Racial Disparities in the Treatment of Menopausal Symptoms Among Patients with Psychiatric Conditions

Background: Vasomotor symptoms (VMS) (i.e., hot flashes) occur in about 70% of women during menopause and are often more severe for black women than white women; low-dose estrogen replacement therapy (ERT) is an effective, FDA-approved treatment for VMS (Faubion 2022). Women with psychiatric conditions often have worsening moods and severe VMS during menopause (Worsely, 2014). Data is lacking on rates of ERT prescription for this population, despite evidence that ERT may improve responses to psychiatric medications during menopause (Rasgon, 2002).

Methods: A retrospective chart review assessing racial disparities in treating menopausal symptoms with ERT among patients with psychiatric conditions was conducted. Inclusion criteria include female sex and age 45-60 years. Descriptive statistics were used to analyze the demographic characteristics of eligible patients with menopause symptoms and psychiatric conditions (based on ICD-10 codes) who were prescribed ERT between January 2017 and September 2022. MetroHealth’s Institutional Review Board approved this study.


Results: Between January 2017 and September 2022, 65,988 female patients between 45-60 years of age were seen at MetroHealth; 31.6% (20,835) were black and 54.0% (36,173) were white. Only 11.5% (7,583) of these patients had documented menopausal symptoms in their charts: 36.3% (2,753) black, 53.5% (4,057) white. 13.1% (991) of patients with menopausal symptoms received ERT: 25.8% (256) black, 65.2% (646) white.29,761 45-60-year-old women had psychiatric conditions: 30.8% (9,167) black, 59.3% (17,648) white. 14.2% (4,218) of these patients also had menopausal symptoms: 34.8% (1,468) black, 56.2% (2,371) white. 35.3% (1,489) of women with psychiatric conditions and menopausal symptoms received ERT: 23.2% (345) black and 67.8% (1,009) white.

Discussion: The data demonstrate low rates of ERT prescriptions for women with documented menopausal symptoms. Compared to all menopausal women, a higher percentage of women with both menopausal symptoms and psychiatric conditions were prescribed ERT. This could indirectly reflect a higher severity of menopausal symptoms among psychiatric patients, eliciting higher rates of providers recommending ERT. However, black women with menopausal symptoms, especially those with psychiatric conditions, were unlikely to receive ERT compared to white patients.

Conclusions: Educating clinicians on disparities among menopausal women with psychiatric conditions may improve the treatment of both conditions and improve care for marginalized women.

Faubion, S., et al. The 2022 hormone therapy position statement of The NAMS. Menopause. 2022; 29(7), 767-794.
Worsley, R., et al. The association between VMS and depression during perimenopause. Maturitas. 2014; 77(2),111-117.
Rasgon N.L., et al. ERT in the treatment of major depressive disorder in perimenopausal women. Journal of Clinical Psychiatry. 2002; 63, 45-8