, 2026.
11. The Menopause Society. Likelihood of Being Prescribed Hormone Therapy May Depend on the Type of Provider Seen. October 20, 2025. Conference poster; not peer-reviewed.
12. Sarrel PM, Njike VY, Vinante V, Katz DL. The Mortality Toll of Estrogen Avoidance. American Journal of Public Health. 2013;103(9):1583–1588.
13. Prentice RL, Manson JE, Langer RD, et al. Women’s Health Initiative View of Estrogen Avoidance and All-Cause Mortality. American Journal of Public Health. 2013;103(12):e2.
14. Katz DL, Sarrel PM, Njike VY, Vinante V. Katz et al. Respond. American Journal of Public Health. 2013;103(12):e2–e3.
15. The Menopause Society. 2022 Hormone Therapy Position Statement—highlights. 2022.
16. U.S. Food and Drug Administration. Compounding and the FDA: Questions and Answers. Updated September 16, 2025.