Менопаузальная гормональная терапия у пациенток с сердечно-сосудистыми и метаболическими заболеваниями: междисциплинарный дельфийский консенсус российских гинекологов, кардиологов, эндокринологов, геронтологов и гериатров, флебологов, клинфармаколов

Сухих Г.Т., Серов В.Н., Шляхто Е.В., Дедов И.И., Арутюнов Г.П., Ткачева О.Н., Сметник А.А., Сучков И.А., Баранов И.И., Шестакова М.В., Мельниченко Г.А., Васюкова О.В., Шереметьева Е.В., Андреева Е.Н., Шестакова Е.А., Орлова Я.А., Виллевальде С.В., Иртюга О.Б., Сергиенко И.В., Явелов И.С., Козиолова Н.А., Ермакова Е.И., Дудинская Е.Н. Менопаузальная гормональная терапия у пациенток с сердечно-сосудистыми и метаболическими заболеваниями: междисциплинарный дельфийский консенсус среди российских гинекологов, кардиологов, эндокринологов, геронтологов и гериатров, флебологов, клинических фармакологов. Терапевтический архив. 2026;98(1):6–27. DOI: 10.26442/00403660.2026.01.203470

© ООО «КОНСИЛИУМ МЕДИКУМ», 2026 г.

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Sukhikh GT, Serov VN, Shlyakhto EV, Dedov II, Arutyunov GP, Tkacheva ON, Smetnik AA, Suchkov IA, Baranov II, Shestakova MV, Mel'nichenko GA, Vasyukova OV, Sheremetyeva EV, Andreeva EN, Shestakova EA, Orlova YaA, Villevalde SV, Irtyuga OB, Sergienko IV, Yavelov IS, Koziolova NA, Smetnik A.A., Ermakova EI, Dudinskaya EN, Arutyunov GP. 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. Terapevticheskii Arkhiv (Ter. Arkh.). 2026;98(1):6–27. DOI: 10.26442/00403660.2026.01.203470

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Аннотация

В Российской Федерации ежегодно более 1 млн женщин вступают в менопаузу. Выраженный эстрогенодефицит приводит к развитию симптомов, значимо влияющих на качество их жизни, а также способствующих повышению риска развития сердечно-сосудистых (ССЗ) и метаболических заболеваний (МЗ). Менопаузальная гормональная терапия (МГТ) – признанный стандарт лечения климактерических симптомов. По инициативе профессиональных сообществ (Российского общества акушеров-гинекологов, Российского кардиологического общества, Российской ассоциации эндокринологов, Евразийской ассоциации терапевтов, Российского общества специалистов по гинекологической эндокринологии и менопаузе, Российской ассоциации геронтологов и гериатров, Ассоциации флебологов России) организовано дельфийское голосование для получения согласованного мнения экспертов различных специальностей по отношению к МГТ у пациенток с ССЗ и МЗ. Целью выступила необходимость совершенствования междисциплинарных научно-практических подходов по ведению женщин с климактерическим синдромом. В результате дельфийский консенсус достигнут по итогу первого раунда. Эксперты пришли к согласованному выводу о том, что назначение МГТ требует тщательной оценки индивидуальных рисков, включая состояние сердечно-сосудистой системы и наличие сопутствующих заболеваний. МГТ может оказывать положительное влияние на метаболические и сердечно-сосудистые факторы риска у женщин в пери- и постменопаузе путем нормализации липидного профиля, улучшения углеводного обмена и снижения инсулинорезистентности. Междисциплинарный подход позволяет персонализировать МГТ, минимизировать возможные осложнения, улучшить качество жизни женщин в пери- и постменопаузе, увеличить продолжительность активного долголетия.

