IMPORTANCE AND OBJECTIVE:Gaps in menopause status classification, reproductive stage documentation, and symptom capture (eg, vasomotor symptoms) within electronic clinical information systems, including electronic health records (EHRs), limit clinical care and menopause research. This scoping review examined how menopause-related data are structured and operationalized within EHR systems and identified gaps in documentation that limit clinical care and research. METHODS:We searched Ovid MEDLINE, Scopus, CINAHL, and IEEE Xplore (2004 to March 2026) using terms related to menopause, climacteric, perimenopause, and EHR documentation, supplemented by backward citation searching. Two reviewers independently screened studies, with discrepancies resolved by consensus. Quality appraisal was conducted using the Johns Hopkins Evidence-based Practice framework. Rayyan and Excel facilitated article management, data extraction, and synthesis. DISCUSSION AND CONCLUSION:Nineteen studies met the inclusion criteria. Most were retrospective cohort or cross-sectional analyses conducted in US health systems (2013-2026), with sample sizes from 45 to 307,512 women. Thirteen studies relied on International Classification of Diseases, Ninth and Tenth Revisions (ICD-9/ICD-10) codes to identify menopause-related experiences; however, only nine reported the codes used. Across studies, three interrelated themes emerged: documentation limitations (including the absence of structured reproductive stage fields and reliance on unstructured text), undertreatment of documented symptoms, and underreporting of menopause-related symptoms in the EHR data. Menopause remains inconsistently represented in EHRs, reflecting structural documentation gaps that constrain longitudinal tracking, clinical decision-making, and research reproducibility. Development of standardized menopause common data elements, including structured stage and symptom documentation, will require coordinated, multidisciplinary efforts to improve data quality and support scalable menopause research.
IMPORTANCE:Physical activity (PA) may mitigate adverse changes in body composition (BC) and body image (BI) in postmenopausal women; however, the magnitude and consistency of its effects remain unclear. OBJECTIVE:To systematically review and synthesize evidence from experimental studies examining the effects of structured PA interventions on BC parameters and BI perception in postmenopausal women (PROSPERO: CRD42024539791). EVIDENCE REVIEW:MEDLINE, Web of Science, and Scopus were searched for randomized controlled trials published in English from 2014 to 2025 reporting BC and/or BI outcomes. Risk of bias and certainty of evidence were assessed using the RoB 2.0 tool and the GRADE approach. Pooled mean differences (MDs) with 95% CIs were estimated using a random-effects model for body mass index (BMI), percentage of fat mass (%F), and waist-to-hip ratio (WHR). FINDINGS:After duplicate removal, 2,483 records were screened, and 13 trials involving 694 postmenopausal women met the inclusion criteria. Most studies had a low risk of bias or some concerns. Despite wide variation in frequency, intensity, type, and duration of PA interventions, meta-analyses suggested significant reductions (P < 0.001) in BMI (MD = -0.87 kg/m2; 95% CI: -1.20 to -0.55), %F (standardized MD: -0.53; 95% CI: -0.81 to -0.26), and WHR (MD = -0.03; 95% CI: -0.04 to 0.02). The heterogeneity was low for BMI and WHR (I2 = 0%) and moderate for %F (I2 = 57%) despite considerable within-study variability. Evidence on BI was limited and inconclusive, with only one study reporting preintervention and postintervention data. CONCLUSIONS AND RELEVANCE:Structured PA appears to improve key BC parameters in postmenopausal women. Evidence regarding BI is insufficient, emphasizing the need for rigorous, long-term trials to clarify PA's effects on BI. These findings may guide clinicians in recommending PA for postmenopausal women to improve BC, while highlighting a critical gap in evidence regarding BI.
