Top six women’s health issues – and how pharmacy assistants can help

Author: Eloise Tombs, Guild Trainer/Assessor
Pharmacy assistants can play an important role in providing advice to women no matter what life stage or age. We can suggest strategies to help live a healthy life and provide information and advice about products and services in the pharmacy and wider community. I’d like to share the top six women’s health issues that I have encountered over the years and how we as pharmacy assistants can help those customers.

1. Fatigue
What – Feeling run down and fatigued is a condition that many women can experience. Fatigue is a symptom, not a condition and can be caused by a combination of lifestyle, social, psychological and general wellbeing issues.

When – Women of any age can experience fatigue, but it’s commonly seen in women aged 25 to 35.

Symptoms – Weariness, tiredness or lack of energy and irritability, poor concentration, headaches, muscle aches
Why – Dehydration, lack of a nutritious diet, menstruation.

Treatment options – Complimentary medicines such as women’s multivitamins contain vitamins, minerals and in some cases herbal ingredients that supplement dietary intake including iron, calcium, magnesium, B vitamins, copper, zinc, iodine and antioxidants.

Lifestyle Advice – A healthy diet, regular exercise, looking after your mental health, reducing your stress levels and getting enough good quality sleep may all contribute to increasing energy levels. Pharmacists are available for further advice should your customers seek more clinical or medicine information.

2. Period Pain
What – Pain in the lower abdomen and lower back around the time of their period most commonly leading up to and during the first day or two.

When – Women of any age can experience painful periods. Some women find periods are no longer painful after pregnancy and childbirth.
Symptoms – Pain in the lower abdomen and lower back.

Why – It is thought that the muscles of the uterus (womb) squeeze and contract harder than normal to dislodge the thickened lining (endometrium). These contractions may also reduce blood flow to the uterus, making the pain worse.

Treatment options – Complimentary medicines such as standardised Vitex agnus-castus and Angelica polymorpha root (Dong Quai) in combination, evening primrose oil capsules. Over the counter analgesics/anti-inflammatories are effective along with hot water bottles or wheat packs.

3. Menopause
What – Is the final part of a woman’s reproductive life cycle. Each woman’s experience of menopause is unique, although most women experience some type of symptom in addition to the ending of their menstrual period. Menopause often marks a new phase in a woman’s life.

When – Typically occurs between the late 40s and early 50s.

Symptoms – The experience of menopause varies widely from woman to woman and from culture to culture. All women, however, undergo the same basic hormonal changes during menopause. Hot flushes are characterised by feelings of heat that spread to the chest, neck, face or the entire body. Hot flushes may be accompanied by sweating, nausea, heart palpitations, and flushed skin and can contribute to sleep disturbances. Flow/Cycle changes are experienced by pre-menopausal women with irregular periods that stop and start with no apparent pattern. It is also common for women to get heavier, lighter or longer periods at this time. Physical changes of the vagina occur due to the reduction in oestrogen levels at menopause such as thinning of the vagina lining and vaginal dryness. Changes in the vagina’s pH level (which keeps naturally occurring bacteria in balance) can occur, resulting in bacterial infections and dryness. Skin and hair becomes thinner and less elastic as we age naturally, these changes are accentuated at menopause as oestrogen appears to play an important role in maintaining the skin. Women may notice a change in the skin’s texture and tone and an increase in the appearance of lines and wrinkles. They may also find their skin is drier or oilier than before, or a combination of both.

Why – A woman’s ovaries produce three types of hormones – oestrogen, progesterone and testosterone. Among other things, these hormones play a vital role in menstruation, ovulation and pregnancy. During the menopause transition, the ovaries’ production of oestrogen and progesterone fluctuates, but ultimately declines, ceasing at menopause.

Treatment options – There are a number of supplements, available in the pharmacy, which women can take to achieve a smoother transition into this new life stage, including clinically researched and standardised Actaea racemosa (black Cohosh), Trifolium pratense (red clover), Vitex agnus-castus and moisturising pH balanced vaginal gels.

Lifestyle Advice – Unpleasant symptoms of menopause can often be reduced by following a healthy diet, regular exercise, maintaining good mental health, reducing stress levels, getting enough good quality sleep, cotton breathable pyjamas and bedding to help with night sweats, avoiding the things that trigger hot flushes, and quitting smoking. Pharmacists are available for further advice should your customers seek more clinical or medical information.

4. Urinary Incontinence
What – Is described as a lack of voluntary control over urination for example bladder leakage problems, particularly during pregnancy, that can be caused by weak pelvic floor muscles but also is age related.

When – More than 70% of people who experience incontinence are women, with many experiencing problems after childbirth and menopause.

