Resolution of the I International forum of experts in menopause

On November 8–9, 2019 in Tbilisi (Georgia) the I International Forum of Menopause Experts initiated by the Association of Gynecologists-Endocrinologists of Ukraine was held. Expert working group included leading specialists in the field of obstetrics and gynecology in Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Uzbekistan and Ukraine. Experts presented data of their countries on the status of menopause management, experience in solving problems of this period of life. During medical counseling women should pay special attention to the timely start of therapy, explaining the benefits and risks of menopausal hormone therapy (MHT), identifying age-dependent risks and ways to overcome them. MHT is the most effective and pathogenetically substantiated method for the correction of menopausal disorders today. The goal of MHT is to partially compensate for the deficiency of sex hormones using minimally optimal doses that can improve the general condition of women and ensure the prevention of late metabolic disorders and osteoporosis. Individualization of MHT depends on the patient's age and menopausal status. For each stage of woman's reproductive aging according to the STRAW+10 a balanced decision is required on the choice of the regimen and dosage of the combined MHT with therapeutically effective low-dosage forms. It is recommended to start MHT mainly in perimenopause or in early postmenopause, but with menopause duration no more than 10 years. It is necessary to evaluate the thickness of the endometrium using transvaginal sonography before therapy. In perimenopause it is preferable to start MHT in a combined cyclic regimen with a lower dose of estrogen. In postmenopausal women it is preferable to start with a lower dose of estrogen and use a continuous combined dosage regimen of estrogen and gestagen. It is proposed a continuous assessment of the fractures risks to effectively prevent the osteoporosis in women in the postmenopausal period. An annual basic examination is necessary throughout the entire period of MHT use: measurement of weight, waist circumference and blood pressure level, gynecological examination, cytological examination of a cervical smear according to Papanicolaou, ultrasound of the pelvic organs with determination of the endometrium thickness and structure, mammography.