Russian eligibility criteria for prescription of menopausal hormone therapy to patients with cardiovascular and metabolic diseases. Agreement document of RKO, ROAG, RAE, EAT, AFR, RNMOT, RAGG

Menopausal symptoms can disrupt the lives of women at the peak of their careers and family life. Currently, the most effective treatment for these symptoms is menopausal hormone therapy (MHT). The presence of cardiovascular and metabolic diseases does not preclude the use of MHT to relieve menopausal symptoms and improve quality of life. However, physicians’ concerns about causing more harm than good often hinder the use of this type of hormone therapy. Caution is especially important when it comes to women with comorbidities. Moreover, it should be acknowledged that high-quality studies on the safety of MHT for major chronic noncommunicable diseases and common comorbid conditions are insufficient. This consensus document analyzes all currently available data from clinical trials of various designs and develops a set of eligibility criteria for prescribing MHT to women with comorbid cardiovascular and metabolic diseases. Based on this document, physicians of various specialties who consult with women in menopause will receive an accessible algorithm that will allow them to avoid potentially dangerous situations and appropriately prescribe HRT in clinical practice.

1. 436691Government of the Russian Federation. Order of the Government of the Russian Federation dated 29.12.2022 No. 4356-p “Approval of the National Strategy for Women’s Action for 2023-2030”. Av. at: https://www.consultant.ru/document/cons_doc_LAW_436691

2. Ulumbekova G.E., Khudova I.Yu. Demographic, social and economic effects of menopause hormonal therapy. Healthcare Management. News, Views, Education. Bulletin of VSHOUZ. 2020;6(4(22)):23–53 doi: https://doi.org/10.24411/2411-8621-2020-14002

3. Lambrinoudaki I, Armeni E, Goulis D, Bretz S, Ceausu I, Durmusoglu F et al. Menopause, wellbeing and health: A care pathway from the European Menopause and Andropause Society. Maturitas. 2022;163:1–14. doi: https://doi.org/10.1016/j.maturitas.2022.04.008

4. Ministry of Health of the Russian Federation. Clinical Guidelines. Menopause and female climacteric states. 2021. Av. at: https://cr.minzdrav.gov.ru/preview-cr/117_2

5. Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW et al. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Menopause. 2012;19(4):387–95. doi: https://doi.org/10.1097/gme.0b013e31824d8f40

6. Drewe J, Bucher KA, Zahner C. A systematic review of non-hormonal treatments of vasomotor symptoms in climacteric and cancer patients. SpringerPlus. 2015;4(1):65. doi: https://doi.org/10.1186/s40064-015-0808-y

7. Schnatz PF, Romegialli A, Abrantes J, Marakovits K, Cunningham D, O’Sullivan DM. The North American Menopause Society: from abstract to publication. Menopause. 2008;15(5):996–1001. doi: https://doi.org/10.1097/gme.0b013e318166f026

8. Paramsothy P, Harlow SD, Nan B, Greendale GA, Santoro N, Crawford SL et al. Duration of the menopausal transition is longer in women with young age at onset: the multiethnic Study of Women’s Health Across the Nation. Menopause. 2017;24(2):142–9. doi: https://doi.org/10.1097/GME.0000000000000736

9. Ministry of Health of Russian Federation. Menopausal hormone therapy and maintaining the health of women in adulthood. Clinical Guidelines. 2015. Av. at: https://www.consultant.ru/document/cons_doc_LAW_320073

10. Schoenaker DA, Jackson CA, Rowlands JV, Mishra GD. Socioeconomic position, lifestyle factors and age at natural menopause: a systematic review and meta-analyses of studies across six continents. International Journal of Epidemiology. 2014;43(5):1542–62. doi: https://doi.org/https://doi.org/10.1093/ije/dyu094

11. Freeman EW, Sammel MD, Sanders RJ. Risk of long-term hot flashes after natural menopause: evidence from the Penn Ovarian Aging Study cohort. Menopause. 2014;21(9):924–32. doi: https://doi.org/10.1097/GME.0000000000000196

12. Costanian C, Zangiabadi S, Bahous SA, Deonandan R, Tamim H. Reviewing the evidence on vasomotor symptoms: the role of traditional and non-traditional factors. Climacteric. 2020;23(3):213–23. doi: https://doi.org/10.1080/13697137.2019.1711051

13. Prior JC. Progesterone for Symptomatic Perimenopause Treatment - Progesterone politics, physiology and potential for perimenopause. Facts, Views & Vision in ObGyn. 2011;3(2):109–20. PMID: 24753856

14. Santoro N, Epperson CN, Mathews SB. Menopausal Symptoms and Their Management. Endocrinology and Metabolism Clinics of North America. 2015;44(3):497–515. doi: https://doi.org/10.1016/j.ecl.2015.05.001

15. Mel’nichenko G.A., Belaya J.E., Rozhinskaya L.Ya., Toroptsova N.V., Alekseeva L.I., Biryukova E.V. et al. Russian federal clinical guidelines on the diagnostics, treatment, and prevention of osteoporosis. Problems of Endocrinology. 2017;63(6):392–426 doi: https://doi.org/10.14341/probl2017636392-426

16. Muka T, Oliver-Williams C, Colpani V, Kunutsor S, Chowdhury S, Chowdhury R et al. Association of Vasomotor and Other Menopausal Symptoms with Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis. PLOS ONE. 2016;11(6):e0157417. doi: https://doi.org/10.1371/journal.pone.0157417

17. Baber RJ, Panay N, Fenton A. 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric. 2016;19(2):109–50. doi: https://doi.org/10.3109/13697137.2015.1129166

18. Kaufman MR, Ackerman AL, Amin KA, Coffey M, Danan E, Faubion SS et al. The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause. Journal of Urology. 2025;214(3):242–50. doi: https://doi.org/10.1097/JU.0000000000004589

19. The NAMS 2020 GSM Position Statement Editorial Panel. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020;27(9):976–92. doi: https://doi.org/10.1097/GME.0000000000001609

20. Rueda C, Osorio AM, Avellaneda AC, Pinzón CE, Restrepo OI. The efficacy and safety of estriol to treat vulvovaginal atrophy in postmenopausal women: a systematic literature review. Climacteric. 2017;20(4):321–30. doi: https://doi.org/10.1080/13697137.2017.1329291

21. Hirschberg AL, Bitzer J, Cano A, Ceausu I, Chedraui P, Durmusoglu F et al. Topical estrogens and non-hormonal preparations for postmenopausal vulvovaginal atrophy: An EMAS clinical guide. Maturitas. 2021;148:55–61. doi: 10.1016/j.maturitas.2021.04.005

