# Treatment provision and management for the menopause: a multinational survey study

## TL;DR

This study finds significant international differences in how menopause is managed, with disparities in treatment access and patient satisfaction across five English-speaking countries.

## Contribution

The study provides new insights into global variations in menopause care through a multinational survey of women's treatment experiences.

## Key findings

- Women in the UK and US consulted more healthcare professionals than those in Australia, Canada, and New Zealand.
- New Zealand, the UK, and the US had higher prescription rates compared to Australia and Canada.
- Despite higher healthcare access, UK women reported lower satisfaction and less involvement in treatment decisions.

## Abstract

Despite available safe hormonal and non-hormonal interventions, most women with troublesome menopausal symptoms do not receive effective, evidence-based therapy, with notable international disparities in provision. This study aimed to investigate self-reported menopausal care experiences in a self-selecting sample from five English-speaking countries: Australia, Canada, New Zealand, the United Kingdom, and the United States, through an anonymous online survey.

The 15–20 min survey, delivered via Qualtrics XM®, included questions on sociodemographic characteristics and treatment experiences, such as the number of healthcare professionals (HCP) seen before getting a prescription, ease of obtaining treatment, involvement in treatment discussions, appropriateness of treatment review and optimization, side effect tolerability, and overall satisfaction.

Data from 3,062 respondents were analyzed: Australia (16.59%, n = 508), Canada (17.54%, n = 537), New Zealand (16.59%, n = 508), UK (24.00%, n = 735), and US (25.28%, n = 774). Significant international differences were observed in both healthcare access and prescribing patterns. More women in the UK and US consulted an HCP compared with Australia, Canada, and New Zealand [χ²(4, N = 3062) = 101.02, p < 0.001, φc = 0.18]. Prescription rates were higher in New Zealand, the UK, and the US compared with Australia and Canada [χ²(4, N = 2,485) = 75.71, p < 0.001, φc = 0.18]. However, UK respondents, despite longer treatment use, generally reported less involvement in treatment discussions, poorer treatment review, lower side effect tolerability, and reduced satisfaction compared with other countries across treatment types.

Based on a self-selected cohort, these findings reveal critical gaps in menopause care, including disparities in treatment access and international differences in patient involvement. Greater access to healthcare in the UK and the US did not translate into higher satisfaction, highlighting the need for patient-centered approaches. Improving care requires better clinician education and strategies to enhance communication and shared decision-making.