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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.