Podcast Episode 7: The role of the pharmacist in the treatment of the perimenopause and menopause with menopause specialist, Hayley Berry
The role of the allied health care professional in a person’s journey through perimenopausal and menopausal treatment can prove essential. On this episode of the Newson Health Menopause Society podcast, host Lauren Redfern talks to in house Newson Health Pharmacist and Menopause Specialist Hayley Berry. Together, Lauren and Hayley pick apart the important position of the pharmacist and how it relates to a person’s menopausal journey. The episode explores the ways in which pharmacists and other allied health care professionals can upskill themselves in order to feel confident consulting on the perimenopause and menopause. It provides advice on how to access appropriate resources, tools, and education, including when to feel assured signposting to another service. Recognising the very important part played by the allied healthcare professional beyond the clinic, Hayley helps to demystify the process of learning, and provides valuable insight into how best to empower patients.
Hayley is an experienced prescribing pharmacist with a background in community pharmacy and now works in both general practice and education and training. She has a keen interest in women’s health including contraception, sexual health and the menopause and is currently working remotely in conjunction with the team at Newson Health.
You can find Hayley on Twitter @hayleyberry8
Lauren Redfern [00:00:06] Welcome to the podcast for the Newson Health Menopause Society, a multidisciplinary collective of interested professionals passionate about improving hormone health across the world. The society exists to educate and inspire others to raise the standard of menopause care and access to treatment, to facilitate research collaborations across specialities and countries, and to provide expert advice and guidance to our associates. The ultimate aim of the Newson Health Menopause Society is to improve the lives and future health of women and all who experience the perimenopause and menopause. I’m Lauren Redfern. I’m a medical anthropologist, and I’ve been exploring the experiences of those using testosterone as part of their HRT treatment. In this podcast series, I’m going to be talking to guests from a variety of different disciplines in order to share knowledge and ultimately improve our understanding of the perimenopause and menopause.
Lauren Redfern [00:01:05] When we think about allied healthcare professionals involved in the treatment of the perimenopause and menopause, the role a pharmacist has to play in the provision of care can arguably be overlooked. Not only do pharmacists have the complicated task of understanding the biochemical actions and interactions of different drugs, their uses and their side effects. They’re also required to interpret and communicate that information in an accessible way to different audiences, be that patient, physician or other healthcare provider. When I began my own research, it took me more than a minute to become familiar with not only the different actions of different hormones, but the different options available for administering them. Why certain patients may select one preparation over another. Why, for instance, an estrogen patch may suit a women’s lifestyle over a gel. When time for many with a clinician can be a luxury, it’s important to recognise how pharmacists can come to play an important role in supporting this decision making. Here to discuss with me today the role of the pharmacist and pharmacy more generally in the care and treatment of the perimenopause and menopause is Hayley Berry, an experienced prescribing pharmacist with a background in community pharmacy, general practice and education and training. Hi Hayley, would you be able to please introduce yourself to those listening and just tell us a little bit more about the work that you do?
Hayley Berry [00:02:35] Yes, thanks for having me today. My name is Hayley, as Lauren has said. So I am a pharmacist. I’ve been a practising pharmacist for about 18 years now. Predominantly, I used to work in Community Pharmacy after qualifying from Bath University, so I worked for about 15 years in Community Pharmacy. Most recently, I’ve worked in education and training support in pharmacists and pharmacy technicians post qualification to help them develop at a postgraduate level. I’ve also worked in general practice, so working in a doctor’s surgery, running my own clinics. I’ve always had a really keen interest in women’s health and this was sort of developed during my years as a community pharmacist, where I did my Master’s in public health pharmacy and specifically focused on emergency contraception. And from that, and from all my dealings with patients in community pharmacy, I’ve really become interested in women’s health. Menopause in particular and contraception in general. So that’s how I’ve sort of become interested in women’s health and menopause, really.
Lauren Redfern [00:03:34] Hmm. It’s interesting. So I actually wanted to start by asking you a fairly broad question which sort of relates to what it is you’ve just sort of outlined, which is that there are different types of pharmacy practice. And obviously, in the introduction, I mentioned that you have a background in community pharmacy, which you’ve just expanded upon there, but you’ve also worked in general practice, education and training. And I wondered if you could talk us through a little bit what those differences in specialities are and why they’re important and how you go to sort of train in one particular area.
