Menopausal hormone prescribing varied by race and insurance in large retrospective study

A retrospective observational study published in Menopause examined menopausal hormone therapy (MHT) prescribing at Loyola University Medical Center from January 2007 through December 2024. Researchers analyzed electronic health records for 305,053 biologically female patients aged 45 or older with at least one outpatient encounter. The primary outcome was any documented MHT prescription during the study period.

Overall, 21,327 patients (6.99%) had an MHT prescription. Reported therapy categories were local (54.61%), systemic (37.66%), combined local and systemic (7.37%), and unknown (0.37%). Compared with White women, adjusted prescribing odds were lower among African American women (adjusted odds ratio [AOR] 0.513; 95% CI 0.486–0.541), Hispanic women (0.644; 0.613–0.676), and Asian women (0.760; 0.688–0.838).

Each one-point increase in Charlson Comorbidity Index was associated with lower prescribing odds (AOR 0.845; 95% CI 0.833–0.856). A documented urinary tract infection history was associated with higher odds (11.056; 10.556–11.580). Medicare Advantage, Medicaid, Medicare, and other insurance categories were associated with lower prescribing odds than commercial insurance.

The findings identify differences relevant to menopause care and potential treatment access. However, this single-center observational analysis cannot establish why prescribing differed or whether individual patients were undertreated. The overall proportion reflects documented prescriptions across 18 years, not current use or the proportion of symptomatic patients eligible for treatment.