The perspective of general practitioners on menopause management and hormone replacement therapy in primary care: a cross-sectional study

The perspective of general practitioners on menopause management and hormone replacement therapy in primary care: a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The perspective of general practitioners on menopause management and hormone replacement therapy in primary care: a cross-sectional study Yan Jiang, Xiaoqing Gu, Yang Zhou, Xiaoxiao Cao, Ying Dong, Hong Chen, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8849443/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background A large group of middle-aged and elderly women has emerged. Menopause management and hormone replacement therapy(HRT) poses a huge public health challenge in China. General practitioners(GPs) are gatekeepers of the health system. But there is a noticeable deficiency regarding GPs’ perspective on menopause management and HRT. Method This cross-sectional study was conducted at fifty-six randomly selected community health service centers in Shanghai, China, from March 1 to August 31, 2025, targeting licensed GPs. We employed convenience and snowball sampling methods to recruit participants, and data were collected through a 22-item questionnaire covering demographic and occupational information, perspective on menopause management and HRT, barriers. Statistical analyses were performed in SPSS(IBM V26.0), using descriptive statistics and χ2 test. P<0.05 showed that the differences in responses were statistically significant. Results A total of 828 GPs participated. Few indicated they were “very familiar” with the indications and contraindications of HRT(2.5%), different administration routes of HRT(1.9%). Lifestyle adjustment was the most participants(97.8%) thought menopausal women need to focus on. 97.3% of GPs indicated that HRT could relive menopausal symptom. Only 6.9% of GPs indicated that HRT was risk-free, and high-risk population was the most common reason for increasing some disease related to HRT. 6.6% of GPs hold the overall attitude of “very recommended” towards HRT. In fact, only 4.3% of GPs always recommend HRT and 5.4% of GPs have prescribed HRT prescriptions for menopausal women. The training experience is a crucial factor that influences their familiarity with menopause management and knowledge related to HRT, their overall attitude towards HRT, the degree of recommendation, and the prescription they provide. Lack of knowledge among GPs(41.0%) and residents(11.0%), insufficient experience(5.8%) were barriers of menopause management and HRT usage in primary care according to 173 respondents’ opinions. Conclusion There are gaps between the awareness and behavior toward menopause and HRT among GPs. GPs lack relevant knowledge and they are hesitancy in the use of HRT. Strategies aiming to improve menopause management and HRT usage among GPs in primary health institutions must consider education experience and gynecologists experience variation. menopause general practitioners hormone replacement therapy training Figures Figure 1 Introduction WHO (World Health Organization, WHO) estimated that almost 1 billion women worldwide are menopausal transitional and postmenopausal by 2050[ 1 ]. During menopausal transitional and postmenopausal stage, there will be a range of non-specific physical and psychological symptoms, such as vasomotor symptoms, vaginal dryness, mood disturbance, fatigue, difficulty in memory, sleep disturbance, joint pain, eventually resulting in a low life quality[ 2 ]. Further, there is an increase incidence in cardiovascular disease and osteoporosis after menopause[ 3 ]. The incidence of perimenopausal syndrome was up to 61.0% among 82,340 Chinese women aged 40 to 65 years old[ 4 ]. This high incidence rate requires the highly attention of healthcare professional. The concept of health menopause, enabling women to achieve needed resilience and self-management gradually gained attention[ 5 ]. A clear consensus guideline have recommended that women and providers discuss hormone therapy as a viable treatment option for the menopause symptoms[ 6 ]. However, the utilization rate of menopausal hormone therapy(MHT) in Chinese menopausal women was only 1–3% by the end of the last century[ 7 ]. Due to the atypical nature of menopausal syndrome and women’s different experience depending on their ethnicity, personal, family factors[ 8 ], menopausal symptoms are often missed during medical consultations. Primary healthcare institutions and GPs are uniquely placed in the healthcare delivery pyramid. And a paper published in the Lancet pointed out that greater focus on recognition of risk factors in primary care is warranted[ 9 ]. The acceptance and promotion of MHT might be determined by the attitude of health-care professionals[ 10 ]. Moreover, common reasons for discontinuation were healthcare professional recommendation[ 11 ]. Health care-related factors, such as GPs’ lack of knowledge[ 12 ], having discussions with healthcare providers about hormone therapy, women reporting feeling physician distrust, GP attitude and poor communication in the primary care consultation influenced the acceptance of hormone therapy[ 13 ], or optimal risk communication and decision making[ 14 ]. Many studies have shown that general practitioners(GP) often encounter difficulties, such as confusing the risk of thrombo-embolism from estrogen used in the post-menopause[ 15 ], in managing menopause and hormone replacement therapy, and there are gender differences involved. A survey found that GP registrars sought more assistance with menopause interactions than any other problem[ 16 ]. Most of GPs are not familiar with menopause[ 17 ]. Male general practitioners always reported more difficulty[ 15 ]. And a survey reported that only 39% of women said that they were provided HRT timely, when GPs or nurses knew they had gone through menopause symptoms[ 18 ]. In the Chinese healthcare setting, GPs constitute an important part of the health care workforce and are crucial for enhancing the service capabilities of grassroots medical institutions. With the prominent issue of aging social and the implementation of policies such as the tiered medical treatment system, the demand for general practitioners among residents is increasing[ 19 ]. As gatekeepers of residents’ health, the number of GPs in China has increased significantly[ 20 ]. In recent years, community management of perimenopausal syndrome has been continuously explored and developed. As the construction of community health services in China has only been going on for over 20 years, there are still many shortcomings, such as insufficient knowledge of perimenopausal syndrome among community doctors[ 21 ]. And the survey shows that nearly 40% of community health centers in Beijing China still do not offer menopausal health care services[ 22 ]. Despite the high prevalence of perimenopausal syndrome, Chinese GP’s perspective on menopause management and HRT remains unknown. This study aims to assess the perspective on menopause and HRT among GP, particularly in China’s medical context and culture diverse and to enhance menopause management protocols. Eventually, findings will helps to close the disparity between guidelines and implementation in primary healthcare institutions. Methods Study design A cross-sectional study design was used to assess GP’s perspective on menopause management and hormone replacement therapy through self-administered questionnaires using the Wenjuanxing platform( https://www.wjx.cn ) at fifty-six randomly selected community health service centers in Shanghai, China, from March 1 to August 31, 2025, after obtaining ethical approval from Ethics Committee of the Shanghai Sixth People’s Hospital. This study followed the Reporting of Observational Studies (STROBE) checklist[ 23 ]. Participants The target population was licensed general practitioners in Shanghai, China. We employed convenience and snowball sampling methods to recruit GPs from Community Health Centers(CHCs) in Shanghai, China and included those who were available and provided informed consent. Eligible participants were invited to take part in a cross-sectional online survey. Eligible participants were GPs who(1)currently practiced in registered healthcare institutions at all levels in Shanghai, China; (2)prescribed psychotropic substances at level 2 independently; (3)managed menopausal women; and(4)provided informed consent to take part in this online survey. The sample size was calculated using the site http://www.raosoft.com/samplesize.html , for a confidence interval of 95%. Hence, the calculated required sample size is 377. Objectives The primary objective of this study was to evaluate community GPs’ perspective on menopause management and HRT. The secondary objective included the analysis of factors and barriers that influence the perspective on management and HRT usage. Data collection tool The questionnaire was adapted from published literature on physician perception of menopause or HRT. After consulting menopause experts and pre-survey, questionnaire comprised 22 questions and composed of two parts:(1)Part1: Demographic and occupational information included gender, age, education level, job title, the working seniority as GPs, the experience of being gynecologists, the experience of receiving the education or training about menopause or HRT; (2)Part2: perspective on menopause management and hormone replacement therapy among GPs in the community. Data collection Data collection was conducted form March 1 to August 31, 2025. First, the questionnaire was upload to Wenjuanxing, an online system widely used in academic study in China. Then, the questionnaire link was sent to GPs from Community Health Centers in Shanghai using convenience and snowball sampling methods. After we explained the aims, procedural, anonymity and confidentiality of this study and participants provided informed consent by checking the confirm button, participants completed questionnaires. Statistical analysis Data were analyzed using IBM SPSS Statistics 26.0 for Windows(IBM Corporation). Demographic, occupational characteristics were summarized using descriptive statistics. Frequencies and percentages were used to describe categorical variables about the awareness of GPs for the menopause and HRT. Categorical variables were analyzed by χ 2 test and reported as numbers/percentages. P<0.05 showed that the differences in responses were statistically significant. Results Participant characteristics Survey responses were from 828 GPs(34.3% response rate) across 56 CHCs accounting for 7.7% of all general practitioners(10,689) in Shanghai, China. Over than half of respondents were over 40 years old(55.6%), female(76.1%), with more than 10 years of working seniority as GPs(63.4%), and had bachelor degree(80.6%). 13.4% respondents had the experience of being gynecologists (Table 1 ). Table 1 Demographic profile (N = 828) GPs Characteristics Proportion of Respondents gender n(%) Male 198(23.9) Female 630(76.1) age ≤ 40 368(44.4) >40 460(55.6) Education level College 32(3.9) Bachelor 667(80.6) Master 128(15.5) Doctor 1(0.1) Job title Resident doctor 129(15.6) Attending doctor 523(63.2) Associate chief physician 157(19.0) Chief physician 19(2.3) Working seniority as GPs(year) 1 ~ 10 303(36.6) >10 525(63.4) Experience of being gynecologists Yes 111(13.4) No 717(86.6) Perspective on menopause management and HRT Most GPs thought common menopause symptoms were vasomotor symptoms(98.1%), sleep disturbance(96.5%) and mood disturbance(96.6%). Most GPs indicated that menopausal women need to focus on lifestyle adjustment(97.8%), psychological counseling(97.6%) and HRT(83.7%). Most recognized the benefits of HRT to relieve menopausal symptoms(97.3%), prevent osteoporosis(90.5%) and reduce the risk of cardiovascular disease(85.7%). Most GPs thought HRT usage was associated with breast cancer(86.8%), endometrial cancer89.4%), thrombosis(73.6%) and indicated the reasons with high-risk population(91.5%), not using HRT during the window period(71.1%), different HRT drug types(72.6%). Few indicated they were “very familiar” with the indications and contraindications of HRT(2.5%), different administration routes of HRT(1.9%). A minority reported they were “very recommended” HRT(6.6%), and always recommend HRT to menopausal women in practice(4.3%). Most indicated patient’s personal wishes(83.6%), severity of patient's symptoms(74.8%), patient's age(60.6%), clinical experience(51.4%), relevant guidelines and literature(37.7%) and side effects(47.9%) were factors of recommendation for HRT . Few reported they have ever prescribed HRT for menopausal women(5.4%) and received training about HRT(20.3%). 