Hormone therapy use in menopause dropped to 1.7%: what the new data means if you're not taking it

A study published this month in Mayo Clinic Proceedings found that hormone therapy use among U.S. women 40 and older fell from 4.4% in 2007 to just 1.7% in 2023. Even among women ages 50 to 59, the group most likely to benefit from treatment, only about 3.5% were using it. Researchers led by Dr. Stephanie Faubion, director of Mayo Clinic's Center for Women's Health, called the gap between the evidence and everyday care a problem worth fixing.

For the women who make up that other 98%, the question isn't really about hormone therapy. It's about what to do instead. Research over the past few years has built a clearer picture of which non-hormonal strategies, from cognitive behavioral therapy to specific botanicals and nutrients, actually move the needle on hot flashes, sleep disruption, and mood swings during the menopause transition.

This article explains why hormone therapy use has fallen so far below clinical guidance, what's driving the gap between research and the care most women receive, and what the evidence says works for the vast majority of women managing menopause without hormone therapy.

Point Details
Hormone therapy use has dropped sharply A Mayo Clinic Proceedings study found use among U.S. women 40 and older fell from 4.4% in 2007 to 1.7% in 2023.
Even the highest benefit group is underusing it Among women ages 50 to 59, only about 3.5% used hormone therapy in 2023, despite this group having the most favorable risk profile.
NAMS still recognizes non-hormonal options The 2023 North American Menopause Society position statement lists cognitive behavioral therapy, clinical hypnosis, and certain prescription medications as having the strongest evidence for hot flashes.
Phytoestrogens show measurable effects A 2025 Frontiers in Aging review found dietary phytoestrogens at 50 to 80 milligrams of isoflavones per day reduced severe hot flashes by up to 92% in the studies analyzed.
Lifestyle factors compound the effect The same review found combined approaches, diet, micronutrients, gut health, and movement together, produced more consistent results than any single intervention.
The 2002 WHI trial still shapes prescribing today Prescribing patterns shifted dramatically after the Women's Health Initiative trial results were published, and that shift has largely persisted for two decades.

Understanding why hormone therapy use has dropped and what that means for menopause care

During the menopause transition, the ovaries gradually produce less estrogen and progesterone. These two hormones do far more than regulate the menstrual cycle. They influence body temperature regulation, sleep architecture, mood, bone density, and the tissues of the vaginal and urinary tract. As levels decline and fluctuate, the result is the familiar list of menopause symptoms: hot flashes, night sweats, disrupted sleep, mood changes, joint discomfort, and vaginal dryness.

For decades, hormone therapy was the default response to these symptoms. Then came the Women's Health Initiative trial in 2002, which raised concerns about cardiovascular risk and breast cancer with certain hormone formulations. Prescribing dropped fast, and according to the Mayo Clinic study, it has kept dropping. From 4.4% of women 40 and older using hormone therapy in 2007, the figure fell to 1.7% by 2023.

What makes this notable is that the original concerns from 2002 applied most strongly to older women starting hormone therapy many years after menopause, not to the women most commonly considered for it today. Dr. Faubion's team pointed out that even women ages 50 to 59, who are typically within the window where hormone therapy's benefits are considered to outweigh its risks, were using it at a rate of only about 3.5% in 2023.

The North American Menopause Society's 2023 position statement still affirms that hormone therapy is the most effective treatment for hot flashes and night sweats in women under 60 who are within 10 years of their final period and don't have contraindications. But that statement exists alongside a full section on non-hormonal therapies, because the society recognizes that a large share of women either can't or won't use hormone therapy, and they still need options grounded in evidence.

For the roughly 98% of women not currently using hormone therapy, that's the part of the conversation that matters most: not whether hormone therapy works, but what else does, and how well.

  • Lingering risk perception carried over from the 2002 Women's Health Initiative findings
  • Limited menopause-specific training in many medical and nursing programs
  • Health conditions that make hormone therapy inappropriate, such as a history of certain cancers or clotting disorders
  • Personal preference for managing symptoms without prescription medication
  • Short primary care appointment times that leave little room for a full menopause discussion
  • Starting menopause care more than 10 years after the final period, which changes the risk and benefit balance

Common reasons women go without hormone therapy and how that affects symptom management

The drop in hormone therapy use isn't a single decision repeated 98 million times. It's the result of several overlapping factors, some clinical, some practical, and some personal. Understanding which ones apply to your situation helps explain why your care has looked the way it has, and where the gaps are likely to be.

Some of these factors are about the healthcare system itself. Others come down to individual health history or preference. A few are about timing: the further a woman is from her final period when she first raises menopause symptoms with a provider, the more the conversation tends to shift away from hormone therapy and toward other options.

