In 2011, nearly half of the 6.1 million pregnancies (or 45%) in the United States were unintended.1 The highest rates of unintended pregnancy occur among low-income women earning less than 200 percent of the federal poverty level, women ages 18 to 24, cohabiting women, and women of color.1
Access to contraceptives is just one area where pharmacists can help women, said Veronica Vernon, PharmD, assistant professor of pharmacy practice at Butler University College of Pharmacy & Health Sciences in Indianapolis, Indiana. Access to a pharmacist can also help women who experience menstrual problems, including period pain, irregular periods, and heavy or unusual bleeding.2
Access to care for women with menstrual disorders was particularly critical during the COVID-19 pandemic, noted Vernon, who is also a gynecology and primary care ambulatory clinical pharmacy specialist at the Richard L. Roudebush Veterans Affairs Medical Center in Indianapolis. More women than men did not miss recommended preventive services, including annual exams and routine tests, and low-income women were more likely to have missed these preventive health services.3
A variety of factors make accessing care difficult for low-income women, including irregular transportation, lack of child care, limited insurance coverage, and a work schedule that prevents them from traveling to clinics. medical appointments, according to a commentary published in Pharmacy.4
“Empowering community pharmacies with specialized family planning skills will increase their ability to meet patient and community needs and subsequently reduce barriers to access.” The newly developed learning resources…provide a bridge to successful implementation of practices (that) reduce stigma, increase patient satisfaction, and improve health outcomes,” wrote the authors, including Sally Rafie, PharmD, BCPS, APH, founder of Birth. Comptroller Pharmacist and Specialist Pharmacist at the University of California, San Diego.
The role of pharmacists in women’s health
Given that 91% of Americans live within 5 miles of a community pharmacy, pharmacists are in a unique position to fill these healthcare gaps.5 “(Pharmacies) can be a center of public health in their communities,” Vernon said.
Pharmacists also play an important role in the inpatient setting. Kayla Popova, PharmD, a clinical pharmacist specializing in obstetrics and gynecology at Michigan Medicine in Ann Arbor, spends her days with obstetrics specialists who see women with high-risk pregnancies. “It is very important to have a pharmacist serving women,” Popova said. “When a woman is pregnant, certain medications cannot be taken. They’re not safe in the first trimester, (but) they may be safe in the second or third trimester. And because of some women’s medical histories, taking a birth control method containing a lot of estrogen is not an option because it can lead to thrombosis, added Popova, who is also an assistant clinical instructor of pharmacy at the University of Michigan .
Providing access to contraceptives
Pharmacists face barriers to providing access to contraception. Without a collaborative practice agreement, pharmacists can only prescribe contraceptives in 20 states.6 Pharmacists are, however, aware that women have difficulty accessing birth control. “We’ve all gotten those panicked phone calls,” Rafie said.
The pharmacist’s role is to serve as a resource for patients who need contraception, Rafie explained. This includes counseling and helping patients choose the method of contraception that is best for them. And in states where pharmacists can prescribe contraceptives, that role includes writing a prescription. “This is a public health challenge,” she said. “It is extremely important that women have autonomy over their own bodies and their own health.”
Rafie, founder of San Diego-based Pharmacists Clinic, provides contraceptive and other clinical services in a community pharmacy environment. It is also important to educate patients about the pharmacist’s ability to prescribe contraceptives. “I strongly encourage pharmacists to make it clear that they offer this service,” she said. Training opportunities include sharing social media posts, wearing buttons promoting the service and using counter tents. Rafie also recommended providing a private or semi-private space — or at least a sound barrier — to help women talk with a pharmacist about birth control options.
Treating menstrual pain
Pain, psychological disturbances, and fatigue are the most common symptoms associated with menstruation, and during menstruation, 1 in 3 women refrain from daily activities due to these symptoms.7 When a pharmacist sees a woman browsing the menstrual pain relief section of the pharmacy, it’s a great opportunity to approach her and ask questions, Vernon said. She recommends using this conversation starter: “You are here looking for relief from period pain. What are your symptoms? How long has this been happening?