22. Weidlinger S, Schmutz C, Janka H, Gruetter C, Stute P. Sustainability of vaginal estrogens for genitourinary syndrome of menopause – a systematic review. Climacteric. 2021;24(6):551–9. doi: https://doi.org/10.1080/13697137.2021.1891218

23. Matarazzo MG, Sarpietro G, Fiorito D, Di Pasqua S, Ingrassano S, Panella MM et al. Intravaginal 6.5 mg prasterone administration in postmenopausal women with overactive bladder syndrome: A pilot study. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2021;263:67–71. doi: https://doi.org/10.1016/j.ejogrb.2021.06.009

24. Duarte PR, Maroto Martín MT, Mar Martín Moya MD, Prados PA. Quality of life analysis measured with the Cervantes 16 scale in treated menopausal women with genitourinary syndrome. Journal of Comparative Effectiveness Research. 2022;11(18):1365–74. doi: https://doi.org/10.2217/cer-2022-0086

25. Labrie F. Intracrinology and menopause: the science describing the cell-specific intracellular formation of estrogens and androgens from DHEA and their strictly local action and inactivation in peripheral tissues. Menopause. 2019;26(2):220–4. doi: https://doi.org/10.1097/GME.0000000000001177

26. Labrie F, Archer DF, Koltun W, Vachon A, Young D, Frenette L et al. Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause. Menopause. 2018;25(11):1339–53. doi: https://doi.org/10.1097/GME.0000000000001238

27. Labrie F, Archer DF, Martel C, Vaillancourt M, Montesino M. Combined data of intravaginal prasterone against vulvovaginal atrophy of menopause. Menopause. 2017;24(11):1246–56. doi: https://doi.org/10.1097/GME.0000000000000910

28. Cappola AR, Auchus RJ, El-Hajj Fuleihan G, Handelsman DJ, Kalyani RR, McClung M et al. Hormones and Aging: An Endocrine Society Scientific Statement. The Journal of Clinical Endocrinology & Metabolism. 2023;108(8):1835–74. doi: https://doi.org/10.1210/clinem/dgad225

29. Serov V.N., Baranov I.I., Andreeva E.N., Abashova E.I., Aganezova N.V., Bezhenar V.F. et al. Joint position of Russian experts on the clinical significance of hyperandrogenism in early postmenopausal women. Obstetrics and gynecology. 2025;5:201–6. doi: https://doi.org/10.18565/aig.2025.118

30. Gluvic Z, Zaric B, Resanovic I, Obradovic M, Mitrovic A, Radak D et al. Link between Metabolic Syndrome and Insulin Resistance. Current Vascular Pharmacology. 2016;15(1):30–9. doi: https://doi.org/10.2174/1570161114666161007164510

31. Stefanska A, Bergmann K, Sypniewska G. Metabolic Syndrome and Menopause: pathophysiology, clinical and diagnostic significance. Advances in Clinical Chemistry. 2015;72:1–75. doi: https://doi.org/10.1016/bs.acc.2015.07.001

32. Hirschberg AL. Hyperandrogenism and Cardiometabolic Risk in Preand Postmenopausal Women – What Is the Evidence? The Journal of Clinical Endocrinology & Metabolism. 2024;109(5):1202–13. doi: https://doi.org/10.1210/clinem/dgad590

33. Hirschberg AL. Approach to Investigation of Hyperandrogenism in a Postmenopausal Woman. The Journal of Clinical Endocrinology & Metabolism. 2023;108(5):1243–53. doi: https://doi.org/10.1210/clinem/dgac673

34. Frederiksen H, Johannsen TH, Andersen SE, Petersen JH, Busch AS, Ljubicic ML et al. Sex- and age-specific reference intervals of 16 steroid metabolites quantified simultaneously by LC-MS/MS in sera from 2458 healthy subjects aged 0 to 77 years. Clinica Chimica Acta. 2024;562:119852. doi: https://doi.org/10.1016/j.cca.2024.119852

35. Torréns JI, Sutton-Tyrrell K, Zhao X, Matthews K, Brockwell S, Sowers M et al. Relative androgen excess during the menopausal transition predicts incident metabolic syndrome in midlife women: Study of Women’s Health Across the Nation. Menopause. 2009;16(2):257–64. doi: https://doi.org/10.1097/gme.0b013e318185e249

36. Alemany M. The Roles of Androgens in Humans: Biology, Metabolic Regulation and Health. International Journal of Molecular Sciences. 2022;23(19):11952. doi: https://doi.org/10.3390/ijms231911952

37. Galmés-Pascual BM, Martínez-Cignoni MR, Morán-Costoya A, Bauza-Thorbrügge M, Sbert-Roig M, Valle A et al. 17β-estradiol ameliorates lipotoxicity-induced hepatic mitochondrial oxidative stress and insulin resistance. Free Radical Biology and Medicine. 2020;150:148– 60. doi: https://doi.org/10.1016/j.freeradbiomed.2020.02.016

38. Nestler JE, Jakubowicz DJ, Falcon De Vargas A, Brik C, Quintero N, Medina F. Insulin Stimulates Testosterone Biosynthesis by Human Thecal Cells from Women with Polycystic Ovary Syndrome by Activating Its Own Receptor and Using Inositolglycan Mediators as the Signal Transduction System. The Journal of Clinical Endocrinology & Metabolism. 1998;83(6):2001–5. doi: https://doi.org/10.1210/jcem.83.6.4886

39. Xing C, Zhang J, Zhao H, He B. Effect of Sex Hormone-Binding Globulin on Polycystic Ovary Syndrome: Mechanisms, Manifestations, Genetics, and Treatment. International Journal of Women’s Health. 2022;14:91–105. doi: https://doi.org/10.2147/IJWH.S344542

40. Dicker A, Rydén M, Näslund E, Muehlen IE, Wirén M, Lafontan M et al. Effect of testosterone on lipolysis in human pre-adipocytes from different fat depots. Diabetologia. 2004;47(3):420–8. doi: https://doi.org/10.1007/s00125-003-1324-0

41. Zang H, Rydén M, Wåhlen K, Dahlman-Wright K, Arner P, Hirschberg AL. Effects of testosterone and estrogen treatment on lipolysis signaling pathways in subcutaneous adipose tissue of postmenopausal women. Fertility and Sterility. 2007;88(1):100–6. doi: https://doi.org/10.1016/j.fertnstert.2006.11.088

42. Grundy SM. Metabolic Syndrome: A Multiplex Cardiovascular Risk Factor. The Journal of Clinical Endocrinology & Metabolism. 2007;92(2):399–404. doi: https://doi.org/10.1210/jc.2006-0513

