SDOH May Affect Use of Menopausal Hormone Therapy: Daily Dose

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On June 4, 2025, we reported on a study published in The Biology of Sex Differences that was designed to evaluate the impact of social determinants of health (SDOH) on the likelihood of hormonal therapy (HT) use among midlife women.

The study

Investigators surveyed women aged 45-60 who received primary care at 4 Mayo Clinic locations between March and June 2021. The cross-sectional study examined electronic medical records for demographic information and self-reported social determinants of health data, including exercise levels, stress, social interactions, abuse history, ability to pay for basic needs, diet, alcohol intake, smoking status, and dental care access. Participants reported their current use of systemic HT for menopause symptoms through the study questionnaire.

The analysis included 1988 women who completed both the survey and social determinants questionnaire within 2 years. Participants averaged 54.4 years of age with a mean body mass index (BMI) of 30.2 kg/m², and 97% identified as White. Only 258 women (13%) reported current systemic HT use. Investigators used univariate logistic regression to measure associations between social determinants and HT utilization.

The findings

The research team reported several significant predictors of reduced HT access. Each 1-unit increase in BMI decreased the odds of HT use by 3% (OR = 0.97, 95% CI 0.95–0.99). Women who did not have partners had 34% lower odds of using HT compared to those who identified themselves as married or with a partner (OR = 0.66, 95% CI 0.45–0.99). The impact of education level was particularly striking, the authors said: women with high school education or less were 55% less likely to use HT compared to those with postgraduate studies (OR = 0.45, 95% CI 0.24–0.85), while the odds for those with some college or 2-year degrees were 31% lower (OR = 0.69, 95% CI 0.49–0.96).

Smoking status also significantly affected treatment access. Current smokers had 62% lower odds of HT use compared to never-smokers (OR = 0.38, 95% CI 0.18–0.83), while former smokers had 29% lower odds (OR = 0.71, 95% CI 0.52–0.96). Conversely, and a small detail of telling importance, women who used extra virgin olive oil as their main dietary fat showed 46% higher odds of HT use (OR = 1.46, 95% CI 1.10–1.94), suggesting that access to healthy foods and health literacy may facilitate treatment access.

Authors' comments

"These findings are important because they indicate that in order to ensure equitable access to menopause care, clinicians should be evaluating for and addressing SDOH with their midlife women patients."

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