Resolution of the VII International Forum of Experts on Menopausal Hormone Therapy
Abstract
The VII International Forum of Experts on Menopausal Hormone Therapy (MHT) was held in Kyiv on November 18, 2025. The modern approach to the MHT prescription is not to resolve the issue of its appropriateness, but to choose the optimal form for a particular woman. Different routes of hormone administration have different pharmacokinetic properties and effects on metabolism, the coagulation system, and women’s somatic health. The recommendations of the European Menopause and Andropause Society emphasize the appropriateness of using combined MHT to improve the glycemic profile and delay the development of diabetes mellitus, with a preference for metabolically neutral progestogens – progesterone and dydrogesterone.Transdermal estrogens enter the systemic circulation directly, minimizing the effect on the liver and coagulation, which makes them the method of choice for women with an increased risk of venous thrombosis, obesity, or hypertriglyceridemia. At the same time, the effectiveness of transdermal MHT is characterized by significant interindividual variability.MHT is an effective antiresorptive method for the prevention of osteoporosis and fractures. Clinical studies demonstrate a significant increase in bone mineral density and a reduction in the risk of fractures with the use of MHT, particularly the combination of estradiol and dydrogesterone. Timely initiated MHT (within the first 10 years after menopause) is also associated with a decrease in all-cause mortality, cardiovascular complications, and neurodegenerative diseases. The individual choice of the form of MHT is a key factor in its safety and clinical efficacy.Particular attention should be paid to oncological safety, particularly the risk of breast cancer, when selecting MHT in patients using a levonorgestrel-releasing intrauterine system. Data from systematic reviews and meta-analyses indicate that the use of estrogens does not increase this risk, while it largely depends on the type of progestogen. Progesterone and dydrogesterone have the most favorable safety profile for the breast compared with synthetic gestagens, which is confirmed by the results of large-scale studies.Psychoemotional and sexual disorders (anxiety, depression, sleep disorders, and decreased libido) are common in perimenopause and are largely due to systemic estrogen deficiency, which affects neurometabolic, vascular, and neuroendocrine homeostasis. The high frequency of these disorders justifies the need for comprehensive diagnostic assessment and individualized MHT in perimenopausal women.