“You’re not going to have 20 (or) 30 minutes for this conversation,” Vernon said. “But you can have a 2-minute conversation with a patient to ask a few questions and determine if there is something more going on than menstruation. …like neglected endometriosis. She also recommends taking advantage of this opportunity to put the woman in contact with a gynecologist if she does not already have one. Of course, this requires doing some research beforehand to develop a list of obstetrician-gynecologists.
Beyond “bikini medicine”
In her speech at a TEDxProvidence event in 2014, Alyson McGregor, MD, now associate dean for faculty affairs and development at the University of South Carolina School of Medicine in Greenville, discussed the mistake of focusing solely on reproduction when it comes to women’s health.8
“Women’s health has become synonymous with reproduction: breasts, ovaries, uterus, pregnancy,” McGregor said in his speech. “This is the term we now call ‘bikini medicine.’ And it remained that way until… the 1980s, when the concept was questioned by the medical community and public health policy makers, when they realized that excluding women from all medical research studies, we were actually doing them a disservice – in that other than reproductive issues, nothing was known about the unique needs of the patient.
Vernon agrees. Women’s health should also focus on smoking cessation management, cardiovascular health and osteoporosis. Importantly, pharmacists must also be prepared to provide health services to patients who are not cisgender women;9 transgender people also need these services.
Vaccinations, preventative care, medication management and lifestyle changes are all services that pharmacists can provide. “Starting with vaccination is a great way to focus on women’s health,” Vernon said. Pharmacists can ensure that all patients receive their annual flu vaccine and are also up to date on human papillomavirus vaccinations, which prevents several types of cervical cancer in cisgender women and genital warts, anal cancers and cancers of the mouth, throat, neck and head in women and men.ten
“Everything we look at in medicine is focused on a male lens,” Vernon said. Increasing awareness of these issues, in pharmacy and beyond, is the first step toward more equitable health care for all.
The references
1. Unintended pregnancy in the United States. Guttmacher Institute. January 2019. Accessed April 18, 2022. https://www.guttmacher.org/sites/default/files/factsheet/fb-unintended-pregnancy-us.pdf
2. Period problems. Office of Women’s Health. Updated March 16, 2018. Accessed April 18, 2022. https://www.womenshealth.gov/menstrual-cycle/period-problems
3. Frederiksen B, Ranji U, Salganicoff A, Long M. Women’s experiences of health care during the COVID-19 pandemic: results from the KFF Women’s Health Survey. Kaiser Family Foundation. March 22, 2021. Accessed April 18, 2022. https://www.kff.org/womens-health-policy/issue-brief/womens-experiences-with-health-care-during-the-covid-19-pandemic-findings-from-the-kff-womens- Health survey
4. Pfaff A, Rafie S. Expanding pharmaceutical capabilities for patient-centered reproductive health services. Pharmacy (Basel). 2020;8(4):236. doi:10.3390/pharmacy8040236
5. Face to face with community pharmacies. National Association of Chain Drug Stores. Accessed April 18, 2022. https://www.nacds.org/pdfs/about/rximpact-leavebehind.pdf
6. Prescription by pharmacist: hormonal contraceptives. National Alliance of State Pharmaceutical Associations. December 1, 2021. Accessed April 18, 2022. https://naspa.us/resource/contraceptives/
7. Schoep ME, Nieboer TE, van der Zanden M, Braat DDM, Nap AW. The impact of menstrual symptoms on daily life: a survey of 42,879 women. Am J Obstet Gynecol. 2019;220(6):569.e1-569.e7. doi:10.1016/j.ajog.2019.02.048
8. McGregor A. Why Medications Often Have Dangerous Side Effects for Women. TEDxProvidence. September 2014. Accessed April 18, 2022. https://www.ted.com/talks/alyson_mcgregor_why_medicine_often_has_dangerous_side_effects_for_women
9. Committee on Gynecologic Practice of the American College of Obstetricians and Gynecologists; American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women. Health Care for Transgender and Gender Diverse People: ACOG Committee Opinion, Issue 823. Obstet Gynecol. 2021;137(3):e75-e88. doi:10.1097/AOG.0000000000004294
10. HPV vaccine: who needs it, how it works. Mayo Clinic. September 18, 2021. Accessed April 18, 2022. https://www.mayoclinic.org/diseases-conditions/hpv-infection/in-degree/hpv-vaccine/art-20047292#
