[Prescribing menopausal hormone therapy by general practice residents: knowledge and training].

Abstract

Objective: Menopausal hormone therapy (MHT) is currently the first-line treatment for vasomotor symptoms and for the prevention of bone loss in recently menopausal women at risk of fracture, according to current CNGOF/GEMVi recommendations. Despite this, its use remains limited in France. The primary objective of this study is to assess the frequency of MHT prescription among medical residents in general practice and to identify the factors associated with this prescription.

Materials and methods: Cross-sectional descriptive and analytical study conducted from April to November 2023 among two GPR cohorts (2019-2022 and 2020-2023) at Nantes Faculty of Medicine (n=215). Data were collected using an anonymous online questionnaire (26 items) assessing gynecological training, MHT knowledge, self-reported prescription practices, and training needs. Statistical analyses were descriptive with between-group comparisons using non-parametric tests (χ², Mann-Whitney, P<0.05).

Results: Sixty-two GPRs responded (29% response rate), 79% female. Eighty-four percent anticipated future gynecological activity in practice. Only 19.4% prescribed MHT first-line when indicated and without contraindications. Mean MHT knowledge score was 67%, with major gaps in indications (45%), contraindications (38%), and initial assessment (47%). Main prescription barriers were perceived lack of mastery (78%) and unfavorable benefit-risk perception (13%). MHT prescription was significantly more frequent among GPRs with gynecology rotations (40 vs. 5%, P=0.001), specific theoretical training (32 vs. 12%, P=0.06), or mentors favoring MHT (46 vs. 12%, P=0.006). Ninety-eight percent reported insufficient menopause training.

Conclusion: Limited MHT prescription propensity among GPRs, primarily linked to training deficits and mentor influence. Strengthening initial gynecological education and general practitioner-gynecologist collaboration appears essential to optimize menopause care in primary care.