Cosmos Study

Hormone Replacement Therapy Prescriptions for Women Up 72% Since 2021

November 24, 2025

Kersten Bartelt, RN | Caleb Cox

Key Findings

Hormone replacement therapy (HRT) prescriptions increased 72% from Q2 2021 to Q3 2025 among women aged 50 to 65, from 29.3 prescriptions per 1,000 women to 50.4 prescriptions per 1,000 women.

UPDATE: The increase in HRT prescriptions continued through Q4 2025, reaching an 86% increase since Q2 2021.

Hormone replacement therapy (HRT) is commonly prescribed to alleviate symptoms associated with perimenopause and menopause, such as hot flashes.¹ The use of HRT declined following the Women’s Health Initiative (WHI) findings in the early 2000s, which raised concerns about cardiovascular and cancer risks and led to black box warnings on HRT products.² Recent research around risks, as well as new formulations, lower doses, and increasing clinical emphasis on quality of life for women, have led to a resurgence of interest in HRT. Clinical societies, including the North American Menopause Society, now emphasize individualized decision-making that balances the risks and benefits of hormone replacement therapies.¹

We studied 24,235,834 women aged 50 to 65 who had a healthcare encounter and any active prescription between January 1, 2018, and September 30, 2025. Women were considered to be receiving hormone replacement therapy if they had a prescription for a medication commonly used for HRT, either new or renewed, during the specified quarter.

The quarterly rate of HRT prescribing remained stable from early 2018 through 2019, averaging around 33 HRT prescriptions per 1,000 women studied. A decline was observed in early 2020, coinciding with widespread disruptions to routine care during the COVID-19 pandemic. Rates remained below pre-pandemic levels through 2021 before beginning a steady upward trend. From Q2 2021 (29.3 per 1,000) to Q3 2025 (50.4 per 1,000), HRT prescribing rose 72%, with the largest growth occurring in the most recent quarters.

Figure 1

HRT Prescription Rate Over Time

Figure 1. The rate of HRT prescriptions among women aged 50 to 65.

These findings suggest a growing clinical usage of HRT use among menopausal women in recent years, potentially reflecting updated clinical guidance and shifting perceptions of benefit-risk balance.

Original Publication Date: November 24, 2025
Last Updated: February 4, 2026

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 300 million patient records from 1,800 hospitals and more than 41,000 clinics from all 50 U.S. states, Canada, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson.

References

The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590. doi:10.1097/GME.0000000000002200
FDA requests labeling changes related to safety information to clarify the benefit/risk considerations for menopausal hormone therapies. U.S. Food and Drug Administration. November 10, 2025. https://www.fda.gov/drugs/drug-safety-and-availability/fda-requests-labeling-changes-related-safety-information-clarify-benefitrisk-considerations. Accessed November 11, 2025.

Data Definitions

Study period: 1/1/2019 to 9/30/2025

Study population: Women aged 50 to 65 with at least one encounter and one active prescription during the study period

Denominator: An encounter and an active prescription during the given quarter

Numerator: Prescription for HRT

HRT: A medication with a simple generic, pharmaceutical subclass, or pharmaceutical class containing “progesterone,” “progestin,” “estrogen,” “estradiol,” “medroxyprogesterone,” “dydrogesterone,” “levonorgestrel,” or “tibolone” excluding those used for acne, cancer treatment, or emergency contraception

Limitations: HRT prescribed outside of Epic that has not been added to the patient’s Epic chart. We did not differentiate by medication route.