43. Hu G, The DECODE Study Group. Gender difference in all-cause and cardiovascular mortality related to hyperglycaemia and newly-diagnosed diabetes. Diabetologia. 2003;46(5):608–17. doi: https://doi.org/10.1007/s00125-003-1096-6

44. Ministry of Health of Russian Federation. Clinical guidelines. Type 2 diabetes mellitus in adults. 2022. Av. at: https://cr.minzdrav.gov.ru/preview-cr/290_2

45. Zhang L, Bao L, Li Y, Wang C, Dong X, Abdulai T et al. Age at menopause, body mass index, and risk of type 2 diabetes mellitus in postmenopausal Chinese women: The Henan Rural Cohort study. Nutrition, Metabolism and Cardiovascular Diseases. 2020;30(8):1347–54. doi: https://doi.org/10.1016/j.numecd.2020.04.003

46. Opoku AA, Abushama M, Konje JC. Obesity and menopause. Best Practice & Research Clinical Obstetrics & Gynaecology. 2023;88:102348. doi: https://doi.org/10.1016/j.bpobgyn.2023.102348

47. Vishram JKK, Borglykke A, Andreasen AH, Jeppesen J, Ibsen H, Jørgensen T et al. Impact of Age and Gender on the Prevalence and Prognostic Importance of the Metabolic Syndrome and Its Components in Europeans. The MORGAM Prospective Cohort Project. PLoS ONE. 2014;9(9):e107294. doi: https://doi.org/10.1371/journal.pone.0107294

48. Lizcano F, Guzmán G. Estrogen Deficiency and the Origin of Obesity during Menopause. BioMed Research International. 2014;2014:757461. doi: https://doi.org/10.1155/2014/757461

49. Zhu J, Zhou Y, Jin B, Shu J. Role of estrogen in the regulation of central and peripheral energy homeostasis: from a menopausal perspective. Therapeutic Advances in Endocrinology and Metabolism. 2023;14:20420188231199359. doi: https://doi.org/10.1177/20420188231199359

50. Drapkina O.M., Kontsevaya A.V., Kalinina A.M., Avdeev S.N., Agaltsov M.V., Alexandrova L.M. et al. 2022 Prevention of chronic non-communicable diseases in Of the Russian Federation. National guidelines. Cardiovascular Therapy and Prevention. 2022;21(4):5– 232 doi: https://doi.org/10.15829/1728-8800-2022-3235

51. Yureneva S.V. Obesity during the menopausal transition: how to break negative connections and prevent consequences? Obstetrics and Gynecology. 2024;11:56–65 doi: https://doi.org/10.18565/aig.2024.291

52. Chen G-C, Arthur R, Iyengar NM, Kamensky V, Xue X, WassertheilSmoller S et al. Association between regional body fat and cardiovascular disease risk among postmenopausal women with normal body mass index. European Heart Journal. 2019;40(34):2849–55. doi: https://doi.org/10.1093/eurheartj/ehz391

53. Russian: Министерство здравоохранения Российской Федерации. Клинические рекомендации. Ожирение. 2024. Доступно на: https://cr.minzdrav.gov.ru/preview-cr/28_3

54. Ministry of Health of Russian Federation. Clinical guidelines. Arterial hypertension in adults. 2024. Av. at: https://cr.minzdrav.gov.ru/preview-cr/62_3

55. Alberti KGM, Zimmet P, Shaw J. The metabolic syndrome – a new worldwide definition. The Lancet. 2005;366(9491):1059–62. doi: https://doi.org/10.1016/S0140-6736(05)67402-8

56. Wang J, Wu D, Guo H, Li M. Hyperandrogenemia and insulin resistance: The chief culprit of polycystic ovary syndrome. Life Sciences. 2019;236:116940. doi: https://doi.org/10.1016/j.lfs.2019.116940

57. Cushman M. Estrogen Plus Progestin and Risk of Venous Thrombosis. JAMA. 2004;292(13):1573–80. doi: https://doi.org/10.1001/jama.292.13.1573

58. Troshina E.A., Pokusaeva V.N., Andreeva E.N. Obesity in women. edited by Melnichenko G.A., Nikiforovskii N.K. - M.: Medical Information Agency LLC; 2017. - 272p

59. Caprio M, Antelmi A, Chetrite G, Muscat A, Mammi C, Marzolla V et al. Antiadipogenic Effects of the Mineralocorticoid Receptor Antagonist Drospirenone: Potential Implications for the Treatment of Metabolic Syndrome. Endocrinology. 2011;152(1):113–25. doi: https://doi.org/10.1210/en.2010-0674

60. Smetnik A.A., Ivanov I.A., Ermakova E.I., Tabeeva G.I. Characteristics of menopausal hormone therapy use in Russia: results of a largescale survey of peri- and postmenopausal women. Obstetrics and gynecology. 2025;8:196–208 doi: https://doi.org/10.18565/aig.2025.200

61. Sukhikh G.T., Serov V.N., Shlyakhto E.V., Dedov I.I., Arutyunov G.P., Tkacheva O.N. et al. Consensus Menopausal hormone therapy in patients with cardiovascular and metabolic diseases: an interdisciplinary Delphi consensus among Russian gynecologists, cardiologists, endocrinologists, gerontologists and geriatricians, phlebologists, and clinical pharmacologists. Therapeutic Archive. 2026;98(1):6–27 doi: https://doi.org/10.26442/00403660.2026.01.203470

62. Dedov I.I., Shestakova M.V., Vikulova O.K., Zheleznyakova A.V., Isakov M.A. Epidemiological characteristics of diabetes mellitus in the Russian Federation: clinical and statistical analysis according to the Federal diabetes register data of 01.01.2021. Diabetes mellitus. 2021;24(3):204–21 doi: https://doi.org/10.14341/DM12759

63. Salpeter SR, Walsh JME, Ormiston TM, Greyber E, Buckley NS, Salpeter EE. Meta‐analysis: effect of hormone‐replacement therapy on components of the metabolic syndrome in postmenopausal women. Diabetes, Obesity and Metabolism. 2006;8(5):538–54. doi: https://doi.org/10.1111/j.1463-1326.2005.00545.x

64. Schindler AE, Campagnoli C, Druckmann R, Huber J, Pasqualini JR, Schweppe KW et al. Classification and pharmacology of progestins. Maturitas. 2008;61(1–2):171–80. doi: https://doi.org/10.1016/j.maturitas.2008.11.013

65. Mendoza N, Ramírez I, De La Viuda E, Coronado P, Baquedano L, Llaneza P et al. Eligibility criteria for Menopausal Hormone Therapy (MHT): a position statement from a consortium of scientific societies for the use of MHT in women with medical conditions. MHT Eligibility Criteria Group. Maturitas. 2022;166:65–85. doi: https://doi.org/10.1016/j.maturitas.2022.08.008