7.5% of female respondents over 40 years old received HRT. Most indicated there are not HRT products in the community(70.5%). Lack of knowledge among GPs(41.0%) and residents(11.0%), insufficient experience(5.8%) were barriers of menopause management and HRT usage in primary care according to 173 respondents’ opinions(Fig. 1 ). The influencing factors of perspective on menopause management and HRT A statistically significant correlation was observed between training experience and degree of familiarity about the indications and contraindications of HRT( P <0.001), degree of familiarity with the indications and contraindications of HRT demonstrated a statistically relationship with gender༈ P = 0.047༉, Age( P = 0.012), experience of being gynecologists( P <0.001). The degree of familiarity with the different administration routes of HRT demonstrated a statistically relationship with training experience( P <0.001༉, experience of being gynecologists( P <0.001). Our study also revealed a significant variation in the overall attitude toward HRT as different training experience( P <0.001༉, gender༈ P = 0.004༉, experience of being gynecologists( P <0.001). Furthermore, training experience significantly impacted the recommendation of HRT( P <0.001), the usage of HRT( P = 0.002), HRT prescriptions( P <0.001), shortage of HRT produce(( P <0.001). Gender significantly affected HRT prescriptions( P = 0.002), shortage of HRT produce(( P = 0.010). Age also significantly impacted the recommendation of HRT( P = 0.021), the usage of HRT( P = 0.003), HRT prescriptions( P = 0.008). Experience of being gynecologists significantly influenced the recommendation of HRT( P <0.001), the usage of HRT( P = 0.018), HRT prescriptions( P <0.001)(Table 2 ). Table 2 knowledge, attitude and behavior toward menopause and HRT among GPs Question Overall Training experience gender Age Experience of being gynecologists Working seniority of general practitioner Yes(n = 168) No(n = 660) P-Value Male(n = 198) Female(n = 630) P-Value ≤ 40(n = 368) >40(n = 460) P-Value Yes(n = 111) No(n = 717) P-Value ≤ 10(378) >10(n = 450) P-Value How familiar with the indications and contraindications of HRT? Not at all familiar 55(6.6) 0(0) 55(8.3) <0.001 20(10.1) 35(5.6) 0.047 24(6.5) 31(6.7) 0.012 3(2.7) 52(7.3) <0.001 21(6.9)) 34(6.5) 0.098 Slightly familiar 305(36.8) 19(11.3) 286(43.3) 75(37.9) 230(36.5) 147(39.9) 158(34.3) 9(8.1) 296(41.3) 111(36.6) 194(37.0) Neutral/moderately familiar 336(40.6) 63(37.5) 273(41.1) 79(39.9) 257(40.8) 154(41.8) 182(39.6) 35(31.5) 301(42.0) 134(44.2) 202(38.5) Fairly familiar/somewhat familiar 111(13.4) 69(41.1) 42(6.4) 23(11.6) 88(14.0) 40(10.9) 71(15.4) 50(45.0) 61(8.5) 34(11.2) 77(14.7) Very familiar 21(2.5) 17(10.1) 4(0.6) 1(0.5) 20(3.2) 3(0.8) 18(3.9) 14(12.6) 7(1.0) 3(1.0) 18(3.4) How familiar are you with the different administration routes of HRT? Not at all familiar 57(6.9) 1(0.6) 56(8.5) <0.001 16(8.1) 41(6.5) 0.341 24(6.5) 33(7.2) 0.108 2(1.8) 55(7.7) <0.001 23(7.6) 34(6.5) 0.099 Slightly familiar 334(40.3) 20(11.9) 314(47.6) 78(39.4) 256(40.6) 151(41.0) 183(39.8) 16(14.4) 318(44.4) 113(37.3) 221(42.1) Neutral/moderately familiar 323(39.0) 81(48.2) 242(36.7) 83(41.9) 240(38.1) 155(42.1) 168(36.5) 41(36.9) 282(39.3) 134(44.2) 189(36.0) Fairly familiar/somewhat familiar 98(11.8) 55(32.7) 43(6.5) 20(10.1) 78(12.4) 33(9.0) 65(14.1) 41(36.9) 57(7.9) 29(9.6) 69(13.1) Very familiar 16(1.9) 11(6.5) 5(0.8) 1(0.5) 15(2.4) 5(1.4) 11(2.4) 11(9.9) 5(0.7) 4(1.3) 12(2.3) What is your overall attitude towards HRT? Not at all recommended 5(0.6) 0(0) 5(0.8) <0.001 5(2.5) 0(0) 0.004 2(0.5) 3(0.7) 0.581 0(0) 5(0.7) <0.001 2(0.7) 3(0.6) 0.714 Slightly recommended 40(4.8) 5(3.0) 35(5.3) 12(6.1) 28(4.4) 16(4.3) 24(5.2) 3(2.7) 37(5.2) 12(4.0) 28(5.3) Neutral/moderately recommended 448(54.1) 44(26.2) 404(61.2) 102(51.5) 346(54.9) 204(55.4) 244(53.0) 29(26.1) 419(58.4) 158(52.1) 290(55.2) Fairly familiar/somewhat recommended 280(33.8) 85(50.6) 195(29.5) 69(34.8) 211(33.5) 127(34.5) 153(33.3) 48(43.2) 232(32.4) 110(36.3) 170(32.4) Very recommended 55(6.6) 34(20.2) 21(3.2) 10(5.1) 45(7.1) 19(5.2) 36(7.8) 31(27.9) 24(3.3) 21(6.9) 34(6.5) Did you actively recommend HRT to menopausal women in practice? Never 121(14.6) 6(3.6) 115(17.4) <0.001 38(19.2) 83(13.2) 0.179 58(15.8) 63(13.7) 0.021 4(3.6) 117(16.3) <0.001 41(13.5) 80(15.2) 0.204 rarely 342(41.3) 26(15.5) 316(47.9) 78(39.4) 264(41.9) 162(44.0) 180(39.1) 19(17.1) 323(45.0) 134(44.2) 208(39.6) Sometimes 240(29.0) 63(37.5) 177(26.8) 58(29.3) 182(28.9) 105(28.5) 135(29.3) 34(30.6) 206(28.7) 83(27.4) 157(29.9) frequently 89(10.7) 49(29.2) 40(6.1) 19(9.6) 70(11.1) 36(9.8) 53(11.5) 32(28.8) 57(7.9) 37(12.2) 52(9.9) always 36(4.3) 24(14.3) 12(1.8) 5(2.5) 31(4.9) 7(1.9) 29(6.3) 22(19.8) 14(2.0) 8(2.6) 28(5.3) Have you personally (as a woman) used hormone replacement therapy?(n = 630) Yes 33(5.2) 15(45.5) 18(54.4) 0.002 6(18.2) 27(81.8) 0.003 11(33.3) 22(66.7) 0.018 6(18.2) 27(81.8) 0.058 No 597(94.8) 123(20.6) 474(79.4) 265(44.4) 332(55.6) 98(16.4) 499(83.6) 212(35.5) 385(64.5) Have you ever prescribed HRT prescriptions for menopausal female patients? Yes 45(5.4) 33(73.3) 12(26.7) 0.000 2(4.4) 43(95.6) 0.002 11(24.4) 34(75.6) 0.008 34(75.6) 11(24.4) 0.000 11(24.4) 34(75.6) 0.110 No 783(94.6) 135(17.2) 648(82.8) 196(25.0) 587(75.0) 357(45.6) 426(54.5) 77(9.8) 706(90.2) 292(37.3) 491(62.7) Does your local community health center have HRT products? Yes 244(29.5) 76(31.1) 168(68.9) 0.000 73(29.9) 171(70.1) 0.010 112(45.9) 132(54.1) 0.592 38(15.6) 206(84.4) 0.263 98(40.1) 146(29.5) 0.179 No 584(70.5) 92(15.8) 492(84.2) 125(21.4) 459(78.6) 256(43.8) 328(56.2) 73(12.5) 511(87.5) 205(35.1) 379(64.9) Data presented as n(%). HRT, hormone replacement therapy. χ 2 analysis was used for comparison between different groups. Discussion Our study identified general practitioners’ perspective on menopausal management and HRT, and they also lack experience in using HRT. Only 4.3% of GPs always recommend HRT and 5.4% of GPs have prescribed HRT prescriptions for menopausal women. Lack of knowledge and experience among general practitioners, shortage of related drugs, few menopausal women, residents' lack of knowledge have hindered community general practitioners from implementing menopause care. The awareness and understanding regarding menopause management among GPs was mainly influenced by training experience and experience of being gynecologists. This study highlights the conceptualization and clinical execution of menopause management among GPs in the context of China. 2.5% and 1.9% of GPs were “very familiar” with the indications and contraindications of HRT and different administration routes of HRT, respectively. The majority of GPs have recognized the benefits of HRT. 6.9% of GPs thought HRT was risk-free. The majority of GPs in this study have shown that menopause women need to focus on lifestyle adjustment(97.8%), followed by psychological counseling(97.6%) and HRT(83.7%). Lifestyle changes were placed in important position by GPs and HRT was always used when symptoms were severely impairing quality of life[ 24 ]. Only 4.3% of GPs always recommend HRT to menopausal women and 5.4% of GPs prescribed HRT before. Meeta et al. also revealed that although 95% of HCPs were aware of the indications, risks and benefits of MHT, 57% used alternative therapies as first-line therapy and 71% used them as an adjunct to MHT[ 25 ]. Thus, there are critical gaps between the awareness and the behavior to menopause and HRT. Patients’ personal wishes, severity of patients’ menopause symptom and patient’s age were the top 3 reasons about recommendation for HRT in this study. To support patient-centered healthcare, there has been a growing global emphasis on patient-centered research. Patient preference studies were one kind of research to capture patients’ preferences[ 26 ]. And, what deserves attention is the patients' attitude towards HRT. However, unfortunately, HRT awareness among women was 3.5% and 2.1% women had used or were using HRT in fact[ 27 ]. Patient satisfaction with GPs is not related to consultation length[ 28 ]. GPs reported that residents' lack of knowledge was one of the shortage for menopause healthcare by GPs and showed the demand for science popularization and publicity according to the result of open-ended questions in this study. Residents reported low confidence in managing menopause basics and using HRT[ 29 ]. Some measures should be taken to improve menopause awareness and acceptance of HRT. On the one hand, we could improve the conception of menopause management through mainstream media, social media and influencers, providing more patient information to improve administration and compliance, providing education to the population based on the United Kingdom’s experience[ 30 ]. On the other hand, general practitioners, as an important part of primary medical institutions, are responsible for disease prevention and health education. GPs have to assume responsibility for educating women about menopause and HRT use. However, although doctors consider menopause management to be an important issue in women's health, there is a significant lack of education on relevant knowledge about menopause and accumulation of relevant experience, which leads to difficulties in discussing this topic[ 31 ]. This has led to a vicious cycle, which has an adverse impact on menopause management. In this study, 20.3% took part in training about the HRT before. Training experience significantly impacted the perspective on menopause management and HRT among GPs. GPs with training experience were more familiar with indications and contraindications of HRT, different administration routes of HRT. And they were more likely to recommend and prescribe HRT. Low et al. also indicated that receiving training on menopause management was the positive predictor of offering MHT[ 32 ]. Previous study has found that nearly 50% of health-care professionals had not received menopause management training in nearly 1 year[ 33 ]. The actual prescription rate was only 0.9% and 83% of primary care doctors had not received any related training in Malaysia[ 32 ]. According to the menopause management in the United Kingdom, they also emphasis the importance of training for HCP including standardized and appropriate education which is online, flexibility, interesting, attractive, appropriate level for each HCP profile and combining clinical practice to providing appropriate care and the safe prescription of MHT[ 30 ]. Thus, it is urgently necessary to establish a “well-educated healthcare professional workforce” that “not only has the basic understanding and awareness of how menopause affects women but also the optimum skill mix to cater for a wide population demand”[ 34 ]. GPs with experience of being gynecologists significantly impacted the knowledge, attitude, and behavior of menopause and HRT among GPs. Precious study conducted in China also found that gynecologists were more likely to prescribe MHT for cardioprotection, reducing colon cancer risk and in women with a history of thromboembolic events than GPs[ 33 ]. The same results that GPs prescribed MHT to a significantly lesser extent than gynaecologists were indicated in the study performed in Sweden[ 35 ] and more GPs consider it difficult to evaluate advantages and disadvantages of HRT, compared to gynecologists[ 36 ]. No-experience in prescribing MHT was recorded as the negative predictors in offering MHT[ 5 ]. Insufficient experience was reported as one of the shortages for menopause health care by GPs in this study and GPs