Women's health. Menopause - what's the pharmacist's role?

It doesn't have to be summer for many women of a certain age to experience the vasomotor symptoms associated with menopausal hormone changes. They will have their own ‘heat waves’ with their personal thermometer rising on the inside.

Hot flashes, night sweats, and other symptoms of menopause are due to a drop in the levels of estrogen and progesterone. This can be a slow, progressive decline over years, or a dramatic crash at once, in a sense more of a ‘crash and burn…and keep burning.’

Someone said: ‘There is no wisdom in menopause, only heat’. Most of us would think this is pretty witty; we often joke about symptoms of menopause, share cartoons depicting women with fans, water hoses, wading pools, etc., trying to combat the common symptoms they suffer from on a daily basis.

Some women take this in stride. They call their hot flashes ‘power surges,' despite being left with no sense of strength or power. We, as women, are so proud of being able to ‘tough it out,’ show our strength by ignoring the symptoms, not sleep and still keep going strong, looking after everyone and everything else in our personal and professional lives.

At the same time statistics show this suffering is happening very often. As pharmacists, we see these women in our pharmacies on a daily basis. According to the 2014 census, women aged 50 to 54 years made up the largest age cohort of women in Canada. In the United States there are approximately 64 million women who are post-menopausal and about half of them are suffering with symptoms.

Looking at statistics, going from perimenopause to menopause, only 20% of women will have no symptoms. The remaining 80% will be symptomatic; the lucky 30% of those with symptoms will have “only” hot flashes. The other symptomatic 70% will have hot flashes, and in addition, they will think they are losing their mind.s Most women are not aware that cognitive dysfunction, insomnia, mood swings, depression, even thinking about suicide are commonly observed symptoms of menopause.

Let’s break down the anatomy of a hot flash.

Hot flashes are complex. Research suggests they are a result of the narrowing of the thermoregulatory zone in the brain, basically a malfunctioning inner thermostat. The smallest change in surrounding temperature can stoke the fire. In a way it is like a broken furnace. That being said, we really don’t understand what is going on with hot flashes. This is partly due to society’s lack of interest in women of a certain age, and partly because they are unpredictable and hard to study (the hot flashes, not the women). Not knowing when they will strike adds to the frustration (again, the hot flashes, not the women).

Is this merely an inconvenience, ruining vacation and summer activities, or is there something more important going on? Is this a warning sign and risk predictor for cardiovascular disease risk? According to more recent research, controlling these symptoms will not only improve QoL, but reduce risk of more serious issues.

Why should this be important to us? Let’s go to a different example: as pharmacists, we see patients with diabetes on a daily basis. In diabetes, the goal is to prevent hyperglycemia. Patients' quality of life is impaired if blood glucose is very high or very low, and we are aiming to prevent long term issues, such as risk of heart disease and dying from complications. Most of us would not find it funny or humorous if a patient starts sweating or slurring his speech in acute hyper- or hypoglycemic state. Agreed?

So, why do we not apply the same standards-of-care to our symptomatic patients going through menopausal transition?

We know the impact of those symptoms on quality of life, the fact that moderate to severe vasomotor symptoms are associated with cardiovascular instability and increased risk of cardiovascular events, such as heart attack and stroke.

Hot flashes are a sign of potentially serious risk – they should be taken as such.

Let’s get more comfortable in starting the conversations about them. It’s time.

Stay tuned for the next post offering helpful tips.