Does insurance determine menopause treatment?

Clinical takeaway: Ask eligible patients with bothersome menopausal symptoms about treatment preferences, verify payer-specific coverage rather than assuming menopausal hormone therapy is inaccessible, and address practical barriers such as follow-up visits, transportation, and continuity of care.

Menopausal hormone therapy (MHT) is the most effective treatment for bothersome vasomotor symptoms, yet use remains low. These findings suggest insurance-related barriers may be contributing to undertreatment and may help explain some racial disparities in menopause care.

In a cross-sectional analysis of pooled 2013-2020 National Health and Nutrition Examination Survey data, researchers evaluated MHT use among 1,666 women aged 45 to 64 years who had Medicaid or private insurance and no identified strict contraindications. The survey-weighted sample represented approximately 22.3 million US women.

Overall, 19.8% reported ever using MHT. Use was substantially lower among women with Medicaid than among those with private insurance: 10.7% versus 20.7%. After adjustment for demographic characteristics, cardiovascular risk factors, body mass index, diet, alcohol use, and health care utilization, Medicaid coverage remained associated with approximately 50% lower odds of prior hormone therapy use.

Current treatment was uncommon across the cohort. Only 3.7% had a prescription for menopause-related medication in the previous 30 days, although nearly 78% of those prescriptions were for hormone therapy. By comparison, 4.9% reported using a menopause supplement.

Black women initially had about 32% lower odds of prior hormone therapy use than White women. That difference weakened after insurance type was considered, suggesting coverage may account for part of the observed disparity.

“Insurance appears to function as a mediator between race and ethnicity and treatment access,” the authors wrote.

The findings cannot establish causality, and the study lacked information on symptom severity. Still, the authors said improving Medicaid formularies, reimbursement, clinician education, and care coordination may help narrow treatment gaps.

Source: Chesnokova A, et al. (2026 July 17) JAMA Netw Open. Insurance Type and Menopausal Hormone Therapy Use Among US Women