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Missed opportunities

Women are ignoring potentially serious health problems during the current pandemic, worried about bothering busy health professionals or struggling to access the services they need

While it seems the only news being reported at the moment is related to Covid-19, this does not mean that women are not experiencing the same health issues and concerns as they were before.

What is worrying is that they are reluctant to seek help during the pandemic, either because they think services are not available or they don’t want to worry their GP at such a busy time – or because it’s simply too difficult to get appointments.

New research carried out by YouGov on behalf of The Eve Appeal charity has found that almost half of women aged 25-34 would delay getting bleeding between periods investigated at the moment. And according to the Royal College of Obstetricians & Gynaecologists (RCOG), even outside of the pandemic, health services miss opportunities to ask the right questions, prevent illness and ensure the best outcomes for women. The RCOG is therefore offering guidance on how conditions should be safely managed. Pharmacies form an essential part of this support.

Encouraging help

The message women have been given during the pandemic is that they should only seek medical help if their need is urgent, and that seeing a professional face to face is to be avoided unless essential. The issue is that while these services have remained open, albeit operating differently, women are either reluctant to seek help or believe that services are closed.

Dr Edward Morris, president of the RCOG, says: “The Covid19 pandemic is an anxious and uncertain time for all. While it may feel like life is on hold at the moment, healthcare services are still open and there to help. Anyone with new or troubling symptoms can still speak to their healthcare professional – they can call their GP or gynaecologist.”

Dr Diana Mansour, vice president, clinical quality, at the Faculty of Sexual and Reproductive Healthcare, says: “A positive outcome of the changes to service provision during the Covid19 pandemic is increased collaboration between pharmacies, GP practices and sexual and reproductive healthcare clinics. Pharmacies offer a local, confidential and accessible setting for individuals seeking advice. For some individuals, particularl in deprived areas, pharmacies are their only contact with healthcare professionals. It is imperative these individuals can access contraceptive advice at their pharmacy during and after the pandemic.”

Dr Mansour believes pharmacies could play an enhanced role in the provision of sexual and reproductive health care services. “With the right training,” she says, “pharmacists could provide counselling to women on the range of contraceptive methods.”

At The Eve Appeal, which helps to fund research into gynaecological cancers, Lydia Brain says: “Every day, the ‘Ask Eve’ service hears from someone who is ‘Sorry to bother us’, but is unsure whether or not to call their doctor at the moment. It’s understandable that people are hesitant to contact their GP, as we hear so frequently how overwhelmed the NHS is now.”

If women visit the pharmacy to ask for advice about whether or not they should report unusual vaginal bleeding, Lydia says: “They should report it to the GP via an initial phone consultation. They will have the patient’s records in front of them and this will help guide them as to whether they need to see her in person for an examination. Abnormal bleeding is a symptom of three of the five gynae cancers (cervical, womb, vaginal) and while it’s unlikely it is caused by cancer, it is still important to get checked out, and matters no less because of Covid-19.”

Research conducted by The Eve Appeal found that 19 per cent of over 45s with gynaecological concerns would not seek advice until after the pandemic for post-menopausal bleeding, a key symptom of womb cancer, which is highly treatable if caught early. And some 30 per cent of women would delay getting unusual bloating – a key sign of ovarian cancer – investigated.

While these services have remained open, albeit operating differently, women are either reluctant to seek help or believe that services are closed

Current advice

  • For inter-menstrual bleeding, women should initially contact their GP by phone. They should only be asked to come for a pelvic examination if cervical cancer is suspected or if there is a risk of an STI
  • Post-menopausal bleeding is a red flag as between five and 10 per cent of women with this symptom will have endometrial cancer. Women should contact their GP by phone and should then be referred to secondary care for investigation
  • For a suspected STI, a home testing service is recommended to confirm infection first, says the RCOG
  • For women who need a new form of contraception, GPs will discuss options by phone or video consultation. Women may be offered a temporary option of the progesterone only pill if it is not possible to fit a long acting reversible contraception (LARC)
  • Women who need an abortion should be told these services are still available, although initial consultations will take place remotely. If the pregnancy is under 10 weeks, women may now be prescribed mifepristone to take at home.

Pharmacies become safe places

Boots pharmacies are offering their consultation rooms as safe places for victims of domestic abuse (both male and female) during the Covid-19 pandemic. Working in partnership with charity Hestia Crisis Support, Boots says its pharmacies can offer information on how to access support via domestic abuse helplines, as well as a safe space to make the call for help.

The Royal Pharmaceutical Society (RPS) supports the initiative. “During the pandemic, when options for victims are even more limited than usual, pharmacies can provide the safe environment needed to get support,” says president Sandra Gidley.

“The trust that the public have in pharmacies makes them an ideal place to access help and take a step away from harm towards a better future.”

The RPS is encouraging other pharmacies to take part and become safe spaces during the pandemic too. For more information, visit Safe Spaces and email uksaysnomore@hestia.org to let them know your pharmacy has become a safe space. For resources, email sarah.dangelis@hestia.org.

Access to HRT

“There were already shortages before the pandemic, but my feeling is the situation has got more complicated now,” says Norma Goldman, pharmacist and founder of the Menopause Exchange. “If a patient’s usual HRT is not available, the GP can prescribe an alternative.… A change in product can of course lead to side effects, which women should discuss with their pharmacist or GP. They might need to take the oestrogen and progesterone separately instead of in combination to get the right dosage.”