OBJECTIVE:An active social lifestyle may protect against cognitive decline in older adults, but few studies have examined specific social support dimensions in relation to specific cognitive domains. This study examines associations between social support dimensions and cognitive function in older women. METHODS:The Early versus Late Intervention Trial with Estradiol (ELITE) was a randomized, double-blinded, placebo-controlled trial of oral 17β-estradiol versus placebo in postmenopausal women, designed primarily to evaluate the timing hypothesis on atherosclerosis progression and cognitive decline; the present analysis is a secondary, hypothesis-generating examination of the psychosocial substudy data (2009-2012). A total of 448 women completed psychosocial assessments every 6 months. Cognitive function was assessed at baseline, 2.5, and 5 years using composite scores for executive function, verbal memory, visual memory, and global cognition derived from 14 standardized tests. Perceived social support was assessed using the Medical Outcomes Study-Social Support Survey (MOS-SSS; 0-100 scale). Paired cognitive-psychosocial assessments were analyzed using linear mixed-effects models adjusted for age, marital status, blood pressure medication, BMI, education, income, race, and randomized treatment (hormone therapy or placebo). RESULTS:A total of 298 women (mean age 60.3 y) provided 322 paired visits. Positive associations were observed between instrumental social support and visual memory (β(SE)=0.0044(0.0022), 95% CI: -0.00002 to 0.0088, P=0.051) and between positive social interaction and global cognition (β(SE)=0.0092(0.0046), 95% CI: 0.0001-0.0182, P=0.047). In age-stratified analyses, the positive social interaction-global cognition association was significant among women <65 years (P=0.042) but not women ≥65 years (P=0.34). No association survived false discovery rate (FDR) correction for multiple comparisons. CONCLUSIONS:In this sample of healthy middle- to older-aged women, no association between specific dimensions of social support and cognitive domains was statistically significant after correction for multiple comparisons. These hypothesis-generating findings suggest any association is modest at best and warrant confirmation in studies designed specifically for this question.
The American College of Obstetricians and Gynecologists (ACOG) recently revised its guidance regarding the evaluation of postmenopausal bleeding (PMB), recommending combined transvaginal ultrasonography (TV U/S) and endometrial (EM) sampling for most patients undergoing initial assessment. This perspective examines the evidence underlying these recommendations and considers their potential implications for clinical practice. Prior ACOG guidance recognized that, when the endometrium is fully visualized and measures ≤4 mm, TV U/S provides a highly effective means of excluding endometrial cancer (EC) in most women with PMB if the TV U/S is adequate and there is no persistent bleeding. Their revised recommendations place greater emphasis on EM sampling, including in several patient populations previously considered appropriate candidates for ultrasound-based evaluation. This perspective reviews the evidence this new guidance relied upon, as well as limitations of blind EM sampling, including published false-negative rates even in cases of known carcinoma, technical challenges associated with tissue acquisition, and potential procedural complications. Particular attention is given to women receiving menopausal hormone therapy, as well as nulliparous women in whom EM sampling may be technically difficult. My perspective is that former guideline-based approaches remain generally appropriate. The concern about the increasing mortality of EC in the United States is appropriate, as is the concern about racial disparities in the incidence and mortality of EC. However, the new ACOG revision will result in inappropriate, invasive EM sampling in a large number of women. The potential harms, as well as difficulties in obtaining tissue, will be substantial. Any real attempt to reduce the mortality of EC will require a better understanding of patient-specific risk factors, as well as information about less common non-EM type II cancers, especially in Black women, and better patient and practitioner education relative to PMB.
OBJECTIVE:Early natural menopause (ENM) is associated with a higher long-term health burden, yet whether social determinants of health (SDH) modulate this risk is understudied. This study aimed to estimate the association of combined SDH with mortality and adverse health outcomes among women with ENM. METHODS:We analyzed data from 19,912 women with ENM in the UK Biobank. Based on 14-item combined SDH scores, participants were categorized into tertiles representing favorable, medium, and unfavorable SDH groups. Multivariable Cox proportional hazards models were used to evaluate the associations of combined SDH with mortality, as well as incident cardiovascular disease (CVD), cancer, and dementia. In addition, we externally validated the mortality findings in the US National Health and Nutrition Examination Survey. RESULTS:In the UK Biobank cohort, higher combined SDH scores showed a progressive association with all-cause mortality and the incidence of CVD and dementia (all P for trend <0.001). Compared with the favorable SDH group, the unfavorable SDH group was linked to higher risks of all-cause mortality (hazard ratio [HR] = 1.75; 95% CI: 1.51-2.03), CVD (HR = 1.48; 95% CI: 1.29-1.70), and dementia (HR = 1.83; 95% CI: 1.30-2.57). Consistently, these all-cause mortality associations were further validated in the US National Health and Nutrition Examination Survey cohort. Notably, among all SDH variables, unemployment exhibited the strongest associations with both all-cause mortality and incident dementia. CONCLUSION:Cumulative social disadvantage significantly amplifies the risks of mortality and multimorbidity in women with ENM. These findings warrant the integration of multidimensional SDH assessments into clinical management to tailor preventive strategies and mitigate disease burden in this vulnerable population.
