Hormone Therapy Use, Understanding, and Perceptions Have Positively Shifted From 2021 to 2025

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Perceptions, understanding, and use of hormone therapy have drastically shifted between 2021 and 2025, report investigators of research presented at The Menopause Society 2025 Annual Meeting. This shift, according to the authors, is a necessary change following early data from the Women’s Health Initiative (WHI).¹

The WHI, which is sponsored by the National Heart, Lung, and Blood Institute, is a long-term national health study that focuses on strategies for preventing heart disease, breast and colorectal cancer, and osteoporosis in postmenopausal women. The original study consisted of 3 parts—a clinical trial, an observational study, and a community prevention study—and data collection was completed in 2005.² The investigators wrote that public and clinical perceptions on hormone therapy have shifted dramatically following the early results of the WHI, even though hormone therapy remains the most effective treatment for vasomotor and genitourinary symptoms of menopause, particularly for those under 60 years of age or within 10 years of menopause onset. The authors explained that the WHI findings are often communicated without correct context, which has led to a noticeable decline in hormone therapy prescribing and usage.^1,2

Further, recent analyses have clarified that for younger individuals with symptoms, the benefits of hormone therapy typically outweigh the risks; however, use remains low, with an estimated 4.7% of postmenopausal women as of 2020 receiving treatment with hormone therapy. The investigators wrote that their prior work estimated this figure to be 8% in 2021. Concurrently, renewed cultural and clinical interest in menopause care, including more nuanced discussions around hormone therapy, has been observed.¹

For their large, perception-based dataset, the investigators present a unique and timely perspective in a landscape in which most post-WHI analyses remain outdated or claims-based. Their objective was to evaluate changes in women’s perceptions, understanding, and use of hormone therapy between 2021 and 2025 in a large, nationally representative sample and to determine whether recent cultural momentum around menopause care is transforming into increased awareness and hormone therapy use.¹

This study, the Attitudes and Usage (A&U) study, was conducted among 6,796 US female participants aged 25 to 65 years (mean age: 44.6 years) who completed an online survey over a 21-day period, with an average completion time of 25 minutes per person. The questionnaire consisted of 111 items on health perceptions, treatment history, understanding of hormone therapy, and treatment decision-making and was required for participants to complete, with the current study focusing on women’s perceptions, understanding, and usage of hormone therapy between 2021 and 2025. The study enrolled White (n = 4288), Black (n = 868), Asian (n = 142), Native American (n = 123), Native Hawaiian or Pacific Islander (n = 112), and Hispanic (n = 982) women and other ethnicities (n = 241). The investigators wrote that the 2021 study for comparison was similarly diverse (White: n = 2936; Black: n = 665; Asian: n = 147; Native American: n = 41; Hispanic: n = 665; other ethnicities: n = 124).¹

Among the enrolled women, the proportion identifying as peri- or menopausal rose from approximately 42% in 2021 to 65% in 2025. Participants who are 40 to 55 years old who self-identified as premenopausal dropped from 38% in 2021 to 21% in 2025. Hormone therapy awareness was also observed to increase, with about 36% of survey takers reporting to know “something” or “a lot” about it in 2025 compared with 28% in 2021. Despite this increase, 48% reported minimal understanding.¹

Notably, perceptions of hormone therapy have shifted to be more positive, with approximately 49% of women aged 40 to 55 years in 2025 believing the benefits outweigh the risks (2021: 38%) and 53% reporting they would be “happy” to take hormone therapy to help them manage symptoms (2021: 40%). Usage among women aged 40 to 60 years rose from 8% in 2021 to 13% in 2025. Significantly, hormone therapy usage rose among Black, Hispanic, and women of other ethnicities, with topical administration methods (eg, creams, gels, sprays) demonstrating the most growth. As more women are initiating hormone therapy use, satisfaction remains stable. About 85% of 2025 users reported being “quite satisfied” or “very satisfied,” which is similar to 87% of users in 2021.¹

The authors emphasized that a positive shift was observed between 2021 and 2025, underlining the idea that women’s perceptions, understanding, and use of hormone therapy have improved. These data highlight meaningful cultural momentum around menopause care and increasing clarity around the risks and benefits of hormone therapy. The authors wrote that, although usage remains modest, a growing willingness to consider hormone therapy—particularly among historically underrepresented groups—was indicated. Further, satisfaction remains high—but flat—underscoring the importance of setting accurate expectations and offering individualized care.¹

“These timely, perception-based data provide a needed update to the post-WHI narrative and complement older claims-based analyses. As awareness and demand grow, these findings underscore the urgent need for clinician education and expanded access to menopause-trained providers to ensure patients receive evidence-based, personalized care,” concluded the authors in their study.¹

REFERENCES

1. Liss J, Jeminiwa D, Balino A, Larkin L, Klein B. P-90 – Hormone Therapy post WHI: Evolving Perceptions, Understanding, and Use in a Contemporary US Sample. Presented at: The Menopause Society Annual Meeting; Orlando, Florida. October 21-25, 2025.

2. National Institutes of Health – National Heart, Lung, and Blood Institute. Women’s Health Initiative (WHI). Accessed October 23, 2025. https://www.nhlbi.nih.gov/science/womens-health-initiative-whi