in this study showed the demand of expert on-site guidance. Shortage of related drugs was also marked as the shortages for menopause health care by GPs. 29.5% of GPs indicated there were HRT product in their community health center. Similarly, previous studies have found 87.1% of primary care doctors reported unavailable MHT in their clinic[ 32 ]. Therefore, it is also necessary to enhance the community's attention to menopause management and hormone replacement therapy (HRT), in order to increase the accessibility and availability of HRT. Chinese government outlined the goal mentioned during the Global Conference on Primary Health Care 2018 of improving the capability of the primary health system in the “Health China 2030” plan. GPs are the first point of contact for medical advice, representing the health protector of family members and the main providers of primary health services. GPs’ work goes beyond disease diagnosis and treatment. It also involves physical examinations, investigations, chronic disease management, health file, contracted family doctor services, health education, teaching students, and scientific research[ 37 ]. The menopausal transition is a crucial period contributing to the increase in cardiovascular diseases. Monitoring middle-aged women’s health and implementing early intervention strategies to reduce the risk of cardiovascular diseases is necessary[ 38 ]. In developed countries, particularly in the United Kingdom, healthcare professionals(HCPs) play a crucial role in menopause management, but professional training is required[ 30 ]. As the general practitioner system in China has only been in place for about 20 years, the services provided by GPs mainly focus on chronic non-communicable diseases such as hypertension, diabetes and chronic lung diseases. Services related to menopause are particularly lacking. To the authors’ knowledge, this is the first article to survey GPs’ knowledge, attitude and behavior toward menopause and HRT. The results of this study may be used to know and improve the status of knowledge, attitude and behavior among GPs, highlighting significant associations between education experience and menopause management, gynecologists experience and menopause management among GPs in China. Having education experience about menopause or HRT and having gynecologists experience before was significantly correlated with improved knowledge, attitude and behavior about menopause and HRT. Strategies aiming to improve menopause management and HRT usage among GPs in primary health institutions must consider education experience and gynecologists experience variation. It is an innovating work that focused on knowledge, attitude and behavior about menopause and HRT of GPs in China. There is a considerable sample size, with 828 participants obtained from 56 community health centers in Shanghai, China. Thus, this study had good statistical power to reflect the true situation. Limitations There are several limitations that need to be considered. Firstly, it is possible that self-reporting bias occurred because of self-reported data. Nevertheless, we provided detailed explanations and clarifications, including strict anonymity measures before the investigation. Secondly, we used a self-developed questionnaire to conduct a preliminary survey on the perspective of general practitioners regarding menopause and HRT. However, it is possible that other issues were not covered. Thirdly, it cannot establish causation because of its cross-sectional design. Despite these limitations, the findings of this study provide reliable suggestions for improving GPs' understanding of menopause and HRT. Conclusion It is an innovating work that focused on perspective on menopause and HRT of GPs from 56 community health centers in Shanghai, China. Our study identified that general practitioners lack relevant knowledge about menopausal management and HRT, and they also lack experience in using HRT. Only 4.3% of GPs always recommend HRT and 5.4% of GPs have prescribed HRT prescriptions for menopausal women. Lack of knowledge and experience among general practitioners, shortage of related drugs, residents' lack of knowledge have hindered community general practitioners from implementing menopause care. The awareness and understanding regarding menopause management among GPs was mainly influenced by training experience and experience of being gynecologists. Abbreviations GPs General practitioners HRT Hormone replacement therapy MHT Menopausal hormone therapy HCPs Healthcare professionals Declarations Ethics approval and consent to participate This study was conducted in accordance with the principles of Declaration of Helsinki. The study was approved by the Ethics Committee of the Shanghai Sixth People’s Hospital(2025-KY-026(K)). All participants consented to the research and were assured of their anonymity. Consent for publication Not applicable. Competing interests The authors affirm that the methods used in the data analyses are suitable applied to their data within their study design and context, and the statistical findings have been interpreted correctly. No conflict of interest has been declared by the author(s). Funding This study has received funding by Shanghai Fengxian District Health Commission through the Community Menopause Health Promotion and Innovative Management Project. Views expressed are however, those of the author(s) only and do not necessarily reflect those of the Shanghai Fengxian District Health Commission. Author Contribution JY, GXQ and TMF conceived and designed the study, performed the literature search. Seven authors made substantial contributions to the acquisition, analysis, and interpretation of data (JY, GXQ, ZY, CXX, DY, CH, TMF); and all authors substantially con-tributed to drafting the work and reviewing it critically. All authors approved the final version and agreed to be accountable for all aspects of the work with respect to integrity and rigor. Acknowledgements Not applicable. Data Availability The data supporting the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. References Research on the menopause in the 1990s. Report of a WHO Scientific Group. World Health Organ Tech Rep Ser. 1996;866:1–107. Nachtigall LE. The symptoms of perimenopause. Clin Obstet Gynecol. 1998;41(4):921–7. Marjoribanks J, Farquhar C, Roberts H, Lethaby A, Lee J. Long-term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev. 2017;1(1):Cd004143. Jia Y, Zhou Z, Cao X, Hu W, Xiang F, Xiong LW. [Incidence of Perimenopausal Syndrome in Chinese Women Aged 40 to 65 Years:a Meta-analysis]. Chin Gen Pract. 2023;26(32):4080–8. Jaspers L, Daan NM, van Dijk GM, Gazibara T, Muka T, Wen KX, Meun C, Zillikens MC, van Roeters JE, Roos-Hesselink JW, et al. Health in middle-aged and elderly women: A conceptual framework for healthy menopause. Maturitas. 2015;81(1):93–8. Faubion SS, Larkin LC, Stuenkel CA, Bachmann GA, Chism LA, Kagan R, Kaunitz AM, Krychman ML, Parish SJ, Partridge AH et al. Management of genitourinary syndrome of menopause in women with or at high risk for breast cancer: consensus recommendations from The North American Menopause Society and The International Society for the Study of Women's Sexual Health. Menopause (New York, NY) 2018, 25(6):596–608. Yang D, Haines CJ, Pan P, Zhang Q, Sun Y, Hong S, Tian F, Bai B, Peng X, Chen W, et al. Menopausal symptoms in mid-life women in southern China. Climacteric. 2008;11(4):329–36. Hoga L, Rodolpho J, Gonçalves B, Quirino B. Women's experience of menopause: a systematic review of qualitative evidence. JBI Database Syst Rev Implement Rep. 2015;13(8):250–337. Brown L, Hunter MS, Chen R, Crandall CJ, Gordon JL, Mishra GD, Rother V, Joffe H, Hickey M. Promoting good mental health over the menopause transition. Lancet. 2024;403(10430):969–83. Yu Q, Lin L. The promotion of menopausal hormone therapy might be determined by the attitude of health-care professionals. Climacteric. 2022;25(3):213–4. Bunnewell S, Keating S, Parsons J, Hickey M, Hillman S. Women's and Health Care Professionals' Experiences of Discontinuing Hormone Replacement Therapy (HRT): A Systematic Review. BJOG: Int J Obstet Gynecol 2025. Harper JC, Phillips S, Biswakarma R, Yasmin E, Saridogan E, Radhakrishnan S, Talaulikar MCD. An online survey of perimenopausal women to determine their attitudes and knowledge of the menopause. Womens Health (Lond). 2022;18:17455057221106890. Pershad A, Morris JM, Shearer K, Pace D, Khanna P. Influencing factors on women's attitudes toward hormone therapy acceptance for menopause treatment: a systematic review. Menopause (New York NY). 2023;30(10):1061–9. Walter FM, Emery JD, Rogers M, Britten N. Women's views of optimal risk communication and decision making in general practice consultations about the menopause and hormone replacement therapy. Patient Educ Couns. 2004;53(2):121–8. O'Connor V, Del Mar C, Sheehan M, Fox-Young S, Cragg C, Siskind V. The menopause and hormone replacement therapy: Australian general practitioners' self-reported opinions, attitudes and behaviour. Fam Pract. 1996;13(5):421–6. De Giovanni JM, Tapley A, Druce PL, Davey AR, van Driel ML, Henderson KM, Catzikiris NF, Mulquiney KJ, Morgan S, Spike NA, et al. GP registrar consultations addressing menopause-related symptoms: a cross-sectional analysis. Menopause (New York NY). 2018;25(5):563–70. Esseffar S, Moumen A, Rkha S, Loukid M. The North-East Moroccan physicians' management of menopause: Prescription vs. nonprescription of hormonal treatment. Afr J Reprod Health. 2022;26(6):116–24. Lancet T. Attitudes towards menopause: time for change. Lancet 2022, 399. Hu B, Zhang T, Chen X, et al. Development status and future demand projections of general practitioners in China. Chin J Gen Pract. 2025;23(03):357–61. Kou R, Mei K, Bi Y, Huang J, Yang S, Chen K, Li W. Equity and trends in general practitioners' allocation in China: based on ten years of data from 2012 to 2021. Hum Resour Health. 2023;21(1):61. Hu S, Shen X, Zhu L. Investigation on related knowledge level of menopause health care among female doctors in basic-level hospitals in Shanghai. Maternal Child Health Care China. 2017;32(18):4497–500. Lv K, Sun Y, Yan C, Li C. The Investigation and Analyses of Women's Health Care Service Capability in Community Health Service Centers of Beijing. Chin J Gen Practic. 2018;21(19):2369–73. Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med. 2007;4(10):e297. Davis SR, Herbert D, Reading M, Bell RJ. Health-care providers' views of menopause and its management: a qualitative study. Climacteric. 2021;24(6):612–7. Meeta M, Guduru S, Tanvir T, Madan A. Awareness of menopause and menopause hormone therapy in India: perspectives of healthcare providers and consumers. Climacteric. 2025;28(3):286–95. Schoefs E, Vanneste A, Blonda A, Claessens Z, Abdallah K, Borges FC, Broekmans J, Desmet T, Lalova-Spinks T, Locquet P, et al. Synergizing Needs Assessments and Patient Preference Studies for Enhanced Patient-Centered Decision Making in Healthcare. Value Health. 2025;28(8):1253–8. Jin F, Tao M, Teng Y, Shao H, Li C, Mills E. Knowledge and attitude towards menopause and hormone replacement therapy in Chinese women. Gynecol Obstet Invest. 2015;79(1):40–5. Mayor S. Patient satisfaction with GPs is not related to consultation length, study finds. BMJ. 2016;355:i5744. Shinnick JK, Raker C, Hampton BS, Eger R. Randomized crossover study investigating resident retention of menopause-related knowledge after completion of learning modules. Menopause (New York NY). 2020;27(1):95–101. Mansour D, Barber K, Chalk G, Noble N, Digpal AAS, Talaulikar V, Gray S. The evolving perspective of menopause management in the United Kingdom. Womens Health (Lond). 2024;20:17455057241288641. Shrivastava S, Gandhi A, Spencer AL. Integrating Women's Health Education into the Internal Medicine Residency Program Curriculum. South Med J. 2021;114(2):116–22. Low TL, Cheong AT, Devaraj NK, Ismail R. Prevalence of offering menopause hormone therapy among primary care doctors and its associated factors: A cross-sectional study. PLoS ONE. 2024;19(9):e0310994. Lin L, Feng P, Yu Q. Attitude and knowledge for menopause management among health professionals in mainland China. Climacteric. 