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Factors associated with hormone replacement therapy use: a systematic review and meta-analysis

Abstract:

Objective: To identify factors associated with HRT uptake among women.

Design: A systematic review and meta-analysis to identify factors associated with HRT uptake.

Setting: Retrospective and prospective cohort studies, case-control studies and crosssectional from any country and in any language.

Population: The study population was women aged 40-60 years old.

Methods :We searched Medline, Embase, CINAHL and Cochrane databases to identify studies reporting associations between demographic, behavioural, or healthrelated factors and HRT uptake. Studies were selected if they reported numbers or odds ratios of the factors and HRT uptake. Studies were combined for metaanalysis, reporting odds ratios and 95% confidence intervals. Quality assessment was performed to quantify the risk of bias.

Main outcome measures: HRT uptake, defined as “ever” versus “never” users.

Results: 5,124 papers were identified for title and abstract screening; 136 full texts were screened; 53 were included in meta-analyses. HRT uptake was 53% lower in Black (OR 0.47, 0.30-0.73) compared to White women. Diabetes, obesity, and history of stroke or venous thromboembolism were associated with lower HRT uptake; (OR 0.71, 0.59-0.85; 0.67, 0.56-0.81; 0.75, 0.63-0.89; 0.78, 0.74-0.0.83 respectively). Osteoporosis and depression were associated with higher HRT uptake; (OR 1.64, 1.10-2.45 and 1.69, 1.17-2.43 respectively).

Conclusions: There are differences in HRT uptake by ethnicity and health characteristics. However, findings are not generalisable globally. Our results could aid healthcare professionals and policymakers to address the gaps in HRT uptake and promote healthcare equity.

Publication status:
Published
Peer review status:
Peer reviewed

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Publisher copy:
10.1111/1471-0528.70160

Authors

More by this author
Institution:
University of Oxford
Division:
MSD
Department:
Primary Care Health Sciences
Role:
Author
More by this author
Institution:
University of Oxford
Division:
MSD
Department:
Primary Care Health Sciences
Role:
Author
More by this author
Institution:
University of Oxford
Division:
MSD
Department:
Primary Care Health Sciences
Oxford college:
St Anne's College
Role:
Author
More by this author
Institution:
University of Oxford
Division:
MSD
Department:
Primary Care Health Sciences
Oxford college:
St Anne's College
Role:
Author


More from this funder
Funder identifier:
https://ror.org/0187kwz08
Grant:
NIHR204901


Publisher:
Wiley
Journal:
BJOG: An International Journal of Obstetrics & Gynaecology More from this journal
Publication date:
2026-01-22
Acceptance date:
2026-01-07
DOI:
EISSN:
1471-0528
ISSN:
1470-0328


Language:
English
Keywords:
Pubs id:
2356946
Local pid:
pubs:2356946
Source identifiers:
W7125521998
Deposit date:
2026-01-07
ARK identifier:

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