How Pharmacists Can Join the Menopause Care Team

In a recent episode of Elevating Practice: The Future of Pharmacy, Erin Albert, PharmD, with Mark Cuban Cost Plus Drugs, and Stephanie Young Moss, PharmD, MHSA, a menopause educator and founder of Menopause in Color, discussed how pharmacists can play a role in joining the menopause care team.

More Than Hot Flashes

"The technical definition of menopause is when you don't have a cycle for 12 months and 1 day consecutively," she said, noting that the years leading up to it—perimenopause—are "really the most symptomatic time," bringing sleep disruption, night sweats, mood changes, brain fog, and genitourinary symptoms.

"If you're waking up several times a night…then the next day you're in the boardroom trying to give a presentation, that can be a problem," Moss said, pointing to absenteeism and presenteeism as measurable workplace costs.

She also pushed back on the idea that menopause is a narrowly reproductive event.

"Estrogen is all over the body,” she said. “We have receptors all over the body, and so it affects all over the body as well," including cardiometabolic health.

The 87% Problem

Albert cited Mayo Clinic research finding that roughly 87% of symptomatic women had not sought care, either from being too busy or unaware of options. Moss found the study population especially telling.

"Those women were actually patients in the Mayo Clinic…they had a primary care doctor, which means they had good health insurance," she said. "Imagine women who don't have health insurance."

She added, "If they don't know what to ask for treatment or what they're treating, then treatment is impossible because they don't even know what's going on with them."

The Long Shadow of WHI

The Women's Health Initiative (WHI) still shapes prescribing 2 decades later. Moss was a new graduate when the findings landed in 2001. "I remember everyone being taken off and freaking out," she said. “We kind of extrapolated how it affects to the older population [and] also the women in the younger population, and they didn't really look at risk versus benefit.”

That correction from WHI never traveled as far as the original alarm of the publication. “The [hormone replacement therapy (HRT)] prescriptions decreased about 80% when women came off of HRT, and now we're starting to see it pick back up because people are more educated. They're starting to understand more. Women are speaking up. Health care providers are studying and understanding more what was going on and why was wrong,” Moss said.

Today's guidance is more individualized, weighing age, health history, and route of administration—oral versus patch. The misconception Moss corrects most often cuts both ways.

"Hormone therapy is either universally dangerous or is universally appropriate for everyone, and that is not the truth," she said.

A close second misconception? "Menopause equals hot flashes? That's not the only thing that menopause is about."

Where Pharmacists Fit

Pharmacists can review complete medication histories, flag supplement interactions, and discuss adherence—but Moss urged starting with the person, not the prescription. "Don't start with medication. It's more important to start with the woman and their symptoms that they're having."

The bigger barrier is legal. Pharmacists in many states may prescribe hormonal contraception under protocol, but hormone therapy is excluded. "That to me does not make sense," Moss said. "It's still in the same bucket."

She envisions structured screening plus collaborative practice agreements—particularly valuable in pharmacy deserts. For pharmacists looking to catch up, she recommends revisiting fundamentals first, then certification through The Menopause Society or ACOG.