OBJECTIVES: Compare clinical and economic outcomes between post-menopausal women treated with combined estrogen and progestogen hormone therapy (HT) within 1 and 1-2 years after diagnosis. METHODS: A retrospective analysis of women age 45 or older from a large U.S. health plan (April 2002-September 2010) was conducted. The first HT prescription during the identification period (April 2005-September 2008) was identified as the index date. Patients were selected if they initiated HT treatment within 2 years of menopause diagnosis, and had 3 years of continuous health plan enrollment before (pre-period) and 2 years after the index date (post-period). Patients with evidence of post-period pregnancy or pre-period other HT treatment were excluded. Two cohorts were created based on HT initiation date (Cohort A: HT initiated within 1 year of diagnosis; Cohort B: 1-2 years after diagnosis). Propensity score matching (PSM) was used to adjust for baseline differences in age, region, procedure used, comorbidities, and healthcare utilizations during the pre-period. RESULTS: Among 4268 eligible patients, 69.3% (N=2956) were included in Cohort A and 30.7% (N=1871) in Cohort B. After PSM, 1310 patients from each group were matched. Patients prescribed HT within 1 year of menopause diagnosis (Group A) were less likely to have Dual-Energy X-RAY Absorptiometry (DEXA) scans and osteopenia than patients treated between 1-2 years after menopause diagnosis. In addition, patients with earlier treatment showed a higher medication possession ratio (MPR) (0.49 vs. 0.46, p=0.272). Healthcare costs and utilizations remained similar, except patients with early HT treatment had significantly lower emergency room visit rates (22.9% vs. 26.5%, p=0.033) than patients with late HT treatment. CONCLUSIONS: Patients initiating HT within 1 year of menopause diagnosis had fewer comorbidities, directionally higher MPR but not significant, and lower emergency room visit rates than women initiating HT between 1-2 years. Other clinical and economic outcomes were similar.