Focusing on women's health

Health problems don’t just affect women physically – they can have a huge mental health impact too. Here's how female customers can benefit from holistic support and guidance in the pharmacy

Over the course of a year, as a member of the pharmacy team, you will encounter a host of ailments, some of which are exclusive to certain groups of customers. For women, these include fertility issues and the menopause. And while it can affect men too, women are also more likely to experience bladder weakness.

Some symptoms can be debilitating – so much so that they don’t just affect physical health, but can affect a person’s mental too. By having a deeper understanding of these issues and their impact, you can be on hand to provide vital support and guidance to women of all ages.

Fertility problems

According to the NHS, around one in seven couples may have difficulty conceiving. Those who have not conceived after a year of trying might find it helpful to visit their GP, who can investigate potential causes and suggest treatments that could help. In the meantime, pharmacy teams can be on hand to play a vital role in offering support and guidance.

For example, there are several factors that affect fertility, such as smoking, alcohol consumption and stress. Signposting customers to smoking cessation products or services, suggesting ways to minimise stress, and pointing to campaigns such as Dry January can help kick start positive lifestyle changes.

Miscarriage

It’s not just getting pregnant where customers can experience fertility issues. Defined as the loss of a pregnancy during the first 23 weeks, the main sign of a miscarriage is vaginal bleeding, which may be followed by cramping and pain in the lower abdomen.

Whilst it should be recognised that light vaginal bleeding is relatively common during the first trimester of pregnancy, pharmacy staff should always refer patients presenting with these symptoms, just in case.

Unfortunately, miscarriages often cannot be prevented, but there are things that can help to ensure a healthy pregnancy, such as avoiding smoking and not drinking alcohol or using recreational drugs. Maintaining a healthy weight, eating a balanced diet and taking steps to reduce the risk of picking up infections can also help.

Ectopic pregnancy

An ectopic pregnancy is when a fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes.

When the egg gets stuck, it won’t develop into an embryo and the health of the mother may be at risk if the pregnancy continues. It is not possible to save the pregnancy and the fertilised egg usually has to be removed using medication or an operation.

In the UK, around one in every 90 pregnancies is ectopic – that’s a total of around 11,000 pregnancies every year. Ectopic pregnancies are usually only detected during routine pregnancy scans, but sometimes symptoms develop between the fourth and 12th week of pregnancy. Pharmacy teams should be aware of these and refer any patients, whether they know they are pregnant or not, if they are experiencing:

• Missed periods/other signs of pregnancy
• Tummy pain low down on one side
• Vaginal bleeding or a brown, watery discharge
• Pain in the tip of the shoulder
• Discomfort when using the toilet.

It is always best for customers with any of the above concerns to have them checked by a GP. However, it is important to note that these symptoms are not necessarily a sign of a serious problem and can sometimes be caused by other issues, such as an upset stomach. You should therefore endeavour not to alarm patients unnecessarily.

If they progress undetected for an extended period of time, ectopic pregnancies can grow large enough to split open the fallopian tube. This is known as a rupture and once this occurs, surgery to repair the fallopian tube needs to be carried out as soon as possible. Signs of a rupture include a combination of:

• Sharp, sudden and intense pain in the tummy
• Feeling very dizzy or fainting
• Feeling sick
• Looking very pale.

A patient who presents with any of these symptoms will need urgent emergency medical attention, so follow your pharmacy’s standard operating procedure (SOP) for dealing with accidents and emergencies. If you don’t know what this is, ask your pharmacist to explain.

Whilst ectopic pregnancies and miscarriages can be physically dangerous for women, they can also take their toll on mental health. Losing a pregnancy can be devastating and many women report feeling a profound sense of grief.

Professional support or counselling can be of great benefit here. Advice and support are also available from hospital and charity groups such as the Ectopic Pregnancy Trust, the Ectopic Pregnancy Foundation and the Miscarriage Association.

Mental health and menopause

A natural part of ageing for women, menopause usually occurs between 45 and 55 years of age, as oestrogen levels decline. Common menopausal symptoms include:

• Hot flushes
• Night sweats
• Difficulty sleeping
• Vaginal dryness
• Reduced sex drive
• Problems with memory and concentration
• Low mood or anxiety.

In the last 20 years, suicide rates for women aged 45 to 54 have risen by six per cent (to 7.1 per cent in 2020), and this age group now has the highest female suicide rate – more than double that for women aged 15 to 19.

According to Dee Murray, founder and CEO of the Menopause Experts Group, a lack of awareness of menopausal symptoms and how menopause affects mental health is the underlying cause.

"Menopause affects every woman differently, but for many it can bring unpleasant physical, emotional and psychological symptoms that can be challenging to deal with," says Dee. "Mental health issues like depression, anxiety and stress are hard to deal with, and many women will not know that they can commonly be caused by menopause. Women who are not aware that they are going through menopause can be caught off guard by feelings of worthlessness, confusion and a complete lack of confidence."

If a customer discloses mental health symptoms in the pharmacy or you are worried about their mental health, you can offer advice such as self care measures to encourage better sleep, minimise stress, healthy eating and regular exercise. It can be really important to open lines of discussion about mental health concerns, so even offering an ear or signposting to information about menopause and mental health could help someone in need.

Dee recommends using the Menopause Experts Group website to learn more. "Women going through menopause need support from friends, family and colleagues,” she says, “and we would recommend that everyone takes our free training, so they are ready for whatever perimenopause and menopause throw at them."

