Portuguese osteopaths’ perceptions on the management of musculoskeletal conditions in menopausal women

Objective This study aimed to examine Portuguese osteopaths’ perceptions, confidence and approaches to managing musculoskeletal conditions in menopausal women.Method A nationwide cross-sectional online survey was conducted among osteopaths registered with the Portuguese Central Administration of the Health System. A 36-item questionnaire, adapted from validated osteopathic instruments, assessed demographics, attitudes, clinical confidence, therapeutic strategies and barriers to menopause-related musculoskeletal management. The primary outcome measures were osteopaths’ attitudes, confidence and therapeutic strategies regarding the relevance of menopause to musculoskeletal health.Results Data from 258 osteopaths were analyzed. Most respondents recognized menopause as relevant to musculoskeletal health (95%) and reported frequent clinical contact with menopausal women (58%). Mobilization, fascial and soft-tissue techniques were commonly used, whereas high-velocity low-amplitude thrusts were less frequent. Confidence in treatment and patient education was moderate to high, although 36% felt under-informed about menopause and musculoskeletal interactions. Lack of clinical guidelines (59%) and limited research availability (75%) were the main barriers. Most participants (81%) reported a need for advanced training in menopause management. Female osteopaths scored significantly higher than males in perceptions of menopause and musculoskeletal conditions (p = 0.015), clinical experience and therapeutic approaches (p = 0.001), and competences in osteopathic practice (p = 0.001).Conclusion Portuguese osteopaths, particularly women, appear aware of and engaged in managing menopause-related musculoskeletal conditions, adapting manual therapy and educational approaches to patients’ needs. However, limited knowledge and the absence of structured clinical guidance may hinder consistent, evidence-informed care. Targeted education and clinical protocols may strengthen osteopathic support for women’s musculoskeletal health during midlife.