66. De Filippis A, Ullah H, Baldi A, Dacrema M, Esposito C, Garzarella EU et al. Gastrointestinal Disorders and Metabolic Syndrome: Dysbiosis as a Key Link and Common Bioactive Dietary Components Useful for their Treatment. International Journal of Molecular Sciences. 2020;21(14):4929. doi: https://doi.org/10.3390/ijms21144929

67. Zuvarox T, Goosenberg E, Belletieri C. Malabsorption Syndromes. In: StatPearls-Treasure Island (FL): StatPearls Publishing; 2025. PMID: 31971746

68. Elkafas H, Walls M, Al-Hendy A, Ismail N. Gut and genital tract microbiomes: Dysbiosis and link to gynecological disorders. Frontiers in Cellular and Infection Microbiology. 2022;12:1059825. doi: https://doi.org/10.3389/fcimb.2022.1059825

69. Xie X, Song J, Wu Y, Li M, Guo W, Li S et al. Study on gut microbiota and metabolomics in postmenopausal women. BMC Women’s Health. 2024;24(1):608. doi: https://doi.org/10.1186/s12905-024-03448-7

70. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767–94. doi: https://doi.org/10.1097/GME.0000000000002028

71. Kim J-E, Chang J-H, Jeong M-J, Choi J, Park J, Baek C et al. A systematic review and meta-analysis of effects of menopausal hormone therapy on cardiovascular diseases. Scientific Reports. 2020;10(1):20631. doi: https://doi.org/10.1038/s41598-020-77534-9

72. Boardman HM, Hartley L, Eisinga A, Main C, Roqué I Figuls M, Bonfill Cosp X et al. Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database of Systematic Reviews. 2015;2015(8):CD002229. doi: https://doi.org/10.1002/14651858.CD002229.pub4

73. Vinogradova Y, Coupland C, Hippisley-Cox J. Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ. 2019;364:k4810. doi: https://doi.org/10.1136/bmj.k4810

74. Goldštajn MŠ, Mikuš M, Ferrari FA, Bosco M, Uccella S, Noventa M et al. Effects of transdermal versus oral hormone replacement therapy in postmenopause: a systematic review. Archives of Gynecology and Obstetrics. 2022;307(6):1727–45. doi: https://doi.org/10.1007/s00404-022-06647-5

75. Kapoor E, Kling JM, Lobo AS, Faubion SS. Menopausal hormone therapy in women with medical conditions. Best Practice & Research Clinical Endocrinology & Metabolism. 2021;35(6):101578. doi: https://doi.org/10.1016/j.beem.2021.101578

76. Morris G, Talaulikar V. Hormone replacement therapy in women with history of thrombosis or a thrombophilia. Post Reproductive Health. 2023;29(1):33–41. doi: https://doi.org/10.1177/20533691221148036

77. Dinger J, Bardenheuer K, Heinemann K. Drospirenone plus estradiol and the risk of serious cardiovascular events in postmenopausal women. Climacteric. 2016;19(4):349–56. doi: https://doi.org/10.1080/13697137.2016.1183624

78. Sobel TH, Shen W. Transdermal estrogen therapy in menopausal women at increased risk for thrombotic events: a scoping review. Menopause. 2022;29(4):483–90. doi: https://doi.org/10.1097/GME.0000000000001938

79. Roetker N, MacLehose R, Hoogeveen R, Ballantyne C, Basu S, Cushman M et al. Prospective Study of Endogenous Hormones and Incidence of Venous Thromboembolism: The Atherosclerosis Risk in Communities Study. Thrombosis and Haemostasis. 2018;118(11):1940–50. doi: https://doi.org/10.1055/s-0038-1673613

80. Tepper NK, Whiteman MK, Marchbanks PA, James AH, Curtis KM. Progestin-only contraception and thromboembolism: A systematic review. Contraception. 2016;94(6):678–700. doi: https://doi.org/10.1016/j.contraception.2016.04.014

81. Mantha S, Karp R, Raghavan V, Terrin N, Bauer KA, Zwicker JI. Assessing the risk of venous thromboembolic events in women taking progestin-only contraception: a meta-analysis. BMJ. 2012;345:e4944. doi: https://doi.org/10.1136/bmj.e4944

82. Nudy M, Chinchilli VM, Foy AJ. A systematic review and meta-regression analysis to examine the ‘timing hypothesis’ of hormone replacement therapy on mortality, coronary heart disease, and stroke. IJC Heart & Vasculature. 2019;22:123–31. doi: https://doi.org/10.1016/j.ijcha.2019.01.001

83. Cho L, Kaunitz AM, Faubion SS, Hayes SN, Lau ES, Pristera N et al. Rethinking Menopausal Hormone Therapy: For Whom, What, When, and How Long? Circulation. 2023;147(7):597–610. doi: https://doi.org/10.1161/CIRCULATIONAHA.122.061559

84. LaVasseur C, Neukam S, Kartika T, Samuelson Bannow B, Shatzel J, DeLoughery TG. Hormonal therapies and venous thrombosis: Considerations for prevention and management. Research and Practice in Thrombosis and Haemostasis. 2022;6(6):e12763. doi: https://doi.org/10.1002/rth2.12763

85. Roach REJ, Lijfering WM, Van Hylckama Vlieg A, Helmerhorst FM, Rosendaal FR, Cannegieter SC. The risk of venous thrombosis in individuals with a history of superficial vein thrombosis and acquired venous thrombotic risk factors. Blood. 2013;122(26):4264–9. doi: https://doi.org/10.1182/blood-2013-07-518159

86. Straczek C, Oger E, Yon De Jonage-Canonico MB, Plu-Bureau G, Conard J, Meyer G et al. Prothrombotic Mutations, Hormone Therapy, and Venous Thromboembolism Among Postmenopausal Women: Impact of the Route of Estrogen Administration. Circulation. 2005;112(22):3495–500. doi: https://doi.org/10.1161/CIRCULATIONAHA.105.565556

87. Middeldorp S, Nieuwlaat R, Baumann Kreuziger L, Coppens M, Houghton D, James AH et al. American Society of Hematology 2023 guidelines for management of venous thromboembolism: thrombophilia testing. Blood Advances. 2023;7(22):7101–38. doi: https://doi.org/10.1182/bloodadvances.2023010177

88. Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ. Executive Summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians EvidenceBased Clinical Practice Guidelines. Chest. 2012;141(2):7S-47S. doi: https://doi.org/10.1378/chest.1412S3

89. Hulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B et al. Randomized Trial of Estrogen Plus Progestin for Secondary Prevention of Coronary Heart Disease in Postmenopausal Women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. JAMA. 1998;280(7):605–13. doi: https://doi.org/10.1001/jama.280.7.605

90. Yuk J-S, Kim GS, Kim D-G, Byun YS, Kim M-H, Yoon S-H et al. Association of menopausal hormone therapy with risk of cardiovascular disease in Korean women. European Journal of Endocrinology. 2025;192(2):73–80. doi: https://doi.org/10.1093/ejendo/lvae161

91. Wassertheil-Smoller S, Hendrix S, Limacher M, Heiss G, Kooperberg C, Baird A et al. Effect of Estrogen Plus Progestin on Stroke in Postmenopausal Women: The Women’s Health Initiative: A Randomized Trial. JAMA. 2003;289(20):2673–84. doi: https://doi.org/10.1001/jama.289.20.2673

92. Hendrix SL, Wassertheil-Smoller S, Johnson KC, Howard BV, Kooperberg C, Rossouw JE et al. Effects of Conjugated Equine Estrogen on Stroke in the Women’s Health Initiative. Circulation. 2006;113(20):2425–34. doi: https://doi.org/10.1161/CIRCULATIONAHA.105.594077

93. Te West NID, Day RO, Hiley B, White C, Wright M, Moore KH. Estriol serum levels in new and chronic users of vaginal estriol cream: A prospective observational study. Neurourology and Urodynamics. 2020;39(4):1137–44. doi: https://doi.org/10.1002/nau.24331

94. Santen RJ, Mirkin S, Bernick B, Constantine GD. Systemic estradiol levels with low-dose vaginal estrogens. Menopause. 2020;27(3):361– 70. doi: https://doi.org/10.1097/GME.0000000000001463

95. Bhupathiraju SN, Grodstein F, Stampfer MJ, Willett WC, Crandall CJ, Shifren JL et al. Vaginal estrogen use and chronic disease risk in the Nurses’ Health Study. Menopause. 2019;26(6):603–10. doi: https://doi.org/10.1097/GME.0000000000001284

96. Crandall CJ, Hovey KM, Andrews CA, Chlebowski RT, Stefanick ML, Lane DS et al. Breast cancer, endometrial cancer, and cardiovascular events in participants who used vaginal estrogen in the Women’s Health Initiative Observational Study. Menopause. 2018;25(1):11– 20. doi: https://doi.org/10.1097/GME.0000000000000956

97. Orlova Ya.A., Plisyuk A.G., Dolgushin G.O., Kirillova K.I., Mikheev R.K., Andreeva E.N. Correlation between prolonged menopausal hormonotherapy and indicators of vascular and replicative aging in women. Prevention Medicine. 2023;26(7):96–102 doi: https://doi.org/10.17116/profmed20232607196

98. Draper MW, Flowers DE, Huster WJ, Neild JA, Harper KD, Arnaud C. A controlled trial of raloxifene (LY139481) HCl: Impact on bone turnover and serum lipid profile in healthy postmenopausal women. Journal of Bone and Mineral Research. 2009;11(6):835–42. doi: https://doi.org/10.1002/jbmr.5650110615

99. Nie G, Yang X, Wang Y, Liang W, Li X, Luo Q et al. The Effects of Menopause Hormone Therapy on Lipid Profile in Postmenopausal Women: A Systematic Review and Meta-Analysis. Frontiers in Pharmacology. 2022;13:850815. doi: https://doi.org/10.3389/fphar.2022.850815

100. Ezhov M.V., Kukharchuk V.V., Sergienko I.V., Alieva A.S., Antsiferov M.B., Ansheles A.A. et al. Disorders of lipid metabolism. Clinical Guidelines 2023. Russian Journal of Cardiology. 2023;28(5):250–97 doi: https://doi.org/10.15829/1560-4071-2023-5471

101. Nordestgaard BG, Chapman MJ, Ray K, Borén J, Andreotti F, Watts GF et al. Lipoprotein(a) as a cardiovascular risk factor: current status. European Heart Journal. 2010;31(23):2844–53. doi: https://doi.org/10.1093/eurheartj/ehq386

102. Honigberg MC, Trinder M, Natarajan P. Lipoprotein(a), Menopausal Hormone Therapy, and Risk of Coronary Heart Disease in Postmenopausal Individuals. JAMA Cardiology. 2022;7(5):565–8. doi: https://doi.org/10.1001/jamacardio.2022.0716

103. Stevenson JC, Chines A, Pan K, Ryan KA, Mirkin S. A Pooled Analysis of the Effects of Conjugated Estrogens/Bazedoxifene on Lipid Parameters in Postmenopausal Women From the Selective Estrogens, Menopause, and Response to Therapy (SMART) Trials. The Journal of Clinical Endocrinology & Metabolism. 2015;100(6):2329–38. doi: https://doi.org/10.1210/jc.2014-2649

104. Miller VT, LaRosa J, Barnabei V, Kessler C, Levin G, Smith-Roth A et al. Effects of Estrogen or Estrogen/ Progestin Regimens on Heart Disease Risk Factors in Postmenopausal Women: The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial. JAMA. 1995;273(3):199–208. doi: https://doi.org/10.1001/jama.1995.03520270033028

105. Binder EF, Birge SJ, Kohrt WM. Effects of Endurance Exercise and Hormone Replacement Therapy on Serum Lipids in Older Women. Journal of the American Geriatrics Society. 1996;44(3):231–6. doi: https://doi.org/10.1111/j.1532-5415.1996.tb00907.x

106. Bunyavejchevin S, Limpaphayom KK. The metabolic and bone density effects of continuous combined 17-beta estradiol and noresthisterone acetate treatments in Thai postmenopausal women: a doubleblind placebo-controlled trial. Journal of the Medical Association of Thailand. 2001;84(1):45–53. PMID: 11281499

107. Çayan F, Gen R, Akbay E, Dilek U, Dilek S. The Effect of Hormone Therapy and Tibolone on Glucose and Lipid Metabolism in Healthy Postmenopausal Women. Turkish Journal of Geriatrics. 2011;14(1):19– 25. [Av. at: https://geriatri.dergisi.org/abstract.php?id=534]

108. Cheng GJ, Liu JL, Zhang Q, Fan W, Ye HF, Wang ZQ et al. Nylestriol replacement therapy in postmenopausal women. A three-year prospective study. Chinese Medical Journal. 1993;106(12):911–6. PMID: 8198628

109. Conard J, Basdevant A, Thomas J-L, Ochsenbein E, Denis C, Guyene TT et al. Cardiovascular risk factors and combined estrogen-progestin replacement therapy: a placebo-controlled study with nomegestrol acetate and estradiol. Fertility and Sterility. 1995;64(5):957–62. doi: https://doi.org/10.1016/S0015-0282(16)57909-6

