title: The medical management of menopause: a four-country comparison care in urban areas.
abstract: OBJECTIVE
  To compare the medical management of menopause across urban areas in four countries which differ by level of income and degree of medicalization.
  
  
  METHODS
  Surveys of health providers who advise women on the menopausal transition were carried out in Beirut, Lebanon (n=100), Madrid, Spain (n=60), Worcester, MA, U.S. (n=59), and Rabat, Morocco (n=50) between 2002 and 2004. Physician characteristics, hormone therapy (HT) prescribing practices, and concerns about the management of menopause were compared across countries using chi(2) and logistic regression analyses.
  
  
  RESULTS
  Across sites, physicians were generally well informed about HT and thought that symptom alleviation and disease prevention were equally important. They had concerns about risks associated with HT, particularly breast cancer, and in 3 sites where the survey was conducted after the WHI (Beirut, Rabat, and Madrid) physicians changed their practices to prescribe HT less frequently, for shorter durations, or shifted to other medications. There were significant differences across sites in the recommended duration of HT, time spent talking with patients, perceived benefits of HT, tests recommended before prescribing HT, and concern about the risks associated with HT. Physicians in Madrid and Massachusetts were more likely to report that decisions about the management of menopause were difficult, but in all sites the main reason for difficulties was concerns about risks. The results also suggest discrepancies between physicians' perceptions and women's reports about the reasons why women consult at menopause.
  
  
  CONCLUSIONS
  Prescription patterns and perceived benefits of HT appear to reflect local medical culture rather than simply physician characteristics. The impact of the WHI study was seen in prescribing patterns and concerns about HT. Physicians in all four countries were generally well informed. Financial support: NIH 5 900 000196.
authors.affiliation: Department of Anthropology, UMass Amherst, 240 Hicks Way, Amherst, MA 01003-9278, USA. leidy@anthro.umass.edu
authors.forename: Lynnette Leidy
authors.initials: LL
authors.lastname: Sievert
authors.forename: Matilda
authors.initials: M
authors.lastname: Saliba
authors.forename: David
authors.initials: D
authors.lastname: Reher
authors.forename: Amina
authors.initials: A
authors.lastname: Sahel
authors.forename: Doris
authors.initials: D
authors.lastname: Hoyer
authors.forename: Mary
authors.initials: M
authors.lastname: Deeb
authors.forename: Carla Makhlouf
authors.initials: CM
authors.lastname: Obermeyer
mesh_terms: D001706:Biopsy / Q000706:statistics & numerical data; D015519:Bone Density; D003657:Decision Making; D004717:Endometrium / Q000473:pathology; D005260:Female; D019538:Health Care Surveys; D020249:Hormone Replacement Therapy / Q000009:adverse effects / Q000706:statistics & numerical data*; D006801:Humans; D007861:Lebanon; D008327:Mammography / Q000706:statistics & numerical data; D008404:Massachusetts; D008511:Medicine; D008593:Menopause; D008875:Middle Aged; D009018:Morocco; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013030:Spain; D013038:Specialization; D019037:Urban Health Services; D014505:Urban Population