Menopausal Hormone Therapy and Vascular Events: What is their Relationship?

Bibliography link: Kuznetsov M.R., Papysheva O.V. Menopausal Hormone Therapy and Vascular Events: What is their Relationship? Doctor.Ru. 2018; 10(154): 51–55. DOI: 10.31550/1727-2378-2018-154-10-51-55
Menopausal Hormone Therapy and Vascular Events: What is their Relationship?
16 November 09:58

Objective of the Review: To present the basic current information about the effects of menopausal hormone therapy (MHT) on arterial and venous vascular events.

Key Points: The article describes possible vascular risks associated with MHT, including the risk of ischemic heart disease, atherosclerosis, and arterial and venous thrombosis. The following aspects of MHT are viewed as important: the time and mode of administration and the choice of preparation, with regard to its composition (estrogen and gestagen components).

Conclusion: When the age of initiation, treatment regimen, and the composition of preparation are chosen correctly, the positive properties of MHT reduce the risk of cardiovascular events. Administering MHT at an earlier age makes it possible to achieve maximum effectiveness and to minimize potential complications. The right approach to choosing MHT preparations with their modes of administration and composition taken into consideration is required. In terms of cardiovascular risks, optimal MHT preparations are oral medications containing analogs of natural sex hormones. The most preferable estrogen is estradiol, and the best gestagen is dydrogesterone, which has proven beneficial in patients with either venous or arterial abnormalities.

M.R. Kuznetsov — N.I. Pirogov Russian National Research Medical University, Russian Ministry of Health, Moscow. N.E. Bauman City Clinical Hospital No.29, Moscow City Department of Health. E-mail:

O.V. Papysheva — N.E. Bauman City Clinical Hospital No.29, Moscow City Department of Health. E-mail:

