Resolution of the Vi International Forum of Experts on Menopausal Hormone Therapy

On November 27, 2024, the VI International Forum of Experts on Menopausal Hormone Therapy (MHT) was held with the support of the Ukrainian Association of Gynecologists-Endocrinologists. Leading specialists from Azerbaijan, Armenia, Georgia, Kazakhstan, Uzbekistan and Ukraine took part in the event. The experts reviewed the criteria for the MHT acceptance, the features of the appointment of this therapy and its safety profile in menopausal women with endometriosis, in patients with uterine fibroids, discussed new studies on menopause and the MHT.Regarding oncological risks, there are no restrictions on the MHT use in women with ovarian and colon cancer. In women with endometrial, cervical, lung cancer, melanoma, with BRCA1 and BRCA2 gene mutations and negative HR receptors, the benefits of MHT outweigh the risks. In case of venous thromboembolism / pulmonary embolism in the anamnesis, the absence of a progestogen component in the composition of MHT is important. In patients with migraines without aura, both estrogen and combined MHT can be used. Combined MHT with metabolically neutral dydrogesterone can be prescribed for tension headache. There are no contraindications to MHT in metabolic syndrome and diseases of the digestive system. MHT is limited in acute hepatitis and inflammatory bowel diseases, and contraindicated in liver cirrhosis.When MHT interacts with other drugs, the effectiveness of estrogens and progestogens may be impaired. MHT can be used simultaneously with many drugs, with the exception of aromatase inhibitors, selective estrogen receptor modulators, anticonvulsants, antineoplastic drugs and immunosuppressive drugs.A large number of women with endometriosis have symptoms of menopause and need MHT. Such therapy should be individualized taking into account the needs of the patient, it is necessary to take into account the possible recurrence of endometriosis and the risk of malignancy in menopause.MHT can be prescribed for asymptomatic uterine fibroids in the absence of indications for surgical treatment. MHT is safest for «old» nodes of stable size. During the MHT an ultrasound monitoring of the nodes growth is needed and therapy should be discontinued if growth is detected.The analysis of the MHT safety showed that ultra-low doses of estradiol and dydrogesterone have a beneficial effect on vasomotor symptoms and quality of life of postmenopausal women, are well tolerated without an increase in the frequency of side effects compared to placebo.