Heterogeneity and clinician typologies in menopause management: Insights from a European survey and latent class...

To investigate clinical practice characteristics, perceived barriers, and prescribing typologies in the management of menopause among clinicians, with a particular focus on menopausal hormone therapy (MHT).

A survey-based observational study was conducted using a 26-item questionnaire assessing physician demographics, clinical practice settings, and prescribing patterns for menopausal patients.

Primary outcomes included the extent of MHT prescribing (categorized into ordinal groups), reasons for non-prescription, and types of therapies used in clinical practice. Secondary outcomes included clinician typologies identified through latent class analysis.

A total of 361 physicians participated in the study. MHT prescribing patterns varied substantially across respondents. In multivariable ordinal regression (Model 1), clinicians practicing in purely private healthcare systems were less likely to report higher MHT use than those in national health systems. In Model 2, perceived barriers such as fear of cancer were associated with lower MHT prescribing in univariable analysis, although these associations were attenuated after adjustment. Latent class analysis identified three distinct clinician typologies: (1) proactive/guideline-aligned prescribers, (2) pragmatic clinicians with balanced use of hormonal and non-hormonal therapies, and (3) conservative or risk-averse clinicians with limited MHT use.

MHT prescribing in menopause management is shaped more by structural and system-level factors than by individual clinician characteristics alone. While concerns such as cancer risk remain relevant, they do not independently explain prescribing behavior when considered alongside other factors. Distinct clinician typologies highlight substantial heterogeneity in practice, underscoring the need for targeted strategies to improve guideline-concordant menopause care.