Hayley Berry [00:04:05] Yeah, there are many different areas that pharmacists can work in now. And I guess since I qualified almost 20 years ago, that scope has massively widened. So for me, Community Pharmacy, I started off in hospital practice, so I did my pre-registration year, which is a year where you work in practice and then do your formal qualification exams at the end of that, 12 months after your university degree for four years. So it’s five years training, really, to become a pharmacist and then you can choose how you want to specialise. So I did my pre-registration year, as it was called then, for 12 months in hospital, which then gave me a really good, solid foundation in hospital. So you learn about sort of dispensary, ward-based management of medications, supporting patients, labs, you sort of rotate through all the different sectors in the hospital pharmacy environment. So that gave me a really good basis. And then you could stay on in hospital and progress into different specialities within the hospital pharmacy department. And for me, I decided to make a move into community pharmacy as throughout my undergraduate training, I did quite a lot of summer placements for various pharmacies and things, so I knew that I had that experience behind me. So I became a pharmacy manager, which is one option for people when they qualify as pharmacists. I ran really busy training pharmacy, part of a large multiple, and we used to have, you know, really large patient base, long hours, we used to do lots of service delivery. And I suppose for me, community pharmacies really having that patient contact really being able to offer this wide variety of services. I used to do phlebotomy, travel vaccines, flu vaccinations, the emergency contraception, stop smoking services. So there’s a massive array of things that pharmacists can get – and their teams – can get involved with in community. I suppose the other thing that I’ve done in my past is general practice. So there’s been a big push in the last sort of three to four years to bring pharmacists and pharmacy technicians into the general practice environment because, you know, there’s not enough clinicians within the NHS at present, and pharmacists have that skill mix to be able to support the general practice team alongside doctors, nurses, healthcare assistants, physicians’ associates, paramedics. You know, they’re trying to broaden the skill mix in general practice. So I was one of the lucky ones that got into general practice about six years ago. I did my independent prescribing training fairly quickly after that, and I’ve worked alongside GPs doing clinics one day a week in a general practice setting since then. And I suppose there’s more and more momentum of getting more and more pharmacists and pharmacy technicians into general practice. So you’ll probably find that there is more than likely in your own general practice across England, a pharmacist or a pharmacy technician, either supporting just one practice or a group of practices so that it’s becoming more of a more of a career option for pharmacists and pharmacy technicians than ever has been before. And I suppose final education and training, which is my other passion, is really, you know, lots of opportunities, whether it be working alongside a university, some sort of training college. I’m really lucky I work for a university and we deliver post-grad training for pharmacists, pharmacy technicians and their teams. And I suppose it’s just meeting lots of people, delivering training, writing resources, working with loads of different experts in different topics. It’s a really good variety and there’s lots of different career paths out there for pharmacists, really. I suppose I’ve been lucky. I’ve had quite a varied career over the years.
Lauren Redfern [00:07:33] Yeah, and I wanted to build a bit on that because it’s fascinating hearing you talk about that in the way that pharmacists and pharmacy technicians can support in that way. And obviously, we’re here to shine a light on and talk about the perimenopause and menopause. And I wondered if you might be able to tell us a little bit more about that role of a pharmacist in supporting the care of perimenopausal and menopausal persons? And ultimately, what is it that pharmacists not only can do to support but help to manage a person’s sort of treatment plan and making those important decisions, as you say, supporting GP’s and other health care professionals, too?
Hayley Berry [00:08:06] Yeah. And I suppose over recent years, as more of a focus on menopause and women’s health than there ever has been before, because I know in my training it’s not really covered at all really, menopause as such. I mean, it’s only from my own personal interest that I’ve gone off and expanded my knowledge. But I suppose in Community Pharmacy pharmacists and their teams are often faced with women with questions about menopausal symptoms. So I think you’ve got a huge role there in menopause support, being able to signpost to the available information resources online, apps to capture symptoms and things to help support them in those consultations with their GP’s. In primary care, my role really was sort of supporting, you know, long term condition management and obviously people who are having medication reviews with menopausal symptoms who are taking HRT, pharmacists can have a really big impact there on symptom control, adjusted dosage, checking you know how they’re getting on with their current medication and things, as well as signposting and, you know, showing patients where resources are that can really help them manage and be really well informed about their condition and their symptoms. So it’s really a lot of, you know, supporting signposting that pharmacists can really get involved in, in any sector, really.