Utrogestan is a micronised progesterone that is becoming more popular, says Norma, and Lenzetto is the first transdermal oestradiol spray to be licensed on the NHS. Pharmacists can contact Norma Goldman for information regarding supply shortages of HRT at norma@menopause-exchange.co.uk.

Category trends

The sanpro, feminine hygiene and incontinence market saw value growth rise by 1.6 per cent to £490 million last year, driven by sales of incontinence products, according to Mintel’s Feminine Hygiene and Sanitary Protection Products report, which was published in February. The analyst predicts that the category will grow by 17 per cent to £575m by 2024.

Eco-friendly sanpro products are an increasing trend, with a rise in use of reusable products, which now account for 10 per cent of the market. Consumers also want organic and biodegradable credentials, as well as products which maintain a healthy pH, says Mintel, with 40 per cent of women saying they look for this benefit from feminine hygiene items.

Swedish brand Intima predicts increased interest in sustainable products such as menstrual cups. “Globally, sustainability will become the most important topic, and for consumers it will change shopping habits for good,” says the company’s Danela ┼Żagar.

Intima saw online sales jump by 73 per cent in March and April. “We are certain most women will continue to use them even after the epidemics,” says Danela.

Alphega Pharmacy member Samina Khan, of Pateley Bridge pharmacy in Harrogate, says independent pharmacies hold 14.5 per cent of the feminine care market – up 3.6 per cent on last year. The most popular women’s health products in the pharmacy are those that treat cystitis, thrush and vaginal dryness. “Together, these products contribute 86.2 per cent of category value sales,” says Samina. “Thrush products deliver £8m and cystitis products £1.6m to the independent chemist sector. Bacterial vaginosis (BV) products also have an important role in independent pharmacy, growing 30.2 per cent on last year.”

Samina has noticed an increase in the number of women asking for advice on menopausal symptoms and incontinence. “To help my customers,” he says, “I am looking to offer the service of an incontinence nurse, who will come into our store once a month to give advice.”

At Numark, services development pharmacist, professional and patient services Naresh Rallmil, says: “Women’s intimate health and bladder weakness can be embarrassing to discuss, so a quieter, more health-focused environment such as a pharmacy with healthcare professionals on hand to offer discrete advice can be preferred.”

He says that thrush treatment is the largest sector, taking 77 per cent of space. “BV is a new, developing category,” he adds. “We used to feature it as part of the thrush and irritation category, but with new products developing, it should be considered separately.”

Better for women

A survey carried out by the RCOG found that many women struggle to access health services – even without a pandemic. Its Better For Women report, published in December, outlines a plan for one-stop health clinics and local support for women’s needs.

“We were not surprised to find out that many women are struggling to access basic healthcare support,” says Jenny Priest, RCOG director of policy and public affairs. “Pharmacists could definitely play a role here in helping women to access services.”

The RCOG report found that 37 per cent of women are unable to access contraception services and 60 per cent cannot access unplanned pregnancy services locally. Only 50 per cent6 of women can access STI services and 56 per cent are unable to seek help for menstrual health issues locally. Some 58 per cent cannot access menopause services.

“Optimising pre-pregnancy health is a role pharmacists could help with,” says Jenny. “For example, when women come in to purchase folic acid, this could be a cue to start a conversation. Pharmacists could also get more involved in menopause support.”

Views from the P3pharmacy category panel 

Selina Gill Rowlands pharmacy, Redditch

“We conduct multiple consultations on the broad area of women’s health daily. Queries range from symptomatic control of premenstrual syndrome (PMS), water retention, nutritional support and menopause symptom relief to general advice around wellbeing. Evening primrose oil has always sold well as many patients feel it helps with PMS. More customers are taking an active interest in their general wellbeing and like to tailor nutritional support, so focusing on women’s supplements is important. To display all women’s health products in one area is difficult. However, we have found it useful having a sub-category within each display unit that is relevant to women’s health.”

Marisa Maciborka Bedminster Pharmacy, Bristol

“Women’s health is an important category for our customers. The most popular requests include treatments for thrush, bacterial vaginosis (BV) and emergency contraception. The best selling products include Canesten, Femfresh and Tena Lady. Women want to know what treatments to use, why they are having health issues, and how to prevent recurrences. One trend we have noticed is that more women are changing to reusable ecofriendly products such as menstrual cups, and moving away from disposable sanitary protection. When thinking about this category, remember that women tend to appreciate discreet displays that are easy to understand.”

Lindsey Fairbrother Goodlife Pharmacy, Hatton, Derbyshire

“We get quite a few queries about menopausal symptoms, and during the pandemic we’ve had a lot of women asking us for EHC as they are not able to access free services and online takes too long. We are hoping these customers will remember us for the future. The Vitabiotics range (Menopace, Pregnacare) does well, while the Numark versions are popular as they are cheaper. Evening primrose oil supplements sell well too. Cystitis and BV remedies have become more popular recently as it’s become more difficult to get prescriptions. As an independent prescriber, I’ve been asked for a lot of UTI privateprescriptions recently – women are prepared to pay to get this quickly.”




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