Resolution of the III International menopause expert forum




resolution, Ukrainian Association of Gynaecology-Endocrinology, International Menopause Expert Forum, menopause hormone therapy, breast cancer, venous thromboembolism, arterial hypertension, uterine fibroids, treatment adherence


The III International Menopause Expert Forum took place on November 24, 2021. The working group of the expert council included leading experts in endocrine gynaecology from Belarus, Armenia, Georgia, Kazakhstan, Kyrgyzstan, Uzbekistan, and Ukraine.
To date, menopause hormone therapy (MHT) initiated during the “therapeutic window of opportunity” has proved to have a protective effect against various age-associated diseases. Despite this, the percentage of women using MHT remains low and, for example, in Ukraine and Kazakhstan, equals nearly 2%. However, only one in four of these women have been using MHT for more than a year.
The main reasons for such low percentage of women using MHT are as follows:
1. Low patient adherence to MHT (due to misunderstanding of the menopause factors, menopause symptoms, treatments, hormonophobia, poor communication with healthcare professionals etc.).
2. Healthcare professional’s vigilance due to the possible risks associated with MHT (breast cancer, venous thromboembolism, cardiovascular diseases etc.).
3. Healthcare professionals face difficulties during the MHT prescription or subsequent patient management (unplanned haemorrhages, concomitant pathologies in a woman, i.e. fibroids, varicose veins, arterial hypertension etc.).
Aiming to improve medical care for menopausal women, experts attending the Forum focused on the latest data on the risks of breast cancer and venous thromboembolism, MHT effect on the risk of coronary heart disease and arterial hypertension, the potential of prescribing MHT to patients with uterine myoma and on increasing treatment adherence.