Customers who are concerned should be referred to the pharmacist or their GP. Treatments such as hormone replacement therapy (HRT) can be prescribed to relieve menopause symptoms by replacing deficient hormones.

"We cannot ignore what is happening or let these women continue to suffer," says Dee.

She adds that anyone who is struggling to cope can contact Samaritans or other sources of support, which can be found on the NHS’s help for suicidal thoughts webpage.

Bladder weakness

Bladder weakness (incontinence) is a condition that affects millions of people, both male and female. Women often experience some form of incontinence as a result of pregnancy and childbirth putting a strain on the pelvic floor muscles. However, there are different types of incontinence, including:

• Stress incontinence – when urine leaks out when the bladder is under pressure (e.g. when coughing, laughing or exercising)
• Urge incontinence – when urine leaks during a sudden, intense urge to empty the bladder, or soon afterwards
• Overflow incontinence (chronic urinary retention) – this causes frequent leaking when a person is unable to fully empty their bladder when they go to the toilet
• Total incontinence – when the bladder cannot store any urine at all, causing the person to pass urine constantly or have frequent leaks.

Managing incontinence will depend on the cause – some types will be life-long, while others are transient. Women with stress incontinence, in particular, may find that their pelvic floor holds the key.

"Up to a third of all women can experience a problem with their pelvic floor muscles at some time during their life," says Karen Irwin, specialist continence nurse and Bladder & Bowel UK service manager. "The most common problems are leaking with activity, sneezing or coughing and pelvic organ prolapse."

The muscles of the pelvic floor come under great strain during pregnancy and childbirth. "These muscles help to keep the bladder and bowel openings closed to prevent any unwanted leakage and they also relax to allow easy bladder and bowel emptying," Karen explains.

She recommends that pharmacy teams encourage all pregnant customers to practice pelvic floor muscle exercises (sometimes called Kegel exercises), even if they are not yet experiencing stress incontinence. These exercises consist of a set of long, held squeezes, as well as short, quick squeezes. "The muscles should be worked until they tire," says Karen. "Undertaking these exercises regularly will help them to become stronger and more effective."

Full details of how best to perform pelvic floor exercises can be found on the Bladder and Bowel UK website. For information on managing incontinence in other ways, visit the NHS Incontinence webpage.

Some women may find that dietary supplements help to ease their symptoms too. According to the US-based National Association for Continence, there are three vitamins in particular that are thought to help with bladder control:

• Vitamin C

A study on Vitamin C intake in 2,060 women aged 30 to 79 years found that high dose vitamin C and calcium had a positive effect.

• Vitamin D

A study among older women found that the risk of developing bladder weakness was 45 per cent lower among those with normal vitamin D levels. Vitamin D is best absorbed via sun exposure or food, but Government advice is that people should consider taking a daily supplement containing 10 micrograms of vitamin D during the autumn and winter, when levels of sunlight are lower.

• Magnesium

Some experts believe that magnesium may help to improve bladder weakness symptoms by reducing muscle spasms and allowing the bladder to empty properly. Good food sources of this include quinoa, fish, nuts and seeds.

To help women cope with urine leaks, there are a variety of products available, from liners to pants. Customers should be encouraged to try these, rather than relying on sanitary liners and pads, which may be cheaper but are not designed or made in the same way, to reduce odour and keep skin dry.

Karen Logan, consultant continence nurse at Gwent Healthcare NHS Trust, explains: "Sanitary pads do not have the same technology. They stay damp and they can make the skin sore. I recommend paying the extra for incontinence pads as they are much more effective and comfortable."

New strategy promises equality

In March last year, the Government launched a call for evidence to inform the development of the fi rst ever Women’s Health Strategy for England. This received nearly 100,000 responses in just 14 weeks from women across the country, and more than 400 written responses from organisations and experts in the healthcare sector.

Analysis of the responses has since informed a policy paper entitled Our Vision for the Women’s Health Strategy for England, which was published on 23 December 2021. This document sets out the Government’s vision for the future, with publication of the actual strategy planned for this spring.

“It is time to re-set the dial on women’s health,” Secretary of State for Health and Social Care Sajid Javid said as he introduced the paper. “This publication sets the Government’s vision for a new healthcare system which offers equal access to effective care and support, prioritising care on the basis of clinical need and not of gender.”

Principally, the Government’s vision focuses on the changing health needs of women as they travel through life. It aims to identify where there are opportunities to promote good health, prevent negative health outcomes and restore health and wellbeing. “Key considerations will include the ways in which specifi c life events or stages of life can infl uence future health,” says the paper. “For example, we know that women who have high blood pressure or pre-eclampsia during pregnancy are at greater risk of heart attack and stroke in the future.”

The paper states that its ambitions are as follows:

• Women feel comfortable talking about their health, whether that be with healthcare professionals, friends or family; women know when they can seek help for symptoms, and women’s health issues are no longer taboo topics
• Women feel better listened to and heard by healthcare professionals, and women’s concerns and symptoms are taken seriously
• Women’s voices and experiences are represented and listened to at all levels and in all areas of the healthcare system.

“Women and healthcare professionals across England have made clear their voices and have told us what they need us to change,” said Mr Javid. “In some areas, this change will come more quickly than in others; there are no silver bullets when it comes to decades of bias, and if change is to be meaningful then it must sometimes take time. But I know that there is real willingness across all parts of the health sector and beyond to make this moment count. We will not let you down.”