Q&A: Pharmacists Are Underutilized but Essential Guides in Menopause Care

Although pharmacists are well-known as the most accessible providers across the health care sector, one area that this reality is especially important is within menopause care. With constant fragmentation in care for patients who see their pharmacist much more than their primary care physicians, pharmacists have an immense role to play in menopause care, which is often overlooked by the greater health care environment.

“I feel like menopause care is so often reduced to the question of whether someone should or should not take hormone therapy, but it’s a whole lot broader than that,” Lisa Miller, PharmD, MSCP, associate dean and clinical professor at the University of Florida College of Pharmacy’s Department of Pharmacy Education & Practice, told Drug Topics®. “That’s where pharmacists come in. It involves medication safety, cardiometabolic risk, mental health, bone health, all of those things, and the patients often come to the pharmacy first, looking for answers.”

Read through Miller’s insights to learn more about the pharmacist’s role in menopause care today, how it could further advance in the future, and what opportunities are available for pharmacy professionals to make an immediate impact on women’s health in their communities.

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Drug Topics: What about the pharmacist’s expertise in menopause care do you believe is often overlooked or undervalued, and how can the pharmacy community come together to make their places known in improving menopause outcomes in the future?

Lisa Miller: Getting back to the fragmented care that I talked about earlier, I think what’s most overlooked is the pharmacist’s ability to see that entire treatment picture. They’re the one person that’s going to see everything come together from all the various specialties. We’ve discussed how many women are piecing together advice from multiple clinicians, but what we haven’t talked about is that they’re also getting advice from social media, online menopause influencers, and other women in social media groups. Not all of that information is correct. Where I really see pharmacists helpful is that I feel like they’re the best trained to step back and say, ‘Is this safe, is this necessary, is this helping, and is there something here that might be making the patient feel worse?’

I feel like menopause care is so often reduced to the question of whether someone should or should not take hormone therapy, but it’s a whole lot broader than that. That’s where pharmacists come in. It involves medication safety, cardiometabolic risk, mental health, bone health, all of those things, and the patients often come to the pharmacy first, looking for answers. One place the pharmacists really shine is that they have a very practical understanding of formulation and route for various hormonal products. They can talk to women about oral versus transdermal estrogen, what local versus systemic therapy means, drug interactions, how to monitor adverse effects. All of these are areas where pharmacists really can contribute meaningfully.

I also think pharmacists need to be more visible and confident in the space. I think we need more continuing education. We could always use more in the menopause space, but again, so could all health care professionals. We could use better practice tools and stronger representation in interdisciplinary menopause conversations as well. And again, we’re not replacing clinicians, we are just helping make the care that patients receive safer, clearer, and more coordinated.

Drug Topics: How can pharmacists in more traditional community or retail settings initiate collaboration in this space to improve outcomes and access to menopause care in their communities?

Lisa Miller: Community pharmacists are the most accessible health care professionals. Study after study has shown us that. It makes them really incredibly important in menopause care. Really, for the pharmacist, the first step is just recognizing patterns. This is where a lot of physicians kind of fall short because they’re only looking at their specialty and they’re not recognizing patterns across multiple areas. For example, if a woman’s regularly picking up medications for sleep or mood, vaginal symptoms, weight management, that can really open the door to an important conversation that the pharmacist can have right there at the time with patients. Even asking something like, ‘Have these concerns changed any during perimenopause or menopause,’ or even having that conversation of, ‘Some of these things occur during perimenopause, has anyone told you that that might be a possibility?’ All of those things can be really incredibly validating for women that are confused within the health care system about what’s going on.

Pharmacists can also help patients better understand the therapies that they’re using, whether that’s hormonal, nonhormonal, supplements, over-the-counter (OTC) products, all of those things women use in the menopause transition. We can really help women sort through what’s evidence-based, what may be risky, and what may deserve further discussion with their health care provider.

On the collaboration side, I think pharmacists can really build relationships with local gynecologists, primary care physicians, even mental health providers in their area. One discipline that many people overlook are pelvic floor therapists. All of these are very useful health care providers in a woman’s armamentarium for going through the menopause transition. Within all of these settings, a pharmacist providing a concise medication regimen or related recommendation can be really valuable. For example, a patient is using multiple OTC sleep products along with an antidepressant and is continuing to report frequent night sweats or vasomotor symptoms. She may benefit from reassessment of these vasomotor symptoms and some additional treatment options. I really feel like community pharmacists don’t have to open a menopause clinic to make a meaningful impact.

READ MORE: Women’s Health Resource Center