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Independents can ensure their teams are well informed about the menopause through a range of high quality resources. Victoria Goldman reports…

A series of articles published in The Lancet in March 2024 revealed that many women feel unsupported during the menopause and there’s a strong need for high-quality information, decision-making tools and targeted support.

Individual experiences of the menopause are influenced by many factors, including age, symptoms, ethnicity, self-esteem, family life and general health.

The media is now bursting with information on the menopause, with advice coming from not only specialist healthcare professionals but also self-styled ‘menopause experts’ with no medical training.

An article published in the Post-reproductive Health journal in March 2024 stated that community settings such as pharmacies are well placed to support and educate women about the menopause.

Community pharmacies already provide advice on contraception and sexual health, as well as relevant lifestyle interventions, such as smoking cessation and weight management.

However, few studies have assessed the effectiveness of specific community pharmacy-led interventions in improving peri- and post-menopausal health.

“As experts in medicines, community pharmacists are well-positioned to educate women by providing clear, accurate information on the different symptoms and stages of the menopause, and what treatment is available,” says Professor Claire Anderson, the Royal Pharmaceutical Society president.

“We can discuss common side effects and answer any questions about myths. Pharmacists can recognise and manage accompanying conditions such as hypertension, bladder problems or anxiety, referring patients on for further support when necessary.”

Education and awareness

According to an editorial in the British Journal of General Practice in September 2024, menopausal symptoms in women over 40 are often treated with hormone replacement therapy (HRT) to counteract oestrogen and/or testosterone deficiency.

However, write the authors, the menopause is also a natural life stage, so it’s important to take a holistic approach rather than solely a medical one, to ensure individualised care.

The launch of the HRT prepayment certificate in April 2023 made HRT more affordable, especially for disadvantaged groups. However, rising demand for HRT has led to short supplies of certain products, fuelling claims that HRT is now being overprescribed in some cases.

An International Menopause Society (IMS) position statement, published as a White Paper in the Climacteric journal in September 2024, states that some menopausal symptoms such as hot flushes and night sweats, sleep disturbances, mood swings and brain fog will usually improve over time on their own.

However, troublesome symptoms should be treated appropriately with HRT, prescribed non-hormonal treatments or a non-medical approach, such as lifestyle changes.

Dry mouth is one of many symptoms associated with the menopause. Also known as xerostomia, dry mouth can leave sufferers feeling constantly parched. It can be sore, can make the lips feel dry and chapped, and can even disrupt sleep or affect the ability to chew or speak.

Dry mouth may occur during menopause due to the reduction of oestrogen and progesterone in the body, which can cause reduced saliva production. Dry mouth doesn't just affect comfort; decreased saliva production also increases the risk of oral health issues, such as tooth decay, infections, and gum disease (gingivitis).

GP Sarah Jarvis, who is working with oral health brand TePe to raise awareness about dry mouth, said: “Saliva plays a crucial role in neutralising acids and washing away food particles and bacteria in the mouth.

“Without sufficient saliva, harmful substances can accumulate and cause oral health issues.” 

Pharmacy advice

Community pharmacists are well-placed to provide health screening and educational programmes on menopause management. A wide range of information on the menopause is available for healthcare professionals and patients.

The CPPE website, for example, has a page devoted specifically to menopause learning resources (www.cppe.ac.uk/gateway/menopause), including its own e-learning programme and resources from the British Menopause Society (https://thebms.org.uk).

Pharmacy customers can be directed to evidence-based patient resources, such as the NHS website, The Menopause Exchange (www.menopause-exchange.co.uk) and Menopause Matters (www.menopausematters.co.uk). 

“The menopause can be a sensitive topic for many women, so it is very important to engage and encourage these conversations,” says Kenny Chan, lead information services pharmacist at Numark.

“Ensure that all pharmacy staff are well-informed about the menopause, its symptoms and available treatments, and use the consultation room where patients can discuss their symptoms and concerns without feeling embarrassed or exposed.

“Display easily accessible leaflets about the menopause, its symptoms and treatment options, and use posters to raise awareness and encourage patients to speak to the pharmacist if they have concerns.”

Most effective treatment for troublesome hot flushes 

According to the British Menopause Society, HRT is the most effective treatment for troublesome hot flushes and night sweats, and it can also reduce the risk of long-term medical conditions such as osteoporosis.

While it may increase the risk of breast cancer, stroke and blood clots, this risk varies from woman and woman. Making an informed individualised decision about the risks of HRT versus its benefits is therefore essential.

“Through consultations, community pharmacists can discuss the risks and benefits of each treatment option and offer personalised advice and resources to help women make informed decisions about their health,” says professor Anderson.

“When dispensing HRT, we can make sure women understand how to use their medicine effectively, discuss potential side effects and encourage them to book in for regular reviews. We can also offer advice on lifestyle changes.”

If women can’t, or don’t want to, take HRT, their GP may be able to prescribe suitable alternatives, depending on their symptoms.

“Non-hormonal prescribed treatments for menopausal hot flushes and night sweats include clonidine, some SSRIs (some of which shouldn’t be taken if women are taking tamoxifen), and an SNRI (venlafaxine),” says Norma Goldman, founder and director of The Menopause Exchange.

“Pharmacists should be aware of new products to treat menopausal symptoms, and a new drug for moderate to severe hot flushes, fezolinetant, which is, at the moment, only available on private prescription.”

Many women prefer to self-manage menopausal symptoms with over-the-counter products, including herbal remedies, phytoestrogens and dietary supplements. Many of these products also carry a risk of side-effects or contraindications.

“If someone wishes to buy a product for the menopause, the pharmacist needs to find out about their symptoms, along with their age, whether they’ve already tried any products, have underlying medical conditions and any medication they’re on,” says Norma Goldman.

For many women, self-help measures can help to ease hot flushes and night sweats.

“Useful tips to pass on include dressing in easily removed layers and wearing natural fibres as much as possible,” says Norma Goldman.

“Cut out or cut down on coffee, tea, cola drinks and spicy foods, as these can trigger hot flushes or make them worse. Reduce stress levels with rest, a good work-life balance and activities such as yoga and tai chi.

“Smoking cessation advice is also important – on average, smokers experience the menopause about one year earlier than non-smokers, and it may be up to two years in heavy smokers.

“Excessive alcohol should be avoided as it can increase hot flushes. If a customer has tried self-help without success, they should discuss prescription treatments with their GP.”