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As evidence mounts that menopause before 40 raises the risk of high blood pressure, independent pharmacies could be central to catching it earlier. By Sasa Jankovic…

Women who go through menopause before the age of 40 face a significantly raised risk of developing high blood pressure, according to a large UK Biobank study published in July in Menopause, the journal of The Menopause Society.

Researchers tracked more than 107,000 postmenopausal women over a median follow-up of 14.5 years, finding that 22.6% of those with premature menopause developed hypertension, compared with 16.6% of women who reached menopause at the typical age after 45.

Even after accounting for weight, lifestyle and other variables, premature menopause carried a 12.3% higher hypertension risk, with the danger peaking among women who stopped menstruating between the ages of 25 and 35.

Pharmacy advice

The current NHS hypertension case finding service principally targets people aged 40 and over, although younger adults may be included exceptionally where pharmacy staff judge them to be at increased cardiovascular risk.

For community pharmacists already at the frontline of hypertension case-finding, these findings emphasise the need to bring younger menopausal women into the conversation about cardiovascular screening.

“This study strengthens the case for recognising premature menopause as a cardiovascular risk marker”, says pharmacist independent prescriber Deborah Evans, owner and founder of Remedi Health, and a menopause and longevity specialist, “although it should also be recognised that whatever age a woman reaches menopause, her risk of heart disease increases.”

The 40 fulcrum

Last October the then Health Secretary Wes Streeting announced that menopause would be added to the NHS Over-40 Health Check – a direct result of campaign group Menopause Mandate’s MM40+ campaign calling for this simple, preventative step to help millions of women recognise symptoms earlier, access appropriate care, and make informed choices about their health.

This follows the findings of Menopause Mandate’s 2025 Mega Survey, which gathered responses from more than 15,000 women, which showed that an overwhelming 99% of respondents said menopause should be included in the 40+ check, as only 14% said they had learnt about menopause from a healthcare professional (HCP), underscoring the urgent need for better education and early intervention.

While the government announcement marked a milestone in recognising menopause as a key women’s health issue and a national healthcare priority, should community pharmacies be the place to offer hypertension screening to more menopausal women under the age of 40?

Evans says she “would support targeted, proactive screening rather than blanket screening of all women under 40” and that “women with confirmed or suspected premature menopause, surgical menopause or premature ovarian insufficiency should be considered for a blood-pressure check and wider cardiovascular risk assessment”.

However, she stresses that “this is different from screening every younger woman reporting a possible menopausal symptom”, adding that: “Community pharmacists should be able to offer the check when clinically indicated, record why the under-40 exception has been applied and communicate the result directly to general practice.”

Model improvement

Despite changes to menopause care progressing at pace, in April this year, the Royal College of Pharmacy warned “there remains significant unmet need” when it comes to clear, evidence-based guidance and advice on menopause.

So, how can guidelines and clinical training in the context of the neighbourhood health service model be improved to ensure women can access the support they need?

"There remains significant unmet need for clear, evidence-based and accessible information about women's health in general, including menopause”, says professor Mahendra Patel, chair of the Royal College of Pharmacy's English Pharmacy Advisory Council.

As a result, he says pharmacy teams need “appropriate, culturally aware training and clear guidance on how they can support women across different communities, including when to provide self-care advice, when further assessment may be needed, and where to signpost or refer.”

It’s also vital that knowledge is current and based on the most recent evidence.

“Training should cover premature ovarian insufficiency and surgical menopause as well as menopause at the usual age; less widely recognised physical and psychological symptoms; cardiovascular and bone health; evidence-based self-care; HRT and non-hormonal options; contraindications and interactions; and how to challenge misinformation sensitively,” says Evans.

As the NHS moves towards neighbourhood-based care, Professor Patel also believes community pharmacy should be “properly integrated into neighbourhood health teams and work alongside general practice, women’s health hubs and other primary care services to provide more joined-up support closer to home."

ICB role

With this in mind, Professor Patel says ICBs play an important role in making this work locally “by ensuring community pharmacy is included from the outset in neighbourhood health planning, as well as understanding and addressing local inequalities and ensuring services meet the needs of their communities, including through accessible settings such as community pharmacy.”

Evans says national commissioners should now review whether premature menopause should be “expressly added to the hypertension case finding service specification’s examples of increased risk”, since ICBs “can turn national recommendations into a functioning local pathway”.

However, experts are clear that outcomes should be monitored by age, ethnicity, deprivation and other relevant characteristics so that a new service does not simply reach women who are already well served.

The co-chair of Menopause Mandate Tina Backhouse says: “I don’t see many ICBs asking women what ideal health provision looks like, and it would be nice if they did so.”

Raising awareness

There is also plenty of room for improvement when it comes to public awareness-raising campaigns about menopause.

“People say that everyone now knows about menopause, but we know from our annual Menopause Mandate survey that this is absolutely not the case”, says Backhouse.

“What’s more, only 14 per cent of women learn about menopause from an HCP; the majority get information from friends, books and an unregulated social media. We need to ensure that every woman has the same information and choices and is seen by an educated HCP. It’s been proven time and again that education makes the transition easier.”

Professor Patel agrees, adding: “We should be making it easier for women to know where to turn for trusted advice and support, wherever they live and whatever their background."

For Evans, any campaign should also show what community pharmacies can offer: “An accessible, confidential conversation; evidence-based self-care advice; medicines support; blood-pressure assessment where eligible; and referral when necessary.

“The clearest message is that women do not have to manage significant symptoms alone and that help should be available close to home without requiring them to navigate a fragmented system.”