Objective of the Review: To analyse the efficacy and safety of the ultralow-dose menopausal hormonal therapy (MHT). Key Points. In developed countries, the life expectancy is growing and the issue of improved quality of life of elderly women is becoming quite acute. On the average, a third (or a half for early menopause) of a modern woman’s life falls on the post-menopause period. Termination of oestrogen synthesis in ovaries during menopause is associated with marked reduction in the quality of life, development of vasomotor symptoms, sleep disturbances, accelerated skin ageing, an increased risk of cardiovascular pathologies and a number of somatic disorders, urinogenital atrophy, osteoporosis, and cognitive disorders. MHT is a proven and efficient means of quality of life improvement; however, the safety of sex hormone therapy in elderly women is still a topical issue. In this article, we are discussing the efficacy and safety of oral MHT drug containing 0.5 mg of 17β-estradiol and 2.5 mg of didrogesteron. Conclusion. The advent of ultralow-dose MHT drugs allowed significantly reducing the number of side effects from sex hormone therapy during post-menopause vs. side effects from higher doses of estradiol with comparable clinical effects. Keywords: menopausal hormonal therapy, ultralow-dose drugs, estradiol, didrogesteron.