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Coronary artery disease and stroke make up the greater part of the pattern of cardiovascular diseases (CVD). Their prevalence is increasing primarily due to death rates decline and life expectancy increase. However, CVDs remain the leading cause of death in both high/middle and low income countries (WHO, 2008). The burden of coronary heart disease and stroke is determined both by a significant decrease in patients’ quality of life and the economic expenditures of healthcare aimed at treating these conditions and managing their complications. The overall CVD risk is more or less the same in men and women, but a detailed analysis shows a clear dependence on the patient age. The CVD risk in men is comparable to the CVD risk in women of younger age groups, i.e. CVD incidence rates in women are about ten years behind such rates in men. CVDs are of major concern for women who enter menopause. The changing endocrine profile predisposes to an increase in the cardiovascular event rates due to a combination of risk factors such as visceral obesity, atherogenic dyslipidemia, impaired glucose regulation, homeostasis disorders, and vascular dysfunction. However, an independent association between age-related degenerative changes in the ovaries and CVD risk has been established primarily in women with premature and early menopause (˂40– 45 years). Menopause hormone therapy (MHT) significantly reduces most CVD risks. The effectiveness of the prevention of irreversible effects of oestrogen deficiency is ensured by the timely MHT start during the very first pathological changes in female health or in the late stage of the menopausal transition/early postmenopausal stage (˂60 years or within ten years after the last menstrual period). The concept of prescribing MHT within the “window of therapeutic opportunity” produces a favourable benefit-risk ratio for patients.

The vulva, vagina, lower urinary tract, and pelvic floor have the same embryonic origin. Thus, all of the abovementioned organs are equally sensitive to estrogen deficiency and menopausal hormone therapy due to expression of the respective receptors. Genitourinary syndrome of menopause (GSM) is a concept first introduced in 2013 to provide a more complete definition of the consequences of estrogen deficiency in urogenital tissues and reflect the full range of vaginal and urinary symptoms that women experience during menopause. The term broadly reflects the condition, which, unlike the older term “vulvovaginal atrophy”, is not limited to a single symptom of dyspareunia and includes women who are not sexually active. The consequences of GSM significantly alter the quality of life of most menopausal women. Some patients with symptoms of vulvovaginal atrophy completely stop their sexual activity (58 %) and avoid sexual intimacy (55%). Various forms of urinary disorders also alter activities of daily living, sleep, sexual activity, and can lead to social isolation and loss of self-respect. Women with recurrent vulvovaginal infection often have to seek medical care. Estrogen therapy during menopause is pathogenetically justified. Estrogens administered intravaginally are more effective in relieving the symptoms of GSM, both objectively and subjectively, than their systemic use. Up to 40% of women receiving systemic menopausal hormone therapy do not have the expected effect of estrogens on the urogenital tract. If the symptoms of GSM prevail, it is advisable to consider monotherapy with local estrogens or combine it with systemic therapy instead of increasing a dose of the latter. The article presents a clinical case of a personalized approach to solving the issue of vulvovaginal atrophy combined with a mixed urinary incontinence (MUI) in a postmenopausal female patient.

Menopause, defined as the cessation of menses for 12 months and more, is a multidimensional evolutionary process, which has a considerable impact on the women’s quality of life and the risk of development of age-associated pathology. 47 million of women around the world enter the menopausal period each year. The menopause onset age is the most important factor which determines the woman health status and, to a large extent, both the risk of morbidity and mortality. Menopause may be induced by a surgical intervention, chemotherapy, and radiation therapy. Post-menopause period accounts for about onethird of a woman’s life and is quite often accompanied by the development of different symptoms associated with estrogen deficiency. Vasomotor symptoms (VMS) are primarily referred to the initial manifestations of the climacteric syndrome. VMS frequency prevails within the two-year period immediately before and after the last menstruation. In some patients, hot flashes can begin long before (10 years prior to) the menopause and persist for a long time. Night sweats, dysphoric disorders, urogenital atrophy / urination disorders, sexual (decreased libido) and cognitive changes, and sleep disturbances are often observed due to the estrogen deficiency. MHT should be considered as a first line therapeutic intervention for the correction of climacteric disorders and prevention of age-associated pathology in women with premature ovarian failure and in menopausal women under the age of 60. For patients who are wary of hormonal therapy or have absolute / relative contradictions to the use of MHT, alternative methods of menopausal disorders correction, which include nonpharmacological and pharmacological non-hormonal drugs with different degrees of efficiency and safety should be considered. Phytoestrogens have confidently filled a niche of alternative therapy for the treatment of menopausal disorders.

