HRT manufacturers have reported “exceptionally high demand” for their products due to a greater awareness of menopause treatments and increased confidence among medical professionals to prescribe. HRT prescriptions have more than doubled in the last five years – according to figures from OpenPrescribing – from 238,000 in January 2017 to 538,000 in December 2021.

 

The increased demand has caused supply shortages for various HRT preparations as far back as 2018. As soon as a product has good availability, it may soon become out of stock as patient prescriptions are switched over to it. It’s frustrating for patients, GPs and pharmacists.

 

And it’s no smooth journey for patients either. No menopause experience is the same and women can experience at least 34 symptoms with different combinations and severity. Symptoms also have a habit of slowly creeping up on women, leaving them confused and overwhelmed.

 

Pharmacists are well placed to help women understand menopause and the stage they are experiencing, as well as being able to validate symptoms and cut through any confusing information online about relief and treatment.

 

During the HRT supply issues, there is also an opportunity to provide lifestyle advice that may help women manage menopause symptoms. It’s vital to know where to signpost women in an ever-changing digital health landscape and how to identify misinformation online.

 

Six ways pharmacists can support menopausal women

 

1) Be up to date about menopause

Knowing about menopausal health is instrumental in talking to women about their experiences. Pharmacists need to improve their knowledge across pathophysiology, diagnosis, stages of menopause, symptoms and treatment. 

 

2) Listen and hold menopause in mind

Menopause symptoms can be variable and vague, and women are looking for relief in a variety of places. When a midlife woman asks for advice, show empathy and be curious as to whether their struggles are related to menopause. Signpost them to help, as navigating health services is difficult, especially when feeling unwell, under pressure and juggling work and home life.

 

3) Understand the impact of HRT shortages

The patient experience can be convoluted and doctors are even asking patients to advise on what local pharmacists have in stock. You can be proactive with your patient advice by checking:

• The Department of Health and Social Care’s serious shortage protocols for HRT products
• Manufacturer websites
• The British Menopause Society, which frequently details resolution dates online.

 

Pharmacists can advise patients and prescribers about suitable alternative products by considering the dose, formulation, a woman’s risk profile and her preferences. If you need help, familiarise yourself with the British Menopause Society’s HRT preparations and equivalent alternatives tool.

 

If a woman’s HRT prescription has been changed, give clear advice on how to administer the new medication and where to go to get advice if they have an adverse reaction or new/worsening symptoms. For example, women switching from transdermal gels to patches need to know that patches should be administered to the abdomen, unlike gels that are typically applied to skin on the thigh. 

 

4) Provide lifestyle and behaviour change advice 

In line with National Institute of health and Care Excellence (Nice) guidance for menopause, pharmacists should provide lifestyle and behaviour change advice to menopausal women. Behaviour change is difficult and can take time, but it can have a marked effect on menopause symptoms with the right encouragement.

 

HRT doesn’t work for everyone or every symptom and it is not appropriate or safe for some. Lifestyle changes, whether as a complement to HRT or not, can improve sleep disturbance, weight gain, bladder problems, low libido and mood issues.

 

Lifestyle advice that can help symptoms includes:

• Increase protein – it helps people feel fuller for longer and keeps sugar cravings at bay 
• Do a weight-based activity twice a week – it can help with weight gain during menopause 
• Avoid caffeine at least six hours before bedtime to help improve sleep 
• Try meditation if experiencing feelings of stress, anxiety and overwhelm
• Try pelvic floor exercises to improve symptoms of urinary incontinence 
• Wear natural clothing fibres or layer clothing to help with hot flushes

 

5) Help patients try apps and online tools

Digital health technology is becoming more commonplace and the World Health Organization reports that “digital technologies will shape the future of global health”. Nice menopause guidelines stipulate that women should be provided with information about menopause in a format suited to their needs, while the International Pharmaceutical Federation (FIP) suggests that digital health tools “improve people’s ability to self-manage their health”.

 

Pharmacists should know what digital health technology can help women during menopause, and be able to educate them on its benefits and uses. By recommending trusted mobile health apps, pharmacists empower women about menopause long after they have left the pharmacy.

 

For example, new menopause relief apps are emerging that can help women learn more about managing symptoms through lifestyle change and cognitive behaviour therapy, such as Stella.

 

6) Safety netting appropriately

For women who have been newly prescribed HRT, pharmacists need to explain that unscheduled vaginal bleeding is a common side effect within the first three months. Let them know to tell their doctor during their medication review, or if vaginal bleeding occurs after the first three months.

 

It’s also important that women seek help from their doctor if their symptoms worsen or change, if they have medication side effects or if their treatment no longer controls their symptoms. Urgent medical attention should be sought for red flag symptoms, such as unintentional weight loss, a change in bowel habit, persistent urinary symptoms (including blood in urine), fatigue that impacts daily life, persistent bloating, or palpitations associated with chest pain or breathlessness.

 

Lastly, pharmacists need to take menopause symptoms seriously. Mood problems are commonly reported during menopause and the rate of suicide for females is highest between 50 and 54 years. There are charities, helplines and resources available for those who need signposting to support, including Samaritans, Menopause Matters, and the Daisy Network (for early menopause). 

 

The time for pharmacists to be part of better menopause care is now

 

Demand for menopause information and treatment will only increase in the coming years. By keeping clinical knowledge up-to-date and learning about new lifestyle change apps, pharmacists can make a difference and provide holistic care to menopausal women. 

 

Helen Henderson is a pharmacist and clinical associate at digital health company Vira Health, which is behind menopause relief app Stella