110. Conard J, Gompel A, Pelissier C, Mirabel C, Basdevant A. Fibrinogen and plasminogen modifications during oral estradiol replacement therapy. Fertility and Sterility. 1997;68(3):449–53. doi: https://doi.org/10.1016/S0015-0282(97)00220-3

111. Davidson MH, Maki KC, Marx P, Maki AC, Cyrowski MS, Nanavati N et al. Effects of Continuous Estrogen and Estrogen-Progestin Replacement Regimens on Cardiovascular Risk Markers in Postmenopausal Women. Archives of Internal Medicine. 2000;160(21):3315–25. doi: https://doi.org/10.1001/archinte.160.21.3315

112. Duvernoy CS, Rose PA, Kim HM, Kehrer C, Brook RD. Combined Continuous Ethinyl Estradiol/Norethindrone Acetate Does Not Improve Forearm Blood Flow in Postmenopausal Women at Risk for Cardiovascular Events: A Pilot Study. Journal of Women’s Health. 2007;16(7):963–70. doi: https://doi.org/10.1089/jwh.2006.0321

113. Casanova G, Dos Reis AM, Spritzer PM. Low-dose oral or non-oral hormone therapy: effects on C-reactive protein and atrial natriuretic peptide in menopause. Climacteric. 2015;18(1):86–93. doi: https://doi.org/10.3109/13697137.2014.940309

114. Haase CL, Tybjærg-Hansen A, Ali Qayyum A, Schou J, Nordestgaard BG, Frikke-Schmidt R. LCAT, HDL Cholesterol and Ischemic Cardiovascular Disease: A Mendelian Randomization Study of HDL Cholesterol in 54,500 Individuals. Journal of Clinical Endocrinology & Metabolism. 2012;97(2):E248–56. doi: https://doi.org/10.1210/jc.2011-1846

115. Lv C, Zhang W, Tan X, Shang X, Găman M-A, Salem H et al. The effect of tibolone treatment on lipid profile in women: A systematic review and dose-response meta-analysis of randomized controlled trials. Pharmacological Research. 2021;169:105612. doi: https://doi.org/10.1016/j.phrs.2021.105612

116. Anagnostis P, Galanis P, Chatzistergiou V, Stevenson JC, Godsland IF, 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: https://doi.org/10.1016/j.maturitas.2017.02.009

117. Falkeborn M, Persson I, Adami H-O, Bergstrom R, Eaker E, Lithell H et al. The risk of acute myocardial infarction after oestrogen and oestrogen-progestogen replacement. British Journal of Obstetrics and Gynaecology. 1992;99(10):821–8. doi: https://doi.org/10.1111/j.1471-0528.1992.tb14414.x

118. Shufelt CL, Manson JE. Menopausal Hormone Therapy and Cardiovascular Disease: The Role of Formulation, Dose, and Route of Delivery. The Journal of Clinical Endocrinology & Metabolism. 2021;106(5):1245–54. doi: https://doi.org/10.1210/clinem/dgab042

119. Anagnostis P, Bitzer J, Cano A, Ceausu I, Chedraui P, Durmusoglu F et al. Menopause symptom management in women with dyslipidemias: An EMAS clinical guide. Maturitas. 2020;135:82–8. doi: https://doi.org/10.1016/j.maturitas.2020.03.007

120. Wenger NK, Lloyd-Jones DM, Elkind MSV, Fonarow GC, Warner JJ, Alger HM et al. Call to Action for Cardiovascular Disease in Women: Epidemiology, Awareness, Access, and Delivery of Equitable Health Care: A Presidential Advisory From the American Heart Association. Circulation. 2022;145(23):e1059–71. doi: https://doi.org/10.1161/CIR.0000000000001071

121. Vogel B, Acevedo M, Appelman Y, Bairey Merz CN, Chieffo A, Figtree GA et al. The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030. The Lancet. 2021;397(10292):2385–438. doi: https://doi.org/10.1016/S0140-6736(21)00684-X

122. Reckelhoff JF. Gender differences in hypertension: Current Opinion in Nephrology and Hypertension. 2018;27:176–81. doi: https://doi.org/10.1097/MNH.0000000000000404

123. Cho L, Davis M, Elgendy I, Epps K, Lindley KJ, Mehta PK et al. Summary of Updated Recommendations for Primary Prevention of Cardiovascular Disease in Women. Journal of the American College of Cardiology. 2020;75(20):2602–18. doi: https://doi.org/10.1016/j.jacc.2020.03.060

124. Gerdts E, Sudano I, Brouwers S, Borghi C, Bruno RM, Ceconi C et al. Sex differences in arterial hypertension. European Heart Journal. 2022;43(46):4777–88. doi: https://doi.org/10.1093/eurheartj/ehac470

125. Zhou B, Carrillo-Larco RM, Danaei G, Riley LM, Paciorek CJ, Stevens GA et al. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. The Lancet. 2021;398(10304):957–80. doi: https://doi.org/10.1016/S0140-6736(21)01330-1

126. O’Keeffe LM, Simpkin AJ, Tilling K, Anderson EL, Hughes AD, Lawlor DA et al. Sex-specific trajectories of measures of cardiovascular health during childhood and adolescence: A prospective cohort study. Atherosclerosis. 2018;278:190–6. doi: https://doi.org/10.1016/j.atherosclerosis.2018.09.030

127. Ji H, Kim A, Ebinger JE, Niiranen TJ, Claggett BL, Bairey Merz CN et al. Sex Differences in Blood Pressure Trajectories Over the Life Course. JAMA Cardiology. 2020;5(3):19–26. doi: https://doi.org/10.1001/jamacardio.2019.5306

128. Maas A, Rosano G, Cifkova R, Chieffo A, Van Dijken D, Hamoda H et al. Cardiovascular health after menopause transition, pregnancy disorders, and other gynaecologic conditions: a consensus document from European cardiologists, gynaecologists, and endocrinologists. European Heart Journal. 2021;42(10):967–84. doi: https://doi.org/10.1093/eurheartj/ehaa1044

129. El Khoudary SR, Aggarwal B, Beckie TM, Hodis HN, Johnson AE, Langer RD et al. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. Circulation. 2020;142(25):e506–32. doi: https://doi.org/10.1161/CIR.0000000000000912

130. Biglia N, Cagnacci A, Gambacciani M, Lello S, Maffei S, Nappi RE. Vasomotor symptoms in menopause: a biomarker of cardiovascular disease risk and other chronic diseases? Climacteric. 2017;20(4):306– 12. doi: https://doi.org/10.1080/13697137.2017.1315089