The growing interest in the tandem of osteoporosis and sarcopenia is dictated by a higher level of low-traumatic fractures, disability, and mortality than against the background of individual diseases. Osteoporosis and sarcopenia are associated with aging and are characterized by a simultaneous decrease in bone and muscle mass. Osteoporosis and sarcopenia share common risk factors (genetic, endocrine, dietary and lifestyle conditions) and etiopathogenetic pathways that combine diseases into a single syndrome known as osteosarcopenia. Among the hormonal factors that play a leading role in the development and maintenance of the functional state of bone and muscle tissue, it is necessary to single out estrogens. Currently available research results confirm the protective effect of hormone replacement therapy in relation to osteoporosis. Data on sarcopenia and hormone replacement therapy require further research. Correct understanding and application of therapeutic strategies is essential in order to stop the growing wave of low-traumatic fractures.

Woman’s nature is unique. Taking into account some historical milestones, it can be noted that the role of women in society has undergone large-scale changes. The woman took a confident position in society. Its main function remains unchanged and it consists in procreation and procreation. A woman’s activity is consistent with the work of her reproductive system (RS). The gradual decrease, and then the cessation of the work of the ovaries, contributes to the life order and health of the fair sex. Menopause is a natural stage in a woman’s life, which corresponds to the peak of social self-realization. However, in some cases, hormonal changes characteristic of this period can serve as a favorable background for the formation of a number of pathological changes. The growing estrogen deficiency is becoming a pathogenetic impetus for the development of a wide range of climacteric disorders. Vasomotor symptoms and hyperhidrosis are the most frequent companions of women during the perimenopausal transition and early postmenopause. Maintaining optimal activity and the full quality of life of patients should be the goal of correcting the negative manifestations of estrogen deficiency and the complications associated with it. Compensating for estrogen deficiency with menopausal hormone therapy (HRT) is the benchmark for menopausal problems. However, there are a number of patients who have contraindications to prescribing HRT or who refuse to receive it for some reason. For this category of patients, alternative methods of diet correction. Combinations of plant extracts with vitamins and minerals have been successfully used in clinical practice for a long time. The article will provide information on the most studied phytoestrogens contained in soy.

Over the past several decades, there has been a global aging of the population around the world. The demographic situation in the Russian Federation is no exception, being a natural result of an increase in the life expectancy of the population. In clinical practice, geriatric diseases have been identified and are widely studied, which deserve priority attention due to a sharp decline in the quality of life of elderly patients. Osteoporosis is called a “silent epidemic” among elderly and senile patients. This disease is associated with a high risk of low-traumatic fractures of various localization. The imperfect rehabilitation program after complex fractures and its insufficient funding are forcing clinicians to focus on more cost-effective solutions to this problem – the prevention and treatment of osteoporosis. Osteomodifying agents are widely used by physicians of various specialties. Bisphosphonates effectively reduce the risk of low-traumatic fractures against the background of an increase in bone mineral density. The level of effectiveness of bisphosphonates depends on the patient’s adherence to antiresorptive therapy and the degree of compensation for vitamin D and serum calcium. Low adherence to osteoporosis therapy is based on the need for long-term use of bisphosphonates and a different spectrum of adverse events. In the article, using alendronate as an example, the problem of low adherence to antiresorptive therapy will be considered and ways to solve it are presented.

In the civilized world, there is a dilemma on how to relate to aging - to perceive it as a natural process characteristic of any living organism or to elevate it to the rank of a disease in order to try to develop methods of “treatment”. Age-related changes in a woman begin at about 40 years old and are associated with various hormonal changes. Often this stage in the life of the fair sex does not go unnoticed, it makes unpleasant corrections to the lifestyle with the need to change established habits and rules. Interestingly, in the era of information technology, women are not always sufficiently informed about the main age-related changes in their own body. The primary task of clinicians is to timely reveal the secrets of women’s health and help them adapt to the upcoming changes. Fluctuations in hormonal status are observed throughout a woman’s life. Contrary to the common misconception among women, it is completely incorrect to identify menopause with old age, because the hormonal function in women begins to fade long before the true aging. Climax is a multistage period of life, during which all systems of the female body adapt to the new conditions of estrogen deficiency.In the treatment of climacteric disorders hormonal therapy with synthetic analogues of female sex hormones is used. Only preparations of bioidentical hormones have a real protective effect on metabolic disorders, osteoporosis, cardiovascular complications, cognitive disorders. According to clinical recommendations, approaches to the treatment of menopausal disorders should be clearly customized to the identified risks and expected benefits. Choosing the optimal composition and regime of MHT allows to increase efficiency and minimize possible risks. Clinicians should not forget about situations where there are restrictions or contraindications to the use of MHT. The presence of absolute and relative contraindications to MHT, as well as widespread hormoneophobia in our country in women have led to the development of alternative methods of treatment of menopausal disorders.

The article presents the basic definitions related to the treatment of postmenopausal osteoporosis, and certain sections from the guidelines of the Russian Association on Osteoporosis (2016) dedicated to the prescription of active vitamin D metabolites (alfacalcidol).

The paper presents a review of accumulated data relating to major definitions in diagnostics and therapy of the premenstrual syndrome and own experience represented by case histories. Various therapeutic approaches from the point of view of evidencebased medicine are highlighted.