Racial disparities in menopausal hormone therapy acceptance: a pilot study

Abstract

Previous studies provide little data on the role of race in acceptance and utilization of hormone therapy. Our primary objective was to examine differences in hormone therapy acceptance between self-reported racial groups, whereas our secondary objective was to assess patient comorbidities and reported symptom frequency at presentation in these cohorts in a menopause-focused care clinic. We conducted a retrospective medical record review of patients presenting to a menopause clinic at an urban university-affiliated academic medical center in the Midsouth between July 2018 and July 2021. Statistical analysis was performed with Student t tests and odds ratios and P values ≤ 0.05 were considered statistically significant. During the 3-year study period, 113 patients presented with menopausal symptoms and were included in the study. The cohort's self-reported racial composition was 51% Black (58 patients), and 42% White (47), and 7% unknown/declined to answer (8). Of the 42 patients who presented to the clinic with a primary complaint of vasomotor symptoms, 55% (23 patients) accepted lifestyle modification therapy, and 45% (19 patients) accepted hormone therapy. Of 34 patients who presented with a primary complaint of vaginal dryness, 85% (29 patients) accepted the recommendation of moisturizers or lubricants, whereas only 15% (5) accepted vaginal hormone therapy. Of patients with vasomotor symptoms, 10 (25%) were excluded from eligibility for systemic hormone therapy due to medical comorbidities. Thirty-seven individuals were eligible for systemic hormone therapy; 18 (49%) White patients accepted hormone therapy; however, only 9 (24%) Black patients accepted with similar clinical criteria ( P = 0.01). Black patients were 24% less likely to accept hormones for menopausal symptom management. The odds ratio was 0.24 (95% confidence interval, 0.09-0.64). Our pilot study suggests a racial disparity in acceptance of both systemic and local hormonal therapy among perimenopausal and postmenopausal patients. The presence of racial disparity in acceptance of these treatment modalities can inform clinicians about patient factors affecting treatment choice for menopausal symptoms and opportunities to explore racial differences in quality of care.