This module synopsises common conditions and considerations specific to women’s health, including menopause and reproductive health.
On completion of this module, it is expected the reader will have an enhanced understanding of conditions such as endometriosis and reproductive health, polycystic ovary syndrome, as well as menorrhagia.
Introduction
Women’s health encompasses the comprehensive care of a woman’s physical, mental and social wellbeing throughout
her entire life. While women and men share many common health conditions, the way these conditions manifest, progress and respond to treatment can differ. Furthermore, women face a spectrum of conditions intrinsically linked to female reproductive biology and hormonal function, many of which remain underdiagnosed or undertreated in traditional healthcare settings.
Clinical research and healthcare have disproportionately focused on male physiology and pathophysiology for many years, resulting in significant gender-based disparities in healthcare delivery. In this evolving landscape, pharmacists are ideally positioned to support women at every stage of their health journey. This article explores key areas of women’s health, from reproductive and menstrual health to healthcare equity. The objective is to highlight the challenges and opportunities, focusing on the pharmacist’s role in delivering a more proactive and holistic model of care.1,2,3
Reproductive and sexual health
Reproductive and sexual health is a cornerstone of women’s overall wellbeing, encompassing menstrual health, contraception, fertility, pregnancy, sexually-transmitted infections and conditions such as dysmenorrhea, menorrhagia, endometriosis and polycystic ovary syndrome (PCOS).
While traditionally associated with childbearing, modern reproductive health extends beyond this to include autonomy, informed choice, and dignified care. In recent years, reproductive health services have undergone major reforms, with broadened access to abortion services and the introduction of the free contraception scheme for women aged 17-to-35. Despite this progress, many challenges remain. Barriers such as access to care, cultural stigma and lack of education can lead to diagnostic delays and inadequate treatment. Timely and individualised reproductive healthcare can support early intervention and improve long-term outcomes for women.4,5
Menstrual health
Menstrual health is a critical and often overlooked component of women’s health. Menstruation is a biological process experienced by approximately 50 per cent of the population at some point in their lives, yet it continues to be surrounded by stigma and misinformation.
Conditions including dysmenorrhoea, menorrhagia, endometriosis and PCOS can significantly impact quality
of life. Menstrual health requires a multifaceted approach involving early recognition, timely referral, education and empowerment. Pharmacists play an important role — not only by supporting symptom relief, but also by promoting awareness and timely intervention.6
Dysmenorrhoea
Among the most common menstrual concerns encountered in pharmacy practice is dysmenorrhoea. It is characterised by pain during menstruation, usually located in the lower abdomen, but which may radiate to the thighs and back. It can affect up to 90 per cent of women of reproductive age at some point in their lives and can significantly impact quality of life, yet it is often undertreated.
Dysmenorrhoea may be primary, occurring without pelvic pathology, or secondary, caused by conditions such as endometriosis, fibroids or pelvic inflammatory disease. The National Institute for Health and Care Excellence (NICE) provides a clinical knowledge summary with treatment guidelines for dysmenorrhoea. They recommend non-steroidal anti- inflammatory drugs (NSAIDs), such as ibuprofen and mefenamic acid, as first-line treatment due to their inhibition of prostaglandin synthesis, which plays a central role in menstrual pain.
NSAIDs should be taken at the onset of menstruation and continued for one-to-three days. Hormonal contraception, including the combined oral contraceptive pill (COCP), the progestogen-only pill and depot injections, may be used if NSAIDs are not effective or contraindicated. Referral is advised if there is no response after three-to- six months, if symptoms suggest a secondary cause or if endometriosis or fibroids are suspected.7,8
Menorrhagia
Menorrhagia, also known as heavy menstrual bleeding, is defined as excessive menstrual blood loss. It interferes with a woman’s physical, emotional and social quality of life, affecting 20-to-30 per cent of women of reproductive age. The most common cause of menorrhagia is hormone imbalance, but it may also result from fibroids, polyps, bleeding disorders, anticoagulation therapy, intrauterine contraceptives, endometriosis or pelvic inflammatory disease.
