By the numbers, yes, treatment is rare relative to symptom prevalence.
Hormone therapy use among US postmenopausal women fell from about 27 percent in 1999 to under 5 percent by 2020, a collapse that far outpaces any real change in how many women are eligible for it. Surveys in the US and Israel independently find that only roughly a quarter to a third of symptomatic women receive any treatment at all, hormonal or not. It's worth being precise about what these numbers do and don't mean: the under-5-percent figure describes all postmenopausal women, including those in their 70s and 80s or with contraindications, not specifically 'eligible women left untreated' - but even accounting for that, the treatment-rate surveys point to the same undertreatment pattern from a different angle.
There's no real dispute about the direction of the numbers - treatment rates are low by any measure. The disagreement is over precisely how to phrase it: the popular shorthand ('only 5% of eligible women are treated') overstates what the main study actually measured, even though the broader undertreatment picture holds up from multiple independent angles.
What the research shows, and which source each finding rests on
NHANES-based analysis (N=13,048): menopausal hormone therapy use among US postmenopausal women fell from 26.9% in 1999 to 4.7% (95% CI 3.4-6.5%) in 2017-March 2020, with declines in every age and racial/ethnic group; by 2020, use was 5.8% in non-Hispanic White women, 2.6% in Hispanic women, and 0.5% in non-Hispanic Black women.
The 4.7% denominator is all postmenopausal women in the survey, including women in their 70s-80s, asymptomatic women, and women with contraindications - it is not a measure of 'eligible women untreated,' and the paper does not directly measure eligibility or treatment appropriateness.
In the Mayo Clinic HERA survey, press materials state only about 1 in 4 symptomatic women were receiving any treatment for menopause symptoms.
Where the real disagreement is
Each position is shown with its own sources. A position listed here is not necessarily the accepted view.
The precise 4.7% figure is being misquoted
a correction flagged directly against the source paper
The 4.7% figure counts all postmenopausal women in a national US health survey, not specifically women who are symptomatic, eligible, and without contraindications, so 'eligible women untreated' overstates what the underlying paper measured.
The broader undertreatment pattern holds regardless
the convergence of separate treatment-rate surveys
Independent surveys in the US and Israel, using different methods and populations, both land on roughly a quarter to a third of symptomatic women receiving any treatment, supporting the same undertreatment conclusion from a different, more directly relevant angle than the NHANES prevalence figure.
What would settle it: A study measuring treatment rates specifically among women confirmed to be symptomatic, eligible, and free of contraindications, rather than either the very broad NHANES prevalence figure or self-reported treatment surveys.
What is really going on here
- Is the statistic I'm hearing about 'eligible women' or 'all postmenopausal women' - those are different denominators?
- Does the treatment-rate figure include non-hormonal treatments, or only hormone therapy specifically?
Questions for your doctor
- Am I a candidate for hormone therapy, and if not, what non-hormonal options exist?
- Why might treatment rates be so low in general - is it about eligibility, awareness, or access in your experience?
- If I've never been offered treatment before, is that because I wasn't a candidate, or because it was never discussed?
Questions with no answer yet
What share of the roughly one-quarter to one-third of symptomatic women who do receive treatment are eligible, informed, and correctly matched to it, versus what share of the untreated majority would have been eligible had they been offered it?
Not directly studied yetNo research does not mean it does not work, and it does not mean it works. It means nobody has tested it yet.
What is known: No study has measured treatment rates specifically among women confirmed to be symptomatic, eligible, and free of contraindications, as opposed to the broader survey-based treatment-rate figures currently available, which do not separate eligibility from access or awareness.
What would test it: A study measuring treatment rates specifically among women confirmed to be symptomatic, eligible, and free of contraindications, rather than either the very broad prevalence figure or self-reported treatment surveys.
Is the low treatment rate mainly an awareness problem, women and clinicians not recognizing symptoms, an access problem, cost or appointment availability, or a willingness problem, patients declining when offered?
Not directly studied yetNo research does not mean it does not work, and it does not mean it works. It means nobody has tested it yet.
What is known: The available data document that the rate is low from several independent angles, but do not separate out which of these distinct mechanisms, awareness, access, or willingness, is doing the most work in driving the overall gap.
What would test it: A study that separately tracks, for the same population, whether symptoms were recognized, whether treatment was offered, and whether it was accepted, to isolate where in that chain most women are lost.
Sources
- 1.Menopausal Hormone Therapy Use Among Postmenopausal Women.Yang L, Toriola AT. Menopausal hormone therapy use among postmenopausal women. JAMA Health Forum 2024;5(9):e243128. · Comparative or small study
- 2.Addressing Menopause Symptoms: Barriers and Opportunities for Improvement.Kapoor E, Safwan N, Chaudhry R, et al. Addressing menopause symptoms: barriers and opportunities for improvement. Mayo Clin Proc 2025;100(11):1897-1907. · Observational study
- 3.Menopausal symptoms and attitudes toward hormone replacement therapy among Israeli women.Frankenthal D, Karni-Efrati Z, Zatlawi M, Keinan-Boker L, Bromberg M. Menopausal symptoms and attitudes toward hormone replacement therapy among Israeli women. J Women Aging 2024;36(1):1-13. · Comparative or small study
The letter grades the type of study behind a claim, not the answer itself.
This page is general information based on published research and public sources. It is not medical advice and not a personal assessment, and it does not replace a conversation with your doctor. Peritale is a wellness product, not a medical device, and is not intended to diagnose, treat, cure or prevent any disease. For any medical question, speak with a licensed clinician.
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Start Free MappingRelated questions
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