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MANAGING MENOPAUSE
Supporting your customer’s journey through menopause
10-minute module
Approximately 33 million women in the UK will experience menopause at some stage in their lives.1 Considering over half of the UK population will go through this life-changing phase, which if disregarded can lead to significant mental and physical health issues,1 it is imperative that pharmacy teams play their part in supporting these women.*
A lack of public awareness perpetuates ignorance, leading to subsequent stigma, shame and embarrassment.
Therefore, education is vital to normalise menopause and enable women to get the support they need.2
WITH GREATER AWARENESS, UNDERSTANDING AND EMPATHY, PHARMACY TEAMS CAN PROVIDE SUPPORT AND ADVICE TO WOMEN TO HELP ALLEVIATE SUFFERING THROUGH THEIR MENOPAUSE JOURNEY.
Learning objectives
After reading this module, you should be able to:
Understand what menopause is and how it affects women both physically and mentally
Recognise risk factors and comorbidities associated with menopause
Know about common treatments, supplements and self-care tips that can help relieve symptoms
Encourage open conversations about menopause to better support those women who are affected
*Throughout this module the term ‘woman’ is used to refer to individuals who were assigned female at birth; however, it is acknowledged that not all individuals assigned female at birth identify as women.
Understanding menopause
What is menopause?
Knowing the different terms used to define the stages of menopause is key to identifying where your customer is on their journey. The stages of menopause are influenced by hormonal fluctuations, with oestrogen and progesterone levels eventually declining over the menopause period.3
Click through the carousel to learn more about the different stages of menopause.
PREMENOPAUSE
Refers to the reproductive years. It begins with the first menstrual cycle and ends with the first signs of perimenopause.3
PERIMENOPAUSE
Usually starts around the mid-40s, when hormone levels start to fluctuate. It is the time during which symptoms of menopause occur but periods haven’t stopped, and lasts until periods have been absent for 12 months, at which point menopause is reached.3,4
MENOPAUSE
Usually occurs between the ages of 45 and 55 and marks the end of menstruation, where the individual has not had a period for 12 months, due to a reduction in hormone levels. It also marks the end of the reproductive years. It can occur earlier for some women due to various factors, including genetics, specific conditions or treatments (e.g. chemotherapy). Certain surgeries (e.g. a hysterectomy) can induce menopause themselves.4
POSTMENOPAUSE
Occurs after menopause and is the period following a woman’s final menstrual cycle.3 Symptoms of menopause may still continue.5
Menstruation and menopause
The menstrual cycle begins when a girl reaches puberty. It can vary from woman to woman; however, it typically lasts between 25-30 days. The menstrual cycle has two phases: the follicular phase and the luteal phase.6
The follicular phase starts from the first day of menstruation until ovulation. During this time, follicle stimulating hormone (FSH) levels increase, which stimulate the production of follicles. Eventually, one follicle, containing an egg, matures. The growth of the dominant follicle causes a rise in oestrogen levels which help promote ovulation (release of the egg from the follicle). The egg then travels into the fallopian tube, awaiting fertilisation.6
The luteal phase of the cycle is fairly constant in most women, lasting around 14 days. The FSH level in the late luteal phase is related to a decline in both oestrogen and progesterone levels.6
MENOPAUSE IS MARKED BY THE END OF MENSTRUATION, SPECIFICALLY WHEN A WOMAN HAS NOT HAD A PERIOD FOR 12 CONSECUTIVE MONTHS.
Menopause occurs due to:7
Ovarian follicle depletion
Hormonal changes, particularly a decline in oestrogen and progesterone
Typically the first indication of approaching menopause is periods becoming irregular, affecting the menstrual cycle length and frequency. Eventually the periods stop completely, which marks the end of perimenopause. The phase spanning these irregularities until periods stop is known as the menopausal transition.7
Symptoms of menopause
Menopause encompasses a broad array of symptoms beyond those more commonly recognised, such as hot flushes and mood changes. Some symptoms can significantly affect the quality of life of women,1 including their ability to perform daily tasks. Many of these symptoms are associated with a change in hormone levels.
Click on the icons below to learn more about some of the different symptoms of menopause.
NOTE THAT THE PREVALENCE AND INTENSITY OF SYMPTOMS CAN BE INFLUENCED BY THE STAGE OF MENOPAUSE, AS WELL AS ETHNICITY. THEY CAN ALSO VARY GREATLY FROM ONE WOMAN TO THE NEXT.8
VASOMOTOR SYMPTOMS (VMS)
VMS symptoms involve the body’s thermoregulatory system and include hot flushes and night sweats. These are the most common symptoms of menopause. In fact, 60-80% of women experience VMS at some point during the menopausal transition.8
VMS symptoms typically affect the head, neck, chest and upper back.8
SLEEP DISTURBANCES
Approximately 40-60% of perimenopausal or postmenopausal women experience sleep disturbances.9 Common sleep issues can include:
Sleep fragmentation
Increased awakenings
Poor sleep quality
These disturbances can significantly impact both physical and mental health. Therefore, it is important to manage this optimally.
