Executive Summary

New survey reveals a significant treatment gap: Only 1 in 5 women who want hormone therapy actually get it

A comprehensive survey of over 1,000 women aged 40-60 across Arizona, Colorado, and Utah reveals a substantial healthcare gap in menopause care. While 9 out of 10 women are experiencing menopause symptoms, from sleep disruption to mood changes, that affect their work and relationships, the treatment gap is striking: only 7.5% of women are currently using hormone replacement therapy (HRT), despite 32% who would consider HRT to manage their menopause symptoms. So, only one in four women who would consider HRT are actually receiving it.

Also concerning, doctors are prescribing a combination of antidepressants and sleep medications at higher rates than HRT, despite evidence that hormone therapy is the most effective treatment for many menopause symptoms. According to The North American Menopause Society, HRT effectively treats vasomotor symptoms like hot flashes and night sweats, as well as sleep disturbances, mood changes, and other common menopause symptoms for appropriately selected women.

The impact on women's lives is substantial: 87% say their confidence and sense of self has taken a hit, 75% report their work is suffering, and 73% report negative effects on their intimate relationships. For women in their 40s, the impact is even more pronounced, with 83% reporting negative effects on their careers.

The survey points to three interconnected challenges: a significant trust gap between women and their doctors; outdated medical practices that delay or shorten effective treatment; and a knowledge gap that leaves nearly half of all women unprepared for this life transition.

What Women Are Experiencing

Nine out of ten women ages 40-60 report at least one symptom associated with the menopause transition from a list of 13 common symptoms.

Nearly two out of three women report experiencing sleep disruption and one out of three report changes in sexual desire.

On average, women report more than five symptoms.

The Impact on Women's Lives

The menopause transition is having a noticeable, negative impact on women in many areas of their lives.

Sense of self

• 87% of survey respondents reported some negative impact from perimenopause or menopause on their overall confidence and sense of self. This was the most prevalent impact on women’s lives.

Work life

• 75% of women reported a negative impact at work. This rose to 83% among women aged 40-44 compared to 63% of women aged 55-60.

Intimate relationships

• 73% of all respondents reported negative impacts on their partnerships. This impact is markedly more pronounced among younger women in the survey. While 67% of women aged 55-60 report negative effects on intimate relationships, this jumps to 78% among women aged 40-44.

The Knowledge Gap: Most Women Are Unprepared for the Menopause Transition

The vast majority—three out of four women—experiencing symptoms view their symptoms as related to the menopause transition. Yet nearly half (48%) of women report that they have limited to no knowledge about the menopause transition, with this knowledge gap particularly pronounced among younger women. Sixty percent of women aged 40 to 44 report having limited to no knowledge about this critical life stage.

For the 49% of women who have not yet spoken with a healthcare professional about menopause, two out of three (66%) report they have limited to no knowledge about the menopause transition. Surprisingly, even 30% of those who have discussed perimenopause or menopause with a healthcare provider still say they have limited to no knowledge about the menopause transition.

Women turn to multiple sources for information about menopause. The top information resource is online search (50%), followed by friends and family (40%) and their primary care physician (39%). Only 29% consult their OB-GYN, and just 13% use social media as an information source.

Getting Help: The Barriers Women Face

Half of the women surveyed (51%) have discussed perimenopause or menopause with a healthcare provider, most commonly with their primary care physician. Of those who have sought help, 54% have had two to three visits on the topic.

However, when women do seek help, the response is often inadequate.

• One out four women (24%) are told to return later if symptoms worsen or when their periods have stopped for a full year, effectively delaying treatment during a period when symptoms may be most disruptive.
• More women are prescribed antidepressants or sleep medications (23% combined) than are prescribed HRT (20%), despite the significant side effects of these medications relative to HRT. Perhaps not surprisingly, one in four women who have sought help report being unsatisfied with the outcome.

The barriers to seeking care are consistent regardless of whether women have already engaged with their healthcare providers or have yet to seek help from a clinician. Both groups cite the same top five obstacles:

1. Cost or insurance concerns
2. Not thinking their concerns are "serious enough"
3. Not knowing where to find a specialist
4. Worrying their concerns will be dismissed
5. Long wait times for appointments

The Trust Gap: Women and Their Clinicians

There is a significant trust gap between women and their healthcare providers in the area of menopause transition care. The majority of women are not confident that their current care providers—whether primary care physicians (56% not confident) or OB-GYNs (60%)—have specialized training in menopause care.

Among women who have discussed menopause with healthcare providers, 16% felt their concerns were dismissed or minimized. The type of provider matters significantly: women who consulted women's health or menopause specialists reported the highest satisfaction, with 59% feeling this type of provider helped them most with their care, notably higher than the 26% satisfaction rate for primary care providers.

These findings underscore the need for improved provider education and training. Nearly three out of four women (72%) want primary care physicians to be required to undergo continuing education to learn about current menopause care practices, recognizing that research and standards of care have changed substantially in recent years.

When asked about their priorities in choosing a menopause care provider, women's responses reveal what matters most to them. The top three criteria are:

1. Takes time to listen and answer questions (86% rated as somewhat or very important)
2. Offers both hormonal and non-hormonal options (76%)
3. Evidence-based approach to treatment (70%)

These priorities underscore women's desire for personalized, comprehensive care that respects their questions and concerns while offering a full range of treatment options grounded in current medical evidence.

