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 cross-sectional studies 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 health-related factors and HRT uptake. Studies were selected if they reported numbers or odds ratios of the factors and HRT uptake. Studies were combined for meta-analysis, 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: 5124 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.