Menopause is a physiological transition that may lead to distressing climacteric symptoms, including vasomotor hot flashes, vaginal dryness, and urinary incontinence. Despite several therapeutic options, menopausal hormone therapy (MHT) remains controversial after the 2002 Women’s Health Initiative study, and heterogeneous guidelines complicate prescribing decisions for general practitioners (GPs).This study aimed to characterize GPs’ therapeutic approaches to climacteric symptoms.A cross-sectional observational study was conducted using a self-administered questionnaire distributed between April and July 2024 to licensed GPs in XXX, excluding those working exclusively in hospitals. Data analysis included Chi-square tests and Mann–Whitney tests for age and years of practice.Among 379 respondents, 282 questionnaires were eligible; 70 were excluded due to missing data and 27 due to contradictory responses. MHT had been initiated by 69% of GPs and renewed by 90%, mainly for disabling vasomotor symptoms (74%) and severe vaginal dryness (54%). First-line management of vasomotor symptoms included phytotherapy or homeopathy (70%) and lifestyle modifications (50%). Severe vaginal dryness was treated primarily with non-hormonal (62%) and local hormonal therapies (53%), while urinary incontinence was managed mainly with pelvic floor rehabilitation (82%) and specialist referral (32%). Specialist referral was the most common second-line option across all symptom categories. Age, years of practice, university supervising role, and gynecology training were significantly associated with MHT initiation, while only sex and supervising status were linked to renewal. Main barriers to prescribing MHT were insufficient training, perceived unfavorable risk–benefit balance, and the belief that management should be under gynecologists’ care.Potential selection and self-reporting biases and limited sample representativeness are acknowledged. Strengths included a large sample, carefully designed questionnaire, and mixed online and in-person distribution, supporting the reliability of the findings. Other studies also show interest of some GPs in homeo‑phytotherapy, despite its lack of superiority over placebo.GPs in XXX reported prescribing MHT mainly for distressing climacteric symptoms, particularly for treatment renewal. Non-hormonal approaches and specialist referral remained widely favored, resulting in practices not always aligned with current guidelines. Further research is needed to understand determinants of GPs’ reluctance to prescribe MHT. Keywords: Menopause; Climacteric; Estrogen Replacement Therapy; General Practitioners; Primary Health Care