Rationale for the choice of menopausal hormone therapy if treatment switching is needed in the context of a personalized approach

Timely and personalized menopausal hormone therapy (MHT), as is indicated, is a key method for maintaining health and quality of life in women and for preventing menopause-related diseases. The benefits of MHT outweigh possible risks in somatically healthy women, but the situation becomes more complicated in comorbid patients. At the same time, active ageing is a new expectation of mankind today. MHT should be selected in terms of the severity of menopausal symptoms, the presence of concomitant diseases, drug tolerance, and other personal characteristics of the patient; it is alsi important to consider the availability of prescription medicines in the country for their long use. In practice, physicians and patients often face the situations requiring that MHT should be switched. A correct algorithm of the physician’s actions will largely ensure treatment efficiency and safety and the woman’s adherence to the prescribed therapy. This aspect demonstrates the relevance of elaborating and introducing an algorithm of actions into practice when a demand arises for MHT drugs to be switched. The paper presents an update on rational MHT. Particular attention is paid to the efficacy, tolerability and safety of combination MHT containing estrogen and progestogen on the basis of the results of relevant studies and in the context of national and international clinical practice guidelines. A tactic in managing menopausal women is demonstrated, by describing clinical cases as an example. The presented algorithms of the physician’s actions, when a demand rises for MHT drugs to be switched, reflect the current approaches to personalizing patient care in real clinical practice and are an effective practical solution. Among the drugs intended for the correction of menopausal symptoms, the estradiol/didrogesterone combination meets all the criteria for MHT according to the International Menopause Society (IMS), the European Menopause and Andropause Society (EMAS), and the National Institute for Health and Care Excellence (NICE). The range of different estradiol/didrogesterone combination dosages and regimens allows personalizing the therapy for menopausal disorders as much as possible and provides an opportunity to manage the patient throughout the period from peripause to postmenopause, without changing the progestogen. Conclusion: The current tactics of managing patients with menopausal symptoms and the algorithm for replacing hormonal drugs give the physician and patient the chance to have the maximum efficiency and safety of therapy and high adherence to treatment and to prevent long-term complications.

menopause, menopausal hormone therapy (MHT), climacteric disorders, combined oral contraceptives (COCs), estradiol, drospirenone, dydrogesterone