Knowledge, Attitudes, and Practices Towards Hormone Replacement Therapy Among Women with Perimenopausal Syndrome: A Cross-Sectional Analysis in Quzhou, Zhejiang Province, China

Abstract

Background: Hormone replacement therapy (HRT) plays a critical role in managing perimenopausal syndrome, yet patients' knowledge, attitudes, and practices (KAP) toward HRT remain insufficiently understood. This study aimed to assess KAP toward HRT among patients with perimenopausal syndrome.

Patients and methods: This cross-sectional study conducted in Quzhou, Zhejiang Province, China, in February 2024 used a validated self-designed questionnaire to assess demographic characteristics and knowledge, attitudes, and practices (KAP) toward hormone replacement therapy (HRT). Structural equation modeling (SEM) was applied to examine the pathways among KAP dimensions.

Results: Among the 520 participants analyzed, 73.3% resided in urban areas, and 37.9% had used HRT for less than one year. The knowledge, attitude, and practice scores were 18.01±6.05 (possible range: 0-26), 37.56±5.07 (possible range: 10-50), and 6.07±1.70 (possible range: 0-8), respectively. There were significant positive correlations among knowledge, attitudes, and practices (all P < 0.001). SEM results showed that knowledge directly influenced attitudes (β = 0.499, P < 0.001) and practices (β = 0.125, P = 0.007), and that attitudes also directly influenced practices (β = 0.175, P = 0.005).

Conclusion: Patients exhibited moderate knowledge and relatively positive practices, though their attitudes toward HRT were suboptimal. The findings highlight the interrelationships among knowledge, attitudes, and practices regarding HRT, suggesting that educational efforts may play a key role in improving patient understanding and engagement.

Keywords: attitude; cross-sectional study; health knowledge; hormone replacement therapy; patient education; perimenopause; practice.

Figure 1

Comparison of KAP scores between patients using hormone replacement therapy (HRT) for ≤3 years and >3 years. This figure presents the mean scores (± standard deviation) of knowledge, attitude, and practice among participants stratified by duration of HRT use. Patients using HRT for more than 3 years demonstrated slightly higher scores across all dimensions, particularly in attitude and practice.

Figure 2

The three items with the lowest scores in each dimension. K11: “Do you understand that HRT may potentially lead to side effects such as uterine bleeding, breast tenderness, and blood clots?”. K12: “Do you understand that HRT may lead to weight gain?”. K10: “Do you understand that HRT may help prevent endometrial hyperplasia or carcinoma?”. A6: “The potential risks of HRT make me feel concerned.”. A7: “I am concerned that HRT may have addictive properties.”. A9: “I believe HRT is safer than non-hormonal drug treatments.”. P1: “Do you sometimes forget to take your medication?”. P4: “When you go on a trip or are away from home for an extended period, do you sometimes forget to carry your medication with you?”. P2: “In the past two weeks, have you forgotten to take your medication for one or more days?”.

Figure 3

The structural equation modelling. This model shows the direct and mediated pathways among the three latent variables. Knowledge has a direct effect on both attitude and practice, while attitude mediates the association between knowledge and practice. Standardized path coefficients are presented.