Lauren Redfern [00:09:18] And I mean, I think that’s interesting. I mean, from my own observations, I really noticed that with HRT, it can be a process of really tweaking as well. You know, starting off on one pump of Oestrogel say, and then upping to two or three and looking at those levels. And so would a pharmacist be involved in sort of monitoring that treatment plan and upping that or lowering the dosage as is needed?
Hayley Berry [00:09:38] Yeah, I suppose it depends on how confident they’re feeling with their practice. I work in a clinic where I am really confident at seeing menopausal women and can adjust treatment plans and prescribe accordingly. Even if it’s a case of helping women in a community pharmacy setting where you wouldn’t necessarily be prescribing, you could be advising women on how to self-diagnose their perimenopausal or menopausal symptoms, how to track their symptoms so that it can approach their GP or healthcare professional at the surgery to really help get the best from that consultation and treatment options and things.
Lauren Redfern [00:10:13] Yeah, I think it’s nice because really, I guess what that shines a light on is exactly that, that you can sort of train in that area of specialism as well. And the more confident you become, you can become more involved. And I think I wanted to touch a bit on that because obviously you mentioned that you yourself have a special interest and experience in working in education and training. And I wondered if you might talk us through what is currently available to pharmacists to help in their learning about the perimenopause and menopause? Because I mean, it’s been interesting for me having a number of conversations with different healthcare professionals who have mentioned that perimenopause, or menopause generally, was not offered a lot of time or space in education when going through med school. So I’m wondering how that is for pharmacists and how it differs or what is available.
Hayley Berry [00:10:59] I would say it’s probably really similar for pharmacists in my undergraduate qualification. There was no mention really of menopause, particularly that I remember. I know that’s all the educational reforms that are happening now for the undergraduate pharmacy qualification, so that may well change in the future over the next few years. But I guess I would say, like other healthcare professions, there’s limited training. But that’s not to say that, you know, people with personal interest, there are courses, programmes, information available that pharmacists and their teams can access. I mean, the British Menopause Society accept pharmacists as members. So there’s lots of resources to expand knowledge and things on their training courses that they can attend. There’s also Red Whale, which is a GP trainer that offers menopause training as well, which is open to pharmacists as well as other healthcare professionals. I suppose for me, there’s always been a bit of a barrier of finding someone to develop that knowledge with, so maybe someone to shadow or having someone else who’s got that specialist knowledge as well, so you can gain confidence and discuss peer to peer conversations with about patients and things. So whether that’s, you know, finding shadowing opportunities, if you do have an interest in menopause and want to develop, you know your career further and get different training opportunities and things, I think that would be a really good thing for pharmacists to do if they are interested in specialising.
Lauren Redfern [00:12:19] No, definitely. And I think for me, if I’m being very honest, I think I myself was a bit guilty of not really considering the role of the pharmacist within the treatment and care of those experiencing perimenopausal or menopausal symptoms. And I’ve actually, it’s been interesting through my research, having conversations with women and people experiencing perimenopause or menopausal symptoms them actually talking about good experiences that they’ve had with pharmacists of the pharmacies, actually being the one that they felt really advocated and supported exactly, as you say, their journey through that treatment process. And I wondered if you might be able to talk us through some of the kind of common misconceptions or barriers that there are when it comes to appreciating how a pharmacist can help assist in the treatment and care of the perimenopause and menopause.