2020;23(6):614–21. Currie H, Abernethy K, Hamoda H. Vision for menopause care in the UK. Post Reprod Health. 2021;27(1):10–8. Götze Eriksson R, Skalkidou A, Cruz N, Lindén Hirschberg A, Iliadis SI. Swedish physicians' knowledge of and prescribing practices for menopausal hormone therapy: A nationwide cross-sectional survey. Maturitas. 2025;197:108263. Andersson K, Pedersen AT, Mattsson LA, Milsom I. Swedish gynecologists' and general practitioners' views on the climacteric period: knowledge, attitudes and management strategies. Acta Obstet Gynecol Scand. 1998;77(9):909–16. Wei Y, Wang F, Pan Z, Jin G, Wang D, Lu X, Cao Q. Work Content of General Practitioners in Beijing, China: A Multi-method Study. Front Public Health. 2022;10:870224. El Khoudary SR, Aggarwal B, Beckie TM, Hodis HN, Johnson AE, Langer RD, Limacher MC, Manson JE, Stefanick ML, Allison MA. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. Circulation. 2020;142(25):e506–32. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8849443","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":599173330,"identity":"ab1d909a-7b09-405f-8fe8-9dcd9857022b","order_by":0,"name":"Yan Jiang","email":"","orcid":"","institution":"Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Jiang","suffix":""},{"id":599173331,"identity":"ba51b4fb-f8c0-4525-80dc-63f07f7c2323","order_by":1,"name":"Xiaoqing Gu","email":"","orcid":"","institution":"Xidu Community Health Service Center of Fengxian District","correspondingAuthor":false,"prefix":"","firstName":"Xiaoqing","middleName":"","lastName":"Gu","suffix":""},{"id":599173332,"identity":"58c3a635-3d6a-4c65-8cf8-d8ac7941d1ef","order_by":2,"name":"Yang Zhou","email":"","orcid":"","institution":"Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Zhou","suffix":""},{"id":599173333,"identity":"30668c99-3510-42fc-9aa2-b73a7ca4b869","order_by":3,"name":"Xiaoxiao Cao","email":"","orcid":"","institution":"Fengxian District Nanqiao Town Community Health Service Center","correspondingAuthor":false,"prefix":"","firstName":"Xiaoxiao","middleName":"","lastName":"Cao","suffix":""},{"id":599173334,"identity":"5eaba469-97da-4dba-8fe1-0f63f1b9b29d","order_by":4,"name":"Ying Dong","email":"","orcid":"","institution":"Shanghai Putuo District Maternal and Child Health Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Dong","suffix":""},{"id":599173335,"identity":"a122d29c-6331-409e-afdb-8c7d03bf7ff8","order_by":5,"name":"Hong Chen","email":"","orcid":"","institution":"Fengxian Women \u0026 Children Health Care Center","correspondingAuthor":false,"prefix":"","firstName":"Hong","middleName":"","lastName":"Chen","suffix":""},{"id":599173336,"identity":"f99707b6-3be7-4db1-9931-0c21024bce2c","order_by":6,"name":"Minfang Tao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYLCCigoGZjCDhxjVYEVnzjAw85Cm5WwblEGUFnv2w0c3HJxXx24vkcD44G0bg7w5QVt40tJuHNx2mJlHIoHZcG4bg+HOBoIOyzG7/XHbAZAWNmneNoYEgwOEtPC/MbtxcE4dSAv7b+K0SOQAtTQwg21hJk7LjWdpNw4cA/rlzMNmyTnnJAw3ENLC3p987MaBmrpk9vbkgx/elNnIE7QFBpIZGBgbgLQEkeqBwI54paNgFIyCUTDiAAA2ejxsRdWGlQAAAABJRU5ErkJggg==","orcid":"","institution":"Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Minfang","middleName":"","lastName":"Tao","suffix":""}],"badges":[],"createdAt":"2026-02-11 08:57:59","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8849443/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8849443/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104170694,"identity":"a16f30ae-ee39-4344-bce6-cb8ecc7829bc","added_by":"auto","created_at":"2026-03-08 14:49:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":457593,"visible":true,"origin":"","legend":"\u003cp\u003eGPs perspectives on menopause management and HRT in primary care\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8849443/v1/39c5ee3c4b06f21f9ee7a67f.png"},{"id":104404778,"identity":"cd54888e-37b9-4afa-97da-54a35b8cea6e","added_by":"auto","created_at":"2026-03-11 12:21:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1398837,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8849443/v1/168b1809-72b1-45e2-a114-4f2433466e37.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The perspective of general practitioners on menopause management and hormone replacement therapy in primary care: a cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWHO (World Health Organization, WHO) estimated that almost 1\u0026nbsp;billion women worldwide are menopausal transitional and postmenopausal by 2050[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. During menopausal transitional and postmenopausal stage, there will be a range of non-specific physical and psychological symptoms, such as vasomotor symptoms, vaginal dryness, mood disturbance, fatigue, difficulty in memory, sleep disturbance, joint pain, eventually resulting in a low life quality[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Further, there is an increase incidence in cardiovascular disease and osteoporosis after menopause[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The incidence of perimenopausal syndrome was up to 61.0% among 82,340 Chinese women aged 40 to 65 years old[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This high incidence rate requires the highly attention of healthcare professional.\u003c/p\u003e \u003cp\u003eThe concept of health menopause, enabling women to achieve needed resilience and self-management gradually gained attention[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. A clear consensus guideline have recommended that women and providers discuss hormone therapy as a viable treatment option for the menopause symptoms[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, the utilization rate of menopausal hormone therapy(MHT) in Chinese menopausal women was only 1\u0026ndash;3% by the end of the last century[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Due to the atypical nature of menopausal syndrome and women\u0026rsquo;s different experience depending on their ethnicity, personal, family factors[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], menopausal symptoms are often missed during medical consultations.\u003c/p\u003e \u003cp\u003ePrimary healthcare institutions and GPs are uniquely placed in the healthcare delivery pyramid. And a paper published in the Lancet pointed out that greater focus on recognition of risk factors in primary care is warranted[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The acceptance and promotion of MHT might be determined by the attitude of health-care professionals[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Moreover, common reasons for discontinuation were healthcare professional recommendation[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Health care-related factors, such as GPs\u0026rsquo; lack of knowledge[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], having discussions with healthcare providers about hormone therapy, women reporting feeling physician distrust, GP attitude and poor communication in the primary care consultation influenced the acceptance of hormone therapy[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], or optimal risk communication and decision making[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Many studies have shown that general practitioners(GP) often encounter difficulties, such as confusing the risk of thrombo-embolism from estrogen used in the post-menopause[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], in managing menopause and hormone replacement therapy, and there are gender differences involved. A survey found that GP registrars sought more assistance with menopause interactions than any other problem[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Most of GPs are not familiar with menopause[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Male general practitioners always reported more difficulty[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. And a survey reported that only 39% of women said that they were provided HRT timely, when GPs or nurses knew they had gone through menopause symptoms[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the Chinese healthcare setting, GPs constitute an important part of the health care workforce and are crucial for enhancing the service capabilities of grassroots medical institutions. With the prominent issue of aging social and the implementation of policies such as the tiered medical treatment system, the demand for general practitioners among residents is increasing[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. As gatekeepers of residents\u0026rsquo; health, the number of GPs in China has increased significantly[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In recent years, community management of perimenopausal syndrome has been continuously explored and developed. As the construction of community health services in China has only been going on for over 20 years, there are still many shortcomings, such as insufficient knowledge of perimenopausal syndrome among community doctors[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. And the survey shows that nearly 40% of community health centers in Beijing China still do not offer menopausal health care services[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the high prevalence of perimenopausal syndrome, Chinese GP\u0026rsquo;s perspective on menopause management and HRT remains unknown. This study aims to assess the perspective on menopause and HRT among GP, particularly in China\u0026rsquo;s medical context and culture diverse and to enhance menopause management protocols. Eventually, findings will helps to close the disparity between guidelines and implementation in primary healthcare institutions.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eA cross-sectional study design was used to assess GP\u0026rsquo;s perspective on menopause management and hormone replacement therapy through self-administered questionnaires using the Wenjuanxing platform(\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.wjx.cn\u003c/span\u003e\u003cspan address=\"https://www.wjx.cn\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) at fifty-six randomly selected community health service centers in Shanghai, China, from March 1 to August 31, 2025, after obtaining ethical approval from Ethics Committee of the Shanghai Sixth People\u0026rsquo;s Hospital. This study followed the Reporting of Observational Studies (STROBE) checklist[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eThe target population was licensed general practitioners in Shanghai, China. We employed convenience and snowball sampling methods to recruit GPs from Community Health Centers(CHCs) in Shanghai, China and included those who were available and provided informed consent. Eligible participants were invited to take part in a cross-sectional online survey. Eligible participants were GPs who(1)currently practiced in registered healthcare institutions at all levels in Shanghai, China; (2)prescribed psychotropic substances at level 2 independently; (3)managed menopausal women; and(4)provided informed consent to take part in this online survey. The sample size was calculated using the site \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.raosoft.com/samplesize.html\u003c/span\u003e\u003cspan address=\"http://www.raosoft.com/samplesize.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e, for a confidence interval of 95%. Hence, the calculated required sample size is 377.\u003c/p\u003e\n\u003ch3\u003eObjectives\u003c/h3\u003e\n\u003cp\u003eThe primary objective of this study was to evaluate community GPs\u0026rsquo; perspective on menopause management and HRT. The secondary objective included the analysis of factors and barriers that influence the perspective on management and HRT usage.\u003c/p\u003e\n\u003ch3\u003eData collection tool\u003c/h3\u003e\n\u003cp\u003eThe questionnaire was adapted from published literature on physician perception of menopause or HRT. After consulting menopause experts and pre-survey, questionnaire comprised 22 questions and composed of two parts:(1)Part1: Demographic and occupational information included gender, age, education level, job title, the working seniority as GPs, the experience of being gynecologists, the experience of receiving the education or training about menopause or HRT; (2)Part2: perspective on menopause management and hormone replacement therapy among GPs in the community.