Black and Asian Women Receive Menopause Hormone Therapy at Half the Rate of White Women
A study of 1.8 million women reveals stark racial gaps in menopause hormone therapy use, with Black women steered toward off-label drugs.
Summary
A large retrospective study using data from over 300 million patient records found significant racial disparities in menopause hormone therapy prescriptions. Non-Hispanic white women had the highest usage rate at 10.8%, while Black women had the lowest at 5.4%. Asian women were most likely to receive no pharmacologic treatment at all. Black women were disproportionately prescribed off-label alternatives like SSRIs and gabapentin. Researchers presented findings at the 2026 ACOG annual meeting, highlighting that these gaps are longstanding and not fully explained by medical contraindications. The study raises important questions about equitable access to evidence-based menopause care, especially as hormone therapy's reputation has been rehabilitated following decades of overcaution after the Women's Health Initiative study.
Detailed Summary
Menopause hormone therapy remains one of the most effective treatments for menopausal symptoms, yet a new study reveals that access to it is far from equal across racial groups. Presented at the 2026 American College of Obstetricians and Gynecologists annual meeting, this research quantifies longstanding disparities that have significant implications for women's healthspan and quality of life during midlife.
Using Epic Cosmos electronic health record data from over 300 million patients, researchers analyzed 1.8 million menopausal women diagnosed between 2020 and 2025. Overall, only 9.6% received hormone therapy. Non-Hispanic white women led utilization at 10.8%, while Black women had the lowest rate at 5.4%. Asian women came in at 6.2%, Native Hawaiian and Pacific Islander women at 6.4%, and American Indian and Alaska Native women at 7.7%. All differences were statistically significant.
The disparities go beyond simple underutilization. Black women were significantly more likely to be prescribed off-label or alternative treatments including SSRIs, fezolinetant, and gabapentin — the latter not FDA-approved for menopause. Asian women were the most likely of all groups to receive no pharmacologic treatment whatsoever. Researchers suggest cultural norms, provider bias, and systemic healthcare inequities may all contribute.
This matters for longevity because menopause hormone therapy, when appropriately prescribed, can protect bone density, cardiovascular health, and cognitive function during a critical biological transition. The FDA recently removed boxed warnings from several hormone therapy products, reflecting an updated evidence base that shows benefits outweigh risks for many women under 60.
The study's main caveat is that individual-level data on why patients were or were not prescribed hormone therapy was unavailable, making it impossible to fully distinguish patient preference from provider-driven disparities. Still, the scale of the dataset lends the findings considerable weight and urgency.
Key Findings
- Black women received menopause hormone therapy at half the rate of white women (5.4% vs 10.8%).
- Black women were 85% more likely to be prescribed SSRIs as off-label menopause alternatives instead of hormone therapy.
- Asian women were most likely to receive no pharmacologic menopause treatment at all among all racial groups.
- All non-white racial groups showed significantly lower hormone therapy utilization with p-values below 0.0001.
- FDA recently removed boxed warnings from several hormone therapy products, improving the evidence-based case for use.
Methodology
This is a meeting coverage news report summarizing a retrospective cohort study presented at ACOG 2026. The study used Epic Cosmos EHR data covering 1.8 million menopausal women from 2020 to 2025, representing a large and credible real-world dataset. Findings are preliminary conference presentations and have not yet undergone full peer-reviewed publication.
Study Limitations
The study lacks individual-level data explaining why patients did or did not receive hormone therapy, limiting conclusions about whether disparities reflect patient preference or provider bias. Findings are from a conference presentation and have not yet been peer-reviewed or published in full. ICD-10 coding accuracy and completeness in EHR data may introduce classification errors.
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