We aim to investigate the patterns of hormone therapy (HT) use and associated factors in women participating in the Brazilian Longitudinal Study of Adult Health. Methods This study included 3281 naturally menopausal women of 40 to 74 years of age at enrollment to the Brazilian Longitudinal Study of Adult Health study, who answered questions regarding their use and discontinuation of HT. Prevalence rates of current and previous HT use were calculated, and a multinomial logistic regression model was constructed to simultaneously analyze the associated factors. Results The prevalence of HT use increased from 1995 onwards, peaking at 55.7% in 1997. A sharp decline occurred in the decade beginning in 2000, reaching 11.1% at the study baseline interview (2008–2010). Current use was associated with being ≥60 years of age (Relative Risk Ratio (RRR): 1.81; 95%CI: 1.10–2.96), divorced (RRR: 1.72; 95%CI: 1.14–2.60), or married (RRR: 2.09; 95%CI: 1.41–3.10); having a university education (RRR: 1.66; 95%CI: 1.14–2.40) or postgraduate degree (RRR: 2.45; 95%CI: 1.80–3.35); and having private health insurance (RRR: 2.86; 95%CI: 2.00–4.09). Body mass index ≥30 kg/m2 was inversely associated with HT use (RRR: 0.37; 95%CI: 0.26–0.53) as was the presence of at least one contraindication to HT use (RRR: 0.63; 95%CI: 0.44–0.89). Of the current users ≥60 years of age, 79.1% had been using HT for at least 5 years, and 73.6% had been menopausal for at least 10 years. Conclusion Although the use of HT has declined in Brazil, the women who continue using it are largely exceeding evidence-based limits of age, time since menopause, and time of use.