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData collection was conducted form March 1 to August 31, 2025. First, the questionnaire was upload to Wenjuanxing, an online system widely used in academic study in China. Then, the questionnaire link was sent to GPs from Community Health Centers in Shanghai using convenience and snowball sampling methods. After we explained the aims, procedural, anonymity and confidentiality of this study and participants provided informed consent by checking the confirm button, participants completed questionnaires.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using IBM SPSS Statistics 26.0 for Windows(IBM Corporation). Demographic, occupational characteristics were summarized using descriptive statistics. Frequencies and percentages were used to describe categorical variables about the awareness of GPs for the menopause and HRT. Categorical variables were analyzed by χ\u003csup\u003e2\u003c/sup\u003e test and reported as numbers/percentages. P\u0026lt;0.05 showed that the differences in responses were statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eParticipant characteristics\u003c/h2\u003e \u003cp\u003eSurvey responses were from 828 GPs(34.3% response rate) across 56 CHCs accounting for 7.7% of all general practitioners(10,689) in Shanghai, China. Over than half of respondents were over 40 years old(55.6%), female(76.1%), with more than 10 years of working seniority as GPs(63.4%), and had bachelor degree(80.6%). 13.4% respondents had the experience of being gynecologists (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic profile (N\u0026thinsp;=\u0026thinsp;828)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGPs Characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProportion of Respondents\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003egender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en(%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e198(23.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e630(76.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e368(44.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e460(55.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollege\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32(3.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e667(80.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e128(15.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoctor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(0.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJob title\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResident doctor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e129(15.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttending doctor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e523(63.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssociate chief physician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e157(19.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChief physician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19(2.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eWorking seniority as GPs(year)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026thinsp;~\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e303(36.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e525(63.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eExperience of being gynecologists\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e111(13.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e717(86.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePerspective on menopause management and HRT\u003c/h2\u003e \u003cp\u003eMost GPs thought common menopause symptoms were vasomotor symptoms(98.1%), sleep disturbance(96.5%) and mood disturbance(96.6%). Most GPs indicated that menopausal women need to focus on lifestyle adjustment(97.8%), psychological counseling(97.6%) and HRT(83.7%). Most recognized the benefits of HRT to relieve menopausal symptoms(97.3%), prevent osteoporosis(90.5%) and reduce the risk of cardiovascular disease(85.7%).\u003c/p\u003e \u003cp\u003eMost GPs thought HRT usage was associated with breast cancer(86.8%), endometrial cancer89.4%), thrombosis(73.6%) and indicated the reasons with high-risk population(91.5%), not using HRT during the window period(71.1%), different HRT drug types(72.6%). Few indicated they were \u0026ldquo;very familiar\u0026rdquo; with the indications and contraindications of HRT(2.5%), different administration routes of HRT(1.9%). A minority reported they were \u0026ldquo;very recommended\u0026rdquo; HRT(6.6%), and always recommend HRT to menopausal women in practice(4.3%). Most indicated patient\u0026rsquo;s personal wishes(83.6%), severity of patient's symptoms(74.8%), patient's age(60.6%), clinical experience(51.4%), relevant guidelines and literature(37.7%) and side effects(47.9%) were factors of recommendation for HRT .\u003c/p\u003e \u003cp\u003eFew reported they have ever prescribed HRT for menopausal women(5.4%) and received training about HRT(20.3%). 7.5% of female respondents over 40 years old received HRT. Most indicated there are not HRT products in the community(70.5%). Lack of knowledge among GPs(41.0%) and residents(11.0%), insufficient experience(5.8%) were barriers of menopause management and HRT usage in primary care according to 173 respondents\u0026rsquo; opinions(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eThe influencing factors of perspective on menopause management and HRT\u003c/h2\u003e \u003cp\u003eA statistically significant correlation was observed between training experience and degree of familiarity about the indications and contraindications of HRT(\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001), degree of familiarity with the indications and contraindications of HRT demonstrated a statistically relationship with gender༈\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.047༉, Age(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012), experience of being gynecologists(\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). The degree of familiarity with the different administration routes of HRT demonstrated a statistically relationship with training experience(\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001༉, experience of being gynecologists(\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). Our study also revealed a significant variation in the overall attitude toward HRT as different training experience(\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001༉, gender༈\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004༉, experience of being gynecologists(\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). Furthermore, training experience significantly impacted the recommendation of HRT(\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001), the usage of HRT(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002), HRT prescriptions(\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001), shortage of HRT produce((\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001). Gender significantly affected HRT prescriptions(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002), shortage of HRT produce((\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.010). Age also significantly impacted the recommendation of HRT(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.021), the usage of HRT(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003), HRT prescriptions(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008). Experience of being gynecologists significantly influenced the recommendation of HRT(\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001), the usage of HRT(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.018), HRT prescriptions(\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001)(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eknowledge, attitude and behavior toward menopause and HRT among GPs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"21\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c18\" colnum=\"18\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c19\" colnum=\"19\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c20\" colnum=\"20\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c21\" colnum=\"21\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eQuestion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eTraining experience\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003egender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c17\" namest=\"c15\"\u003e \u003cp\u003eExperience of being gynecologists\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c21\" namest=\"c19\"\u003e \u003cp\u003eWorking seniority of general practitioner\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes(n\u0026thinsp;=\u0026thinsp;168)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo(n\u0026thinsp;=\u0026thinsp;660)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMale(n\u0026thinsp;=\u0026thinsp;198)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFemale(n\u0026thinsp;=\u0026thinsp;630)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;40(n\u0026thinsp;=\u0026thinsp;368)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026gt;40(n\u0026thinsp;=\u0026thinsp;460)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c15\"\u003e \u003cp\u003eYes(n\u0026thinsp;=\u0026thinsp;111)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c16\"\u003e \u003cp\u003eNo(n\u0026thinsp;=\u0026thinsp;717)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c17\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c19\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;10(378)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c20\"\u003e \u003cp\u003e\u0026gt;10(n\u0026thinsp;=\u0026thinsp;450)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c21\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"21\" nameend=\"c21\" namest=\"c1\"\u003e \u003cp\u003eHow familiar with the indications and contraindications of HRT?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot at all familiar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55(6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55(8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20(10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e35(5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e24(6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e31(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e3(2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e52(7.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e21(6.9))\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e34(6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSlightly familiar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e305(36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19(11.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e286(43.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e75(37.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e230(36.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e147(39.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e158(34.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e9(8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e296(41.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e111(36.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e194(37.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutral/moderately familiar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e336(40.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e273(41.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e79(39.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e257(40.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e154(41.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e182(39.