From Adolescence to Menopause: Counseling Women at Every Life Stage

This content was independently produced by Pharmacy Times in partnership with Bayer Healthcare.

Menopause is a natural part of biological aging for every woman. Often beginning in perimenopause, women experience many symptoms and health risks.^1,2 Unmanaged, these may impact quality of life, productivity, and emotional state. In the US, approximately 1.3 million women enter menopause annually and the average age of menopause is 52.^2,3

Women should be educated about symptoms, risks of chronic conditions, and the biologic transition occurring during menopause. Proper management during this period results in healthy aging and better quality of life. Pharmacists are uniquely positioned to counsel women at this stage of life.

Menarche to Menopause

Menarche, the first menstrual period, marks the beginning of the reproductive years for women. Age at menarche varies, typically ranging between ages 10 and 16 with an average age of onset at 12.4 years old.⁴ A woman’s reproductive lifespan is the interval between menarche and menopause.⁵

Perimenopause is the period leading up to menopause and signals the final years of a woman’s reproductive life. It can last several years, with an average of 4 years.² It begins with irregular menstrual cycles marked by a gradual loss of ovarian follicular function (ie, the ovaries begin to stop releasing eggs for fertilization) and a decline in circulating estrogen and progesterone levels.^1,2 This period may usher in numerous symptoms often related to hormonal changes and fluctuations.²

Ovaries are the primary estrogen source in a woman’s body, with follicles that synthesize and release the hormone. A single ovary has approximately 1 million to 2 million oocytes (immature cells within a follicle that potentially mature into fully developed eggs) at birth. The ovary releases a fully developed egg during ovulation, which travels down the fallopian tube for potential fertilization.^6,7 As women age and at various stages during the menopause transition, they may only have a few hundred to a few thousand oocytes left. Estrogen levels decrease and menstrual periods become irregular.^6,7 In the absence of regular ovulation during the menopause transition, the ovaries no longer produce high levels of estrogen and progesterone.⁸

Menopause occurs or is diagnosed after 12 consecutive months without menstruation in the absence of clinical intervention or other physiologic or pathologic cause. It marks the end of the reproductive years.^1,2

It important to inform patients that pregnancy is possible during perimenopause. Although menstruation is irregular, the ovaries can still release eggs. It is impossible to accurately predict ovulation, and women must use adequate contraception until 1 full year after the last period to avoid unwanted pregnancy.²

A woman cannot become naturally pregnant after menopause because the ovaries have stopped releasing eggs for fertilization. Importantly, however, women can still contract sexually transmitted infections, so experts advise women to use adequate protective measures.² Common symptoms of perimenopause and menopause are outlined in Table 1.^2,9

Chronic Conditions

Cardiovascular disease and osteoporosis can result from decreased hormone levels during menopause and beyond.² Coronary heart disease rates are 2 to 3 times higher in those who have reached menopause compared with those at the same age who have not. Women generally have a lower risk of heart disease than men before the age of 55, but after menopause, the risk for heart disease is comparable to that of men of the same age.²

Estrogen deficiency during menopause also causes the typical bone loss or decreased bone density seen in osteoporosis.² Up to 20% of bone loss can happen during this period.¹⁰ Increased risk of fractures, pain, mobility issues, and loss of height are consequences of osteoporosis, which is a progressive condition that can worsen over time.

Hormonal and Nonhormonal Therapy

Menopausal hormone replacement therapy (HRT) involves the administration of synthetic estrogen and progesterone to replace a woman’s hormones to help alleviate symptoms. Women should be educated about HRT’s risks and benefits and consider their personal risk before starting treatment.¹¹ Prescribing HRT at the lowest possible dose and for the shortest possible duration to achieve symptomatic relief while avoiding adverse effects is critical.¹¹

FDA-approved HRT is available as oral pills, gels, transdermal patches, vaginal creams and rings, transdermal skin sprays and patches, and injections. HRT use is most favorable in women who are within 10 years of menopause onset and are younger than 60 years of age, with no contraindications.¹² HRT initiation is not recommended in women older than 60 or in those who are 10 years post menopause. The FDA has approved HRT for vasomotor and urogenital symptoms of menopause, and prevention of postmenopausal osteoporosis.¹¹

