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, Massachusetts, U.S. (n=59), and Rabat, Morocco (n=50) from 2002 to 2004. Physician characteristics, hormone therapy (HT) prescribing practices, and concerns about the management of menopause were compared across countries using chi-square and logistic regression analyses.Results-After controlling for physician specialty and sex, physicians in Madrid (OR 3.228) and Massachusetts (OR 7.641) were more likely to write >5 prescriptions for HT per month compared with physicians in Beirut. Physicians in Massachusetts (OR 3.961) were most likely to recommended HT for 10 years or more. Physicians in Madrid were significantly less likely to talk with patients about menopause for ≥ 15 minutes (OR 0.160), and were less likely to say that the benefit of HT was "very high" for symptom alleviation (OR 0.253) or osteoporosis prevention (OR 0.146). Physicians in Beirut were most likely to obtain a mammogram and an endometrial biopsy prior to treating symptoms. Physicians in Massachusetts (OR 0.298) and Rabat (OR 0.399) were significantly less apt to describe their concern about breast cancer as "serious."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 4 countries were generally well informed.