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e35(31.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e301(42.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e134(44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e202(38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFairly familiar/somewhat familiar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e111(13.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69(41.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42(6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23(11.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e88(14.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e40(10.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e71(15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e50(45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e61(8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e34(11.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e77(14.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery familiar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21(2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17(10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1(0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e20(3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3(0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e18(3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e14(12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e7(1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e3(1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e18(3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"21\" nameend=\"c21\" namest=\"c1\"\u003e \u003cp\u003eHow familiar are you with the different administration routes of HRT?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot at all familiar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57(6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56(8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16(8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e41(6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.341\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e24(6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e33(7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e2(1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e55(7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e23(7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e34(6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSlightly familiar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e334(40.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(11.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e314(47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e78(39.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e256(40.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e151(41.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e183(39.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e16(14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e318(44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e113(37.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e221(42.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutral/moderately familiar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e323(39.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81(48.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e242(36.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e83(41.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e240(38.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e155(42.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e168(36.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e41(36.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e282(39.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e134(44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e189(36.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFairly familiar/somewhat familiar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98(11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55(32.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43(6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20(10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e78(12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e33(9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e65(14.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e41(36.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e57(7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e29(9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e69(13.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery familiar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1(0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e15(2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e5(1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e11(2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e11(9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e5(0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e4(1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e12(2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"21\" nameend=\"c21\" namest=\"c1\"\u003e \u003cp\u003eWhat is your overall attitude towards HRT?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot at all recommended\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5(2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2(0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3(0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.581\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e5(0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e2(0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e3(0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e \u003cp\u003e0.714\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSlightly recommended\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40(4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35(5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12(6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e28(4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e16(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e24(5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e3(2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e37(5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e12(4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e28(5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutral/moderately recommended\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e448(54.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44(26.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e404(61.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e102(51.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e346(54.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e204(55.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e244(53.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e29(26.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e419(58.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e158(52.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e290(55.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFairly familiar/somewhat recommended\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e280(33.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85(50.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e195(29.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e69(34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e211(33.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e127(34.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e153(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e48(43.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e232(32.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e110(36.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e170(32.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery recommended\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55(6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34(20.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21(3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10(5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e45(7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e19(5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e36(7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e31(27.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e24(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e21(6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e34(6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"21\" nameend=\"c21\" namest=\"c1\"\u003e \u003cp\u003eDid you actively recommend HRT to menopausal women in practice?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e121(14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e115(17.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e38(19.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e83(13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e58(15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e63(13.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e4(3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e117(16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e41(13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e80(15.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e \u003cp\u003e0.204\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003erarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e342(41.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26(15.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e316(47.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e78(39.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e264(41.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e162(44.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e180(39.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e19(17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e323(45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e134(44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e208(39.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSometimes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e240(29.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63(37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e177(26.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e58(29.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e182(28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e105(28.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e135(29.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e34(30.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e206(28.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e83(27.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e157(29.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efrequently\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89(10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49(29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40(6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19(9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e70(11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e36(9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e53(11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e32(28.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e57(7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e37(12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e52(9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ealways\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5(2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e31(4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e29(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e22(19.