Importance: Menopausal estrogen decline is the leading cause of osteoporosis, leaving bones vulnerable to fractures. Of the interventions available for preserving bone density, exercise is potentially the most accessible. However, the ideal type, intensity, and age of initiation of exercise interventions remain under debate. Objective: This systematic review and meta-analysis set out to summarize recent evidence on the effects of high-intensity, impact, and strength training on bone mineral density in postmenopausal women, and to compare this evidence to equivalent data in premenopausal women. Evidence Review: PubMed and the Cochrane Central Register of Controlled Trials were searched on July 17, 2025, for randomized controlled trials published on or after March 1, 2018. Search terms were structured around menopause-related, exercise-related, and bone-related terms. Studies were eligible if they included either premenopausal or postmenopausal women, at least one intervention arm completing either high-intensity, impact or strength training, a control arm, and bone mineral density as an outcome. Following identification of eligible studies, participant and study characteristics were tabulated, and studies were assessed for quality using the Physiotherapy Evidence Database scale and risk of bias using the RoB 2 tool. Outcomes data were extracted, and a meta-analysis was performed. Findings: Eight randomized controlled trials incorporating 379 participants met the inclusion criteria; six (n=267) in postmenopausal and two (n=112) in premenopausal women. Meta-analysis of pooled intervention types revealed small but significant effects of high-intensity, impact, and strength training at the femoral neck (0.47, t [3]=5.22, P =0.014; n=141) and lumbar spine (0.36, t [4]=4.36, P =0.012; n=182) in postmenopausal but not premenopausal women. Conclusions and Relevance: High-intensity, impact, and strength training (pooled analysis) appeared to be effective at increasing bone mineral density in postmenopausal women, though the small effect sizes and methodological limitations identified should be considered. Further studies are required to determine whether more robust protocols would have generated stronger effects in premenopausal women, or whether there are different osteogenic responses to exercise in the two populations.
OBJECTIVES:Estrogen decline during menopause transition is associated with physical and psychological symptoms that impair overall well-being. In a previous randomized trial, a probiotic formula comprising Levilactobacillus brevis KABP052, Lactiplantibacillus plantarum KABP051, and Pediococcus acidilactici KABP021 was found to be associated with a slower decline in estrogen levels. Therefore, we hypothesized that the intake of 1×109 colony-forming units/day of this formula could improve menopausal symptoms and quality of life. METHODS:We conducted a decentralized, randomized, double-blind, placebo-controlled trial using a real-world approach. Women between 45 and 60 years old who were in perimenopause or postmenopause and had Cervantes Quality of Life score ≥ 38 were enrolled and allocated 2:1 to the probiotic (n=160) or placebo group (n=85) for a 3-month period. Menopausal symptoms and quality of life were evaluated by using the Menopause Rating Scale II, Cervantes and Utian Quality of Life questionnaires. RESULTS:In the full analysis set, Menopause Rating Scale II total score decreased significantly in the probiotic group compared to placebo across the study (global mean difference between groups: -1.00 [0.47], P=0.033), with an improvement in the somato-vegetative domain (-0.54 [0.20], P=0.007). Per-protocol analysis also revealed differences in the psychological domain between groups, favoring the probiotic (-0.51 [0.25], P=0.040). Cervantes scale showed no significant differences between groups, but the change in Utian Quality of Life score was significantly higher in the probiotic group (2.21 [1.07], P=0.040). CONCLUSION:In this real-world study, the probiotic formula was associated with improvements in menopause-associated symptoms and quality of life, whereas the global Cervantes score appeared to be similar between groups. Future investigations are required to confirm this clinical effect and the underlying mechanisms of action. ClinicalTrials.gov identifier: NCT06604234.
OBJECTIVE:Limited research has assessed prospective associations of systemic inflammatory (GlycA) and immune (complement factor 3 [C3] and 4 [C4]) biomarkers with future cognition in midlife women, who potentially experience worsening inflammation around the menopause transition. We aim to assess the associations of midlife serum GlycA, C3, and C4 with future cognitive performance in women. METHODS:Serum GlycA, C3, and C4 were repeatedly measured over 6.1 ± 3.9 years in 503 midlife women (1,234 observations) from the Study of Women's Health Across the Nation high-density lipoprotein ancillary study. Longitudinal measures of working memory, processing speed, and episodic memory, immediate and delayed recall, were administered 1.46 ± 0.95 years later. We applied joint models to examine the associations of baseline biomarkers and their changes since baseline with subsequent cognition. RESULTS:Higher levels of serum GlycA and complement factor 4 at baseline (50.17 ± 2.65 y) were significantly associated with worse working memory and better immediate recall, respectively, over the next decade. Higher baseline complement factor 4 and increases in C3 and C4 since baseline tended to associate with better future immediate and/or delayed recall. CONCLUSIONS:Higher baseline GlycA, rather than its changes since baseline, was associated with lower future working memory, whereas higher baseline complement factor 4 and increases in C3 and C4 since baseline appeared cognitively protective. Targeting inflammation amelioration and immunity improvement over the menopause transition may provide an open avenue to preserve future cognitive health.