Ключевые слова: менопаузальная гормональная терапия, менопауза, климактерический синдром, сердечно-сосудистые заболевания, метаболические заболевания, междисциплинарный консенсус, метод Дельфи, качество жизни, активное долголетие

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More than one million women in Russia enter menopause each year. The severe estrogen deficiency associated with this transition causes symptoms that significantly impair quality of life and contribute to an increased risk of cardiovascular (CVD) and metabolic diseases (MD). Menopausal hormone therapy (MHT) is the established standard of care for menopausal symptoms. On the initiative of several professional societies (the Russian Society of Obstetricians and Gynecologists, the Russian Society of Cardiology, the Russian Association of Endocrinologists, the Eurasian Association of Therapists, the Russian Society of Gynecological Endocrinology and Menopause, the Russian Association of Gerontologists and Geriatricians, the Association of Phlebologists of Russia), a Delphi panel was convened to develop a multidisciplinary expert consensus on MHT for patients with CVD and MD. The goal was to enhance research and clinical approaches to managing menopausal women. A consensus was reached at the end of the first Delphi round. The experts agreed that initiating MHT requires a thorough assessment of individual risks, including cardiovascular health and comorbidities. MHT can offset metabolic and cardiovascular risk factors in peri- and postmenopausal women by normalizing the lipid profile, improving carbohydrate metabolism, and reducing insulin resistance. An interdisciplinary approach allows for personalized MHT, minimizes potential complications, improves the quality of life for peri- and postmenopausal women, and promotes active longevity.

Keywords: menopausal hormone therapy, menopause, climacteric syndrome, cardiovascular diseases, metabolic diseases, interdisciplinary consensus, Delphi method, quality of life, active longevity

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Авторы

Сопредседатели: Г.Т. Сухих*^1,2, В.Н. Серов¹, Е.В. Шляхто³, И.И. Дедов⁴, Г.П. Арутюнов⁵, О.Н. Ткачева⁵, А.А. Сметник¹, И.А. Сучков⁶
Члены рабочей группы: И.И. Баранов¹, М.В. Шестакова⁴, Г.А. Мельниченко⁴, О.В. Васюкова⁴, Е.В. Шереметьева⁴, Е.Н. Андреева⁴, Е.А. Шестакова^4,7, Я.А. Орлова⁸, С.В. Виллевальде³, О.Б. Иртюга³, И.В. Сергиенко⁹, И.С. Явелов¹⁰, Н.А. Козиолова¹¹, А.А. Сметник¹, Е.И. Ермакова¹, Е.Н. Дудинская⁵, Г.П. Арутюнов⁵

¹ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. акад. В.И. Кулакова» Минздрава России, Москва, Россия;
²ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
³ФГБУ «Национальный медицинский исследовательский центр им. В.А. Алмазова» Минздрава России, Санкт-Петербург, Россия;
⁴ФГБУ «Национальный медицинский исследовательский центр эндокринологии им. акад. И.И. Дедова» Минздрава России, Москва, Россия;
⁵ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России (Пироговский Университет), Москва, Россия;
⁶ФГБОУ ВО «Рязанский государственный медицинский университет им. акад. И.П. Павлова» Минздрава России, Рязань, Россия;
⁷ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
⁸ФГБОУ ВО «Московский государственный университет им. М.В. Ломоносова», Москва, Россия;
⁹ФГБУ «Национальный медицинский исследовательский центр кардиологии им. акад. Е.И. Чазова» Минздрава России, Москва, Россия;
¹⁰ФГБОУ «Национальный медицинский исследовательский центр терапии и профилактической медицины» Минздрава России, Москва, Россия;
¹¹ФГБОУ ВО «Пермский государственный медицинский университет им. акад. Е.А. Вагнера», Пермь, Россия

Эксперты, принимавшие участие в голосовании, формировании консенсуса и разработке документа: А.С. Алиева, Е.Н. Андреева, Н.В. Артымук, Г.П. Арутюнов, А.Г. Арутюнов, А.Ю. Бабенко, В.Е. Балан, И.И. Баранов, Е.И. Баранова, С.А. Бобров, О.В. Васюкова, С.В. Виллевальде, Р.И. Габидуллина, Н.Ю. Григорьева, О.Р. Григорян, И.В. Губарева, Ю.Э. Доброхотова, С.О. Дубровина, Е.Н. Дудинская, Е.В. Енькова, Е.И. Ермакова, С.К. Зырянов, О.Б. Иртюга, Л.Ю. Карахалис, Е.Н. Карева, Н.Ю. Каткова, Т.В. Кирсанова, Н.А. Козиолова, В.В. Коренная, В.М. Кулешов, Т.А. Макаренко, Л.И. Мальцева, С.В. Мальчикова, Г.А. Мельниченко, Н.В. Мингалева, С.В. Недогода, С.Ю. Никулина, Т.А. Обоскалова, Я.А. Орлова, В.И. Подзолков, Н.М. Подзолкова, А.Э. Протасова, И.В. Савельева, Е.А. Сандакова, М.С. Селихова, И.В. Сергиенко, А.А. Сметник, Т.М. Соколова, Л.С. Сотникова, Н.В. Спиридонова, И.А. Сучков, Г.И. Табеева, Н.И. Тапильская, Е.И. Тарловская, О.Н. Ткачева, И.В. Фомин, М.Б. Хамошина, А.З. Хашукоева, А.И. Чесникова, Г.А. Чумакова, И.И. Шапошник, Е.В. Шереметьева, Е.А. Шестакова, М.В. Шестакова, Е.В. Ших, С.В. Юренева, И.С. Явелов, М.И. Ярмолинская
*g_sukhikh@oparina4.ru