Hayley Berry [00:13:04] OK, I suppose it’s in general. I know when I speak to friends and family they don’t really know what a pharmacist does particularly. But I think, you know, that is changing as more and more pharmacists are working in different settings. You know, we’re not stood behind counters, dispensing tablets, and, you know, we do have a more expanded role. So I think it’s just raising awareness in general of the pharmacist, and the pharmacy technician, you know, in all healthcare settings. I think it’s a really exciting time for pharmacists to get involved in different opportunities as they arise. And I think menopause, contraception, are really massive opportunity’s well really menopause. And I suppose that’s what I’m passionate about because you can really, you know, as a pharmacist, you can make a massive difference to someone’s life by supporting them, listening to them about their perimenopause/menopausal symptoms and really giving them the opportunity to talk to you and discuss potential next steps or treatment options, even if it is just that ear to listen to in a community pharmacy where you know your patients as a pharmacist, I used to have hundreds of patients that I knew on first name basis they would come to talk to me. I would listen, you know, signpost, give them information so they could go to those consultations at the surgery in different clinical settings and be fully informed so that they could have the most useful consultation that they could have. I suppose it’s just about raising awareness of what the pharmacist can do. And you know, I encourage people to go and speak to their pharmacists, really.
Lauren Redfern [00:14:28] Yeah. And I couldn’t agree with you more on two levels: the first being that it was interesting for me observing, I think care and time is such an important part of treatment in this circumstance and setting, I mean, even if we think about the fact that for lots of women, a symptom they might experience is brain fog. And if you’re experiencing brain fog, it can often be hard in a shorter consultation with a doctor to go through all of your symptoms and have that space to talk. So I think you’re really right of being able to just provide that support and space to be able to really air what’s going on for you is so key. And also, I think it is. I mean, I love my pharmacist, I genuinely just if I want to go and get advice, that is where I go for finding out what to do with a particular issue. So I think it’s exactly, as you say, using that resource. I wondered as well, what your thoughts were on how we can best encourage pharmacists to become advocates or more active in undertaking training or feeling more confident in administering hormone prescriptions and where they can go for signposting, advice and support. Or exactly, as you say, if they want to take on that role, if they want to do more training where they could go to do that and how they can best empower themselves in their practice.
Hayley Berry [00:15:40] Yeah, I suppose I would say to become familiar with the resources, so there are, you know, massive amounts of resources online, CPPPE – Centre for Pharmacy Postgraduate Education – does have a menopause e-learning, which is open to all pharmacy professionals. The Faculty of Sexual Health, they have some menopause resources, as do the British Menopause Society and the Red Whale that I’ve mentioned. There’s also the Fourteenfish training, which is available to all healthcare professionals as well, including pharmacists. And that’s really something that would definitely help with those consultations around what to expect from consultations and how to get the most from those consultations and really have that whole holistic patient approach. And I suppose there are lots of resources available, and it’s just finding something that works for you. And I mean, the Menopause Society, you know, if you become a member, there’s lots of great resources that are going to be building on their over upcoming months, and that would be a good place to start for your own personal development. I’d also say to have a look at apps that can track your symptoms, you know, so that you’re familiar with what women may be using. So, you know, if people come and talk to you about their symptoms, you can encourage them to use different apps to record and track. That’s really useful. I also think for me, the thing that really supported my development after doing various courses and learning was the fact that I had the opportunity to shadow a menopause clinic that really made a massive difference to me, and I would encourage other pharmacists who do have that interest to try and arrange that locally. I know there’s not very many of us who do have a specialist interest, potentially, but you know, even if pharmacists, nurses, doctors, if you have a good relationship with someone who does have a specialist interest in menopause, see if there is any shadowing opportunities for you. I sat in with some doctors and a couple of nurses and the other pharmacist that works at the clinic, and that really, really helped me get my head around the consultations and what I was looking for and sort of helped me build my confidence really, because it was things that I knew, but it was having that confidence of seeing someone else do it. And I suppose that’s the benefit of the Fourteenfish training is that you’re watching consultations and you can really see what it’s like from the patient and from the practitioner point of view. So that’s the benefit of that. So you can see what good looks like.
Lauren Redfern [00:17:57] I mean, that’s our hope as well with the society is that it is building that space of community too, you know, so that you have those opportunities to network with others and really pick the brains of other healthcare professionals, be that pharmacist, nurse practitioner, GP, you know, to be able to have that space to talk because I think it’s always great to be able to find a space that, as you say, you can kind of share tips and also ask questions.
Hayley Berry [00:18:21] Definitely. Yeah, I think peer support and peer learning has been a massive help for me over the last few years. Definitely.
