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Menopause relief through the pharmacy

Lila Thakerar
Community Pharmacist
Harrow, Middlesex

Pharmacists are well placed to help women find relief for the symptoms of the menopause with advice, over-the-counter remedies and self-help measures. This brief article provides an overview of the ways in which pharmacists can help women suffering from health problems associated with the menopause

Pharmacists are vital in the management of the menopause and, of course, women do not need to make an appointment to see one. Pharmacists can give advice about hormone replacement therapy (HRT), other prescribed medicines, over-the-counter products and self-help measures. Embarrassing topics, such as incontinence, vaginal or bladder infections, libido or any other symptoms of the menopause, can also be discussed in a private consultation room.
 
Medicines advice
If the woman is taking HRT, the pharmacist can discuss why it has been prescribed, how and when it should be taken, any side-effects and prescription charges. If the woman is taking medicines for other medical conditions, the pharmacist will carry out a general Medicine Use Review (MUR). The patient can discuss any concerns they may have about their medicines or any side-effects they may be experiencing and the pharmacist can suggest changes to the medicines and discuss other aspects of treatment. 
The pharmacist will ask about any underlying medical conditions, including:

  • Migraine and headaches
  • Diabetes
  • Asthma
  • Epilepsy
  • History of breast cancer
  • Vaginal bleeding
  • Fluid retention
  • Leg cramps
  • Dizziness.

The pharmacist will also ask if any other medicines are being taken regularly or occasionally (prescribed, over-the-counter or complementary).
 
Common menopausal symptoms
Some of the menopausal symptoms that the local community pharmacist may be able to advise on include the following:
 
Flushes, sweats and mood swings
Some women treat their menopausal symptoms with natural remedies because they worry about HRT side-effects. Phytoestrogens are plant medicines that work like weak oestrogens and may help to relieve hot flushes, night sweats and mood swings. Isoflavones are found naturally in red clover, soya, tofu, linseeds, chickpeas and lentils. The recommended dose of isoflavone supplements is 40 to 80 mg per day, but it can take weeks before any benefit is seen. Other natural products that may help include black cohosh, dong quai and wild yam in the short term and flaxseed (containing phytoestrogens and
omega-3 acids).

These natural products have minimal side-effects, but it's crucial to remember that plant-based or natural remedies aren't harmless. It's important that women do not take too many "natural" products together without the advice and knowledge of their pharmacist, GP or nurse, particularly if taking any other medicines.
 
Dry skin, hair and eyes
A lack of oestrogen leads to dry, thinner and less elastic skin, as it reduces the collagen and oil content. Women can be advised to use a rich moisturiser and oil-based shower gel frequently and after a shower or bath while the skin is damp. Repeat the moisturiser two to three times a day.
Some menopausal women experience dry eyes. Artificial tears are available over the counter. Preservative-free eye drops are the most soothing.

Vaginal dryness
Lubricating gels, such as KY Jelly, are available from a pharmacy for vaginal dryness. These should be used liberally, particularly around the vaginal opening, just before intercourse. Artificial lubricants can be used two to three times a week. They coat the inside of the vagina and last for a day or two, so they don't have to be used immediately before intercourse. Women should be advised not to use petroleum jelly or other oil-based products as these can increase the risk of infections.

Urge/stress incontinence
It's common to leak a little urine from the bladder on slight exertion (for example, laughing, sneezing, coughing or lifting a heavy object). This embarrassing problem often stops women from going out, but pharmacies can supply a range of discreet incontinence pads
and pants.

Urinary and vaginal infections
Thrush may be recurrent during the menopause. Antifungal creams can treat vaginal itching, irritation or discharge. Internal single-use creams or pessaries can give relief for up to seven days. An oral antifungal is also available as a single dose to relieve symptoms within 24 hours. It may be more effective to use these products together. It's important that the woman's partner is treated as well to avoid recurrent infections. A pharmacist is able to provide advice, but further investigation may be needed if the woman has had more than two attacks in six months, is over 60 years old or has bloodstained discharge or other symptoms.

If the woman has any signs of a urine infection, the pharmacist may refer to the GP, especially if symptoms persist, or if a fever, unusual vaginal discharge, high blood pressure or heart conditions are present.
 
Sleep disturbance
Over-the-counter remedies for insomnia are available from the pharmacist but these should only be used for short-term sleeplessness. These products may cause drowsiness and dizziness, and even interfere with alertness and performance the next morning.

Over-the-counter sleep aids contain sedating anti-histamines or calming herbs.

Your comments (terms and conditions apply):

"This article raises that pharmacists can assist women with incontinence by supplying incontinence pads. While this is a practical way to assist women to cope with this problem, it should no way considered a solution. Women need to be encouraged to seek advice from healthcare professional to work toward treating or managing incontinence. Using Pads is not considered a treatment option and conveying this may prevent women from seeking help" - Faith Howard, London