Symptoms – Symptoms such as leaking of urine when coughing, sneezing, lifting, laughing or doing exercise.

Why – Pelvic floor muscles which support the uterus and bladder can be weakened due to the weight of the growing fetus during pregnancy and childbirth.

Treatment options – Incontinence products to help with controlling leakage are varied and easily accessible for customers such as pads that slip into underwear and discreet pull on pants that address light to heavy urine leakage with odour control.

Lifestyle Advice – Try to squeeze, lift and hold pelvic floor muscles before sneezing, coughing, blowing the nose or lifting. Try crossing your legs and squeeze them tightly together before each cough or sneeze and don’t lift heavy loads. Pelvic floor muscle training is something to recommend to assist with strengthening pelvic floor muscles. Go to the toilet when needed, not ‘just in case’, along with avoiding stimulants like caffeine. It is recommend customers see their GP if symptoms worsen.

5. Pregnancy Supplements
When – Pre-pregnancy, pregnancy and during breast feeding.

Symptoms – Fatigue due to the demands on the body during pregnancy and breastfeeding.

Why – Good nutrition during pregnancy is beneficial for the development of a healthy baby. The need for certain nutrients, such as iron, iodine and folate, is increased at this time and if diet alone cannot achieve the recommend daily intake, a supplement may assist. Studies have shown that neural defects such as spina bifida can be avoided by increasing folic acid, and iodine can assist with healthy brain development of the fetus.

Treatment options – Pregnancy supplement have been proven to be effective in providing the required recommended daily intake (RDI) of vitamins and minerals during pregnancy and breastfeeding and for optimal health when trying to fall pregnant.

Lifestyle Advice – Eat a well-balanced diet, cut out or reduce certain foods and drinks such as raw/deli type foods, alcohol and caffeine, gentle exercise and plenty of rest, quit smoking and arrange regular check-ups with a health care professional.

6. Cystitis/UTI
What – Cystitis is an infection of the bladder that almost always follows (is secondary to) bacterial infection in the urine. It is the most common type of urinary tract infection (UTI), particularly in women.

When – Women in their late teens and older are most susceptible to cystitis, especially if they are sexually active and/or during certain stages of the menstrual cycle, during pregnancy, during menopause and after a total hysterectomy.

Symptoms – Cystitis can be mild to severe. The symptoms include frequent urge to urinate, if only to pass a few drops, burning pain or a ‘scalding’ sensation on urination, strong-smelling urine, cloudy or bloody urine and sometimes pain in the lower abdomen.

Why – Cystitis occurs when bacteria travels up the urethra (the tube that connects the bladder to the outside of the body), infects the urine and inflames the bladder lining. While it is painful and annoying, it isn’t dangerous or contagious, and the infection can’t be passed on to your partner during sex.
If left untreated, the infection can ‘backtrack’ deeper into the urinary system from the bladder and reach the kidneys. A kidney infection is serious and needs prompt medical attention as it can cause kidney damage or even kidney failure.

Treatment options – The earliest symptom of cystitis is usually a faint prickling feeling on passing urine. It is possible to get rid of mild cystitis if you take action immediately.
Some suggestions include: Drink plenty of liquids and take a commercial urinary alkaliser (refer onto a pharmacist for advice) or one teaspoon of baking soda (bicarbonate of soda) in water. The use of medicine containing the active ingredient Methenamine hippurate have been proven to be an effective preventative treatment of reoccurring UTI’s and are available in pharmacy. The good news is there is no known treatment resistance developing with continuous use of Hiprex, so it can be taken long-term. Refer onto a pharmacist to ensure Hiprex is suitable for your customer.

Lifestyle Advice – Urinate as soon as you feel the need rather than holding on and drink plenty of water every day to flush the urinary system. Wipe from front to back (urethra to anus) after going to the toilet and wash the genitals before sex and encourage your partner to do the same. Urination after sex, unperfumed soaps along with avoiding synthetic underwear can also help. If self-help treatments aren’t working, seek medical advice quickly. A doctor will probably test the urine to check which micro-organism is present. Cystitis can be treated with a course (or more than one course) of antibiotics. Regular or severe attacks of cystitis need to be investigated by a doctor, because an underlying disorder such as kidney stones or a kidney infection could be the trigger. Pharmacists are a great source of knowledge, not only about the prescription medications the patient is taking, but also the medical concerns with which your customers are experiencing. Numerous over-the-counter products can help with many of these concerns. Ensure a pharmacist is always involved in the discussion to help you discern which over-the-counter items best suit your customer’s needs.

The use of complimentary medicines in Australia are regulated by The Therapeutic Goods Administration under The Therapeutic Goods Act 1989, for more information see the TGA website.