Pharmacists Play a Key Role in Educating and Supporting Women With Premature or Early Menopause

At The Menopause Society (TMS) 2025 meeting in Orlando, Florida, Cynthia A. Stuenkel, MD, MSCP, clinical professor of medicine at the University of California, San Diego, discusses the critical role pharmacists play in supporting women with premature or early menopause. She emphasizes that pharmacists can educate patients about the risks and benefits of hormone therapies, explain why estrogen is important, and help manage early side effects such as breast tenderness or breakthrough bleeding. Stuenkel highlights that pharmacists can provide reassurance, clarify what is normal during cyclical therapies, and guide patients toward consistent long-term care.

Pharmacy Times: How can pharmacists play a role in supporting patients through premature or early menopause and its long-term health implications?

Cynthia A. Stuenkel, MD, MSCP: I think pharmacists can have an incredibly important role because they can help explain the risks and benefits of these agents. They can help explain why estrogen is important. They are probably knowledgeable in understanding some of the early side effects.

If a patient says, “Oh, my breasts seem a little bit tender on this patch. Do I have to worry about that?” they can reassure her that this will be a transient finding and will get better over time. I think those things are so important.

If she has questions about bleeding while taking cyclical therapies, pharmacists can reassure her that this is normal and how the drugs are intended to work. I think they can also be very helpful in these discussions. Hopefully, they are aware that for young women with premature or early menopause, this is a long-term commitment.

This isn’t something where they should counsel patients to take therapy for three to five years and then stop because of potential concerns about breast health after that. That is not an appropriate message for these young women. We want to help reassure them that they are doing the right thing—the safe thing—and the thing that will most benefit them.

Pharmacy Times: What emerging therapies or approaches hold the most promise in improving outcomes for these patients?

Stuenkel: So, in these patients, I think one of the most important things we can do is educate them early on. I mentioned psychological counseling, which is often needed. These cases can be related to other disease processes or genetic conditions, such as a Fragile X premutation, where the whole family may need to be informed and evaluated. For example, Fragile X is associated with anxiety disorders, so patients and their families should understand that these feelings are not “just in their head,” but can be part of their syndrome.

Other cases may arise from autoimmune disorders. There are conditions known as autoimmune polyglandular syndromes (APS) in the endocrine world, where patients can experience involvement not only of the ovaries but also the adrenal glands, thyroid gland, and sometimes other endocrine organs. These patients need to know that they may require ongoing monitoring and management of these additional systems over time.

The major categories include genetic factors, autoimmune causes, and other exposures. For example, if the condition is related to a cancer therapy, they may be considering different treatment options. If they develop issues such as osteoporosis, they should know that there are additional therapies available to help protect their bones. For cardiovascular prevention, if lipid levels increase or other metabolic changes occur, there are also medications that can help.

There are a number of added pharmaceuticals they may be introduced to, but I think at every step along the way, the pharmacist can be incredibly helpful in helping patients understand their treatment options and, importantly, stay consistent with their therapies.