FATIGUE
Physical and mental fatigue are a common menopause symptom linked to hormone changes during this period. Fatigue can deplete energy, motivation and concentration, which can be debilitating for many women.
For some, menopause-related fatigue can make them feel unwell as fatigue can persist even after rest or sleep. It can also cause emotional stress and a lack of enthusiasm in many women, therefore affecting quality of life.10
GENITOURINARY SYMPTOMS
Genitourinary syndrome of menopause (GSM) describes changes during the menopause transition and postmenopause which can affect the sexual and urinary systems. These can include:11
Genital symptoms such as vaginal dryness, irritation, burning or pain
Sexual symptoms such as painful or difficult sex, bleeding after sex or loss of libido
Urinary symptoms such as painful urination, stress incontinence, urgency or recurrent urinary tract infections (UTIs).
Sexual dysfunction may negatively affect physical and emotional satisfaction and, in turn, lead to relationship issues, further impacting quality of life.12 50-70% of postmenopausal women have genitourinary symptoms, at least to some degree, but many feel too embarrassed to seek help or consider their symptoms a normal part of ageing so don't seek medical advice.11
COGNITIVE AND
PSYCHOLOGICAL CHANGES
The frequency and severity of cognitive and psychological symptoms can vary widely among women. Alongside other symptoms associated with menopause, customers can suffer from the following:13
COGNITIVE SYMPTOMS
Forgetfulness
Poor concentration or ‘brain fog’
PSYCHOLOGICAL SYMPTOMS
Low mood and depression
Anxiety
Anger and irritability
Loss of self-esteem and confidence.
Risk factors and comorbidities
It’s important to recognise the factors that can cause the aforementioned symptoms to become more severe, more frequent or likely so that, where possible, women can reduce the likelihood of them occurring. By doing so, you can educate your customers on the importance of mitigating these risk factors and encourage them to care for themselves in the best way possible.
Some factors can increase the risk of VMS, such as smoking, obesity, a sedentary lifestyle and negative mood including: higher levels of anxiety; depressive symptoms and perceived stress.8
VMS in turn can be a risk factor, contributing to poor sleep.8
Comorbidities that have an established link with menopause-related oestrogen decline include:
Cardiovascular disease (CVD) - Menopausal transition is associated with a higher prevalence of certain risk factors for CVD, e.g. artertial hypertension, glucose intolerance and central adipostiy.14
Obesity - At least 50% of women experience weight gain during perimenopause and menopause.
Most of the weight accumulates around the abdomen and upper body as the metabolic rate slows and lean muscle mass reduces.15Osteoporosis - This is the most prevalent disease in menopausal women, and usually occurs around 10-15 years after menopause. This can also be influenced by genetic and other risk factors, e.g. ethnicity.16
THESE RISK FACTORS AND COMORBIDITIES CAN FURTHER IMPACT QUALITY OF LIFE, THEREFORE IT IS IMPORTANT THAT YOU ARE EQUIPPED WITH BOTH THE SKILLS AND KNOWLEDGE TO IDENTIFY AT-RISK PATIENTS AND PROVIDE APPROPRIATE SUPPORT.
Ways you can help
Although menopause is a part of life for women all around the world, they don’t have to suffer in silence. There are some treatments, over-the-counter (OTC) products and self-care measures that may help to reduce the frequency and intensity of symptoms and the risk of developing associated comorbidities.
LIFESTYLE CHANGES AND SELF-CARE ADVICE
Lifestyle adjustments can bring relief from symptoms for women going through menopause.
Your customer could try to:17
Manage stress by using techniques such as mindfulness and deep breathing
Maintain a healthy bodyweight and exercise regularly
Adopt a healthy diet, as certain foods can exacerbate symptoms
Avoid potential triggers, excessive alcohol or caffeine consumption
Quit smoking
To manage vasomotor symptoms, stay cool by wearing looser clothing
Practise good sleep hygiene to minimise sleep disturbances
Address mental and physical health through cognitive behavioural therapy (CBT).
SUPPLEMENTS AND OTC PRODUCTS
There are many supplements and traditional herbal remedies (THRs) available. Some common examples include red clover and black cohosh. These are not tested and regulated in the same way as medicines such as hormone replacement therapy (HRT).18
Vaginal moisturisers and lubricants can help with vaginal dryness symptoms and be used independent of sexual activity.17
TREATMENT
Hormone replacement therapy (HRT) is available in various formats including transdermal, oral and topical formulations. It helps to replace depleted levels of oestrogen in small doses (together with progesterone in women with a uterus) in the body.18 Although this is helpful for many women, HCPs should consider an overall balance of indication, risk and convenience amongst other suitability factors when making recommendations. Non-hormonal therapies are considered for women suffering when hormone therapy is not an option.
Empowering your customers
Did you know over 90% of women in the UK feel unprepared for menopause?19
Although attitudes have evolved, stigma around ageing and menopause persists, and those entering, experiencing and completing menopause often feel ashamed, embarrassed and alone. When having conversations with these customers, it is important to practise EDUCATION, ENGAGEMENT and EMPATHY.
Click through the carousel to find out more about each of these.