OBJECTIVE:Menopausal symptoms are challenging conditions with a significant impact on women's health, especially in managing type 2 diabetes mellitus (T2DM). However, few studies have explored the link between T2DM and menopausal symptoms in South Korea. Therefore, this study aims to examine the association between T2DM and the number and severity of menopausal symptoms among Korean midlife women. METHODS:A cross-sectional observational study was conducted involving 296 women aged 40-64 in South Korea. Based on their fasting blood glucose and HbA1c levels, participants were classified into the diabetic group and the nondiabetic group. The Midlife Women's Symptom Index (MSI) was used to measure menopausal symptoms, and various background and health-related characteristics were also assessed. Data analyses were conducted using independent t tests, Mann-Whitney U tests, and hierarchical multiple regression analyses. RESULTS:Women in the diabetic group showed a significantly greater number and higher severity of menopausal symptoms compared with those in the nondiabetic group. Subgroup analyses revealed significant differences in both the number and severity of menopausal symptoms, particularly among postmenopausal stage, with no differences observed in the premenopausal and perimenopausal stages. Furthermore, T2DM was significantly associated with both the number and the severity of menopausal symptoms after controlling for confounding variables. CONCLUSION:T2DM was significantly associated with the number and severity of menopausal symptoms among Korean midlife women. Postmenopausal women with T2DM also reported a greater menopausal symptom burden than those without T2DM. Tailored interventions may help managing symptom burden and improve overall quality of life in this population.
OBJECTIVES:To evaluate the independent and combined effects of premature menopause (PM, before age 40) and hypertension on the risk of cardiovascular disease (CVD) events in postmenopausal women using a nationwide Korean cohort. METHODS:This retrospective cohort study used data from the Korean National Health Insurance Service, including 1,168,791 postmenopausal women (aged ≥40 y) without prior myocardial infarction or stroke, followed from 2009 to 2022 (mean follow-up, 11.5 y). PM was self-reported; hypertension was defined as blood pressure ≥140/90 mmHg or antihypertensive medication use. The primary endpoint was incident myocardial infarction, stroke, or CVD mortality, identified using ICD-10 codes. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) with 95% CIs. RESULTS:The prevalence of PM was 1.7%, whereas that of hypertension was 43.2%. During follow-up, 117,499 CVD events occurred (9.1 per 1,000 person-years). Compared with women with neither risk factor (6.0 per 1,000 person-years), adjusted HRs were 1.42 (95% CI: 1.40-1.44) for hypertension alone, 1.18 (95% CI: 1.12-1.24) for PM alone, and 1.64 (95% CI: 1.56-1.71; 18.4 per 1,000 person-years) for both. Risks were consistent for myocardial infarction (HR: 1.54), stroke (HR: 1.64), and CVD mortality (HR: 1.85), and across all clinical subgroups. CONCLUSIONS:Coexisting PM and hypertension confer a markedly elevated risk of CVD beyond either factor alone. Menopausal age and hypertension should be integrated into CVD risk stratification and primary prevention strategies for postmenopausal women.
OBJECTIVE:We sought to determine if age affects how women with pelvic organ prolapse (POP) perceive associated symptoms. METHODS:A secondary analysis was performed on a previously published cross-sectional study of participants presenting for POP to three urogynecology centers in the United States, the United Kingdom, and Chile. Participants completed a questionnaire regarding the presence and bother of associated symptoms. Statistical analysis was performed using Mantel-Haenszel χ2 tests or Fisher's exact tests. RESULTS:Of 202 participants, 25 were under 50 years, 38 were aged 50-59 years, 71 were aged 60-69 years, and 68 were aged 70 years and above. The majority of participants below 50 and 50-59 years had POP-Q stage 2 prolapse (60% and 53%, respectively), and the majority of participants 60-69 years and 70 years and above had POP-Q stage 3 prolapse (70% and 51%, respectively). The most common symptom was bulge (80.2%). Only three symptoms, stress urinary incontinence, back pain, and pelvic pain, significantly varied in the degree of bother among the three groups, with pelvic pain and back pain almost twice as common in those below 50 years old (64.0% and 64.0%) compared with those 70 years and above (39.7% and 33.8%, P=0.04 and <0.01). CONCLUSIONS:Vaginal bulge is the most common prolapse-associated symptom. POP-associated pelvic floor symptoms are experienced similarly across study participants, regardless of age, with the exception of stress urinary incontinence and pain.