The Hormone Therapy Paradox

Despite growing evidence supporting the safety and efficacy of HRT for many women, it has not reached the mainstream.

• 32% of respondents would consider HRT, yet
• 55% would consider lifestyle changes
• 45% would consider supplements
• 35% would pursue alternative therapies like acupuncture

Interestingly, a slightly higher percentage of women (36%) are willing to consider testosterone to treat low libido.

Younger women in the survey showed greater willingness to consider hormone therapy, with 35% of women aged 40-44 open to HRT compared to 29% of women aged 55-60. This suggests that attitudes toward hormone therapy may be evolving as newer research on HRT safety becomes more widely known.

The recent FDA decision to remove "black box" cancer warnings from HRT labeling has not significantly changed opinions. The majority of respondents (76%) were unaware of the FDA decision, and only 3% followed the news closely. Only 6% of women reported that they are now more likely to consider HRT in light of the announcement.

Among the small proportion of women currently using HRT (7.6% of respondents), outcomes are overwhelmingly positive. Half report that treatment has significantly improved their lives, with only 3% reporting side effects that are difficult to manage. This stark contrast between the positive experiences of current HRT users and the low adoption rate suggests a significant information and education gap.

Outdated Practices Force Women Off Effective Treatment

Among the 8.4% of respondents who had once used but had discontinued HRT, 37% stopped treatment because either they themselves or their healthcare provider felt they had been using HRT for "too long." Notably, the former HRT users who discontinued treatment for duration concerns nevertheless reported that HRT had significantly improved their quality of life.

The North American Menopause Society (NAMS), the leading authority on menopause care, states in its 2022 Hormone Therapy Position Statement that there is no arbitrary time limit for HRT use, and the decision to continue should be individualized based on each woman's symptoms, quality of life, and risk-benefit profile. NAMS explicitly notes that for women who started HRT before age 60 or within 10 years of menopause, the benefits typically outweigh risks, and women can continue therapy as long as the benefits persist and outweigh any potential risks in their individual case. This survey finding highlights that the gap between current evidence-based guidelines and actual practice is leaving many women without effective treatment for no medically justified reason.

State-Based Differences

While responses across Arizona, Colorado, and Utah were largely consistent on most survey questions, several notable differences emerged among the three states.

The most significant variation appeared in HRT prescription rates.

• Utah women were prescribed HRT at substantially higher rates than women in the other two states: 27% of Utah respondents who discussed symptoms with a healthcare provider were prescribed HRT, compared to just 16% in Arizona and 17% in Colorado.
• This represents a 68% higher prescription rate in Utah compared to Arizona and Colorado.

Willingness to consider HRT as a treatment option also varied by state.

• Women in Colorado and Utah showed greater openness to hormone therapy, with 34% in each state indicating they would consider HRT
• Just 27% of women in Arizona reported that they would consider HRT for treating perimenopause and menopause symptoms.

Access to OB-GYN care differed notably across states as well. Arizona women were more likely to have an OB-GYN (57% reported discussing menopause with an OB-GYN specialist) compared to 43% in Colorado and 46% in Utah, suggesting potential differences in healthcare access or utilization patterns across the region.

Survey Demographics

The survey included 1,026 women aged 40 to 60, with an average age of 48 years.

Age Distribution:

• Representative sample with 3% to 6% from each individual year within the 40-60 age range

Race and Ethnicity:

• White: 79%
• Hispanic or Latino: 13%
• Black or African American: 6%
• American Indian or Alaska Native: 4%
• Asian: 4%
• Native Hawaiian or other Pacific Islander: 1%

Socioeconomic Profile:

• Median household income: Less than $75,000 (66% of respondents)
• Education: 50% had completed some college education or less
• Average children: Fewer than three
• Grandchildren: 65% had none

HRT Use Status:

• Never used HRT: 74.1%
• Past users (discontinued): 8.4%
• Current users: 7.5%

Survey Methodology

This online survey examined women's experiences with perimenopause and menopause in the Mountain West and was fielded between December 17 and December 30, 2024. The target population consisted of women ages 40–60 residing in Arizona, Colorado, and Utah. A non-probability, quota-based sample was recruited through an online research panel administered by RepData, Inc., resulting in a total of 1,021 completed surveys, including n = 340 respondents from Arizona, n = 350 from Colorado, and n = 331 from Utah. The survey instrument measured menopause-related symptom experience, knowledge and awareness of the menopause transition, healthcare-seeking behavior, interactions with healthcare providers, perceived barriers to care, treatment preferences, and experiences with hormone replacement therapy. Standard data quality checks were applied prior to analysis, and demographic variables were collected to support interpretation of the findings. The study was designed and analyzed for Inflexxion Health by Dr. Steven Holiday, Associate Professor in the University of Alabama Department of Advertising & Public Relations, and Dr. Kevin K. John, Associate Professor in the Brigham Young University School of Communications and Fellow in the Simmons Center for Cancer Research, who served as the study's principal investigators.