Perimenopause and menopause can affect every aspect of a woman’s physical, emotional, and social health. When we start to count the cost the symptoms of hormone changes on the workplace, on family lives and on society, it is staggering. General practice pharmacists are uniquely positioned to change that— offering informed, and personalised care that can significantly improve outcomes for women navigating menopause.

How pharmacists in general practice can discuss menopause with patients

Pharmacists working in general practice are often in a strong position to start meaningful conversations about menopause. Many women do not realise their symptoms—such as fatigue, anxiety, sleep disruption, or joint pain—are related to hormonal changes, or will put them down to other stressors in daily life and often don’t join up the dots. Pharmacists will already be seeing these women for long term condition reviews and can gently raise the subject during medication reviews or clinic consultations.

‘Do you think your symptoms could be caused by your hormones?’ can be a great opener and the use of (MSQ) score or symptoms tracker such as the   will help to give an objective measure of the impact the symptoms are having on the individual.

Social, cultural and ethnic considerations

Menopause does not affect all women in the same way and our standard definition of menopause at the age of 51 relates to white British women. Ethnic background, cultural beliefs, language ability, and socioeconomic status all influence how menopause is experienced, understood, and managed.

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South Asian women may present with different symptoms such as joint pain. However, these women are less likely to seek help or be prescribed hormone replacement therapy (HRT), often due to cultural, socioeconomic or language barriers.

Pharmacists need to approach menopause care with cultural sensitivity and a commitment to equality. This includes using non-medical language and asking specifically about sensitive subjects such as vaginal dryness and urinary incontinence, being mindful of differing beliefs about menopause, and recognising systemic inequalities in care. Signposting to translated resources via The Menopause Charity website, or engaging interpreters can help ensure that all women receive the care they deserve.

Treatment options

Menopause treatment is not a one-size-fits-all. Pharmacists can help women understand the full range of options, from hormonal to non-hormonal therapies and lifestyle interventions.

Hormonal treatments include:

  • Oestrogen (oral, patch, gel, spray) – to treat systemic symptoms. Transdermal products carry no increased risk of blood clots.
  • Progesterone – used alongside oestrogen for endometrial protection in women with a uterus
  • Testosterone – for some women with low libido, once established on systemic HRT. Androfeme has been granted a UK MHRA license in august 2025 and will hopefully be available for NHS prescribing in 2026.
  • Vaginal oestrogen – for genito-urinary symptoms, with minimal systemic absorption – safe for all women and available to but over the counter as Gina.

The British Menopause Society Practical Prescribing Guide and HRT guide are great to help guide your prescribing in this are.

Non-hormonal treatments:

• Certain antidepressants (SSRIs/SNRIs) for hot flushes
• Clonidine or gabapentin (used in specific cases)
• Vaginal moisturisers and lubricants

Lifestyle interventions:

  • Diet, physical activity, stress reduction, sleep improvement, and avoiding smoking and excess alcohol can  .

Pharmacists can offer clear explanations of how treatments work, who they are suitable for, and what to expect. They can also provide reassurance about safety, especially where may be causing fear. This is a great opportunity to have a mid-life check in with women who may not be frequent users of NHS services.

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Using shared decision making to support women to make informed choices

Shared decision making is at the heart of good menopause conversations and pharmacists are already great at navigating these conversations in complex areas. The NICE NG23 Menopause: Identification and Management guideline emphasises that women should be given evidence-based information and supported to make informed choices that align with their personal values and health priorities.

Pharmacists can play a crucial role in these discussions by explaining treatment options clearly and contextualise risks v benefits of HRT. Some women may be focused on symptom relief; others may be more concerned about long-term health benefits of HRT. Pharmacists can use visual aids, printed materials, or trusted digital tools like the gpevidence.org to help explain benefits and risks.

What pharmacists bring to primary care in terms of depth of understanding of these medicines

Pharmacists are already seeing women at this stage in life and have great person-centred skills to manage menopause in primary care. If your GP practice does not currently have a women’s health lead, then is this a gap which could be filled by a pharmacist? This might involve input into policy development such as whether the practice will prescribe testosterone for women or how you manage patients who have been seen privately and whether there is a funded service for coil fitting as part of HRT, as well as of course delivering a dedicated menopause clinic.

Pharmacological treatments are safe and effective for symptom control and offer some protection against future health issues associated with low hormone levels post-menopause.  If menopause care is manged really well in general practice, then this actually frees up GP time for more acute issues.

Pharmacists can:

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  • Review HRT regimens and optimse treatment based on response
  • Ensure vaginal oestrogens are used correctly to prevent UTIs and improve genito-urinary symptoms of menopause (gsm)
  • Reassure women about risks, especially in complex cases (e.g. past breast cancer or cardiovascular issues)
  • Pharmacists can lead menopause clinics, conduct safety audits, train other staff, and collaborate with GPs to improve service delivery.

Conclusion

Menopause can be a vulnerable and confusing time for many women, but it doesn’t have to be. Pharmacists in general practice are in a unique position to provide timely, evidence-based, and compassionate care. By opening conversations, considering cultural contexts, explaining treatment choices, and optimising medicine use, pharmacists can ensure more women experience menopause with dignity, understanding, and better health outcomes.

As menopause care becomes more of a priority in the NHS and society, the pharmacy profession has a powerful role to play—and when got right, menopause care can be transformational for women.