Practice spotlight: pharmacist practice in an outpatient menopause clinic.

T he management of symptoms associated with menopause and related conditions can be challenging for women and their health care providers. Available information about menopause and treatment options is often contradictory, with various opinions and misconceptions about potential therapy. As the number of Canadian women in midlife grows (expected to reach 22% of the country's population by 2026 1), the demand for balanced, evidence-based support during the menopause transition will increase. The Menopause Clinic at the Lois Hole Hospital for Women, which is part of the Royal Alexandra Hospital in Edmonton, Alberta, is an interdisciplinary program targeting the needs of women as they transition through menopause and beyond. The program's objectives are to manage the care of women with complex perimenopausal and menopausal health concerns and to assist women in becoming active, informed partners in decision-making affecting their health. Patients access the program through physician referral. Each patient initially attends a 2-hour group education session on menopause and midlife health, conducted by a nurse. The patient then attends the interdisciplinary clinic, which operates once a week out of the Lois Hole Hospital for Women. Each patient is asked to complete a health profile questionnaire, which captures information about current symptoms, medical history, medications, family and social history, and risk factors for osteoporosis, cardiovascular disease, and breast cancer. At the first clinic visit, the team completes a comprehensive assessment of menopause symptoms and other health concerns and then works with the patient to develop a management plan. Common problems addressed in the clinic include vasomotor irregularities, disturbed sleep, urogenital symptoms (e.g., vaginal dryness, urinary incontinence), hormonal migraines, and mood disturbances. Preventive care strategies for cardiovascular disease, osteoporosis, and weight management are also covered. Patients are seen every 3 to 6 months, as appropriate, until their menopause symptoms have stabilized. All information regarding the clinic visit, as well as the management plan, is communicated to the referring physician. The Menopause Clinic, launched in May 2008, is modelled after a similar clinic at the Grey Nuns Community Hospital in Edmonton, which opened in 1997. Both programs primarily serve women in Edmonton and surrounding areas, but nearly 10% of their current patients come from other parts of Alberta. The Grey Nuns Community Hospital also runs a stand-alone osteoporosis clinic. 2 The Menopause Clinic teams are composed of a family physician, a gynecologist, nurses, a dietician, and a pharmacist. Both teams also have access to …