Dragana Skokovic-Sunjic on menopause, probiotics and the role of pharmacists in healthcare

When did you start as a pharmacist? “I’ve been working as a community pharmacist in Canada since 1995—I came to Canada in 1992 to escape a war in my home country, and then I had to pass the exams and get my licence here. “I started working with a great group of pharmacies in Hamilton. They’re gone now, but they had 15 stores. And they really supported additional education and their pharmacists getting specialties." What drew you to specializing in menopause? “Curiosity! Before 2002, a large percentage of my prescriptions in the pharmacy were Premarin and Provera, because basically, whenever women had any issues or complaints about menopausal issues, they were given hormones. But then there was a large study that put a different spin on the safety of hormones in an older population, and initially, the results were misinterpreted, and the pendulum swung back, and everybody stopped using hormones." “So then, we had a population that was now suffering. And the women who are in menopause are active, they have teenagers, jobs, they have parents to look after, and they’re in the prime of their lives. So I got curious to find out, well, what can we offer women to help them?” Read: 5 tips for helping patients make informed decisions about menopause hormone therapy How did you become a specialist in menopause? “I became a member of the North American Menopause Society and took their certification exam in 2003, the first year they opened the certification to non-physicians. I’m trained in menopause, but it also applies to women’s health of any age: perimenopause, libido, women’s health in general." “Within the community pharmacies I worked for, I developed a specialty stream in women’s health, and we started offering clinics for the public. We used to have education programs that we ran once a week for six weeks, for a fee, and they were surprisingly popular. Everybody told us nobody would come and pay, but then we had waiting lists, and we had mothers and daughters coming in together. I also did 1:1 consultations, lunch ’n’ learns with physicians, and mentored other pharmacists in the same chain who eventually became certified as well.” What’s the most rewarding thing about this work? “A few things. When women are given time to talk about their issues, and they realize they’re not alone, they’re overwhelmed. I always have Kleenex in my office, and there’s often a stream of tears. They think they are weak because they are suffering, and seeing them understand that this is common and that there are ways that we can help is extremely rewarding. “And we now know that assisting these patients is not only improving their quality of life, but that hot flashes and night sweats can actually increase the risk of heart attack and stroke. If we use the treatment appropriately we can reduce the risk of dying of all causes by 40%. We are actually reducing the risk of chronic disease, complications and death, which is huge.” Read: Two new menopause guidelines on sexuality highlight new treatments And now you work in a family health team? “Yes, that chain of pharmacies I worked with ended up being sold in 2011, and at that point I started working as a clinical pharmacist in the Hamilton Family Health Team. In this setting, I now see patients for all kinds of reasons, such as pain management and chronic diseases, but many of the people I see are still here for menopause or women’s health issues." "I work two days a week on a salary, and the physicians and nurse physicians refer patients to me. I don’t prescribe, but I do suggest prescriptions and discuss them. Being a member of a team where pharmacists are an essential part of decision-making about treatment approaches is very rewarding. A family health team is a great model for how things should be." “I’m also still working on educating my peers by doing sessions within the Family Health Team and with residents in local hospitals. And I’m very involved in the North American Menopause Society itself, serving on its exam committee, among other things.” Read: 'It's exciting': B.C. pharmacists' new prescription and injection powers begin And you’re involved in probiotics as well? “The rest of the time, I’m working on a project called the Clinical Guide to Probiotic Products. It’s a clinical tool that I started in 2008, following another curiosity of mine. Prior to that, I was doing presentations for pharmacists on the research around probiotic strains, and I got feedback saying they were frustrated with the lack of practical tools that could suggest brand names, so I was asked to prepare something to connect the brand name with the evidence." “Initially, in 2008, I created a table of nine products that was fully referenced and asked some colleagues to review it. The feedback was overwhelming, so we decided to do an update of that guide every year, and we’ve published it as a website and as an app too. We also do online education and patient handouts now. It’s all free because we get unrestricted educational funding from the industry members, though they don’t have any control over the content." “The Probiotic Guide tells points you to the products, and pharmacists love it, physicians love it because it narrows it down—say you wanted a probiotic for IBS, there’s a whole shelf full of probiotics but they’re not the same. If using the Probiotic Guide they can recommend one supported by evidence." “So many things that I do might seem separate, but they connect and overlap. In 2019, in the last large in-person meeting for the North American Menopause Society before the pandemic, I was asked to moderate a large session titled Women and Their Microbes between Dr. Jack Gilbert and Dr. Caroline Mitchell. It was in a space that held 1,200 people, and it was standing room only. It is interesting to note that this was the first time that a pharmacist had been onstage in the history of the North American Menopause Society Annual Meetings. It made me really proud of Canadian pharmacy—it was like, "Yeah, we can do it! We never know where we’re going to end up.” Read: Do probiotics play a role in pharmacy? This interview has been edited for clarity.

Dragana Skokovic-Sunjic on menopause, probiotics and the role of pharmacists in healthcare

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