OBJECTIVES: To evaluate the economic burden of menopausal women enrolled in the U.S. Medicaid program.  METHODS: Menopausal women (International Classification of Disease, 9^thRevision, Clinical Modification [ICD-9-CM] diagnosis code 627) were identified using U.S. Medicaid data from 01JAN2008 through 31DEC2010. The initial diagnosis date was designated as the index date. A separate group of patients without a menopause diagnosis but of the same age, race, and gender was identified, matched and designated as the comparison group. A random index date was chosen to minimize selection bias. Patients in both groups were required to be at least age 18 years, with continuous medical and pharmacy benefits 1 year before, and 1 year after the index date. One-to-one propensity score matching (PSM) was used to compare health care costs and utilizations during the follow-up period between the menopausal and the comparison groups, and were adjusted for baseline demographic and clinical characteristics. RESULTS: After risk adjustment by PSM, a total of 67,740 patients in each cohort were matched. More menopausal patients had inpatient admissions (15.18% vs. 11.89%, p<0.0001) and other service (99.98% vs. 90.29%, p<0.0001) and pharmacy visits (86.55% vs. 71.23%, p<0.0001) compared to those without menopause. Menopausal patients also incurred significantly higher other service visit ($11,215 vs. $8,812, p<0.0001) and pharmacy costs ($2,448 vs. $1,878, p<0.0001) than comparison patients.  CONCLUSIONS: In the U.S. Medicaid program, menopausal patients had higher health care utilization and incurred higher costs than those without menopause, highlighting the economic burden of the disease.