Patients should be assessed for anaemia and treated with iron supplementation if appropriate. Treatment is guided by patient preference, comorbidities, the underlying cause and response to treatment. A levonorgestrel-releasing intrauterine system (LNG-IUS) is recommended by NICE guidelines as first-line treatment. If unsuitable, hormonal options such as the combined oral contraceptive pill or cyclic oral progestogens may be used.
Non-hormonal options, such as NSAIDs and tranexamic acid, may also be considered and are particularly useful for women who are trying to conceive or are unsuitable for hormonal therapy. Tranexamic acid, an antifibrinolytic, can reduce blood loss and is typically taken orally three times daily for five days.9,10
Polycystic ovary syndrome (PCOS)
PCOS is a common endocrine disorder affecting women of reproductive age, with an estimated prevalence of 10-to-20 per cent
in Ireland. It is a chronic condition with reproductive, metabolic and psychological features that requires a long-term, multifaceted approach to management. Symptoms often begin in adolescence and can vary widely, including irregular or absent menstruation, infertility, hirsutism (excess hair growth), acne, alopecia, weight gain and mood disorders.
PCOS is also associated with increased risk of long-term complications such as type 2 diabetes, dyslipidaemia, hypertension and cardiovascular disease. Management should be tailored to the individual. Lifestyle modifications is the first-line intervention, particularly for overweight or obese women. Modest weight loss can restore ovulation and improve metabolic markers, and referral to a dietitian may be considered in line with NICE guidance.11,12
The combined oral contraceptive pill is first-line treatment for menstrual regulation, with cyclic progestogens an alternative. Combined oral contraceptive pills containing anti-androgenic progestins such as cyproterone acetate or drospirenone may be used to treat hirsutism and alopecia. Topical eflornithine can help slow the growth of facial hair, while spironolactone or finasteride may be considered under specialist supervision. Letrozole is recommended as the first-line ovulation induction agent. Metformin may be considered in women with insulin resistance. Regular screening
Endometriosis is estimated to affect approximately 10-to- 15 per cent of women of reproductive age
for type 2 diabetes, lipid profiles and blood pressure is advised.11,12
Endometriosis
Endometriosis is a chronic inflammatory condition in which tissue similar to the endometrium grows outside the uterine cavity, often on the ovaries, Fallopian tubes, uterosacral ligaments and the gastrointestinal tract. This ectopic tissue responds to hormonal changes during the menstrual cycle, leading to inflammation and scarring that can severely impact quality of life.
Endometriosis is estimated to affect approximately 10-to-15 per cent of women of reproductive age. Symptoms can range from mild, to severely debilitating and may include dysmenorrhea, chronic pelvic pain, dyspareunia (pain during intercourse), dysuria, heavy or irregular menstrual bleeding, and infertility. Diagnostic delays are common and often reflect a minimisation of menstrual pain, limited awareness among healthcare professionals, and reduced access to specialist services.
NICE guidelines recommend that diagnosis should be based on clinical symptoms and not be solely reliant on laparoscopic confirmation. Treatment should not be delayed if symptoms are strongly suggestive of endometriosis. Living with endometriosis can have a significant psychosocial impact, contributing to depression, anxiety, fatigue and social withdrawal. NICE guidance also emphasises the importance of psychological support.13,14
The management of endometriosis is individualised, depending on symptom severity, fertility goals and response to previous treatments. Paracetamol or an NSAID can be used alone or in combination as first-line treatment for endometriosis- related pain. If this is not sufficient, other pain management options and referral for further assessment should be considered. Neuromodulators used for neuropathic pain, including amitriptyline, duloxetine, gabapentin and pregabalin, may be considered.13,14
Hormonal therapies aim to suppress menstruation and reduce pain, while not negatively affecting future fertility. NICE advises that the combined oral contraceptive pill can be taken either cyclically or continuously. Progestogens, such as norethisterone or medroxyprogesterone acetate, may also be considered. The LNG-IUS causes endometrial atrophy, which can reduce menstrual bleeding or induce amenorrhoea. Gonadotropin- releasing hormone (GnRH) analogues, such as goserelin, may be used in the short-term (typically up to six months) to relieve pain. Surgical intervention may be considered for moderate-to- severe cases that do not respond to medical therapy, which may improve fertility outcomes and relieve pain, although recurrence is common.13,14
Contraception
Contraception refers to the prevention of pregnancy through various methods that interrupt ovulation, fertilisation or implantation. The range of contraceptive options for females can be broadly categorised into permanent methods, barrier methods, hormonal methods and long-acting reversible contraception. Each method has different efficacy rates, adverse effect profiles and non-contraceptive benefits. Tubal ligation is a permanent method that is highly effective but may not be reversible.
