Racial Differences Persist for Menopause Hormone Therapy Prescriptions

WASHINGTON — Rates of menopause hormone therapy significantly differed by racial group, a retrospective cohort study found.

Non-Hispanic white patients had the highest utilization of menopause hormone therapy at 10.8% while Black patients had the lowest rate at 5.4%, reported Nikita Chigullapally, an MD candidate at the Carle Illinois College of Medicine in Urbana, Illinois, in a presentation at the American College of Obstetricians and Gynecologists (ACOG) annual meeting.

In fact, all non-white groups had significantly lower rates of menopause hormone therapy use (P<0.0001):

• Native Hawaiian/Other Pacific Islander: 6.4%
• Asian: 6.2%
• American Indian/Alaska Native: 7.7%
• Other: 9.1%

“Some races have more cultural and social norms that leave them less likely to get hormone replacement therapy or get treatment for menopausal symptoms,” Chigullapally told MedPage Today, noting that previous research has not fully quantified these racial disparities in utilization.

Authors found that Black and Asian women were less likely to receive menopause hormone therapy compared to white women with respective ORs of 0.56 and 0.59. Chigullapally noted that the gaps between white and Black women and white and Asian women are longstanding.

On top of that, Black women were more likely to be prescribed other treatments, like selective serotonin reuptake inhibitors (OR 1.85), fezolinetant (Veozah; OR 1.82), and gabapentin (Neurontin; OR 1.42), which is not FDA approved for menopause.

Of all racial groups, Asian women were the most likely to not receive any pharmacologic therapy for menopause (P<0.001).

“Black women are being steered towards those other alternatives and Asian women are under using all treatments, not just hormone treatments,” Chigullapally said.

Utilization of menopause hormone therapy plummeted across the board in the early 2000s after the pivotal Women’s Health Initiative (WHI) study raised the alarm on increased risks of breast cancer, coronary heart disease, stroke, and pulmonary embolism among those taking conjugated equine estrogen for menopause. The FDA placed a black box warning on the therapy as a result.

However, in the decades since, evidence has evolved on which groups and specific hormones have the most benefit and least risk. In February, the boxed warning was removed from several menopause hormone therapy products. Menopause hormone therapy’s reputation as a useful treatment for menopausal symptoms is still bouncing back.

Chigullapally’s group sought to quantify the racial and ethnic differences in the use of menopause hormone therapy. They used Epic Cosmos electronic health record data from more than 300 million patients across the country to analyze 1.8 million menopausal women. In all, 9.6% of menopausal women in the cohort used hormone therapy.

Patients ages 45 to 60 who had a menopause diagnosis, indicated by an ICD-10 code and two or more encounters in any 2-year window from 2020 to 2025, were included. Those with contraindications, like relevant cancers, thrombophilia, or stroke, were excluded.

Researchers looked at hormone replacement therapy ICD-10 codes and prescription data, as well as alternative treatments such as paroxetine (Paxil), fezolinetant, and gabapentin.

The study’s main limitation was a lack of individual-level data on why patients were or were not prescribed menopause hormone therapy.

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