Significant specialty-dependent gaps in menopausal hormone therapy knowledge and prescribing confidence persist in Türkiye, with internal medicine physicians demonstrating the lowest awareness and willingness to prescribe.
Key Findings
Results
Overall physician familiarity with menopausal hormone therapy guidelines was low, with significant differences across specialties.
53.2% of all participating physicians reported familiarity with menopausal hormone therapy guidelines.
Specialty-based differences in guideline familiarity were statistically significant (p<0.001).
A total of 235 physicians participated in the cross-sectional online survey conducted between January and June 2025.
Specialties surveyed included obstetrics and gynecology, endocrinology, and internal medicine.
Results
Internal medicine physicians demonstrated the lowest awareness and highest self-reported inadequate knowledge of menopausal hormone therapy.
94.4% of internal medicine physicians self-reported inadequate knowledge of menopausal hormone therapy.
Internal medicine physicians had the lowest awareness of menopausal hormone therapy guidelines among the three specialties surveyed.
This finding was identified through a 15-item structured questionnaire assessing knowledge, attitudes, and prescribing behaviors.
Results
Willingness to prescribe menopausal hormone therapy for symptomatic women aged 50-59 years differed significantly by specialty.
Specialty-based differences in willingness to prescribe were statistically significant (p<0.001).
Willingness to prescribe was highest among obstetrics and gynecology physicians and lowest among internal medicine physicians.
The target patient population specified was symptomatic women aged 50-59 years.
Results
In multivariable logistic regression, both internal medicine and endocrinology specialties were independently associated with lower willingness to initiate menopausal hormone therapy compared to obstetrics and gynecology.
Internal medicine specialty was associated with significantly lower willingness to initiate menopausal hormone therapy (aOR 0.179, 95% CI 0.067-0.474; p=0.001).
Endocrinology specialty was also independently associated with lower willingness to initiate menopausal hormone therapy (aOR 0.252, 95% CI 0.120-0.531; p<0.001).
Adjusted odds ratios were derived from multivariable logistic regression controlling for other factors.
Obstetrics and gynecology served as the reference specialty in the regression model.
Methods
The study used a cross-sectional online survey design with a structured questionnaire to assess menopausal hormone therapy knowledge, attitudes, and prescribing behaviors.
The survey was conducted between January and June 2025 among physicians in Türkiye.
A 15-item structured questionnaire was used.
Descriptive statistics and chi-square tests were used for analysis, with p<0.05 considered statistically significant.
Multivariable logistic regression was performed to identify factors associated with willingness to initiate menopausal hormone therapy.
Total sample size was 235 physicians across three specialties.
What This Means
This research suggests that many physicians in Türkiye, particularly those in internal medicine and endocrinology, have significant gaps in their knowledge and confidence regarding menopausal hormone therapy (MHT) — a treatment used to relieve symptoms of menopause such as hot flashes and sleep disturbances. In a survey of 235 doctors conducted in 2025, only about half reported being familiar with current MHT guidelines, and nearly all internal medicine physicians (94.4%) rated their own knowledge as inadequate. Obstetricians and gynecologists were far more willing to prescribe MHT to eligible women than their colleagues in internal medicine or endocrinology.
The study found that specialty type was a strong and independent predictor of whether a physician would be willing to prescribe MHT. Even after accounting for other factors, internal medicine physicians were about 82% less likely, and endocrinologists about 75% less likely, to be willing to initiate MHT compared to gynecologists. This matters because menopausal women often seek care from a wide range of physicians, and if most non-gynecologist doctors are reluctant or ill-equipped to address MHT, many women may go untreated or undertreated for significant symptoms.
This research suggests that targeted educational efforts and better dissemination of up-to-date clinical guidelines could help close these specialty-based knowledge gaps. Ensuring that physicians across different fields are adequately informed about when and how to use MHT may reduce the undertreatment of symptomatic menopausal women in Türkiye and potentially in other countries with similar patterns of care.
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Erdem M, Yetkin N, Güneş A. (2026). Menopausal hormone therapy in Türkiye: physician knowledge and practice gaps.. Revista da Associacao Medica Brasileira (1992). https://doi.org/10.1590/1806-9282.20260307