Knowledge, attitudes, and practices of general practitioners regarding menopause management and hormone replacement therapy in primary care: a cross-sectional study

A large population of middle-aged and elderly women has emerged, making menopause management (MM) and hormone replacement therapy (HRT) a major public health challenge in China. General practitioners (GPs) serve as the gatekeepers of the healthcare system; however, there is a noticeable deficiency in their knowledge and practices regarding MM and HRT. This cross-sectional study was conducted from March 1 to August 31, 2025, at 56 randomly selected community health service centers in Shanghai, China. We employed convenience and snowball sampling methods to recruit licensed GPs, and data were collected using a 21-item questionnaire covering demographic and occupational information, knowledge, attitudes, and practices regarding MM and HRT, as well as perceived barriers. Statistical analyses were performed using Stata/SE 15.0, with descriptive statistics, chi-square tests, and multivariable logistic regression. A two-tailed P < 0.05 was considered statistically significant. A total of 828 GPs participated. Most identified lifestyle adjustment (97.8%) and psychological counseling (97.6%) as health priorities, while 83.7% recognized HRT as relevant. For HRT benefits, 97.3% recognized symptom relief, 90.5% recognized osteoporosis prevention, and 85.7% recognized cardiovascular risk reduction. For HRT risks, 89.4% identified endometrial cancer, 86.8% identified breast cancer, and 73.6% identified thrombosis. Only 15.9% of GPs were familiar with the indications and contraindications of HRT, and 13.7% with its different administration routes. Regarding attitudes, 40.4% held a positive attitude toward recommending HRT. In practice, 15.1% actively recommended HRT, and 5.4% had ever prescribed it. Multivariable logistic regression identified HRT availability at the community health center (adjusted OR = 56.58, 95% CI: 16.21–197.54, P < 0.001) and experience as a gynecologist (adjusted OR = 34.52, 95% CI: 11.70–101.88, P < 0.001) as the strongest independent predictors of prescribing behavior; overall attitude toward HRT (adjusted OR = 19.60, 95% CI: 8.25–46.56, P < 0.001) was the strongest predictor of recommendation behavior. The main barriers to MM were GPs’ lack of knowledge (41.0%), residents’ lack of knowledge (11.0%), and insufficient clinical experience (5.8%). Substantial gaps exist between GPs’ knowledge, attitudes, and practices regarding MM and HRT. Prescribing is driven by drug availability and gynecological experience, while recommendation is driven by attitude, knowledge, and training. Improving menopause care in primary care requires tiered interventions addressing both individual-level and system-level barriers.