Context. Estrogens not only regulate important aspects of the functioning of the cardiovascular system, but also decrease the risk of developing cardiovascular diseases. One of the consequences of estrogen deficiency in postmenopause is a significant increase in the frequency of cardiovascular pathology, caused by changes in the elastic properties of blood vessels, a violation of the electrophysiological mechanism of pulse formation in the myocardium and atherosclerosis. Objective. To assess the effect of HRT on the elastic properties of blood vessels and on the characteristics of idiopathic ventricular arrhythmias without structural changes in the heart in women with vascular risk factors in the postmenopausal period. Patients. 64 women in the early postmenopausal period (52.8 ± 2.8 years).3 groups: I group-oral HRT, II transdermal forms, III-control Methods. Daily Holter monitoring of the ECG was performed to assess the types and parameters of rhythm disturbances. Elastic properties of blood vessels (speed of pulse wave propagation, augmentation index) were measured by sphygmography. The treatment control interval was 6 months. Results. The beneficial effect of estrogen-progestogen drugs on the elastic properties of the vascular wall in patients in the early postmenopausal period, most pronounced when using transdermal forms, has been established. In women with hypertension 1-2 stages receiving antihypertensive therapy, the use of combined HRT demonstrated a decrease in pulse wave velocity (by 38.3 + 5.7%) and improvement of vessel stiffness parameters, but an increase in the augmentation index (by 13.3+ 0.9%), possibly related to the interference of antihypertensive drugs. In patients with idiopathic rhythm disturbances the predominance of single, paired and group ventricular arrhythmias was revealed in the structure, which is explained by the electrophysiological features of the work of the woman's myocardium. Purpose HRT leads to a significant decrease in the number of ventricular arrhythmias (a decrease in single and paired (by 58.5 + 1.1%), the disappearance of group ventricular extrasystoles). Conclusions. The appointment of menopausal hormone therapy can reduce the risk of cardiovascular disease in women with vascular risk factors in the postmenopausal period by improving the elastic properties of the vascular wall and stabilizing the electrophysiological mechanism of pulse formation in the ventricular myocardium.