OBJECTIVES: To examine the economic burden and health care utilization of menopausal women in the U.S. Medicaid population. METHODS: Female patients diagnosed with menopausal symptoms and/or those prescribed estrogen hormone therapy were identified using the U.S. Medicaid database from 01JUL2008 through 30JUN2010. The first diagnosis or prescription date was designated as the index date. Control patients were identified during the same time period and assigned a random index date. Patients in both cohorts were required to be aged 40-65 years and have continuous, fee-for-service medical and pharmacy benefits, 6 months pre- and post-index date. Controls were matched to cases based on age, state, race and index study year. Health care resource utilization and costs during the 6-month follow-up period were compared between the menopause and control cohorts. Generalized linear models were used to adjust for differences in baseline and demographic characteristics between the cohorts.  RESULTS: A total of 71,076 patients were included in each cohort. Patients in the menopause cohort were significantly more likely to be diagnosed with depression (23.4% vs. 17.3%, p<0.001) and anxiety (11.6% vs. 8.0%, p<0.001) compared to those in the control cohort. After adjusting for baseline and demographic characteristics, significantly more patients in the Menopause Cohort had inpatient (10.9% vs. 9.3%, p<0.001), outpatient hospital (80.6% vs. 34.7%, p<0.001) and physician office visits (89.7% vs. 74.8%, p<0.001). Higher health care utilizations translated to higher health care costs for menopausal patients ($7,237 vs. $6,739, p<0.001) compared to control patients. CONCLUSIONS: Patients diagnosed with menopausal symptoms or treated with hormone therapy incurred significantly higher health care utilization and costs compared to women without menopausal symptoms or treatment.