Prescribing practices for menopausal hormone therapy in France in 2025: A national online survey (MENOPRAT).

OBJECTIVES

This study was performed to provide an updated overview of menopause management among French gynaecologists in 2025, with a focus on prescribing practices for menopausal hormone therapy (MHT), perceived barriers, and the use of alternative therapies.

STUDY

DESIGN

This national, cross-sectional, anonymous online survey was conducted between March and June 2025.

MAIN OUTCOME MEASURES: The primary outcome was the proportion of respondents prescribing MHT as first-line therapy for moderate to severe vasomotor symptoms (VMS) in women without contraindications. The secondary outcomes were physicians' perceptions assessed using 0-10 scales, barriers to prescribing, and the use of alternative therapies.

RESULTS

In total, 440 questionnaires were analysed. Overall, 76.4% of physicians reported prescribing MHT as first-line treatment for VMS. The median rating of 'comfort with prescribing' was 8.0 (interquartile range 7.0-9.0), and perceived benefit was high (median 9.0, interquartile range 8.0-10.0). The most frequently reported barriers were patients' hesitancy (59.8%), physicians' concern regarding elevated risks of breast cancer and cardiovascular events (34.8% and 29.5%, respectively). Alternative therapies were commonly used, mainly in cases of contraindication to or refusal of MHT; dietary supplements (70.0%), acupuncture (39.0%), and phytoestrogens (37.0%) were the most frequently prescribed. Finally, 67% of respondents expressed interest in additional training on MHT.

CONCLUSIONS

Despite strong perceived benefits and a high level of comfort with prescribing, one in four gynaecologists does not systematically offer MHT as first-line therapy for moderate to severe VMS. A gap persists between guidelines and real-life menopause care. Patient hesitancy and risk perceptions underline the need for improved education and decision-support tools.