Keywords: menopause, GP

Background:

General practitioners (GPs) often serve as first-line care providers for women in menopause, yet confidence in managing menopausal symptoms remains variable. International guidelines recommend integrating menopause care into primary care, but educational gaps persist in Bulgaria.

Research questions:

What are the current practices, confidence levels, and educational needs of Bulgarian GPs in managing menopausal symptoms?

Method:

A cross-sectional online survey was conducted among 137 Bulgarian GPs. The questionnaire assessed formal training, clinical practices, therapeutic confidence (including hormonal replacement therapy), and educational needs. Descriptive statistics summarized responses. Associations between training history and prescribing practices were analyzed using chi-square tests.

Results:

Although most respondents regularly consulted menopausal patients, only 17.5% reported confidence in prescribing hormone therapy. Lifestyle advice (72.3%) and herbal remedies (44.5%) were preferred over evidence-based hormonal treatments (15.3%), even when indicated. Barriers included fear of side effects, lack of national guidelines, and limited training. GPs who had received prior postgraduate education in menopause care were significantly more likely to recommend hormonal therapy (p < 0.05). Interest in structured training was high, with 88.3% expressing a desire for further education.

Conclusions:

The management of menopausal symptoms in Bulgarian primary care is marked by uncertainty and underutilization of hormonal therapy. Educational programs and national guidelines are needed to bridge the gap between evidence-based recommendations and real-world practice, empowering GPs to provide more confident, comprehensive care.

Points for discussion:

• How can menopause care be integrated into GP curricula and CME?

• What policy steps are needed to support guideline development?

• Should multidisciplinary models involving GPs and specialists be piloted?