Hormone therapy (HT), long known as hormone replacement therapy, often uses estrogen, progestin, or a combination to relieve symptoms of menopause such as hot flashes, night sweats, and vaginal dryness, and to help prevent bone loss.¹ Its use fell dramatically in the U.S. after 2002, when the Women’s Health Initiative trial reported that combined estrogen-plus-progestin therapy was associated with increased risks of heart disease, stroke, blood clots, and breast cancer, prompting the U.S. Food and Drug Administration (FDA) to add prominent “black box” safety warnings.²,³ National survey data show that use among postmenopausal women declined from roughly 27% in 1999 to under 5% by 2020.⁴ In the years since, reanalyses of the original trial have suggested that its reliance on an older population overstated the risks for the typical woman beginning treatment in her early 50s. In 2022, the U.S. Preventive Services Task Force reaffirmed that HT should not be used to prevent chronic disease but left using HT for symptom treatment to individual clinical judgment.⁵ Most recently, in November 2025, the FDA removed the black box warnings related to cardiovascular disease, breast cancer, and dementia from estrogen-containing products, citing newer evidence that benefits may outweigh risks when therapy begins within 10 years of menopause onset.⁶ Against this shifting backdrop, it remains unclear how real-world prescribing has changed in terms of frequency, formulation, and target population.
We examined hormone therapy use among 163,348,471 adult women seen in U.S. outpatient care between January 2017 and April 2026. Women with a history of breast cancer, a current pregnancy, or evidence of gender-affirming care were excluded. Because the data do not directly capture menopausal status, we used age bands as an approximation.
Hormone therapy use among women in outpatient care nearly doubled over the study period, rising from about 1.7% in January 2017 to about 3.6% by April 2026, as seen in Figure 1. The trend was relatively flat through 2022, holding near 1.8–1.9%, and then climbed steeply from 2023 onward. The increase was not uniform across age groups and was concentrated among women in the years surrounding the menopausal transition. Women aged 45–54 saw the largest relative rise, nearly tripling, and by the end of the study had the highest use rate of any age group. This is consistent with the typical age of menopause onset in the U.S. and with the demographic for whom recent guidance most strongly supports symptom-directed therapy.⁶ Women aged 55–64 and 35–44 each roughly doubled. Growth was more modest at the extremes of age, with the youngest women (18–34) and the oldest (65–79) having slight growth in usage.
The growth in hormone therapy was driven mainly by single-hormone products and by non-oral routes. Among hormonal compositions, progestin-only use grew most (about 3.3-fold, from roughly 0.3% to 1.1%) and estrogen-only use rose about 2.3-fold (from roughly 1.1% to 2.6%). Meanwhile, estrogen-plus-progestin and androgen/testosterone products changed little over the period.
By route, transdermal formulations such as patches and gels grew fastest (about 3.5-fold, from 0.33% to 1.17%) and vaginal products nearly tripled (from 0.45% to 1.26%), each outpacing oral therapy and injectables.