Cause Mechanism Impact
Risk perception from the 2002 WHI trial Early findings on older, postmenopausal participants were generalized to all ages and formulations Many women never raise hormone therapy as an option, even when they'd qualify
Limited provider training in menopause care Menopause medicine receives minimal coverage in many training programs Symptoms get attributed to aging or stress rather than addressed directly
Medical contraindications History of hormone-sensitive cancers, clotting disorders, or cardiovascular disease shifts the risk and benefit balance Non-hormonal options become the primary path rather than a backup
Personal preference Some women prefer to manage symptoms through diet, supplements, or lifestyle changes first Treatment plans focus on nutrition, movement, and targeted nutrients
Delayed care seeking Symptoms are often managed informally for years before a provider visit By the time care is sought, timing windows for some options may have shifted
Access and appointment time Insurance coverage and short visit windows limit in-depth menopause discussions Women leave appointments without a full picture of their options
  • Geographic distance from providers who specialize in menopause care
  • Discomfort discussing symptoms like vaginal dryness or low libido during a routine visit
  • Assumption that symptoms are simply something to "push through"
  • Overlap between menopause symptoms and other conditions, which can delay an accurate picture

Non-hormonal strategies that address menopause symptoms after 40

Cognitive behavioral therapy and mind-body practices

The 2023 NAMS position statement places cognitive behavioral therapy and clinical hypnosis among the non-hormonal options with the strongest evidence for reducing hot flashes and night sweats. These approaches don't change hormone levels, but they change how the brain processes the temperature-regulation signals that trigger a hot flash, and they have a strong track record for improving sleep and anxiety symptoms that often accompany the menopause transition.

Dietary phytoestrogens

Phytoestrogens are plant compounds, found in soy, flaxseed, and other legumes, that have a mild estrogen-like structure. A 2025 review in Frontiers in Aging found that dietary phytoestrogens at 50 to 80 milligrams of isoflavones per day reduced severe hot flashes by up to 92% across the studies analyzed, and were considered safe for reproductive tissues at these intakes. Flaxseed lignans specifically were associated with reduced perimenopausal symptoms.

Black cohosh, dong quai, and red clover

These three botanicals are among the most studied for menopause symptom support and are frequently combined because they appear to work through complementary pathways. Black cohosh and red clover have been linked to reductions in vasomotor symptoms in multiple studies, while dong quai is traditionally paired with these botanicals for broader hormonal balance support. Evidence quality varies across studies, which is why combination formulas are common rather than relying on a single botanical alone.

Magnesium and B vitamins

Magnesium glycinate and B vitamins support the nervous system pathways involved in sleep onset and stress response. For women whose menopause symptoms include night waking, restlessness, or a heightened stress response, these nutrients address a different piece of the puzzle than botanicals aimed directly at hot flashes.

Probiotics and the gut-hormone connection

The same Frontiers in Aging review found that a probiotic strain, L. brevis KABP052, increased circulating estrogen levels by up to 26% over 12 weeks in the studies reviewed. The gut microbiome plays a role in how the body processes and recycles estrogen, which is one reason gut health has become a more prominent part of the menopause conversation.

Movement and a Mediterranean-style eating pattern

A 2025 review in Climacteric on lifestyle medicine found that nutrition, physical activity, restorative sleep, and stress management together were associated with reductions in vasomotor symptoms, improved sleep quality, and better long-term metabolic and bone health outcomes. The Mediterranean dietary pattern in particular has shown consistent associations with reduced cardiovascular burden during and after the menopause transition.

Pro Tip: Botanical and nutrient-based approaches typically take 4 to 8 weeks of consistent daily use before symptom changes become noticeable. Track hot flash frequency and sleep quality in a simple daily note for the first month so you have a clear before-and-after comparison rather than relying on memory.

Comparing non-hormonal support with hormone therapy for menopause symptoms

Hormone therapy and non-hormonal approaches aren't strictly competing options. For some women, hormone therapy remains the right choice and the most effective one. For others, due to preference, medical history, or timing, non-hormonal strategies are the primary path. And for many women, the two can work alongside each other under a provider's guidance.

The table below lays out how these approaches compare across the factors that matter most when deciding what fits your situation.

Approach Pros Considerations Best For
Hormone therapy Most effective option for hot flashes and night sweats, also supports bone density Requires medical evaluation, not appropriate for everyone, timing relative to menopause matters Women under 60, within 10 years of menopause, without contraindications
Cognitive behavioral therapy and mind-body techniques Strong evidence for sleep, anxiety, and how hot flashes are experienced Requires time investment and access to a trained provider Women managing mood and sleep alongside vasomotor symptoms
Botanical and nutrient-based support Convenient daily routine, generally low risk profile Effects build gradually over weeks and vary between individuals Women who prefer a daily non-prescription routine
Lifestyle medicine, diet, movement, sleep habits Foundational benefits that extend well beyond menopause symptoms Requires consistency and tends to show results more slowly Every woman, regardless of which other approaches are used
Combination approach Addresses multiple symptom pathways at once Works best when coordinated with a healthcare provider Women with multiple, moderate to severe symptoms

For women who have already discussed hormone therapy with a provider and decided against it, or who don't qualify for it, the non-hormonal options above aren't a downgrade. The 2025 systematic review in Healthcare found that nonpharmacological interventions produced meaningful reductions across depression, anxiety, sleep disturbance, and overall menopausal symptom scores, with nutritional and herbal approaches showing the most consistent results.

