The use of menopausal hormone therapy in women at high cardiovascular risk

Abstract

The review article presents the stages of the use of menopausal hormone therapy (MHT) from the standpoint of primary and secondary prevention of the risk of developing coronary heart disease (CHD) and deaths. Based on the data obtained, a number of guidelines and statement documents have been updated to reflect the need to comply with the “time hypothesis” in the appointment of MHT in order to improve the prognosis. The arguments of the possible use of MHT are shown both in the primary prevention of cardiovascular diseases in women with cardiovascular risk factors, and in patients with a history of coronary artery disease, myocardial infarctions, with the development of chronic heart failure and atrial fibrillation. In 2021, a proposal was put forward to determine the choice of MHT depending on the cardiovascular risk groups (CVR). However, such an approach to the choice of MHT excludes the personification and individualization of the possibility of using this method of treatment in the presence of certain factors of low, intermediate CVR, such as arterial hypertension, hypercholesterolemia, type 2 diabetes mellitus and others, especially with their good control. Therefore, the adoption of clinical decisions on the use of MHT in conditions of high CVR and the presence of individual clinically significant risk factors should be carried out by a multidisciplinary team, which will exclude both unmotivated prohibitions and appointments in the presence of contraindications.