  1. World Health Organization. GHE: Life expectancy and healthy life expectancy. Available from: [], last accessed 07.06.2022.
  2. United Nations. Life expectancy at birth for both sexes combined (years). Available from: [ v&f=variableID%3A68], last accessed 07.06.2022.
  3. Makara-Studzińśka, M.T., Kryś-Noszczyk, K.M., Jakiel, G. “Epidemiology of the symptoms of menopause – an intercontinental review.” Prz Menopauzalny 13.3 (2014): 203–11. DOI: 10.5114/pm.2014.43827
  4. Sarrel, P., Portman, D., Lefebvre, P., et al. “Incremental direct and indirect costs of untreated vasomotor symptoms.” Menopause 22.3 (2014): 260–6.
  5. Genazzani, A.R., Monteleone, P., Giannini, A., Simoncini, T. “Hormone therapy in the postmenopausal years: considering benefits and risks in clinical practice.” Hum Reprod Update 27.6 (2021): 1115–50. DOI: 10.1093/humupd/dmab026
  6. Turner, R.J., Kerber, I.J. “Eu-estrogenemia, WHI, timing and the “Geripause”.” Int Urogynecol J Pelvic Floor Dysfunct 19 (2008): 1461–3.
  7. Nappi, R.E., Simoncini, T. “Menopause transition: a golden age to prevent cardiovascular disease.” Lancet Diabetes Endocrinol 9.3 (2021): 135–7. DOI: 10.1016/S2213-8587(21)00018-8
  8. Morion Data, Rx test, Q4 2019 – Q3 2020, ATC G3F, G3C.
  9. Baber, R.J., et al. “2016 IMS Recommendations on women’s midlife health and menopause hormone therapy.” Climacteric 19 (2016): 109–50.
  10. North American Menopause Society. “The 2017 hormone therapy position statement of The North American Menopause Society.” Menopause 24 (2017): 728–53.
  11. Slopien, R., et al. “Menopause and diabetes: EMAS clinical guide.” Maturitas 117 (2018): 6–10.
  12. Lumsden, M.A. “The NICE Guideline – Menopause: diagnosis and management.” Climacteric 19.5 (2016): 426–9. DOI: 10.1080/13697137.2016.1222483
  13. Hamoda, H., et al. “The British Menopause Society & Women’s Health Concern 2020 recommendations on hormone replacement therapy in menopausal women.” Post Reprod Health 26.4 (2020): 181–209. DOI: 10.1177/2053369120957514
  14. Maas, A.H.E.M., Rosano, G., Cifkova, R., et al. “Cardiovascular health after menopause transition, pregnancy disorders, and other gynaecologic conditions: a consensus document from European cardiologists, gynaecologists, and endocrinologists.” Eur Heart J 42.10 (2021): 967–84. DOI: 10.1093/eurheartj/ehaa1044
  15. Mathelin, C., Molière, S. “La consultation de suivi du THM. Conduite à tenir en cas de tumeur mammaire (clinique ou radiologique) et de microcalcifications. RPC Les femmes ménopausées du CNGOF et du GEMVi.” Gynécologie Obstétrique Fertilité & Sénologie 49.5 (2021): 485–92. DOI: 10.1016/j.gofs.2021.03.026
  16. Shen, M., Duan, H., Chang, Y., Wang, S. “Growth of surgically confirmed leiomyomas in postmenopausal women: analysis of the influencing factors.” Menopause 28.11 (2021): 1209–13. DOI: 10.1097/GME.0000000000001846
  17. Muka, T., Oliver-Williams, C., Colpani, V., et al. “Association of Vasomotor and Other Menopausal Symptoms with Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis.” PLoS One 11.6 (2016): e0157417. DOI: 10.1371/journal.pone.0157417
  18. Anagnostis, P., Lambrinoudaki, I., Stevenson, J.C., Goulis, D.G. “Menopause-associated risk of cardiovascular disease.” Endocr Connect 11.4 (2022): e210537. DOI: 10.1530/EC-21-0537
  19. Moro, E., Degli Esposti, E., Borghese, G., et al. “The Impact of Hormonal Replacement Treatment in Postmenopausal Women with Uterine Fibroids: A State-of-the-Art Review of the Literature.” Medicina (Kaunas) 55.9 (2019): 549. DOI: 10.3390/medicina55090549
  20. Vinogradova, Y., Coupland, C., Hippisley-Cox, J. “Use of hormone replacement therapy and risk of breast cancer: nested case-control studies using the QResearch and CPRD databases.” BMJ 371 (2020): m3873. DOI: 10.1136/bmj.m3873
  21. Vinogradova, Y. “Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases.” BMJ 364 (2019): k4810. DOI: 10.1136/bmj.k4810
  22. Piróg, M., et al. “Differential effect of the ultra-low dose and standard estrogen plus dydrogesterone therapy on thrombin generation and fibrinolysis in postmenopausal women.” Acta Obstet Gynecol Scand 96.12 (2017): 1438–45. DOI: 10.1111/aogs.13239
  23. Blondon, M., Timmons, A.K., Baraff, A.J., et al. “Comparative venous thromboembolic safety of oral and transdermal postmenopausal hormone therapies among women Veterans.” Menopause 28.10 (2021): 1125–9. DOI: 10.1097/GME.0000000000001823
  24. Timmis, A., Townsend, N., Gale, C.P., et al. “European Society of Cardiology: Cardiovascular Disease Statistics 2019.” Eur Heart J 41.1 (2020): 12–85. DOI: 10.1093/eurheartj/ehz859
  25. Maffei, S., Guiducci, L., Cugusi, L., et al. “Women-specific predictors of cardiovascular disease risk – new paradigms.” Int J Cardiol 286 (2019): 190–7. DOI: 10.1016/j.ijcard.2019.02.005
  26. Visseren, F.L.J., Mach, F., Smulders, Y.M., et al. “2021 ESC Guidelines on cardiovascular disease prevention in clinical practice.” Eur Heart J 42.34 (2021): 3227–337.
  27. World Health Organization. Risk factors for noncommunicable diseases in Ukraine in 2019. Summary of results from the WHO STEPS survey and comparison with selected countries. Available from: [], last accessed 07.06.2022.
  28. О+K Research. Study of the appointment and use of menopausal hormone therapy (February 2020).
  29. Williams, B., Mancia, G., Spiering, W., et al. “2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension” J Hypertens 36.10 (2018): 1953–2041. DOI: 10.1097/HJH.0000000000001940
  30. Madika, A.L., MacDonald, C.J., Fournier, A., et al. “Menopausal hormone therapy and risk of incident hypertension: role of the route of estrogen administration and progestogens in the E3N cohort.” Menopause 28.11 (2021): 1204–8. DOI: 10.1097/GME.0000000000001839
  31. Srinivasan, V., Martens, M.G. “Hormone therapy in menopausal women with fibroids: is it safe?” Menopause 25.8 (2018): 930–6. DOI: 10.1097/GME.0000000000001105
  32. Brennan, A., Rees, M. “Menopausal hormone therapy in women with benign gynaecological conditions and cancer.” Best Pract Res Clin Endocrinol Metab 35.6 (2021): 101575. DOI: 10.1016/j.beem.2021.101575
  33. International Menopause Society. Menopausal hormone therapy and risk of breast cancer: long debating, yet no confirmed conclusion. Available from: [], last accessed 07.06.2022.
  34. Rozenberg, S., Di Pietrantonio, V., Vandromme, J., Gilles, C. “Menopausal hormone therapy and breast cancer risk.” Best Pract Res Clin Endocrinol Metab 35.6 (2021): 101577. DOI: 10.1016/j.beem.2021.101577
  35. Royston, P. “Multiple imputation of missing values.” Stata J 4 (2004): 227–41.
  36. Jimmy, B., Jimmy, J. “Patient medication adherence: Measures in daily practice.” Oman Med J 26.3 (2011): 155–9. DOI: 10.5001/omj.2011.38
  37. Constantine, G.D., et al. “Behaviours and attitudes influencing treatment decisions for menopausal symptoms in five European countries.” Post Reprod Health 22.3 (2016): 112–22.
  38. British Medical Association. Challenging the culture on menopause for working doctors. Available from: [], last accessed August 19, 2020.



How to Cite

-, .-. (2022). Resolution of the III International menopause expert forum. REPRODUCTIVE ENDOCRINOLOGY, (65), 80–88.



Management of menopause