The HRT uptake meta-analysis is largely drawn from high-income country data and cannot be generalized globally, whereas the ongoing influence of WHI-era risk framing on prescribing underscores the need for individualized absolute risk assessment—supported by decision aids that do not yet adequately exist for many clinical scenarios.
A meta-analysis of 53 studies found that Black women had 53% lower odds of HRT use than White women, and that diabetes, obesity, stroke, and VTE history were each associated with lower uptake—findings that point to both racial inequities and potentially overcautious prescribing in women with cardiovascular risk factors who may benefit from individualized assessment.
