Socio-professional factors and clinical determinants of menopausal hormone therapy prescription in peri- and postmenopausal women: An observational study

Abstract

Relevance: This study’s relevance stems from the increasing life expectancy of women and the growing proportion of the postmenopausal population, making menopausal health a priority in modern medicine. Climacteric syndrome is accompanied by vasomotor, psycho-emotional, and somatic disturbances that impair women’s quality of life and increase the demand for medical care. Despite the well-established efficacy of menopausal hormone therapy (MHT), its prescription in clinical practice remains insufficiently standardized and is frequently subject to subjective factors, including the physician’s professional experience and diagnostic confidence. This underscores the need to investigate the determinants of MHT prescribing decisions.

The study aimed to determine the clinical and professional factors influencing the prescription of menopausal hormone therapy and to assess the characteristics of climacteric syndrome in women during menopause.

Materials and Methods: An observational study was conducted involving 446 menopausal women and 106 physicians of various specialties. Demographic and clinical data were collected, including age, body mass index, comorbid pathology, and severity of the climacteric syndrome. Physicians’ professional characteristics and their clinical confidence in diagnosing climacteric syndrome were considered. Multivariable regression models were used to analyze associations.

Results: Severe climacteric syndrome was identified in 15.5% of patients, and MHT was prescribed to 38% of women. The most significant predictor of MHT prescription was the physician’s confidence in the accuracy of climacteric syndrome diagnosis (OR = 2.14; 95% CI, 1.31-3.51; p = 0.002). Patient age, physician work experience, and medical specialty did not demonstrate a statistically significant influence on the decision to prescribe MHT. The predictive model for severe climacteric syndrome based on available clinical characteristics had low predictive accuracy (AUC < 0.65).

Conclusion: The prescription of MHT is primarily determined by the physician’s subjective confidence in diagnosing climacteric syndrome, whereas the severe course of the syndrome cannot be reliably predicted based on standard clinical parameters. The study’s results emphasize the need to improve physicians’ clinical competence in diagnosing climacteric syndrome and to develop integrative approaches to assessing symptom severity.