Female condoms and diaphragms are examples of barrier methods; however, they have higher failure rates than some other options and may cause irritation or discomfort. Hormonal contraceptive methods include combined oral contraceptives, progestogen-only pills, transdermal patches, vaginal rings, implants, and hormonal intrauterine systems. LNG- IUS and the copper intrauterine device (IUD) are examples of long-acting reversible contraception options.15,16
NICE provides guidelines that support contraceptive use and informed decision-making. They emphasise that women should be offered full information about all available contraceptive options, including non-contraceptive benefits and potential adverse effects. The guidance highlights the importance of timely access to contraception and shared decision-making. NICE advocates for the use of long-acting reversible contraception due to its higher efficacy compared to user- dependent methods.17
In Ireland, access to contraception has been expanding. Free contraception was initially offered to women aged 17-to-25 and has since been extended to include those aged 17-to-35. This scheme, funded through the Health Service Executive (HSE), covers the cost of doctor consultations, prescriptions and dispensing of various contraceptive methods. These measures have reduced financial barriers, improved access and supported reproductive autonomy. However, barriers such as social stigma, misinformation and concerns about adverse effects still exist.18
NICE provides guidelines that support contraceptive use and informed decision-making
Pharmacists are the primary providers of emergency hormonal contraception, often offering immediate access without prescription, which has significantly improved timely access. Two treatment options are available: Levonorgestrel, effective up to 72 hours after unprotected intercourse; and ulipristal acetate, effective up to 120 hours after. Pharmacists conduct a structured consultation to assess clinical appropriateness, discuss timing, identify potential drug interactions and provide advice on ongoing contraception. While not available in pharmacy, the copper IUD remains the most effective form of emergency contraception and must be fitted by a clinician.19
Menopause
Menopause marks the permanent end of menstrual cycles due to the cessation of reproductive hormone production by the ovaries for at least 12 consecutive months. It typically occurs between ages 45-to-55, with the average age in Ireland being 51, though this can vary.
Menopause is a natural life transition, but it is often under- recognised and under-supported. The diagnosis is typically made retrospectively. In women over 45, menopause can be diagnosed clinically — without hormone testing — if there has been 12 months of amenorrhoea. It is characterised by fluctuating hormone levels, particularly a decline in oestrogen, which can cause a wide variety of symptoms: Vasomotor (hot flushes, night sweats, migraines, palpitations), urogenital (vaginal dryness, burning or irritation), psychological (low mood, insomnia, irritability, anxiety), cognitive (brain fog), sexual (reduced libido, pain with intercourse) and musculoskeletal (joint aches).20
Management of menopause focuses on alleviating symptoms that may significantly impact quality of life.
Treatment should be individualised and guided by patient preference, symptom severity and risk factors. Hormone replacement therapy HRT) is the most effective treatment for vasomotor and urogenital symptoms, recommended by NICE guidelines as first-line therapy for many women, provided there are no contraindications.
