The area of female health is a complex and diverse area and it is a hugely important category in Pharmacy, as for many women, the pharmacy is their first stop when seeking out products for their health, both intimate and otherwise.
This article is centred around a number of specific areas that are particularly relevant to pharmacists who treat patients in community pharmacies.
Many of the issues that female patients present with in Pharmacy are sensitive issues and they will need to be dealt with in an open yet delicate manner, so it is important that a pharmacist know what they are, and the best method of treating them.
Below, Irish Pharmacy News outlines some of the ailments that women with period or fertility problems, or reproductive health issues are likely to be experiencing if they present to a pharmacy.
Period problems
Problems in a woman’s menstrual cycle, called menstrual irregularities, are commonplace. Periods may be too regular, to infrequent, or event unpredictable or painful.
If not caused by pregnancy, these menstrual irregularities may be a sign of a gynaecological condition or problem.
Premenstrual Syndrome (PMS)
There are many conditions that cause period problems with one of the most common problems being premenstrual syndrome (PMS).
PMS refers to a collection of physical, psychological and emotional symptoms related to a woman’s menstrual cycle.
Symptoms include abdominal bloating and cramps, breast tenderness or swelling, stress or anxiety, headache, joint or muscle pain, fatigue, irritability, and mood swings.
Most women with PMS (about 80%) experience one or more of these symptoms at some point.
Symptoms generally disappear before the menstrual cycle begins, however an estimated two to five percent of experience significant premenstrual symptoms characterised by severe mood swings and other symptoms related to emotions.
It is important that when a pharmacist is helping a patient with PMS they treat the patient with care and understanding. It is also very important for pharmacists to inform their patients that there are also alternatives to OTC medications when dealing with symptoms of PMS.
The alternatives such as advice on lifestyle and diet changes to alleviate symptoms, should be discussed in private with the patient.
In addition, a pharmacist may recommend natural supplements like vitamin B6 and omega oils like Krill oil, which have been shown to be very beneficial in treating PMS related symptoms.
Amenorrhoea
This refers to the absence of menstrual periods in a woman during her reproductive years.
Amenorrhoea is either classified as either ‘primary’ (menstrual periods not having started by age 16 years) or ‘secondary’ which is the absence of menstrual periods in a woman who has previously been menstruating for six months or more.
The frequency of primary amenorrhoea in the population is about 0.5-1.2%, while the frequency of secondary amenorrhoea is approximately 5%.
Patients may have headaches, visual disturbance or tiredness caused by diseases affecting the pituitary gland in addition to the absence of menstrual periods.
Amenorrhoea can be caused by a number of factors in a woman’s life including excessive exercising, an eating disorder, severe stress, hormonal or genetic problems. Treatment depends on the underlying cause and it is usually advisable to refer the patient to her GP for further investigation.
Oligomenorrhea
Oligomenorrhea is a condition in which a woman experiences infrequent menstrual periods, and occurs in women of childbearing age.
Some variation in menstruation is normal, but a woman who regularly goes more than 35 days without menstruating may be diagnosed with oligomenorrhea. Periods usually occur every 21 to 35 days.
Like amenorrhoea it is not a disease but it is a symptom of a larger condition e.g. Polycystic ovary syndrome (PCOS). Again, the patient should be referred to her GP in cases such as this.
Dysmenorrhoea
It is common for women to experience an ache in their lower abdomen, back and tops of the legs, especially in the first few days of your period, known as Dysmenorrhoea.
The first two days are usually the worst. Some women have more pain than others.
Pharmacists can give a patient painkillers or anti-inflammatory painkillers such as ibuprofen usually ease the pain if it is troublesome.
The cause of the pain in most women is not fully understood. Sometimes conditions such as endometriosis can make period pains become worse.
Pharmacists should advise women suffering from Dysmenorrhoea to see a doctor if: The pain becomes gradually worse in each period; Pain begins a day or more before the onset of bleeding; Pain is severe over the whole time of the period. It is important to note, however, that sometimes dysmenorrhoea may be caused by infection, endometriosis, fibroids or ovarian cysts.
Treatment must be tailored to the specific problem; therefore, a definite diagnosis must be made.
Menorrhagia
Menorrhagia refers to abnormal or heavy bleeding which is different to normal menstrual bleeding.
Typically a hormone imbalance the cause of menorrhagia, particularly in adolescents and women approaching the menopause. It is advised that pharmacists refer patients to a GP if they present experiencing Menorrhagia.
Primary Ovarian Insufficiency
Premature ovarian failure – also known as primary ovarian insufficiency – is a loss of normal function of a woman’s ovaries before age 40. If their ovaries fail, they don’t produce normal amounts of the hormone oestrogen or release eggs regularly.
The most common result of this is infertility.
Sometimes Primary Ovarian Insufficiency is referred to as premature menopause, but the two conditions aren’t the same. Women with premature ovarian failure can have irregular or occasional periods for years and might even become pregnant. Women with premature menopause stop having periods and can’t become pregnant.
Restoring oestrogen levels in women with premature ovarian failure helps prevent some complications, such as osteoporosis, that occur as a result of low oestrogen.
Women with POI may have no periods or may get them infrequently.
If a patient presents in Pharmacy with symptoms relating to POI then referral to her GP is advisable as in some cases oestrogen replacement therapy will be prescribed.
Female infertility
Female infertility is also common for women to present to a pharmacy with. Both a lack of ovulation, or infrequent ovulation are the two most common problems when it comes to female infertility. These can be caused by PCOS, POI, hypothalamic amenorrhoea, or pituitary gland problems.
