Dr Heather Currie of the British Menopause Society explains how community pharmacies can play their part in promoting the society’s Vision for Menopause Care and ensure women throughout the UK receive reliable and accurate advice.
As an Associate Specialist Gynaecologist at Dumfries and Galloway NHS, a Trustee and past Chair of the British Menopause Society (BMS), and the founder of the Menopause Matters magazine, Dr Heather Currie knows how menopause care could be improved.
That’s why she was an author of the BMS’ Vision for Menopause Care in the UK, which seeks to ensure that
all healthcare professionals offer up-to-date and consistent advice to women going through the transition from reproductive to post-reproductive years.
“The vision states that we want all women to have a good understanding of menopause – that’s the biggest thing that we want to achieve – but we also want all healthcare professionals to have the same basic understanding,” says Heather.
“In each region, we would like there to be a specialist menopause service supporting the primary care teams. Then, in each primary care setting, there should be at least one person – it doesn’t matter whether it’s a doctor, or nurse or pharmacist – with a special interest in menopause care.
“Wherever women are in the UK, we want them to get consistent advice. That hasn’t happened in the past. Depending on healthcare professionals’ interests and whether they are up to date with current recommendations and guidelines, women may or may not receive accurate advice.
“So it doesn’t matter which health professional the woman is seeing, the Vision sets out a consistent understanding of menopause and treatment options.”
“It doesn’t matter which health professional a woman sees, the Vision sets out a consistent understanding of menopause and treatment options”
One area where all community pharmacists can definitely play a role is to offer correct information about HRT treatment.
“HRT highlights the inconsistency around menopause information because media headlines can exaggerate the risks but often don’t balance that with the benefits. Overall, for most women with symptoms, the benefits of HRT far outweigh the risks,” Heather says.
Of course, HRT is well known as the most effective treatment for menopause symptoms indicative of oestrogen deficiency, such as hot flushes, sweats, sleep disturbances, joint aches and mood changes. But research also shows that HRT can provide long-term health benefits – particularly in terms of osteoporosis and cardiovascular disease – and the sooner post-reproductive women start a course of HRT, the better.
“We know that HRT is very good for bone health. Osteoporosis and osteoporotic fractures are increasing significantly, partly because we’re living longer, but a recent study has also shown that, more important than age is the number of years with oestrogen deficiency,” Heather says.
“In fact, pharmacies may even be more accessible than GPs, when you consider the difficulty in getting appointments”
“Women particularly at risk of later health problems are younger women. Women who have an untreated early or premature menopause have significantly increased risks of osteoporosis and cardiovascular disease. But if HRT is started within 10 years of the menopause, or under the age of 60, it then very likely provides cardiovascular protection.”
She continues: “One risk with the tablet form of HRT is an increased risk of deep vein thrombosis (DVT). But using transdermal HRT – HRT patches or gel – doesn’t have any effect on a woman’s own baseline risk, and, for many women at low risk of DVT, a tablet will still be a reasonable option,” Heather says. “The other big thing that women worry about is HRT’s association with breast cancer. The current understanding is that HRT doesn’t cause breast cells to turn into cancer, but it may promote cancer cells that are already present, if it is used for more than five years after the age of 50. So it’s a promoter rather than an initiator, which is a really important concept.”
Dealing with shortages
As community pharmacists will know all too well, the recent shortage of HRT created significant pressures for pharmacies and distress for the women affected.
“A lot goes into the decision to take HRT in the first place and sometimes women change their type of HRT quite a few times before finding the one that suits them,” Heather says.
“To then find that particular type is not available is very unsettling and some women are very worried that they won’t be able to get the treatment that suits them and the symptoms they’ve just got under control may come back. So it’s very distressing and it’s hugely time-consuming for GPs, practice nurses and pharmacists, which is why there have been a number of calls to ask the Department of Health to set up a group to look at why has this happened.”
In the meantime, should such a situation reoccur, there is some simple advice for pharmacists: “The supply issues are out of pharmacists’ hands, but if pharmacists can continue to look at what the other preparation options are and offer those, rather than having nothing, that would be a huge benefit,” Heather says.
“Here in Dumfries and Galloway we have good communication with our community pharmacies. If they find something unusual or can’t quite understand why a patient is on a particular treatment, they’ve been excellent
at contacting us. And during the HRT shortages, they have communicated with our team a lot.
“I know that community pharmacists are very knowledgeable and I’m certain they can play an important role in providing advice and information to women and signposting them to online resources. In fact, pharmacies may even be more accessible than GPs, when you consider the difficulty in getting appointments and actual appointment times not being very long. So I think there is a huge role for community pharmacies here.”
- As well as her roles with the BMS, the NHS and Menopause Matters, Heather is Co-Editor of Post Reproductive Health (the journal of the British Menopause Society) and the Scottish National Clinical Lead for Modernising Gynaecology Outpatients.
- Heather chose to focus on the menopause while studying for her membership exam of the Royal College of Obstetricians and Gynaecologists.
- In her free time Heather cooks and helps her husband with their small holding.
- One of Heather’s proudest professional moments was winning an award with Menopause Matters at the Scottish Magazine Awards.