Hormone Prescribing to High-Risk Women Rises
Prescriptions of hormone therapy or combined contraception to women with contraindications increased in University of Pennsylvania Health System primary care from 2022 through April 2026.
Updated on Nov. 13, 2026 in Women’s Health
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Adjusted prescribing of hormone therapy or combined contraception to women with a documented contraindication rose from 3.2 per 10,000 encounters in 2022 to 23.1 per 10,000 encounters through April 2026, according to an electronic health record study presented at The Menopause Society 2026 Annual Meeting in San Diego, California.
Why it matters
The findings suggest that clinicians in primary care may be prescribing treatments to women for whom they carry elevated risk, at a time when a grant that would have supported a primary care menopause pathway was lost. Philadelphia-area patients in similar settings may be affected by the same gap in standardized care.
The adjusted prescribing rate for women aged 45 to 60 with a contraindication rose from 3.2 to 23.1 per 10,000 encounters between 2022 and April 2026, an incidence rate ratio of 1.64 per year (95% CI, 1.54-1.75). The study does not explain the cause of the rise or report whether patients were harmed.
The players
University of Pennsylvania Health System
An academic health system in Philadelphia that operates hospitals and outpatient primary care practices across the region.
Agency for Healthcare Research and Quality (AHRQ)
A federal agency within the U.S. Department of Health and Human Services that funds health services research, including learning health system grants.
The details
Researchers reviewed outpatient family medicine, internal medicine and general OB/GYN encounters among women aged 45 to 60 in the University of Pennsylvania Health System. The team said the loss of an AHRQ learning health system grant slowed development of a primary care menopause pathway, and the team plans to test that pathway and share it with other health systems.
Timeline
2022: Adjusted contraindicated prescribing was 3.2 per 10,000 encounters.
2025: Adjusted contraindicated prescribing reached 14.8 per 10,000 encounters, and AHRQ had halted more than 100 research grants since that year.
October 20-24, 2026: The study was presented at The Menopause Society 2026 Annual Meeting in San Diego, California.
April 2026: Adjusted contraindicated prescribing reached 23.1 per 10,000 encounters.
Health Landscape
The reduction in AHRQ learning health system funding, which has halted more than 100 research grants since 2025, removes support for the kind of clinical decision tools meant to guide menopause care in primary settings. The Philadelphia findings therefore bear on whether federally backed safety infrastructure can keep pace with prescribing trends in routine care.
Women aged 45 to 60 with a contraindication to hormone therapy or combined contraception should review their current prescriptions with a clinician. Patients who have questions about their own risk can ask whether a menopause pathway is available at their primary care practice.
The takeaway
Clinicians and patients both benefit from confirming that a hormone therapy or contraceptive prescription is appropriate given a patient's documented risk factors. Standardized primary care pathways, of the kind this study describes, are one way health systems can reduce the chance that high-risk women receive these treatments in error.
Further reading
Explore more in Women's Health coverage for context on menopause care and prescribing safety.
Source note: This article includes information reported by Patientcareonline.
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