Lauren Redfern [00:18:27] Yeah. And that’s our hope as well with the society that that will allow, you know, other pharmacists that are interested in specialising that they can meet other pharmacists that are specialising in that area, too. Definitely.
Hayley Berry [00:18:36] I mean, I’m supporting some trainee pharmacists prescribers at the moment in that they’re going to shadow my clinics, you know, my remote clinics so that they can understand what it’s like and how they can put all their ideas and thoughts in practice to support their prescribing going forward. So there are opportunities available for different people.
Lauren Redfern [00:18:52] Yeah. One thing I wanted to talk a bit about is obviously depending on the legal scope of practice, pharmacists in some settings have the ability to contribute to prescribing or become a pharmacist prescriber, which obviously means they’re able to administer certain medications, for example, immunisations, as you were saying before, vaccines. And there has been some discussion emerging around how medications such as Viagra, for example, are available over the counter and now we have contraception available without a clinician’s prescription. And I wondered if you had any thoughts on what this might be and where this might be going in relation to HRT, whether we could be moving towards that direction and if so, what we need to do to get there because I think there are so many people that feel it would be great to just be able to go and get the hormones that they need. So I was just keen to hear your thoughts on that if you have any.
Hayley Berry [00:19:45] Yeah, I suppose pharmacy is changing. As I mentioned, the undergraduate initial training and education standards are changing over the next few years, so pharmacists will emerge from universities within five years as prescribers. So I think that will change the future of pharmacy long term, because at the moment, there’s only a small group of pharmacists that are actually prescribers. And I suppose at the moment a lot of the pharmacy services specifically in community pharmacy are delivered via patient group direction. So there’s no prescriptions involved, it’s just pharmacists that sign up to a service, and they are then able to deliver certain prescription-only medicines as long as they fulfil the service criteria against a patient group direction. And I suppose in the future, you know, it’s really exciting that there’s lots of talk about menopause at the moment. So I think, you know, community pharmacy would be a good – they’re on the high street, people can come in and talk to you, you’re really accessible. People feel comfortable talking to their community pharmacist, everywhere has a consultation room now, so you do have that private setting. And you know, there’s lots of other services that are delivered through pharmacy like you’ve mentioned, you know, flu jabs, vaccinations, emergency contraception. They are all delivered through pharmacies. So whether in the future that would move towards menopause care as well as contraception. There’s definitely lots of opportunities and scope going forward.
Lauren Redfern [00:21:06] So I think it’s an interesting kind of watch this space moment.
Hayley Berry [00:21:08] Definitely. Yeah.
Lauren Redfern [00:21:10] Yeah. I wondered Hayley, as well. I do tend to ask people that come on if they have any best practice tips or advice for anybody listening. So if you’ve got other pharmacists listening today that might want to pick up some best practice tips really for working around the perimenopause and menopause, what yours would be if you have any?
Hayley Berry [00:21:27] OK, so I suppose my best practice tips would be thinking about, your level of knowledge, so become familiar with the resources that are out there. Know where you can find the resources and be able to signpost your patients effectively because, you know, as a community pharmacist, you are often asked lots and lots of things on a daily basis. And from my practice in community pharmacy, don’t be afraid to say to a patient, I’m just going to go and find out for you. Yes, and get some more information and then get back in touch with them and share the resources with them, if you don’t have them at your fingertips there and then. There are lots of amazing resources for menopause support, perimenopause support out there and it’s just becoming familiar with them so that you can signpost your patients so they can get all the evidence-based information and have that at their fingertips really to support their decision making going forward. So that was probably my first top tip. Yeah, my second top tip was to talk to women.
Lauren Redfern [00:22:19] Yeah.