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e14(2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e8(2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e28(5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"21\" nameend=\"c21\" namest=\"c1\"\u003e \u003cp\u003eHave you personally (as a woman) used hormone replacement therapy?(n\u0026thinsp;=\u0026thinsp;630)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33(5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18(54.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6(18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e27(81.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e11(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e22(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e6(18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e27(81.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e597(94.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123(20.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e474(79.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e265(44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e332(55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e98(16.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e499(83.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e212(35.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e385(64.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"21\" nameend=\"c21\" namest=\"c1\"\u003e \u003cp\u003eHave you ever prescribed HRT prescriptions for menopausal female patients?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45(5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33(73.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2(4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e43(95.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e11(24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e34(75.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e34(75.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e11(24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e11(24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e34(75.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e \u003cp\u003e0.110\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e783(94.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135(17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e648(82.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e196(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e587(75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e357(45.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e426(54.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e77(9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e706(90.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e292(37.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e491(62.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"21\" nameend=\"c21\" namest=\"c1\"\u003e \u003cp\u003eDoes your local community health center have HRT products?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e244(29.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76(31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e168(68.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e73(29.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e171(70.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e112(45.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e132(54.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.592\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e38(15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e206(84.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e0.263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e98(40.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e146(29.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e584(70.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92(15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e492(84.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e125(21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e459(78.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e256(43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e328(56.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e73(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e511(87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e205(35.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c20\"\u003e \u003cp\u003e379(64.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c21\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"21\"\u003eData presented as n(%). HRT, hormone replacement therapy. χ\u003csup\u003e2\u003c/sup\u003e analysis was used for comparison between different groups.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study identified general practitioners\u0026rsquo; perspective on menopausal management and HRT, and they also lack experience in using HRT. Only 4.3% of GPs always recommend HRT and 5.4% of GPs have prescribed HRT prescriptions for menopausal women. Lack of knowledge and experience among general practitioners, shortage of related drugs, few menopausal women, residents' lack of knowledge have hindered community general practitioners from implementing menopause care. The awareness and understanding regarding menopause management among GPs was mainly influenced by training experience and experience of being gynecologists.\u003c/p\u003e \u003cp\u003eThis study highlights the conceptualization and clinical execution of menopause management among GPs in the context of China. 2.5% and 1.9% of GPs were \u0026ldquo;very familiar\u0026rdquo; with the indications and contraindications of HRT and different administration routes of HRT, respectively. The majority of GPs have recognized the benefits of HRT. 6.9% of GPs thought HRT was risk-free. The majority of GPs in this study have shown that menopause women need to focus on lifestyle adjustment(97.8%), followed by psychological counseling(97.6%) and HRT(83.7%). Lifestyle changes were placed in important position by GPs and HRT was always used when symptoms were severely impairing quality of life[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Only 4.3% of GPs always recommend HRT to menopausal women and 5.4% of GPs prescribed HRT before. Meeta et al. also revealed that although 95% of HCPs were aware of the indications, risks and benefits of MHT, 57% used alternative therapies as first-line therapy and 71% used them as an adjunct to MHT[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Thus, there are critical gaps between the awareness and the behavior to menopause and HRT.\u003c/p\u003e \u003cp\u003ePatients\u0026rsquo; personal wishes, severity of patients\u0026rsquo; menopause symptom and patient\u0026rsquo;s age were the top 3 reasons about recommendation for HRT in this study. To support patient-centered healthcare, there has been a growing global emphasis on patient-centered research. Patient preference studies were one kind of research to capture patients\u0026rsquo; preferences[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. And, what deserves attention is the patients' attitude towards HRT. However, unfortunately, HRT awareness among women was 3.5% and 2.1% women had used or were using HRT in fact[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Patient satisfaction with GPs is not related to consultation length[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. GPs reported that residents' lack of knowledge was one of the shortage for menopause healthcare by GPs and showed the demand for science popularization and publicity according to the result of open-ended questions in this study. Residents reported low confidence in managing menopause basics and using HRT[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Some measures should be taken to improve menopause awareness and acceptance of HRT. On the one hand, we could improve the conception of menopause management through mainstream media, social media and influencers, providing more patient information to improve administration and compliance, providing education to the population based on the United Kingdom\u0026rsquo;s experience[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. On the other hand, general practitioners, as an important part of primary medical institutions, are responsible for disease prevention and health education. GPs have to assume responsibility for educating women about menopause and HRT use. However, although doctors consider menopause management to be an important issue in women's health, there is a significant lack of education on relevant knowledge about menopause and accumulation of relevant experience, which leads to difficulties in discussing this topic[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. This has led to a vicious cycle, which has an adverse impact on menopause management.\u003c/p\u003e \u003cp\u003eIn this study, 20.3% took part in training about the HRT before. Training experience significantly impacted the perspective on menopause management and HRT among GPs. GPs with training experience were more familiar with indications and contraindications of HRT, different administration routes of HRT. And they were more likely to recommend and prescribe HRT. Low et al. also indicated that receiving training on menopause management was the positive predictor of offering MHT[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Previous study has found that nearly 50% of health-care professionals had not received menopause management training in nearly 1 year[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The actual prescription rate was only 0.9% and 83% of primary care doctors had not received any related training in Malaysia[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. According to the menopause management in the United Kingdom, they also emphasis the importance of training for HCP including standardized and appropriate education which is online, flexibility, interesting, attractive, appropriate level for each HCP profile and combining clinical practice to providing appropriate care and the safe prescription of MHT[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Thus, it is urgently necessary to establish a \u0026ldquo;well-educated healthcare professional workforce\u0026rdquo; that \u0026ldquo;not only has the basic understanding and awareness of how menopause affects women but also the optimum skill mix to cater for a wide population demand\u0026rdquo;[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGPs with experience of being gynecologists significantly impacted the knowledge, attitude, and behavior of menopause and HRT among GPs. Precious study conducted in China also found that gynecologists were more likely to prescribe MHT for cardioprotection, reducing colon cancer risk and in women with a history of thromboembolic events than GPs[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The same results that GPs prescribed MHT to a significantly lesser extent than gynaecologists were indicated in the study performed in Sweden[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] and more GPs consider it difficult to evaluate advantages and disadvantages of HRT, compared to gynecologists[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. No-experience in prescribing MHT was recorded as the negative predictors in offering MHT[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Insufficient experience was reported as one of the shortages for menopause health care by GPs in this study and GPs in this study showed the demand of expert on-site guidance.\u003c/p\u003e \u003cp\u003eShortage of related drugs was also marked as the shortages for menopause health care by GPs. 29.5% of GPs indicated there were HRT product in their community health center. Similarly, previous studies have found 87.1% of primary care doctors reported unavailable MHT in their clinic[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Therefore, it is also necessary to enhance the community's attention to menopause management and hormone replacement therapy (HRT), in order to increase the accessibility and availability of HRT.