131. Chapman N, Ching SM, Konradi AO, Nuyt AM, Khan T, TwumasiAnkrah B et al. Arterial Hypertension in Women: State of the Art and Knowledge Gaps. Hypertension. 2023;80(6):1140–9. doi: https://doi.org/10.1161/HYPERTENSIONAHA.122.20448

132. Coutinho T. Arterial Stiffness and Its Clinical Implications in Women. Canadian Journal of Cardiology. 2014;30(7):756–64. doi: https://doi.org/10.1016/j.cjca.2014.03.020

133. Picone DS, Kodithuwakku V, Mayer CC, Chapman N, Rehman S, Climie RE. Sex differences in pressure and flow waveform physiology across the life course. Journal of Hypertension. 2022;40(12):2373–84. doi: https://doi.org/10.1097/HJH.0000000000003283

134. Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, LloydJones DM et al. Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women – 2011 Update: A Guideline From the American Heart Association. Circulation. 2011;123(11):1243–62. doi: https://doi.org/10.1161/CIR.0b013e31820faaf8

135. Issa Z, Seely EW, Rahme M, El-Hajj Fuleihan G. Effects of hormone therapy on blood pressure. Menopause. 2015;22(4):456–68. doi: https://doi.org/10.1097/GME.0000000000000322

136. Mancia G, Kreutz R, Brunström M, Burnier M, Grassi G, Januszewicz A et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). Journal of Hypertension. 2023;41(12):1874–2071. doi: https://doi.org/10.1097/HJH.0000000000003480

137. Kobalava Zh.D., Konradi A.O., Nedogoda S.V., Shlyakhto E.V., Arutyunov G.P., Baranova E.I. et al. Arterial hypertension in adults. Clinical guidelines 2020. Russian Journal of Cardiology. 2020;25(3):149– 218 doi: https://doi.org/10.15829/1560-4071-2020-3-3786

138. Curb JD, Prentice RL, Bray PF, Langer RD, Van Horn L, Barnabei VM et al. Venous Thrombosis and Conjugated Equine Estrogen in Women Without a Uterus. Archives of Internal Medicine. 2006;166(7):772– 80. doi: https://doi.org/10.1001/archinte.166.7.772

139. Blondon M, Wiggins KL, Van Hylckama Vlieg A, McKnight B, Psaty BM, Rice KM et al. Smoking, postmenopausal hormone therapy and the risk of venous thrombosis: a population‐based, case–control study. British Journal of Haematology. 2013;163(3):418–20. doi: https://doi.org/10.1111/bjh.12508

140. Ruan X, Mueck AO. Impact of smoking on estrogenic efficacy. Climacteric. 2015;18(1):38–46. doi: https://doi.org/10.3109/13697137.2014.929106

141. Schreinlechner M, Noflatscher M, Reinstadler SJ, Sommer P, Lener D, Reiser E et al. Early onset of menopause is associated with increased peripheral atherosclerotic plaque volume and progression Atherosclerosis. 2020;297:25–31. doi: https://doi.org/10.1016/j.atherosclerosis.2020.01.023

142. Rockman CB, Maldonado TS, Jacobowitz GR, Adelman MA, Riles TS. Hormone Replacement Therapy is Associated With a Decreased Prevalence of Peripheral Arterial Disease in Postmenopausal Women. Annals of Vascular Surgery. 2012;26(3):411–8. doi: https://doi.org/10.1016/j.avsg.2011.10.012

143. Westendorp I, In’T Veld BA, Grobbee DE, Pols H, Meijer WT, Hofman A et al. Hormone Replacement Therapy and Peripheral Arterial Disease: The Rotterdam Study. Archives of Internal Medicine. 2000;160(16):2498–502. doi: https://doi.org/10.1001/archinte.160.16.2498

144. Hodis HN, Mack WJ, Henderson VW, Shoupe D, Budoff MJ, HwangLevine J et al. Vascular Effects of Early versus Late Postmenopausal Treatment with Estradiol. New England Journal of Medicine. 2016;374(13):1221–31. doi: https://doi.org/10.1056/NEJMoa1505241

145. Chen IJ, Stanczyk FZ, Sriprasert I, Karim R, Shoupe D, Kono N et al. Sex steroid hormones and subclinical atherosclerosis progression in postmenopausal women. European Journal of Endocrinology. 2025;192(3):248–56. doi: https://doi.org/10.1093/ejendo/lvaf032

146. Anagnostis P, Mikhailidis DP, Blinc A, Jensterle M, Ježovnik MK, Schernthaner G-H et al. The Effect of Menopause and Menopausal Hormone Therapy on the Riskof Peripheral Artery Disease. Current Vascular Pharmacology. 2023;21(5):293–6. doi: https://doi.org/10.2174/0115701611263345230919122907

147. Grady D, Herrington D, Bittner V, Blumenthal R, Davidson M, Hlatky M et al. Cardiovascular Disease Outcomes During 6.8 Years of Hormone Therapy: Heart and Estrogen/Progestin Replacement Study Follow-up (HERS II). JAMA. 2002;288(1):49–57. doi: https://doi.org/10.1001/jama.288.1.49

148. Davies RSM, Vohra RK, Bradbury AW, Adam DJ. The Impact of Hormone Replacement Therapy on the Pathophysiology of Peripheral Arterial Disease. European Journal of Vascular and Endovascular Surgery. 2007;34(5):569–75. doi: https://doi.org/10.1016/j.ejvs.2007.06.002

149. Polyakov D.S., Fomin I.V., Belenkov Yu.N., Mareev V.Yu., Ageev F.T., Artemjeva E.G. et al. Chronic heart failure in the Russian Federation: what has changed over 20 years of follow-up? Results of the EPOCHCHF study. Kardiologiia. 2021;61(4):4–14 doi: https://doi.org/10.18087/cardio.2021.4.n1628

150. Appiah D, Schreiner PJ, Demerath EW, Loehr LR, Chang PP, Folsom AR. Association of Age at Menopause With Incident Heart Failure: A Prospective Cohort Study and Meta‐Analysis. Journal of the American Heart Association. 2016;5(8):e003769. doi: https://doi.org/10.1161/JAHA.116.003769

151. Schierbeck LL, Rejnmark L, Tofteng CL, Stilgren L, Eiken P, Mosekilde L et al. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ. 2012;345:e6409. doi: https://doi.org/10.1136/bmj.e6409

152. Lindenfeld J, Ghali JK, Krause-Steinrauf HJ, Khan S, Adams K, Goldman S et al. Hormone replacement therapy is associated with improved survival in women with advanced heart failure. Journal of the American College of Cardiology. 2003;42(7):1238–45. doi: https://doi.org/10.1016/S0735-1097(03)00938-0