Menopausal Hormone Therapy and Vascular Events: What is their Relationship?
16 November 09:58
  1. Baber R.J., Panay N., Fenton A.; IMS Writing Group. 2016 IMS Recommendations on women's midlife health and menopause hormone therapy. Climacteric. 2016; 19(2): 109–50. DOI: 10.3109/13697137.2015.1129166
  2. Rosano G.M.C., Vitale C. Window of opportunity for the vascular effect of estrogens: implications for HT. Menopause management. 2009; 18(4): 27–9.
  3. Boardman H.M., Hartley L., Eisinga A., Main C., Roqué i Figuls M., Bonfill Cosp X. et al. Hormonal therapy for the prevention of cardiovascular disease in postmenopausal women. Cochrane Database Syst. Rev. 2015; 10(3): CD002229. DOI: 10.1002/14651858.CD002229.pub4
  4. Сметник В.П., Ильина Л.М., ред. Ведение женщин в пери- и постменопаузе: практические рекомендации. М.—Ярославль: ООО «ИПК «Литера»; 2010. 221 с. [Smetnik V.P., Il'ina L.M., red. Vedenie zhenshchin v peri- i postmenopauze: prakticheskie rekomendatsii. M.—Yaroslavl': OOO “IPK “Litera”; 2010. 221 s. (in Russian)]
  5. Zhao D., Guallar E., Ouyang P., Subramanya V., Vaidya D., Ndumele C.E. et al. Endogenous sex hormones and incident cardiovascular disease in post-menopausal women. J. Am. Coll. Cardiol. 2018; 71(22): 2555–66. DOI: 10.1016/j.jacc.2018.01.083
  6. Rovinski D., Ramos R.B., Fighera T.M., Casanova G.K., Spritzer P.M. Risk of venous thromboembolism events in postmenopausal women using oral versus non-oral hormone therapy: a systematic review and meta-analysis. Thromb. Res. 2018; 168: 83–95. DOI: 10.1016/j.thromres.2018.06.014
  7. Beyer-Westendorf J., Bauersachs R., Hach-Wunderle V., Zotz R.B., Rott H. Sex hormones and venous thromboembolism — from contraception to hormone replacement therapy. Vasa. 2018; July 16: 1–10. DOI: 10.1024/0301-1526/a000726
  8. Менопаузальная гормонотерапия и сохранение здоровья женщин в зрелом возрасте. Клинические рекомендации (протокол лечения). Письмо Министерства здравоохранения Российской Федерации от 2 октября 2015 г. № 15-4/10/2-5804. [Menopauzal'naya gormonoterapiya i sokhranenie zdorov'ya zhenshchin v zrelom vozraste. Klinicheskie rekomendatsii (protokol lecheniya). Pis'mo Ministerstva zdravookhraneniya Rossiiskoi Federatsii ot 2 oktyabrya 2015 g. № 15-4/10/2-5804. (in Russian)]
  9. Tuomikoski P., Lyytinen H., Korhonen P., Hoti F., Vattulainen P., Gissler M. et al. Coronary heart disease mortality and hormone therapy before and after the Women’s Health Initiative. Obstet. Gynecol. 2014; 124(5): 947–53. DOI: 10.1097/AOG.0000000000000461
  10. Salpeter S.R., Cheng J., Thabane L., Buckley N.S., Salpeter E.E. Bayesian meta-analysis of hormone therapy and mortality in younger women. Ann. Intern. Med. 2009; 122(11): 1016–22. DOI: 10.1016/j.amjmed.2009.05.021
  11. Stubbins R.E., Najjar K., Holcomb V.B., Hong J., Núñez N.P. Oestrogen alters adipocyte biology and protects female mice from adipocyte inflammation and insulin resistance. Diabetes Obes. Metab. 2012; 14(1): 58–66. DOI: 10.1111/j.1463-1326.2011.01488.x
  12. Stachowiak G., Pertyński T., Pertyńska-Marczewska M. Metabolic disorders during menopause. Prz. Menopauzalny. 2015; 14(1): 59–64. DOI: 10.5114/pm.2015.50000
  13. Cieraad D., Conradt C., Jesinger D., Bakowski M. Clinical study comparing the effects of sequential hormone replacement therapy with oestradiol/dydrogesterone and conjugated equine oestrogen/norgestrel on lipids and symptoms. Arch. Gynecol. Obstet. 2006; 274(2): 74–80. DOI: 10.1007/s00404-006-0132-4
  14. Bitoska I., Krstevska B., Milenkovic T., Subeska-Stratrova S., Petrovski G., Mishevska S.J. et al. Effects of hormone replacement therapy on insulin resistance in postmenopausal diabetic women. Maced. J. Med. Sci. 2016; 4(1): 83–8. DOI: 10.3889/oamjms.2016.024
  15. Pan A., Lucas M., Sun Q., van Dam R.M., Franco O.H., Manson J.E. et al. Bidirectional association between depression and type 2 diabetes mellitus in women. Arch. Intern. Med. 2010; 170(21): 1884–91. DOI: 10.1001/archinternmed.2010.356
  16. Spencer C.P., Godsland I.F., Cooper A.J. Ross D., Whitehead M.I., Stevenson J.C. Effects of oral and transdermal 17beta-estradiol with cyclic oral norethindrone acetate with insulin sensitivity, secretion and elimination in postmenopausal women. Metabolism. 2000; 49(6): 742–7. DOI: 10.1053/meta.2000.6238
  17. 2018 European Society of Cardiology (ESC) and European Society of Hypertension (ESH) Joint Guidelines for the Management of Arterial Hypertension. First look at the new 2018 European Guidelines for the treatment of high blood pressure. The-ESC/Press-Office/Press-releases/first-look-at-the-new-2018-european-guidelines-for-the-treatment-of-high-blood-p (дата обращения — 15.09.2018).
  18. Lobo R.A., Clarkson Т.В. Different mechanisms for benefit and risk of coronary heart disease and stroke in early postmenopausal women: a hypothetical explanation. Menopause. 2011; 18(2): 237–40.
  19. The NAMS 2017 Hormone Therapy Position Statement Advisory Panel. The 2017 hormone therapy position statement of The North American Menopause Society. Menopause. 2017; 24(7): 728–53. DOI: 10.1097/GME.0000000000000921
  20. Madigan D., Shin J. Drospirenone-containing oral contraceptives and venous thromboembolism: an analysis of the FAERS database. Open Access J. Contracept. 2018; 9: 29–32. DOI: 10.2147/OAJC.S161737
  21. Hänggi W., Lippuner K., Riesen W., Jaeger P., Birkhäuser M.H. Long term influence of different postmenopausal hormone replacement regimens on serum lipids and lipoprotein(a): a randomised study. Br. J. Obstet. Gynaecol. 1997; 104(6): 708–17.
  22. Anagnostis P., Galanis P., Chatzistergiou V., Stevenson J.C., Godsland I.F., Lambrinoudaki I. et al. The effect of hormone replacement therapy and tibolone on lipoprotein (a) concentrations in postmenopausal women: a systematic review and meta-analysis. Maturitas. 2017; 99: 27–36. DOI: 10.1016/j.maturitas.2017.02.009
  23. Slopien R., Wender-Ozegowska E., Rogowicz-Frontczak A., Meczekalski B., Zozulinska-Ziolkiewicz D., Jaremek J.D. et al. Menopause and diabetes: EMAS clinical guide. Maturitas. 2018; 117: 6–10. DOI: 10.1016/j.maturitas.2018.08.009
Similar article
19 May 15:04, Allergology
V.M. Ganuzin, N.L. Chernaya, G.S. Maskova
Features of Specialised Medical Consultation of Adolescents with Bronchial Asthma: Clinical Observation
Doctor.Ru Pediatrics. Vol. 19, No. 3 (2020)
19 May 14:30, Allergology
S.E. Mitskevich, I.A. Fedorov, A.I. Chuprynina, O.G. Rybakova
Use of Omalizumab in Management of Severe Uncontrolled Bronchial Asthma in Children
Doctor.Ru Pediatrics. Vol. 19, No. 3 (2020)