\u003c/p\u003e \u003cp\u003e Chinese government outlined the goal mentioned during the Global Conference on Primary Health Care 2018 of improving the capability of the primary health system in the \u0026ldquo;Health China 2030\u0026rdquo; plan. GPs are the first point of contact for medical advice, representing the health protector of family members and the main providers of primary health services. GPs\u0026rsquo; work goes beyond disease diagnosis and treatment. It also involves physical examinations, investigations, chronic disease management, health file, contracted family doctor services, health education, teaching students, and scientific research[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe menopausal transition is a crucial period contributing to the increase in cardiovascular diseases. Monitoring middle-aged women\u0026rsquo;s health and implementing early intervention strategies to reduce the risk of cardiovascular diseases is necessary[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. In developed countries, particularly in the United Kingdom, healthcare professionals(HCPs) play a crucial role in menopause management, but professional training is required[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. As the general practitioner system in China has only been in place for about 20 years, the services provided by GPs mainly focus on chronic non-communicable diseases such as hypertension, diabetes and chronic lung diseases. Services related to menopause are particularly lacking. To the authors\u0026rsquo; knowledge, this is the first article to survey GPs\u0026rsquo; knowledge, attitude and behavior toward menopause and HRT. The results of this study may be used to know and improve the status of knowledge, attitude and behavior among GPs, highlighting significant associations between education experience and menopause management, gynecologists experience and menopause management among GPs in China. Having education experience about menopause or HRT and having gynecologists experience before was significantly correlated with improved knowledge, attitude and behavior about menopause and HRT. Strategies aiming to improve menopause management and HRT usage among GPs in primary health institutions must consider education experience and gynecologists experience variation.\u003c/p\u003e \u003cp\u003eIt is an innovating work that focused on knowledge, attitude and behavior about menopause and HRT of GPs in China. There is a considerable sample size, with 828 participants obtained from 56 community health centers in Shanghai, China. Thus, this study had good statistical power to reflect the true situation.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThere are several limitations that need to be considered. Firstly, it is possible that self-reporting bias occurred because of self-reported data. Nevertheless, we provided detailed explanations and clarifications, including strict anonymity measures before the investigation. Secondly, we used a self-developed questionnaire to conduct a preliminary survey on the perspective of general practitioners regarding menopause and HRT. However, it is possible that other issues were not covered. Thirdly, it cannot establish causation because of its cross-sectional design. Despite these limitations, the findings of this study provide reliable suggestions for improving GPs' understanding of menopause and HRT.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIt is an innovating work that focused on perspective on menopause and HRT of GPs from 56 community health centers in Shanghai, China. Our study identified that general practitioners lack relevant knowledge about menopausal management and HRT, and they also lack experience in using HRT. Only 4.3% of GPs always recommend HRT and 5.4% of GPs have prescribed HRT prescriptions for menopausal women. Lack of knowledge and experience among general practitioners, shortage of related drugs, residents' lack of knowledge have hindered community general practitioners from implementing menopause care. The awareness and understanding regarding menopause management among GPs was mainly influenced by training experience and experience of being gynecologists.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eGPs General practitioners\u003c/p\u003e\u003cp\u003eHRT Hormone replacement therapy\u003c/p\u003e\u003cp\u003eMHT Menopausal hormone therapy\u003c/p\u003e\u003cp\u003eHCPs Healthcare professionals\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e This study was conducted in accordance with the principles of Declaration of Helsinki. The study was approved by the Ethics Committee of the Shanghai Sixth People’s Hospital(2025-KY-026(K)). All participants consented to the research and were assured of their anonymity.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eNot applicable.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eThe authors affirm that the methods used in the data analyses are suitable applied to their data within their study design and context, and the statistical findings have been interpreted correctly. No conflict of interest has been declared by the author(s).\u003c/p\u003e \u003cp\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study has received funding by Shanghai Fengxian District Health Commission through the Community Menopause Health Promotion and Innovative Management Project. Views expressed are however, those of the author(s) only and do not necessarily reflect those of the Shanghai Fengxian District Health Commission.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJY, GXQ and TMF conceived and designed the study, performed the literature search. Seven authors made substantial contributions to the acquisition, analysis, and interpretation of data (JY, GXQ, ZY, CXX, DY, CH, TMF); and all authors substantially con-tributed to drafting the work and reviewing it critically. All authors approved the final version and agreed to be accountable for all aspects of the work with respect to integrity and rigor.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data supporting the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eResearch on the menopause in the 1990s. Report of a WHO Scientific Group. World Health Organ Tech Rep Ser. 1996;866:1\u0026ndash;107.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNachtigall LE. The symptoms of perimenopause. Clin Obstet Gynecol. 1998;41(4):921\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarjoribanks J, Farquhar C, Roberts H, Lethaby A, Lee J. Long-term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev. 2017;1(1):Cd004143.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJia Y, Zhou Z, Cao X, Hu W, Xiang F, Xiong LW. [Incidence of Perimenopausal Syndrome in Chinese Women Aged 40 to 65 Years:a Meta-analysis]. 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Randomized crossover study investigating resident retention of menopause-related knowledge after completion of learning modules. Menopause (New York NY). 2020;27(1):95\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMansour D, Barber K, Chalk G, Noble N, Digpal AAS, Talaulikar V, Gray S. The evolving perspective of menopause management in the United Kingdom. Womens Health (Lond). 2024;20:17455057241288641.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShrivastava S, Gandhi A, Spencer AL. Integrating Women's Health Education into the Internal Medicine Residency Program Curriculum. South Med J. 2021;114(2):116\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLow TL, Cheong AT, Devaraj NK, Ismail R. Prevalence of offering menopause hormone therapy among primary care doctors and its associated factors: A cross-sectional study. 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Acta Obstet Gynecol Scand. 1998;77(9):909\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWei Y, Wang F, Pan Z, Jin G, Wang D, Lu X, Cao Q. Work Content of General Practitioners in Beijing, China: A Multi-method Study. Front Public Health. 2022;10:870224.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl Khoudary SR, Aggarwal B, Beckie TM, Hodis HN, Johnson AE, Langer RD, Limacher MC, Manson JE, Stefanick ML, Allison MA. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. Circulation. 2020;142(25):e506\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"menopause, general practitioners, hormone replacement therapy, training","lastPublishedDoi":"10.21203/rs.3.rs-8849443/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8849443/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eA large group of middle-aged and elderly women has emerged. Menopause management and hormone replacement therapy(HRT) poses a huge public health challenge in China. General practitioners(GPs) are gatekeepers of the health system. But there is a noticeable deficiency regarding GPs\u0026rsquo; perspective on menopause management and HRT.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eThis cross-sectional study was conducted at fifty-six randomly selected community health service centers in Shanghai, China, from March 1 to August 31, 2025, targeting licensed GPs. We employed convenience and snowball sampling methods to recruit participants, and data were collected through a 22-item questionnaire covering demographic and occupational information, perspective on menopause management and HRT, barriers. Statistical analyses were performed in SPSS(IBM V26.0), using descriptive statistics and χ2 test. P\u0026lt;0.05 showed that the differences in responses were statistically significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 828 GPs participated. Few indicated they were \u0026ldquo;very familiar\u0026rdquo; with the indications and contraindications of HRT(2.5%), different administration routes of HRT(1.9%). Lifestyle adjustment was the most participants(97.8%) thought menopausal women need to focus on. 97.3% of GPs indicated that HRT could relive menopausal symptom. Only 6.9% of GPs indicated that HRT was risk-free, and high-risk population was the most common reason for increasing some disease related to HRT. 6.6% of GPs hold the overall attitude of \u0026ldquo;very recommended\u0026rdquo; towards HRT. In fact, only 4.3% of GPs always recommend HRT and 5.4% of GPs have prescribed HRT prescriptions for menopausal women. The training experience is a crucial factor that influences their familiarity with menopause management and knowledge related to HRT, their overall attitude towards HRT, the degree of recommendation, and the prescription they provide. Lack of knowledge among GPs(41.0%) and residents(11.0%), insufficient experience(5.8%) were barriers of menopause management and HRT usage in primary care according to 173 respondents\u0026rsquo; opinions.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThere are gaps between the awareness and behavior toward menopause and HRT among GPs. GPs lack relevant knowledge and they are hesitancy in the use of HRT. Strategies aiming to improve menopause management and HRT usage among GPs in primary health institutions must consider education experience and gynecologists experience variation.\u003c/p\u003e","manuscriptTitle":"The perspective of general practitioners on menopause management and hormone replacement therapy in primary care: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-08 14:49:47","doi":"10.21203/rs.3.rs-8849443/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"36245322968336173652372465917388727249","date":"2026-03-02T08:42:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-26T11:32:53+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-26T10:52:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-11T22:27:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-11T22:27:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Primary Care","date":"2026-02-11T08:26:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1df35356-05b2-4201-8200-7996dc89305b","owner":[],"postedDate":"March 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-08T14:49:47+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-08 14:49:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8849443","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8849443","identity":"rs-8849443","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}