________________________________________________

Co-Chairs: Gennadii T. Sukhikh*^1,2, Vladimir N. Serov¹, Evgeny V. Shlyakhto³, Ivan I. Dedov⁴, Gregory P. Arutyunov⁵, Olga N. Tkacheva⁵, Antonina A. Smetnik¹, Igor A. Suchkov⁶
Working Group Members: Igor I. Baranov¹, Marina V. Shestakova⁴, Galina A. Mel'nichenko⁴, Olga V. Vasyukova⁴, Ekaterina V. Sheremetyeva⁴, Elena N. Andreeva⁴, Ekaterina A. Shestakova^4,7, Yana A. Orlova⁸, Svetlana V. Villevalde³, Olga B. Irtyuga³, Igor V. Sergienko⁹, Igor S. Yavelov¹⁰, Natalya A. Koziolova¹¹, Antonina A. Smetnik¹, Elena I. Ermakova¹, Ekaterina N. Dudinskaya⁵, Gregory P. Arutyunov⁵

¹Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia;
²Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
³Almazov National Medical Research Centre, Saint Petersburg, Russia;
⁴Endocrinology Research Centre, Moscow, Russia;
⁵Pirogov Russian National Research Medical University (Pirogov University), Moscow, Russia;
⁶Pavlov Ryazan State Medical University, Ryazan, Russia;
⁷Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
⁸Lomonosov Moscow State University, Moscow, Russia;
⁹Chazov National Medical Research Center of Cardiology, Moscow, Russia;
¹⁰National Research Center for Therapy and Preventive Medicine, Moscow, Russia;
¹¹Vagner Perm State Medical University, Perm, Russia

Experts who participated in the voting, consensus development, and preparation of the document: Alieva A.S., Andreeva E.N., Artymuk N.V., Arutyunov G.P., Arutyunov A.G., Babenko A.Yu., Balan V.E., Baranov I.I., Baranova E.I., Bobrov S.A., Vasyukova O.V., Villevalde S.V., Gabidullina R.I., Grigorieva N.Yu., Grigoryan O.R., Gubareva I.V., Dobrokhotova Yu.E., Dubrovina S.O., Dudinskaya E.N., Enkova E.V., Ermakova E.I., Zyryanov S.K., Irtyuga O.B., Karakhalis L.Yu., Kareva E.N., Katkova N.Yu., Kirsanova T.V., Koziolova N.A., Korennaya V.V., Kuleshov V.M., Makarenko T.A., Maltseva L.I., Malchikova S.V., Melnichenko G.A., Mingaleva N.V., Nedogoda S.V., Nikulina S.Yu., Oboskalova T.A., Orlova Ya.A., Podzolkov V.I., Podzolkova N.M., Protasova A.E., Savelyeva I.V., Sandakova E.A., Selikhova M.S., Sergienko I.V., Smetnik A.A., Sokolova T.M., Sotnikova L.S., Spiridonova N.V., Suchkov I.A., Tabeeva G.I., Tapilskaya N.I., Tarlovskaya E.I., Tkacheva O.N., Fomin I.V., Khamoshina M.B., Khashukoeva A.Z., Chesnikova A.I., Chumakova G.A., Shaposhnik I.I., Sheremetyeva E.V., Shestakova E.A., Shestakova M.V., Shikh E.V., Yureneva S.V., Yavelov I.S., Yarmolinskaya M.I.
*g_sukhikh@oparina4.ru

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