The risks of menopausal HRT outweigh its benefits for many patients, so additional options are needed. The FDA has approved a few nonhormonal therapies for varying uses during menopause. FDA-approved therapies are outlined in Table 2.¹³

Women should not take HRT if they have an allergy to the hormone medication; bleeding disorders; current or past cancers, such as breast or uterine cancer; current or past blood clot, stroke, or heart attack; liver disease; or problems with vaginal bleeding.¹³

Lifestyle Modifications

Lifestyle changes help counter the chronic conditions that often arise post menopause and are important and necessary for healthy aging in women. These include a healthy diet, adequate calcium and vitamin D intake, physical activity, healthy weight, and limited or no alcohol and tobacco use. Lifestyle modifications may improve menopause symptoms even if symptoms are not eliminated.¹⁴

Pharmacist Counseling Points

There are many counseling points pharmacists should remain cognizant of when counseling women during perimenopause, menopause, and postmenopause. Throughout the reproductive years, pharmacists should counsel women on the appropriate use of contraception.

Once women reach menopause, pharmacists should educate them on the benefits and risks of HRT and other FDA-approved therapies. Pharmacists can collaborate with prescribers to find treatments that work for patients, and pharmacy teams can maintain a list of reputable resources that can provide additional support for patients. Finally, pharmacists can educate women on lifestyle changes and modifications necessary for healthy aging.

REFERENCES

1. Menopause. World Health Organization. October 16, 2024. Accessed September 17, 2025. https://www.who.int/news-room/fact-sheets/detail/menopause

2. Menopause basics. Office on Women’s Health. Updated March 17, 2025. Accessed September 17, 2025. https://womenshealth.gov/menopause/menopause-basics

3. Menopause. Society for Women’s Health Research. Accessed September 17, 2025. https://swhr.org/health_focus_area/menopause/

4. Signs your child is about to start their first period. Mayo Clinic. August 1, 2023. Accessed September 17, 2025. https://mcpress.mayoclinic.org/parenting/signs-your-child-is-about-to-start-their-first-period/

5. Shadyab AH, Macera CA, Shaffer RA, et al. Ages at menarche and menopause and reproductive lifespan as predictors of exceptional longevity in women: the Women's Health Initiative. Menopause. 2017;24(1):35-44. doi:10.1097/GME.0000000000000710

6. Vollenhoven B, Hunt S. Ovarian ageing and the impact on female fertility. F1000Res. 2018;7:F1000 Faculty Rev-1835. doi:10.12688/ f1000research.16509.1

7. Zhou J, Peng X, Mei S. Autophagy in ovarian follicular development and atresia. Int J Biol Sci. 2019;15(4):726-737. doi:10.7150/ijbs.30369

8. Progesterone. Cleveland Clinic. December 29, 2022. Accessed September 17, 2025. https://my.clevelandclinic.org/health/body/24562-progesterone

9. What is menopause? National Institute on Aging. Updated October 16, 2024. Accessed September 17, 2025. https://www.nia.nih.gov/health/menopause/what-menopause

10. Menopause and bone loss. Endocrine Society. January 24, 2022. Accessed September 17, 2025. https://www.endocrine.org/patient-engagement/endocrine library/menopause-and-bone-loss

11. Menopause. FDA. Updated December 14, 2023. Accessed September 17, 2025. https://www.fda.gov/consumers/womens-health-topics/menopause

12. "The 2022 Hormone Therapy Position Statement of The North American Menopause Society" Advisory Panel; Faubion SS, Crandall CJ, Davis L, et al. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794. doi:10.1097/GME.0000000000002028

13. Menopause: medicines to help you. FDA. Updated August 22, 2019. Accessed September 17, 2025. https://www.fda.gov/consumers/free-publications-women/menopause-medicines-help-you

14. Infographic: staying healthy during and after menopause. National Institute on Aging. Updated June 5, 2025. Accessed September 17, 2025. https://www.nia.nih.gov/health/menopause/staying-healthy-during-and-after-menopause