In women with an intact uterus, HRT typically includes both oestrogen and a progestogen to prevent endometrial hyperplasia. HRT is available in a variety of formulations to suit individual needs and preferences, including oral tablets, transdermal patches, gels, sprays, vaginal creams, pessaries and vaginal rings. Transdermal options are particularly suitable for women with an increased risk of venous thromboembolism or those with liver dysfunction, as they bypass first-pass metabolism. Vaginal oestrogen therapies are preferred for women experiencing vaginal atrophy and usually do not require additional progestogen.20,21,22
NICE also highlights the importance of HRT in maintaining bone density and reducing the risk of osteoporotic fractures in postmenopausal women. However, HRT is not without risk. Potential adverse effects of HRT include breast tenderness, headaches, nausea and irregular bleeding. Long- term use — particularly of combined HRT — is associated with a slightly increased risk of breast cancer.
The risk of venous thromboembolism and stroke is primarily linked to oral oestrogens, not transdermal formulations. An individualised assessment should always be undertaken when selecting therapy. Pharmacists can play a key role in counselling women about these risks, dispelling concerns and supporting adherence.20,21,22
Non-hormonal options may be considered in certain cases, particularly if HRT is not tolerated, appropriate or effective. Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) and clonidine may help alleviate vasomotor symptoms, though they are not considered first- line treatments.
Fezolinetant, a neurokinin-3 receptor antagonist, is a novel non- hormonal treatment for hot flushes in moderate-to-severe cases. It has recently been approved but is not yet included in the NICE guidelines. Potential adverse effects of fezolinetant include hepatic toxicity, abdominal discomfort and insomnia. NICE also recommends considering testosterone supplementation in women with low libido if HRT alone is not sufficient.20,21,22
Lifestyle modifications such as regular exercise, smoking cessation, weight management, nutritional support and reducing alcohol intake can also contribute to symptom relief and improved long-term health outcomes. Cooling strategies, moisturisers and lubricants are safe and potentially effective alternatives.
Moisture pessaries provide direct hydration and relief from vaginal dryness. Daily oral supplements such as PrecisionBiotics Women’s Flora, which contains lactobacilli strains and biotin, helps to support microbiome balance and vaginal health. Menoelle Plus is a supplement containing key micronutrients and may help alleviate menopausal symptoms like hot flushes and night sweats. These non-hormonal options offer women additional tools to manage symptoms and maintain comfort.20,21,22
In Ireland, growing awareness in recent years has improved access to treatment for many women. However, significant barriers to menopause support still exist. Many women do not receive adequate education and continue to face stigma and misinformation. From June 2025, the health service has offered free HRT to women in Ireland, aiming to reduce financial barriers. However, ongoing stock shortages have led to delays or interruptions in treatment for several women.23
Access to healthcare and the role of the pharmacist Despite notable progress in women’s health in recent years, significant barriers to equitable healthcare remain in Ireland. Women may face long waiting times, limited services, cultural stigma, lack of information and financial constraints. Even where services are available, misinformation or low health literacy can prevent women from accessing appropriate care. Persistent stigma surrounding menopause, contraception and menstrual disorders continues to undermine open dialogue and early intervention. In addition, ongoing shortages of HRT and contraceptive products have added to the frustration experienced by both patients and healthcare providers.24,25
Nonetheless, there is a growing opportunity to address these challenges. The rollout of free contraception and HRT schemes
has marked a shift towards more inclusive and accessible healthcare. Public awareness campaigns are helping to increase the visibility of conditions such as endometriosis and menopause, reducing stigma and encouraging earlier engagement
Future initiatives may allow for direct access to the combined oral contraceptive pill without a prescription
with healthcare services.24,25
Irish pharmacists are well-positioned to be at the forefront of this effort by expanding access, supporting adherence and facilitating informed conversations around women’s health.24,25 They play a vital role in medication counselling, emergency contraception provision and health promotion. Pharmacists are also trusted sources of information who can help counter misinformation through evidence-based guidance. Future initiatives may allow for direct access to the combined oral contraceptive pill without a prescription, representing a significant step towards enhanced reproductive autonomy. As their clinical role continues to expand in Ireland, pharmacists must be recognised as proactive partners in advancing women’s health equity nationwide.24,25
References available on request