If a woman is experiencing pituitary gland problems it means that their glands are releasing too much prolactin, which is a hormone that affects oestrogen levels.
Age is also a major factor when it comes to infertility, as the number of eggs produced by a woman’s body decreases as she gets into her 30’s. In addition, female infertility can be as a result of tubular blockage, endometriosis or male factor infertility.
Other hormone related conditions such as an underactive thyroid gland, diabetes, obesity and occasionally Cushings syndrome can affect female fertility.
Problems with Ovulation may be treated using fertility drugs such as FSH or LH, which work like natural hormones and help to bring it about.
Pharmacists prescribing drugs to women experiencing ovulation problems typically choose clomiphene, gonadotropin therapy, human chorionic gonadotropin (HCG), bromocriptine or cabergoline.
PCOS, along with causing period problems, is also a major cause of female infertility. Women with PCOS have increased androgen (male hormone) levels, leading to an imbalance in the hormones that regulate ovulation and normal egg development.
Signs and symptoms include an irregular menstrual cycle, excessive hair growth on the face and body, and obesity.
Treatment of PCOS can vary from patient to patient, but a woman’s ovulation cycle can be restored in many cases through a combination of medication and lifestyle changes.
Some women can become pregnant after they have been diagnosed with POI, however this is unlikely.
Contraception options
The pharmacy is the first stop for women who are looking for contraception. Over half of all pregnancies are unplanned, so it is important that both women and men are made aware of the various contraception options that are available to them.
Women who wish to avoid an unplanned pregnancy can be advised by their pharmacist to use condoms, a contraceptive implant, intrauterine system (IUS), an intrauterine device (IUD), progestogen-only pill, or a diaphragm or cap.
The most effective method of contraception is the IUD; however, a woman must be referred to her doctor for this.
Pharmacists may also provide emergency contraception to women who have recently had unprotected sex in the form of the morning after pill.
Although IUD is most effective, many women prefer not to have to be subject to invasive treatment, preferring to take a pill.
The most effective oral contraceptive on the market is Ulipristal Acetate (ellaOne), which has been demonstrated to be effective up to 120 hours after unprotected sexual intercourse, and which acts by modifying the activity of the natural hormone progesterone which is necessary for ovulation to occur.
Although it is advised that women should not use emergency contraception frequently, providing emergency contraception is nonetheless an integral service provided by pharmacists with regard to women’s reproductive health, and pharmacists should be aware of the products and options available to women.
Last month, Minister for Health Simon Harris announced that medical card holders would now have access to emergency contraception without prescription, ending what the Irish Pharmacy Union (IPU) called a ‘two-tier system’. It is expected that this will result in greater compliance, and less unplanned pregnancies. Pharmacists had been allowed to supply the emergency contraception to women without a prescription since 2011.
Pregnancy
When a woman is pregnant, she can experience extreme discomfort at times, and a pharmacist can suggest or supply products to ease her pain or distress.
Nausea and vomiting often develop by five to six weeks of pregnancy. The symptoms are worst around nine weeks, and typically improve by 16 to 18 weeks of pregnancy. However, symptoms continue until the third trimester in 15 to 20 percent of women and until delivery in 5 percent of women.
To ease the symptoms of nausea, a pharmacist can suggest dietary changes, or a number of products.
Vitamin B6 or antihistamines are often helpful for pregnancy women with mild to moderate nausea.
If the nausea and vomiting is triggered by gastrointestinal distress, OTC reflux medications like Zantac or Pepcid can sometimes be effective.
It is advised that pregnant women avoid smoking cigarettes, as they could be harmful to their baby –pharmacists can suggest smoking deterrents, such as nicotine replacement therapy to a patient. There are many products that women cannot take while pregnant, as they will cause harm to her foetus.
If a woman who is pregnant has cold or flu, it is very important that pharmacists do not give cold remedies that contain alcohol, or the decongestants pseudoephedrine and phenylephrine, which can affect blood flow to the placenta.
Pharmacists can also suggest Folic acid for foetal health, as it helps prevent neural tube birth defects, which affect the brain and spinal cord.
Neural tube defects develop in the first 28 days after conception, before many women know they are pregnant.
It is also recommended that any woman who could get pregnant take 400 micrograms (mcg) of folic acid daily, starting before conception and continuing for the first 12 weeks of pregnancy.
Menopause
Menopause is the time in a woman’s life when menstruation stops and she can no longer conceive.
A woman is said to have experienced the menopause when she has had twelve consecutive months without a period. On average, the menopause occurs when a woman is 51 years of age, but this varies quite a bit.
The premenopausal, or perimenopausal, process usually begins in or around the early 40’s. Symptoms of this include hot flushes and night sweats, mood swings, vaginal dryness, diminished sexual desire, forgetfulness, trouble sleeping and urinary incontinence.
After a woman has experienced the menopause her body produces less of the female hormones oestrogen and progesterone. Symptoms of the menopausal transition can be very troubling for many women, with many doctors prescribing hormone therapy (HRT, HT, ERT, ET) to ease symptoms. Many different types of hormone therapies are available for a pharmacist to give to a patient. These include tablets, patches, gel, vaginal preparations and nasal sprays. A pharmacist should discuss the available options for a patient privately with them.
A pharmacist can also discuss with the patient some alternatives to hormone replacement therapy e.g. regular exercise, dietary changes, natural supplements like soy isoflavones and omega oils etc. They should also advise a patient see their doctor, if they are to make an informed decision about further treatment.