OBJECTIVE:Kidney stone disease (KSD) is a global health burden. Premature menopause (PM) may increase the likelihood of KSD, but the influence of hormone therapy (HT) and genetic predisposition is unclear. We examined the association between PM and KSD in two large cohorts and evaluated potential modification by HT and polygenic risk scores (PRS). METHODS:We conducted cross-sectional analyses in 7,112 women from the National Health and Nutrition Examination Survey and 189,900 women from UK Biobank (UKB), with PM defined as menopause before age 40 years. Logistic regression estimated odds ratios (ORs) for prevalent KSD, and Cox models estimated hazard ratios (HRs) for incident KSD over a mean follow-up of ∼15 years in UKB. Sensitivity analyses and PRS stratification were performed to assess robustness and potential effect modification. Statistical analyses were conducted using R software. RESULTS:In National Health and Nutrition Examination Survey (N = 7,112), KSD prevalence was higher in women with PM compared with women without PM (13.4% vs. 8.4%), with logistic regression showing 50% higher odds (OR: 1.54, 95% CI: 1.11-2.13). In the UKB baseline analysis (N = 189,900), PM was associated with higher odds of KSD (OR: 1.55, 95% CI: 1.32-1.83). In the prospective cohort (N = 188,282), women with PM had a 29%-55% higher hazard of incident KSD (HR: 1.29-1.55). Cumulative hazard curves showed early divergence (P < 0.001). PRS analyses demonstrated increasing hazards of KSD with higher genetic predisposition (HR: 1.22-1.80). HT use partially attenuated, but did not eliminate, the elevated association. CONCLUSION:PM was consistently associated with KSD across two large cohorts. This association remained robust across multiple analytical approaches. Genetic predisposition was associated with higher hazards of KSD, whereas HT did not meaningfully modify these associations. These findings suggest a clinically relevant link that warrants further investigation in prospective and mechanistic studies.
OBJECTIVES:To investigate the associations of individual and cumulative social determinants of health (SDoH) with reproductive lifespan among US women using nationally representative National Health and Nutrition Examination Survey (NHANES) data. METHODS:This cross-sectional study used data from the NHANES 1999-2018. A total of 8,576 women aged ≥45 years were included. Reproductive lifespan was defined as the interval between age at menarche and menopause. SDoH indicators included socioeconomic status, education, marital status, employment, food security, health care access, insurance, and housing. Weighted linear regression models were used to examine associations between individual SDoH indicators and reproductive lifespan. Weighted quantile sum regression was applied to assess the joint effects of multiple SDoH factors. RESULTS:In weighted linear regression analyses, lower education level, lower poverty income ratio (PIR), and renting a home were significantly associated with a shorter reproductive lifespan. Weighted quantile sum analysis further showed that higher cumulative social disadvantage was significantly associated with a shorter reproductive lifespan (β=-3.06, 95% CI: -3.92 to -2.19, P<0.001). Food security contributed the highest weight to the mixture (0.34), followed by housing status (0.25), education level (0.17), and PIR (0.16). Sensitivity analyses supported the main findings. CONCLUSIONS:Higher cumulative social disadvantage was associated with a shorter reproductive lifespan among women. Food security, housing status, education level, and PIR were important contributors within the SDoH mixture, highlighting the potential relevance of SDoH in reproductive aging.
