Resolution of The II International Menopause Expert Forum

The II International Menopause Expert Forum was held on November 20, 2020. The working group included leading specialists in gynecological endocrinology from Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Uzbekistan and Ukraine. The experts addressed issues related to the early onset of menopausal hormone treatment (MHT), the safety profile of MHT on the breast, and developed algorithms for managing unscheduled bleeding in women taking MHT.Currently, there is also convincing evidence of comprehensive benefits of timely initiation of MHT – during the “window of opportunity” (in women under the age of 60 or earlier than 10 years after the menopause).Personalized approach to the treatment of each patient is a priority when choosing the treatment tactics for menopausal symptoms. The lower dose of estrogen is preferred at the beginning of treatment, cyclic combined regimen is preferred in perimenopause and continuous combined regimen in postmenopause. MHT requires periodic dosage adjustments depending on the stage of reproductive aging, age, treatment efficacy and tolerability. The incidence of bleeding on MHT is up to 77% when cyclic regimen is used and up to 40% with continuous regimen. As a result, up to 50% of women stop MHT, so proper management is critical. The key issues clinicians need to address are to rule-out endometrial cancer and establish the cause of hemorrhage; there can be multiple causes of unscheduled bleeding but they are often benign. The management should be rational and does not require the discontinuation of MHT if there are no endometrial pathology or significant risk factors.Breast cancer risk associated with MHT often becomes the cornerstone when prescribing medication. Hormonal therapy with a gestogenic component makes the greatest contribution to the risk of breast cancer. Studies have shown that progesterone and dydrogesterone in MHT are not associated with an increased risk of breast cancer, but synthetic progestogens are associated. The risk minimization activities include taking history, evaluation of breast status, informing patients and choosing the right MHT components.