EDUCATION
Comprehensive menopause education is essential to ensure that women feel prepared, supported and empowered throughout their menopausal journey.2 Education can equip women with strategies to manage their symptoms, inform them about treatment options and help them recognise the difference between myths and facts about menopause.
ENGAGEMENT
It’s important to remember to use as many open questions as possible during your discussions with menopausal women to maintain engagement. This can help you gather as much information as possible, helping to ensure appropriate advice and treatment is given. Using the WWHAM framework can help you to establish the facts.
EMPATHY
In healthcare, empathy is where a health care practitioner puts themselves in a patient’s position to acknowledge their feelings, concerns and expectations, and behaves in a way to show that they understand the patient's perspective.20
Empathy and patient-centred care can improve quality of care, treatment success, health outcomes, and quality of life. For example, saying things like: “I understand how this is frustrating”, or showing that you believe the customer’s experiences are genuine, could make the customer feel listened to when she talks about her condition. Maintaining a friendly manner, emphasising comfort and wellbeing and checking patient understanding are all ways to show empathy in your conversations.
To help you feel confident in leading menopause conversations, you should:
Stay up to date with the latest information about menopause
Approach menopause with an open and inquisitive mindset, considering all symptoms
Show genuine interest and openness in menopause discussions
Encourage women to speak to a HCP to ensure they receive the treatment they need, when they need it
Consider signposting women to a menopause specialist. You can locate specialists in your area by using
The British Menopause Society’s specialist finder.
Summary
Menopause is a normal part of life for all women, and it can significantly affect both physical and mental health
By having compassionate and structured conversations with women seeking your support, you will create an environment where they feel comfortable discussing their experiences and symptoms, enabling an accurate diagnosis, adequate support and effective treatment.
1. The Menopause Charity. 2024. Available at: https://www.themenopausecharity.org/
2. The Lancet. Attitudes towards menopause: time for change. 2022. Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01099-6/fulltext.
3. Menopause Now. Premenopause. 2020. Available at: https://www.menopausenow.com/premenopause
4. NHS. Menopause. 2022. Available at: https://www.nhs.uk/conditions/menopause/
5. NHS inform. After the menopause. 2024.
Available at: https://www.nhsinform.scot/healthy-living/womens-health/later-years-around-50-years-and-over/menopause-and-post-menopause-health/after-the-menopause/
6. Reed BG, et al. The Normal Menstrual Cycle and the Control of Ovulation. 2018. Available at: https://www.ncbi.nlm.nih.gov/books/NBK279054/
7. Menopause Now. Menopause. 2023. Available at https://www.menopausenow.com/
8. Thurston R, et al. Vasomotor Symptoms and Menopause: Findings from the Study of Women's Health across the Nation. 2011.
Available at: https://www.sciencedirect.com/science/article/abs/pii/S0889854511000702?via%3Dihub
9. Pengo M. Sleep in Women across the lifespan. Chest. 2018. Available at: https://journal.chestnet.org/article/S0012-3692(18)30570-1/abstract
10. Jones B, et al. Can fatigue be a symptom of menopause. Verywellhealth. 2024. Available at: https://www.verywellhealth.com/does-menopause-make-you-tired-5218103
11. Angelou K, et al. The Genitourinary Syndrome of Menopause: An Overview of the Recent Data. 2021.
Available at: https://www.cureus.com/articles/29859-the-genitourinary-syndrome-of-menopause-an-overview-of-the-recent-data#!/
12. Ghazanfarpour M, et al. Investigating the Relationship Between Sexual Function and Quality of Life in Menopausal Women. J Family Reprod Health. 2016 (4):191-197.
13. NHS Inform. Menopause and your mental wellbeing. 2022. Available at: https://www.nhsinform.scot/healthy-living/womens-health/later-years-around-50-years-and-over/menopause-and-post-menopause-health/menopause-and-your-mental-wellbeing/
14. Anagnostis P, et al. Menopause-associated risk of cardiovascular disease. Endocr Connect. 2022. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9066596/
15. British Menopause Society. Menopause: Nutrition and Weight Gain. 2023.
Available at: https://thebms.org.uk/wp-content/uploads/2023/06/19-BMS-TfC-Menopause-Nutrition-and-Weight-Gain-JUNE2023-A.pdf.
16. Ji MX, Yu Q. Primary osteoporosis in postmenopausal women. Chronic Dis Transl Med. 2015. Available at: https://pubmed.ncbi.nlm.nih.gov/29062981/
17. NHS. Menopause – things you can do. 2022. Available at: https://www.nhs.uk/conditions/menopause/things-you-can-do/
18. NHS. Treatment – Menopause. 2022. Available at: https://www.nhs.uk/conditions/menopause/treatment/
19. Primary Care Women’s Health Forum. Research reveals 92% of women in the UK feel unprepared for menopause. 2022.
Available at: https://pcwhf.co.uk/news-article/research-reveals-92-of-women-in-the-uk-feel-unprepared-for-menopause/.
20. Smith KA et al. J Gen Int ern Med 2020;35: 3007–14.
Online references last accessed December 2024
Content developed by Bayer working together with CIG Healthcare Partnership.
© 2024 CIG Healthcare Partnership
December 2024