This study analyzed trends and correlates of menopausal hormone therapy (MHT) use among postmenopausal women in the US from 1999 to March 2020 using data from the National Health and Nutrition Examination Survey (NHANES). The prevalence of MHT use decreased significantly over the 20-year period, from 26.9% in 1999 to 4.7% in 2020. The decline was most pronounced among women aged 52 to 65 years, with a 31.4% decrease. Prevalence varied by race and ethnicity, with non-Hispanic White women having the highest rates, while non-Hispanic Black women had the lowest. MHT use decreased across all racial and ethnic groups, with the greatest relative decline among non-Hispanic Black women. Estrogen-only formulations accounted for more than 50% of MHT prescriptions in most periods. Factors such as age, race, income, education, health insurance, BMI, and smoking status were associated with MHT use. The study highlights the continued decline in MHT use among postmenopausal women, with significant variations across age and racial groups. The findings underscore the need for further research to understand the safety and effectiveness of different MHT formulations for women with menopausal symptoms. The study also notes that MHT remains the most effective treatment for menopausal symptoms but is not recommended for the prevention of chronic conditions. The results emphasize the importance of considering sociodemographic factors in discussions and policies regarding MHT use.This study analyzed trends and correlates of menopausal hormone therapy (MHT) use among postmenopausal women in the US from 1999 to March 2020 using data from the National Health and Nutrition Examination Survey (NHANES). The prevalence of MHT use decreased significantly over the 20-year period, from 26.9% in 1999 to 4.7% in 2020. The decline was most pronounced among women aged 52 to 65 years, with a 31.4% decrease. Prevalence varied by race and ethnicity, with non-Hispanic White women having the highest rates, while non-Hispanic Black women had the lowest. MHT use decreased across all racial and ethnic groups, with the greatest relative decline among non-Hispanic Black women. Estrogen-only formulations accounted for more than 50% of MHT prescriptions in most periods. Factors such as age, race, income, education, health insurance, BMI, and smoking status were associated with MHT use. The study highlights the continued decline in MHT use among postmenopausal women, with significant variations across age and racial groups. The findings underscore the need for further research to understand the safety and effectiveness of different MHT formulations for women with menopausal symptoms. The study also notes that MHT remains the most effective treatment for menopausal symptoms but is not recommended for the prevention of chronic conditions. The results emphasize the importance of considering sociodemographic factors in discussions and policies regarding MHT use.