If you've never had a full conversation about hormone therapy with a provider, the Mayo Clinic data is a good reason to bring it up at your next visit, even if you end up choosing a non-hormonal path. The goal is an informed decision either way, not a default by omission. For more on what to do when hormone therapy alone isn't covering every symptom, see when hormone therapy is not enough.

Pro Tip: If you're combining a botanical supplement with any prescription medication, including antidepressants or thyroid medication, mention it to your pharmacist or provider. Some botanicals, including St. John's Wort, can interact with common prescriptions, even though many others do not.

Know when to seek professional evaluation:

  • Hot flashes or night sweats are disrupting sleep most nights of the week
  • Mood changes are affecting work, relationships, or daily functioning
  • You're experiencing irregular or heavy bleeding
  • Symptoms started suddenly or feel different from your usual pattern
  • You have a personal or family history that affects whether hormone therapy is an option
  • Non-hormonal strategies haven't produced any change after 8 to 12 weeks of consistent use

Discover natural support for menopause well-being

Botavive Balance was formulated around the categories of support that show up consistently in menopause research: botanicals studied for hormonal balance, nutrients tied to sleep and mood regulation, and probiotics connected to gut and hormone health. The formula includes dong quai, red clover, black cohosh, ashwagandha, DHA, B vitamins, magnesium, and probiotics in a single daily routine.

For women managing hot flashes, night sweats, mood swings, or general hormonal balance without hormone therapy, Balance is built to work alongside the lifestyle strategies covered in this article, not instead of them. Diet, movement, and sleep habits remain the foundation. A daily formula like Balance is designed to fill in the categories of support that are hardest to get consistently from food alone.

As with any non-hormonal approach, give it time. Most women using botanical and nutrient-based formulas notice initial changes within 4 to 8 weeks of consistent daily use.

Frequently asked questions

Why has hormone therapy use dropped so much since the 2000s?

Prescribing fell sharply after the 2002 Women's Health Initiative trial raised concerns about cardiovascular and cancer risk. Those concerns applied most strongly to older women starting therapy many years after menopause, but prescribing patterns shifted broadly and have stayed low for two decades, even as later research clarified the risk picture for younger, recently menopausal women.

How long does it take to notice a difference with non-hormonal options?

Most botanical and nutrient-based approaches take 4 to 8 weeks of consistent daily use before changes in hot flash frequency, sleep, or mood become noticeable. Cognitive behavioral therapy and lifestyle changes like diet and exercise often take a similar window, sometimes longer for sleep-specific improvements.

Is one ingredient enough, or do I need a combination?

Research generally points toward combination approaches. The 2025 Frontiers in Aging review described a multi-domain strategy, phytoestrogen-rich foods, targeted micronutrients, gut health support, and movement, as providing more consistent results than any single intervention on its own.

Does non-hormonal support reverse hormone decline, or just manage symptoms?

Non-hormonal approaches don't restore estrogen and progesterone to premenopausal levels. What the research supports is symptom management: reducing the frequency and intensity of hot flashes, improving sleep quality, and supporting mood and metabolic health during and after the transition.

What's the difference between hormone therapy and a hormonal balance supplement?

Hormone therapy supplies estrogen, progesterone, or both, directly, and requires a prescription and medical oversight. A hormonal balance supplement like Balance contains botanicals and nutrients studied for their effects on the body's response to hormonal changes, without supplying hormones themselves. They address different mechanisms and aren't interchangeable.

Sources

  1. Mayo Clinic News Network, 2026. Hormone therapy use for menopause declines despite proven benefits, study finds. Hormone therapy use among U.S. women 40 and older fell from 4.4% in 2007 to 1.7% in 2023, including only about 3.5% among women ages 50 to 59. newsnetwork.mayoclinic.org
  2. The North American Menopause Society, 2023. The 2023 nonhormone therapy position statement of The North American Menopause Society, published in Menopause. Reviews evidence levels for cognitive behavioral therapy, prescription medications, dietary supplements, and lifestyle approaches for vasomotor symptoms. pubmed.ncbi.nlm.nih.gov/37252752
  3. Bolgova O, Shypilova I, Mavrych V, 2025. Natural strategies to optimize estrogen levels in aging women: mini review, published in Frontiers in Aging. Reviews 48 studies on dietary phytoestrogens, micronutrients, gut microbiome modulation, and botanical remedies for menopause symptoms. pmc.ncbi.nlm.nih.gov/articles/PMC12685915

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