OBJECTIVES:To examine the association between body mass index (BMI), Body Roundness Index (BRI), and A Body Shape Index (ABSI), with handgrip strength (HGS) and dynapenia in postmenopausal women. METHODS:This is a cross-sectional study involving 259 postmenopausal women. Age, age at menopause, alcohol consumption, height, weight, waist circumference, and smoking status were recorded. BMI, BRI, and ABSI were separately calculated. Serum creatinine, glucose, glycated hemoglobin, and uric acid were evaluated. HGS was measured using a digital dynamometer, and physical activity was assessed by the International Physical Activity Questionnaire. Student t test, χ2 test, Pearson correlation coefficient, and multivariable linear and logistic regression models were performed for data analysis. RESULTS:HGS was not correlated with BMI (r=-0.004, P=0.930), BRI (r=-0.080, P=0.190), and ABSI (r=-0.019, P=0.750). The multivariable linear regression models showed that HGS was not significantly associated with BMI (β= 0.01; 95% CI, -0.11 to 0.12), BRI (β= -0.04; 95% CI, -0.34 to 0.25), and ABSI (β= 43; 95% CI, -38 to 124). The multivariable logistic regression models displayed no significant association between dynapenia with BMI (OR= 1.00; 95% CI, 0.92-1.09), BRI (OR= 1.06; 95% CI, 0.84-1.34), and ABSI (OR= 0.80; 95% CI, 0.55-1.14). CONCLUSIONS:There were no associations between BMI, BRI, and ABSI with HGS. Furthermore, in postmenopausal women, dynapenia was also not associated with these anthropometric indices of obesity.
OBJECTIVE:To examine whether the combined assessment of low handgrip strength (HGS) and low adductor pollicis muscle thickness (APMT) represents a simple and integrated risk stratification approach for identifying adult women at increased likelihood of low muscle mass and low bone mass. METHODS:In this cross-sectional study, 296 adult women aged 24-59 years were evaluated. HGS and APMT were measured using a manual dynamometer and anthropometric calipers, respectively. Muscle mass, bone mineral density, and femoral geometry were assessed through dual-energy x-ray absorptiometry. Low muscle mass and low bone mass were defined using established criteria. Low HGS and low APMT were categorized using data-derived cutoffs obtained through receiver operating characteristic curve analysis. Associations were examined using adjusted linear and logistic regression models. RESULTS:Both HGS and APMT were independently associated with muscle mass (P < 0.001) and femoral bone outcomes (P = 0.001 and P = 0.005, respectively). When categorized, the combination of low HGS and low APMT showed stronger associations with reduced muscle mass and low bone mass (OR: 7.52, 95% CI: 2.88-19.63; P < 0.001), including the femoral neck (OR: 7.20, 95% CI: 2.34-22.16; P < 0.001), lumbar spine (OR: 3.28, 95% CI: 1.02-10.56; P = 0.047), and at least one site (OR: 4.47, 95% CI: 1.62-12.36; P = 0.004). CONCLUSION:The combined assessment of HGS and APMT captures complementary dimensions of musculoskeletal health and may serve as a practical approach for preliminary risk stratification, particularly in resource-limited settings where access to standard diagnostic methods, such as dual-energy x-ray absorptiometry, remains limited.
OBJECTIVE:To examine whether clinicians' awareness of a recent US Food and Drug Administration (FDA) regulatory communication on menopausal hormone therapy (MHT) was associated with reported changes in clinical practice, counseling priorities, and treatment choices in standardized clinical vignettes. METHODS:This cross-sectional, web-based survey included 600 practicing obstetricians and gynecologists providing menopause or perimenopause care. A composite Regulatory Awareness Score was created from survey items addressing recognition of the regulatory action, perceived relevance, understanding of its rationale, and appraisal of its correctness and timeliness. The primary outcome was self-reported change in routine clinical approach after the regulatory communication. Multivariable logistic regression was used to examine the association between awareness and reported practice change. Ranked counseling factors were compared across awareness tertiles, and vignette choices were examined using multinomial logistic regression. RESULTS:Regulatory awareness was not independently associated with reporting a change in clinical practice (adjusted odds ratio [aOR]: 0.89; 95% CI: 0.69-1.14; P=0.345). Higher odds of reported change were associated with use of a standard hormone therapy protocol (aOR: 1.50; 95% CI: 1.05-2.14; P=0.024), more favorable perceptions of compounded bioidentical hormone therapy (BHT) (aOR: 1.85; 95% CI: 1.35-2.54; P<0.001), stronger prioritization of patient preference (aOR: 1.21; 95% CI: 1.06-1.38; P=0.004), and higher menopause patient volume (aOR: 1.01; 95% CI: 1.00-1.01; P=0.042). Across awareness tertiles, counseling priorities were broadly similar, with only modest differences for symptom severity. In vignette analyses, higher awareness was associated with lower relative selection of compounded BHT in a context-dependent manner. CONCLUSION:Regulatory awareness alone did not explain self-reported change in menopausal hormone therapy practice after adjustment for clinician characteristics, protocol use, BHT perceptions, and counseling priorities. BHT perceptions, use of a standard protocol, and patient-preference prioritization showed stronger associations with reported change, whereas awareness was more clearly reflected in vignette-based treatment choices than in global self-reported practice change.
