OBJECTIVES: Apply probabilistic linkage to add menopause symptoms recorded in a registry database to claims data, and compare healthcare utilizations and costs among women with and without symptoms. METHODS: Menopausal women age ≥45 prescribed estrogen only hormone therapy from a large U.S. claims database (04/01/2005-09/30/2008) were linked with the University of Michigan Women’s Registry Database menopausal group using probabilistic linkage, controlling for osteoporosis, gynecological disorders/procedures, genital infection, bladder/pelvic floor support problem, gynecology system cancer, breast condition, gut condition, hormone disorder, nerve problem, and other comorbidities (rheumatoid disease, depression, blood clotting). After linkage, registry patients’ menopause symptoms were added to claims database records. The same linkage procedures were repeated 250 times, the mean and 95% confidence interval (CI) of healthcare costs and utilizations during the follow-up period were compared between women with and without symptoms. RESULTS: Among 80 matched patients, 84% had at least one symptom, with hot flashes being the most common. The average cost of patients with at least one symptom was much higher than of patients without symptoms ($13,570 [95% CI: $13,459-$13,680] vs. $3,391 [95% CI: $3,345-$3,436], p-value<0.001). Cost differences were mainly from inpatient ($1,997 [95% CI: $1,925-$2,070], p-value<0.001 vs. $247 [95% CI: $239-$254, p-value<0.001), physician visit ($967 [95% CI: $961-$974], p-value<0.001 vs. $248 [95% CI: $246- $251], p-value<0.001), and pharmacy costs ($3,676 [95% CI: $3,648-$3,704], p-value<0.001 vs. $903 [95% CI: $890- $916], p-value<0.001). Women with symptoms were more likely to have inpatient (12.78% vs. 4.05%, P<0.001), outpatient emergency room (20.6% vs. 6.31%, p<0.001), and physician visits (79.86% vs. 18.71%, p<0.001). CONCLUSIONS: Women with menopause symptoms incur higher healthcare utilizations and costs than those without. Results suggest that symptoms can be an important predictor of economic outcomes. Therefore, it would be beneficial to control for them using probabilistic linkage to bridge the gap between registry and claims data.