by Irene Stronczak-Hogan B.Pharm.Hons.R.Ph. NCMP
By the year 2025 12% of the world’s population will consist of menopausal women. The baby boomers have reached their peak and are now joined by the Gen X ladies.
Menopause is still a taboo subject for many. Most women have little knowledge about what to expect or how to find solutions. Of the women who do seek help, 75% are untreated or offered platitudes such as “it’s your age, learn to live with it, hormones cause cancer and don’t waste your money on supplements.”
Women often feel ashamed and confused. Physicians have neither the time nor education to help menopausal women with their multitude of symptoms. All women will experience menopause. Up to 80% of them will suffer with symptoms such as hot flashes, night sweats, insomnia, brain fog, weight gain and decreased libido. Hot flashes may last for up to 11 years and have been shown in some women to be an indicator of CVD. These symptoms interfere with their physical and mental health.
This is an untapped market where pharmacists can not only build a sustainable consulting practice, they can improve their patients’ health at the same time as forming long-lasting relationships with them.
So, let’s look at how to introduce a menopause clinic in your pharmacy.
How to identify and assess patients with menopausal symptoms? What supplements are effective? What are the non-hormonal and hormonal options recommended? Be familiar with the current guidelines for hormone replacement therapy. Be able to individualise treatment plans for your patients.
How does one start? With your very first patient one at a time. Screen your patient profiles for women in the age group 40-60 years of age for prescriptions for oral contraceptives, anti-depressants, sleeping pills, osteoporosis drugs, vaginal hormones and hormone replacement therapy. Are they compliant? Do they know about nutrients that may be beneficial or need supplementing with their prescription medications?
Offer a patient consultation to those patients. This is a time to talk, answer questions, gather information, and give the patient uninterrupted quality time to discuss their issues and look at solutions and begin to formulate a plan based on their individual risks and priorities.
Menopause occurs naturally after 12 consecutive months of amenorrhea, and the average age of a woman is 52. Perimenopause is the time prior to menopause and may last up to 15 years. Perimenopause is a time of large fluctuations in hormones, increasing estrogen, declining progesterone, changes in menses combined with menopausal symptoms. In menopause, there is a rapid decrease in ovarian hormones which can cause hot flashes, night sweats, insomnia, weight gain, vaginal dryness, incontinence, mood changes and decreased libido amongst many others. Women are looking for proven therapies to help them. You can fill that niche and become the go-to expert.
The menopause quick 6 screen is a useful tool to screen patients:
Any changes in your periods?
Are you having any hot flashes?
Any vaginal dryness or pain or sexual concerns?
Any bladder issues/ incontinence?
How’s your sleep?
How’s your mood?
Treatment options include the following:
- Nutritional supplementation
- Vitamin & herbal supplements
- Lifestyle options – i.e. weight management, stress reduction, exercise, CBD, hypnosis, paced respiration
- Hormonal options – Individualized therapy
- -Dosage form choices
- -Dosage adjustment
- -Dosage tapering
- Non-hormonal options
There are many resources available to learn about supplements and herbs for women’s health. Become familiar with the research and their use.
The guidelines and landscape for hormones in menopause are in constant flux. Therefore, as a pharmacist you need to be aware of the current guidelines from the recognized organizations.
As a certified menopause practitioner with NAMS I refer to their documentation frequently.
Here are their current updated guidelines:
- Hormone therapy gold standard for relief of VMS
- Estrogen alone after hysterectomy
- Women with a uterus Estrogen+Progestogen or CEE + bazedoxifene(TSEC)
- Lowest dose that offers relief and assess periodically
- Progestogens relieve VMS-
- Micronized progesterone 300mg hs/synthetic progestins no long-term studies
- Benefits are mostly likely to outweigh risks for symptomatic women who initiate HT when aged <60 years or who are within 10 years of menopause onset
- Limited observational evidence suggests that HT use does not further increase risk of breast cancer in women with a family history of breast cancer or in women after oophorectomy for BRCA 1 or 2 gene mutation
- Lowering doses and/or changing to transdermal HT may be appropriate as women age or in those with metabolic syndromes such as hypertriglyceridemia with risk of pancreatitis or fatty liver
A common question is when do women need to stop HRT, and the answer is that each woman is an individual. Do not just stop treatment due to age alone.
For those pharmacists interested in further options for their patients, compounding is a specialty that offers individualization of treatment plans and solutions that may not be available commercially. This includes testosterone replacement for women. Vaginal preparations for vaginal atrophy, painful sex, anorgasmia, and vaginisimus, which are not obtainable in regular pharmacies. These may include for example estriol, diazepam, hyaluronic acid, amitriptyline and other active ingredients in a vaginal delivery system.
Marketing your practice is essential. Many opportunities exist. These are just some of my suggestions:
- Med checks
- Specialty compounding
- Screening clinics-osteoporosis,
- Women’s workshops
- Thermography clinics -Breast health
- Weight management clinics
- Nutritional & natural supplements consults
This is an overview of how I initiated a paid for women’s health consulting business in the pharmacy I worked at. We started at 1 day a week and ended up with one full-time pharmacist and a technician.
I now run an independent consulting business along with authoring a book on menopause. I still work in community pharmacy.
When will you take the first step to offer your patients a service that will not only improve their wellness, but also your revenue and satisfaction with the profession of pharmacy?
NAMS North American Menopause Society
Natural Medicine’s Database
The Complete Natural Medicine Guide to Women’s Health
Women’s Encyclopedia of Natural Medicine
Encyclopedia of Natural Medicine
Irene Stronczak-Hogan B.Pharm.Hons.R.Ph. NCMP