153. Liu L, Klein L, Eaton C, Panjrath G, Martin LW, Chae CU et al. Menopausal Hormone Therapy and Risks of First Hospitalized Heart Failure and its Subtypes During the Intervention and Extended Postintervention Follow-up of the Women’s Health Initiative Randomized Trials. Journal of Cardiac Failure. 2020;26(1):2–12. doi: https://doi.org/10.1016/j.cardfail.2019.09.006

154. Baik SH, Baye F, McDonald CJ. Use of menopausal hormone therapy beyond age 65 years and its effects on women’s health outcomes by types, routes, and doses. Menopause. 2024;31(5):363–71. doi: https://doi.org/10.1097/GME.0000000000002335

155. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal. 2016;37(38):2893–962. doi: https://doi.org/10.1093/eurheartj/ehw210

156. Fang MC, Singer DE, Chang Y, Hylek EM, Henault LE, Jensvold NG et al. Gender Differences in the Risk of Ischemic Stroke and Peripheral Embolism in Atrial Fibrillation: The AnTicoagulation and Risk factors In Atrial fibrillation (ATRIA) Study. Circulation. 2005;112(12):1687–91. doi: https://doi.org/10.1161/CIRCULATIONAHA.105.553438

157. Van Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns HJGM et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal. 2024;45(36):3314–414. doi: https://doi.org/10.1093/eurheartj/ehae176

158. Antoun I, Layton GR, Abdelrazik A, Eldesouky M, Zakkar M, Somani R et al. The Pathophysiology of Sex Differences in Stroke Risk and Prevention in Atrial Fibrillation: A Comprehensive Review. Medicina. 2025;61(4):649. doi: https://doi.org/10.3390/medicina61040649

159. Perez MV, Wang PJ, Larson JC, Virnig BA, Cochrane B, Curb JD et al. Effects of Postmenopausal Hormone Therapy on Incident Atrial Fibrillation: The Women’s Health Initiative Randomized Controlled Trials. Circulation: Arrhythmia and Electrophysiology. 2012;5(6):1108– 16. doi: https://doi.org/10.1161/CIRCEP.112.972224

160. Magnussen C, Niiranen TJ, Ojeda FM, Gianfagna F, Blankenberg S, Njølstad I et al. Sex Differences and Similarities in Atrial Fibrillation Epidemiology, Risk Factors, and Mortality in Community Cohorts: Results From the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe). Circulation. 2017;136(17):1588–97. doi: https://doi.org/10.1161/CIRCULATIONAHA.117.028981

161. Tsai W-C, Haung Y-B, Kuo H-F, Tang W-H, Hsu P-C, Su H-M et al. Hormone replacement therapy and risk of atrial fibrillation in Taiwanese menopause women: A nationwide cohort study. Scientific Reports. 2016;6(1):24132. doi: https://doi.org/10.1038/srep24132

162. Wong JA, Rexrode KM, Sandhu RK, Moorthy MV, Conen D, Albert CM. Menopausal age, postmenopausal hormone therapy and incident atrial fibrillation. Heart. 2017;103(24):1954–61. doi: https://doi.org/10.1136/heartjnl-2016-311002

163. Lee J, Kim Y, Park H, Kim C, Cho S, Kim J. Clinical Impact of Hormone Replacement Therapy on Atrial Fibrillation in Postmenopausal Women: A Nationwide Cohort Study. Journal of Clinical Medicine. 2021;10(23):5497. doi: https://doi.org/10.3390/jcm10235497

164. Fleury M-A, Clavel M-A. Sex and Race Differences in the Pathophysiology, Diagnosis, Treatment, and Outcomes of Valvular Heart Diseases. Canadian Journal of Cardiology. 2021;37(7):980–91. doi: https://doi.org/10.1016/j.cjca.2021.02.003

165. Rodriguez-Arias JJ, García-Álvarez A. Sex Differences in Pulmonary Hypertension. Frontiers in Aging. 2021;2:727558. doi: https://doi.org/10.3389/fragi.2021.727558

166. Hye T, Dwivedi P, Li W, Lahm T, Nozik-Grayck E, Stenmark KR et al. Newer insights into the pathobiological and pharmacological basis of the sex disparity in patients with pulmonary arterial hypertension. American Journal of Physiology-Lung Cellular and Molecular Physiology. 2021;320(6):L1025–37. doi: https://doi.org/10.1152/ajplung.00559.2020

167. Liu A, Schreier D, Tian L, Eickhoff JC, Wang Z, Hacker TA et al. Direct and indirect protection of right ventricular function by estrogen in an experimental model of pulmonary arterial hypertension. American Journal of Physiology-Heart and Circulatory Physiology. 2014;307(3):H273–83. doi: https://doi.org/10.1152/ajpheart.00758.2013

168. Badlam JB, Badesch D, Brittain E, Cordell S, Ding T, Fox K et al. Sex hormone exposure and reproductive factors in pulmonary arterial hypertension: a case–control study. Pulmonary Circulation. 2020;10(1):1–9. doi: https://doi.org/10.1177/2045894020908786

169. Ministry of Health of Russian Federation. Clinical recommendations. Migraine. 2024. Av. at: https://cr.minzdrav.gov.ru/preview-cr/295_4

170. Nappi R, Tiranini L, Sacco S, De Matteis E, De Icco R, Tassorelli C. Role of Estrogens in Menstrual Migraine. Cells. 2022;11(8):1355. doi: https://doi.org/10.3390/cells11081355

171. Academic Committee of the Korean Society of Menopause, Lee SR, Cho MK, Cho YJ, Chun S, Hong S-H et al. The 2020 Menopausal Hormone Therapy Guidelines. Journal of Menopausal Medicine. 2020;26(2):69–98. doi: https://doi.org/10.6118/jmm.20000

172. Australasian Menopause Society. Migraine headaches, menopause and MHT/HRT. Available at: https://menopause.org.au/hp/information-sheets/migraine-headaches-menopause-and-mht-hrt

173. British Menopause Society. Migraine and HRT. Av. at: https://thebms.org.uk/publications/tools-for-clinicians/migraine-and-hrt/

174. Garvey WT, Garber AJ, Mechanick JI, Bray GA, Dagogo-Jack S, Einhorn D et al. American Association of Clinical Endocrinologists and American College of Endocrinology Position Statement on the 2014 Advanced Framework for a New Diagnosis of Obesity as a Chronic Disease. Endocrine Practice. 2014;20(9):977–89. doi: https://doi.org/10.4158/EP14280.PS