Q&A: Pharmacist Urges Women to Advocate for Their Menstrual Health

Menstrual pain is a reality for many women, yet for too long, conversations about effective management have been relegated to the sidelines of health care. As awareness grows and stigma fades, pharmacists are emerging as key advocates for women seeking relief from monthly discomfort. Michelle Palmer, PharmD, FASCP, a medication therapy management pharmacist at Consana Health, offers a holistic approach that blends medication, lifestyle changes, and patient empowerment—helping women move beyond simply enduring their symptoms.

Palmer discusses a range of evidence-based strategies for managing menstrual pain, from heat therapy and gentle exercise to the use of NSAIDs and continuous hormonal contraception. She emphasizes the importance of tracking symptoms and tailoring care to each individual, highlighting the growing role of technology like period tracker apps in personalizing treatment. As pharmacists take on expanded responsibilities—including, in some states, prescribing oral contraceptives—Palmer’s insights reflect a new era in women’s health, where practical advice, compassion, and innovation come together to support patients in taking control of their menstrual well-being.

A range of evidence-based strategies for managing menstrual pain, such as heat therapy and gentle exercise, can help improve menstrual pain. | Image Credit: Pat Lalli - stock.adobe.com

Drug Topics®: What are some of the nonpharmacological strategies pharmacists can recommend for managing menstrual pain? How can pharmacists integrate these into a patient counseling session?

Michelle Palmer, PharmD, FASCP: There are several nonpharmacologic strategies that are supported by evidence. This includes heat therapy, gentle exercise, adequate sleep, and relaxation techniques such as yoga. If a patient's interested in heat therapy, you can recommend options such as heating pads, hot water bottles, or adhesive heat patches, and the goal of the heat therapy is to provide it to the lower abdomen or lower back for about 15 to 30 minutes at a time. You want to recommend using a thin barrier to protect the skin and minimize irritation. It could be helpful to pair the heat with NSAIDs to improve relief; also, adding some light stretching or some exercise—all this can really enhance the blood flow—and hydration and relaxation can really amplify all those benefits. So when you're counseling patients, come up with a really practical plan. Start with NSAIDs, use heat, stay hydrated, and incorporate some light activity and some relaxation techniques.

Drug Topics: How can pharmacists counsel a patient who presents with severe, debilitating menstrual pain that has not responded to multiple OTC therapies?

Palmer: So it's important to try a few cycles at first to see if these medications are helping. If a patient that hasn't found relief after maybe 3 to 6 cycles, I would certainly refer them to their OBGYN to rule out any secondary causes, such as endometriosis. They may need imaging or a trial of hormonal suppression. You can also encourage them to track their cycle patterns, the bleeding, and pain severity and any other previous treatments so they can help their prescriber come up with a targeted plan. One thing you might mention to the patients as well is if they're having really severe or disruptive pain that they might look at continuous sideline and hormonal contraception. So that would mean using an oral contraceptive, a patch, or a ring without the placebo or that hormone-free week. This can be really effective. So what this approach does is it suppresses ovulation and limits that endometrial buildup, so it can overall reduce that cramping and bleeding. They may have some breakthrough bleeding at first, but most patients may see improvement over time, and I'm a big proponent of continuous cycling. It's safe and evidence-based and very convenient for patients.

Drug Topics: How can pharmacists stay up-to-date on new guidelines, medications, and nonpharmacological treatments related to women's health conditions like dysmenorrhea, PCOS, or menopause?

Palmer: There are many helpful resources that can help patients stay up to date. One of my favorites are the clinical guidelines from professional organizations such as ACOG, which stands for the American College of Obstetricians and Gynecologists. Pharmacists can also stay up-to-date using PubMed alerts or family medicine or OBGYN summaries and looking for CE that's focused on women's health.

Drug Topics: How do you see the role of the pharmacist evolving in the area of women's health, particularly with the growing number of OTC options and direct-to-consumer health care models?

Palmer: So pharmacists really are increasingly the frontline for self-care for these patients. We can really help patients optimize their NSAID use, manage hormonal therapies, possibly even prescribe oral contraception in some states and integrate nondrug strategies. Something that I'm very interested in, again, are these period tracker apps. It's a valuable tool for patients to log their symptoms, track their flow, and identify any patterns. So this would be a great suggestion for patients as well, and these apps can vary in what their focus or their strength is. Some are designed to track their fertility or ovulation. Some of them help track symptoms, severity, mood, and lifestyle or even include educational content or maybe targeted for teens. So when counseling, I would just really encourage patients to gather information about themselves and their body and look for an app that's based upon their personal goals and can ensure patient privacy they might want to look into how data is stored, whether it's shared with any third parties and if it's encrypted or can use the passcode to protect their data.

Drug Topics: Is there anything else you would like to add?

Palmer: I want to end on the importance of a comprehensive assessment. What is the patient cycle pattern? Encourage a period tracker to get that information. What NSAIDs have they tried? Are you optimizing the dose and timing? Make sure we're looking at contraindications for any of our recommendations, any bleeding patterns, pain with intercourse, or even a family history of endometriosis, and encourage your patients to speak up. I want them to be empowered to talk to you or their health care provider if the pain is impacting their life. Provide a written action plan, including their medication, the dose, the timing, and any nondrug strategies, and really to reassess care after 2 to 3 cycles. Above all, our role as pharmacists is to support our patients and help them take control of their menstrual health and help them come up with safe and effective management.

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