Hormone Therapy Use Has Nearly Doubled Since 2017, Driven by Women in Their Late 40s and Early 50s

Hormone therapy prescribing among U.S. women in outpatient care roughly doubled between January 2017 and April 2026, climbing from about 1.7% to about 3.6%, according to a new analysis from Epic Research that tracked 163,348,471 adult women. The steepest rise landed in women aged 45 to 54, the typical age of menopause onset in the United States, where use nearly tripled and now sits higher than any other age band in the cohort.

The reversal has been underway since 2023, two years before the FDA's most recent action on the category, and the curve tracks two decades of accumulated evidence shifting clinical defaults toward earlier and broader use of hormone therapy for menopause symptoms. Hormone therapy is the broad term for estrogen, progestin, or a combination, prescribed most often to relieve hot flashes, night sweats, vaginal dryness, and bone loss around the time of menopause.

The story starts in 2002. The Women's Health Initiative trial, a large federal study of postmenopausal women, reported that combined estrogen-plus-progestin therapy carried higher cardiovascular and breast cancer risks than previously understood. The FDA responded by adding a "black box" warning, the strongest safety warning the agency places on a drug label, to systemic estrogen products. National survey use of hormone therapy among postmenopausal women collapsed from roughly 27% in 1999 to under 5% by 2020, and an entire generation of clinicians trained in the post-WHI era treated the therapy as a fallback rather than a first option.

In the years that followed, reanalyses of the WHI data argued the original trial overstated risks for women who started therapy in their early 50s and within 10 years of menopause onset. The U.S. Preventive Services Task Force reaffirmed in 2022 that hormone therapy should not be used to prevent chronic disease in postmenopausal women, but it left symptom treatment to individual clinical judgment. In November 2025, the FDA removed the black-box warnings for cardiovascular disease, breast cancer, and dementia from estrogen-containing products, citing newer evidence that benefits can outweigh risks when therapy begins within 10 years of menopause onset. Harvard Health's coverage of the change describes the move as a rebalancing rather than a reversal of the underlying evidence.

The Epic Research data, drawn from a single electronic health record vendor's outpatient records, show the bend arriving before the FDA acted. Use was flat at roughly 1.8% to 1.9% through 2022, then climbed steeply through 2023, 2024, and into 2026. The November 2025 label change is the regulatory ratification of a clinical shift that the reanalyses, professional society guidance, and direct-to-patient marketing had already pushed into practice. A prior Epic Research brief found hormone replacement prescriptions for women up 72% since 2021, and a Truveta research post documented the same direction of travel in an independent claims dataset.

Epic's cohort is women seen in U.S. outpatient care across a single EHR vendor's footprint, so the 1.7% and 3.6% are prescribing rates within that sample, not population prevalence. Menopausal status is approximated through age bands rather than directly measured, which means the 45-to-54 surge includes both perimenopausal and recently postmenopausal women. The 2022 USPSTF position is still in force, and the FDA's action did not endorse hormone therapy for chronic-disease prevention.

For a woman in her late 40s or early 50s, the question is no longer whether hormone therapy is a normal option for hot flashes, sleep disruption, and bone loss. It is whether her clinician is up to date on the post-2022 evidence and the November 2025 label change, and whether her own risk profile, including family history of breast cancer and cardiovascular disease, fits the "within 10 years of menopause onset" window that now anchors the guidance.