Hayley Berry [00:22:20] It’s amazing that since I started thinking about menopause, it’s amazing when you’re doing medication reviews with women, how many have perimenopause or menopausal symptoms and actually, when you’re thinking that, it takes part in that consultation. So really, take the time to listen to women – I know time is an issue for every healthcare practitioner at the moment. We don’t have a lot of time in our standard consultations, but if you do, just have a listen to them, take time to listen to their stories and find out really how the perimenopause and menopause is affecting their life. I can’t believe how it does impact on people’s lives. So really, that was my other top tip was to talk to women. I would also say the linking to that is just be inquisitive, ask lots of questions, because it will really help you understand the treatment if you understand the patient journey and the impact that the correct treatment and advice has on them in their life going forward and their quality of life, really, which is what we’re looking for with treatment. And I suppose my final tip is thinking about shadowing. So I said that really, really helped me develop my confidence and expertise and, you know, move into a role of working in a specialist menopause clinic. So if you have any local opportunities anywhere where you can shadow, you know, a nurse, pharmacist, doctor, anyone who’s – it doesn’t have to be in a specialist clinic – if there’s someone in your local surgery that you work alongside, see if they would be happy, if they’re seeing women to do with menopause or perimenopause, if they would be happy for you to sit in on those consultations with them and just have a discussion with them afterwards. I think having that opportunity for me really helped develop my knowledge and confidence in the area really, definitely helped me as a practitioner move into that area with a lot more confidence than I had to start with.
Lauren Redfern [00:24:07] Yeah. And I think what’s also lovely about what you’re saying, as well as it’s to be a curious thinker too, you know, I was listening to Louise talk about this the other day of saying that, you know, sometimes symptoms that might not seem to have anything to do with perimenopause or menopause have everything to do with menopause or menopause. You know, she was saying, well, actually, one of the first questions should always be ‘what are your periods like? ‘What are your periods doing?’ Thinking about how to be curious about – okay, how old is this person? Or are they showing any signs or things that are ringing that bell? You know, because it’s if you don’t ask, you don’t know, which I guess is also developing on that point of having the confidence that you can to ask someone to say, ‘Can I come and watch?’ Yeah, because I know in my research, you know, that’s basically all I do is hang out and watch, and you can see so much from just observing and standing outside it.
Hayley Berry [00:24:52] Yeah, definitely. That really, really helped me with my development and my confidence, shadowing and talking to other clinicians involved in menopause.
Lauren Redfern [00:25:00] Well you pick up so much when you can see other people, don’t you? Yes, going, Oh, that’s great, I’ll keep that for me.
Hayley Berry [00:25:05] Yeah, yeah. Get your little toolkit of good phrases and different things and evidence of different resources. You’re always gathering those as a healthcare professional anyway. But I think shadowing, especially in an area where we don’t have a lot of training throughout our careers, which is the same as what we’ve discussed with other healthcare professions. You know, there isn’t a lot at the moment, and I think that will change in the future.
Lauren Redfern [00:25:26] And I think hopefully in the work that you’re doing, Hayley, we’re going to see that changing. Yeah, I’m so grateful for you coming on to chat with us. It’s been really fascinating for me to learn more about this and think more about this. I sort of end every episode really with asking our guests if they have any take home messages. You know, anything they’d like to stress from the things we’ve talked about, could be pharmacy related, education related. Yeah, but I wondered if you have any sort of take home messages that you’d like to stress?
Hayley Berry [00:25:49] I would just say, don’t be afraid to ask lots of questions, whether that be with your patients or with clinicians that you managed to arrange shadowing opportunities with. That’s how we learn.
Lauren Redfern [00:25:59] Yes.
Hayley Berry [00:26:00] I talk about the menopause and perimenopause all the time with colleagues, with friends, with family, because I think it’s really good to raise awareness and actually half of the population are going to go through it at some stage in their lives. So it’s really good to raise that awareness. So that’s probably my – always have menopause and perimenopause on your agenda somewhere in the back of your head to think about – that would be my top tip.
Lauren Redfern [00:26:23] I agree. And I mean, I think everyone in my life could not be done enough, now, with me talking about dry vaginas.
Hayley Berry [00:26:30] And mine!
Lauren Redfern [00:26:32] It’s like, ‘please enough’. I agree. It’s like, curiosity. Thank you so much for joining me today, Hayley, and hopefully we can have you back to talk more about pharmacy in the future.
Lauren Redfern [00:26:40] Okay, thank you very much.
Lauren Redfern [00:26:45] We would love for you to join our collective of professionals passionate about the menopause. Visit NHMenopauseSociety.org to become an associate, you’ll receive regular webinars and advice from our experts, as well as opportunities to network and connect with the latest research from around the world. You can follow us on Twitter at @NHMenoSociety. And don’t forget to tell your colleagues about the Newson Health Menopause Society.