Presentation (CTI)

OBJECTIVES: Recent data showed a sharp reduction in hormone replacement therapy (HRT) use across women of all ages and racial/ethnic groups from the late 90s (27%) to 2020 (<5%). We sought to understand the most recent trends in HRT use among HRT-eligible women in the US using a nationally representative sample from 2017-2025.
METHODS: Women aged ≥40 in the Veradigm Network EHR linked to Komodo claims with continuous enrollment during each calendar year (2017-2025) separately were included. Those with a history of contraindications for HRT were excluded. A sensitivity analysis without HRT contraindications was included. Systemic or topical estrogen, combination estrogen+ progestogen, and progestogen-only were included in the definition of HRT. Trends in HRT use were presented by year overall, and broken out by race/ethnicity, and ages 40+, 50+, and 50-59.
RESULTS: Each year of analysis included between 3.6-8.5 million women aged 40+. Overall rate of HRT use in 2025 was 12.1%. Among women aged 50+, utilization rates were 8.5% in 2017 and reached 13.2% by 2025. A modest upward trend was observed among women aged 40-49 (3.3% in 2017 and 7.9% in 2025). In 2025, HRT use was lowest among women aged 40-49 of Black race (4.2%), although small increases in utilization were observed (2.2% in 2017). Utilization was highest among those aged 50-59 and of White race, with 23.6% in 2025 (compared to 12% in 2017). Differences in utilization among those with vs without contraindications were small.
CONCLUSIONS: After years of relatively flat utilization, HRT use among eligible women appears to be turning a corner. While HRT utilization remains low in absolute terms across age groups and racial categories, the post-2022 acceleration is a positive signal that may reflect growing clinical and public awareness of HRT. However, differences in HRT use by race are significant and warrant further exploration.