Primary care doctors' practices in managing menopausal symptoms and views on patient clinical conditions influencing their decision to offer menopause hormone therapy: A cross-sectional study.

Introduction: Menopausal symptoms, such as vasomotor disturbances, mood changes and atrophic vaginitis, significantly affect women's quality of life. This study aimed to examine how primary care doctors (PCDs) manage these symptoms and the clinical conditions influencing their decision to offer menopause hormone therapy (MHT), bridging gaps between guidelines and real-world practices. Methods: A cross-sectional study was conducted from June to October 2022 among PCDs in public health clinics in Selangor, Kuala Lumpur and Putrajaya. An online survey was distributed to 1301 PCDs, achieving a 42.9% response rate (559 respondents). Data were analysed descriptively. Results: Lifestyle modifications were the most common recommendation (98.4%), while complementary treatments were widely recommended (54.8%). MHT was discussed by 83.5% of the PCDs but directly prescribed by only 0.9%, with 66.0% referring patients to tertiary care. MHT was primarily offered for vasomotor symptoms (80.5%) and mood disorders (56.7%) but less commonly for non-communicable diseases such as hypertension (14.1%) and diabetes mellitus (25.2%). It was withheld in cases of breast cancer (91.9%) or venous thromboembolism (86.0%), with breast cancer concerns being a major barrier (75.3%). Conclusion: Lifestyle modifications and complementary treatments were common practice options. MHT discussions were frequent, but prescription was limited due to patient concerns and comorbidities. Targeted updates to guidelines and tools can support healthcare professionals in counselling, risk assessment and effective management of menopausal symptoms.