Women are facing many challenges in their lives when they come to you for advice. How ready are you to help them deal with their health concerns?

Women come to their local pharmacy because of the expert advice you can offer on a range of conditions. "The main thing to remember is that women will make up the majority of your customers and it's essential they are made to feel comfortable before discussing any potentially embarrassing conditions with you," suggests pharmacist Sara Baco at Avicenna pharmacy in Braintree, Essex.

"Ideally, take them to your private consulting room. We have a sign-up in our women's health section to say they can speak to a member of staff about women's health concerns. We also have a dedicated member of staff who's specially trained in women's health."

Mark Stakim, the pharmacist at Alphega pharmacy in Dalston, Carlisle, says: "Women make up a large percentage of a pharmacy's customer base and while they may be shopping for many members of the family, there is also a huge area for potential business in the management of female-specific conditions. Counter staff is ideally positioned to start conversations and dispensing staff can identify those with associated prescriptions. The key to handling these conversations well is good staff knowledge."

Modern living

The pace and stress of modern women's lives mean they are contending with stress, anxiety, depression, insomnia, and headaches at alarming rates. According to the Adult Psychiatric Morbidity Survey (2016), one in five women has a common mental health disorder and rates have risen steadily since 2000. Young women are a high-risk group, with one in four having self-harmed and with high rates of PTSD and bipolar disorder.

Stress at work is a common cause of mental health problems. According to an HSE report (2016), work-related stress is considerably more common in women, with 1,820 cases per 100,000 workers, compared with 1,190 men.

The higher rate may be because a larger percentage of women work in public service and vocational jobs such as teaching and nursing, which involve high levels of stress.

Lack of sleep and insomnia are increasing problems among women. A recent survey by the Sleep Apnoea Trust Association found that 43 percent of British women don't get enough sleep. Some 46 percent of women said they have trouble sleeping and 36 percent wake during the night and can't get back to sleep. Some 31 percent said sleep problems had led to weight gain and 33 percent said their skin was less healthy. However, only a small minority considered seeing their GP about sleep issues, so this is an area where pharmacy staff should offer advice.

Headaches and migraine are more common in women, too. According to the Migraine Trust, migraine affects three times as many women as men, mainly due to hormonal changes. About 50 percent of women say their menstrual cycle affects their migraines. Menopause can have an effect on frequency and severity, with 45 percent of women finding they get worse and 15 percent seeing an improvement.

Bladder weakness

Bladder weakness is one of the most common reasons for women seeking advice, comments Ms. Baco, and having a good range of products, and knowledge, available in community pharmacy is important.

Madeline Peyret, category manager at Careway UK pharmacies, says: "This can be a sensitive topic to discuss, so the key thing is to be mindful of how to identify and initiate conversations. Look out for customers buying large volumes of sanitary protection or taking a long time to choose products. Respect the customer's dignity by asking a general question followed by the offer of a chat in a quiet area. Reassure your customer that conditions such as bladder weakness are common and the range of products can be difficult to understand."

"The sensitivity of the subject can transpire into a reluctance to approach members of the pharmacy team or the use of unsuitable sanitary protection," says Donna Wilson, TENA training and brand manager.

"However, women are increasingly likely to seek advice for sensitive issues in the pharmacy, as they view it as a trusted environment. One in seven women chooses to seek health advice from their local pharmacist. Pharmacy teams should ensure they are taking the first step and proactively approaching customers and making it clear that discreet help and support are available."

Depend conducted a survey and discovered that almost half of British women will experience incontinence at some point, 64 percent find it hard to talk about and one in five doesn't speak to anyone about it. "These women are making drastic changes to their lifestyle because of their incontinence," says brand manager Jing Zhuang.

"We know women find it difficult to approach professionals for fear of feeling embarrassed. It is important that women can access information easily in pharmacies, with leaflets available for those not able to ask for advice."

Carol Smillie, the founder of Pretty Clever Pants, a range of washable leak-proof underwear, says: "The way you speak and your whole approach needs to be carefully thought out. Be specific and explain what stress incontinence is, as many women don't know about it. One in three women experiences it, but it's still a taboo subject. Try to be chatty and not medical and ask questions such as 'Do you get bladder leakage when you run/jump/sneeze?'"

Menopause symptoms

One in two women in the UK goes through menopause without ever consulting a healthcare professional, according to a survey by the British Menopause Society. This is despite the fact that women report an average of seven symptoms, with 42 percent saying they were worse than expected. More than a third of women said menopause symptoms affected their work life, 50 percent said it impacted their sex life, and 36 percent on their social life.

Some 80 percent of women experience menopausal symptoms, says Norma Goldman, pharmacist, and founder of the Menopause Exchange. "The symptoms most likely to affect working women are hot flushes, night sweats, and lack of concentration," she says.

Intimate health matters

"The trend towards longer life expectancy means there is an increasing number of women who will spend the rest of their lives with menopausal symptoms such as vaginal dryness and its associated higher risk of infections, including bacterial vaginosis and thrush," says Dr. Karen Gardiner, managing director at Purple Orchid Pharma and Hyalofemme vaginal moisturizer. "Two recent international surveys showed that 45 percent of post-menopausal women suffered from vulvovaginal atrophy, but only four percent recognized what it was."

One study found only 22 percent of women seek help for vaginal dryness. "It's important for staff to know the difference between BV and thrush, especially if a woman has recurrent thrush, as she may be self-treating with the wrong product," says Dr. Gardiner. "Also, be aware of the difference between a lubricant and a moisturizer."

Anne-Sophie Martin, brand manager for Replens vaginal moisturizer, says this is a difficult topic for women to discuss. "Research by Replens found that reduced sex drive is the health issue women feel most uncomfortable discussing with GPs and pharmacists, followed by discomfort during sex and vaginal dryness. Our research found that women will consider having a conversation with their pharmacist, especially if there is a private room available. If women are purchasing products related to menopause, they could be discreetly asked about symptoms of vaginal dryness."

According to a study for Vagisil, despite 45 percent of women experiencing vaginal dryness, awareness levels remain low, with many women not aware the condition is treatable. "Pharmacists are in a good position to unearth vaginal dryness sufferers by asking simple questions about the symptoms," says Luis Mendez, marketing manager for Vagisil, which has produced pharmacy detail aids and shelf edgers.

One of the most common vaginal infections is bacterial vaginosis (BV), yet many women have not heard of it or confused symptoms with thrush, suggests Annae Liu, Canesten, and Canestest brand manager. BV is caused by an imbalance in the normal bacteria in the vagina and affects up to one in three sexually active women. Encourage women to discuss their intimate health symptoms by taking them to the consultation area to help them feel as relaxed as possible, she suggests.

Feminine hygiene market

"The feminine hygiene and sanpro category have grown slowly and steadily in recent years, driven by the feminine hygiene and incontinence sectors," says Rashida Khanan at Mintel. Up by 1 percent last year, continued growth is expected until 2020.

Inappropriate products are still being used for bladder weakness, says Mintel, with 21 percent of women who use liners also using them for bladder leakage. Sales of incontinence pads are worth £14,220,786 in independent pharmacy (IRI, March 2017).

Beware of bloating

Many women experience bloating and it's important to find out the cause. Common reasons include excess wind, constipation, IBS, or food intolerance. Coeliac disease, which needs to be diagnosed by a GP, is a more unusual cause.

Persistent bloating can be a sign of ovarian cancer, along with other signs including stomach pain, difficulty eating or feeling full quickly, needing to urinate more often, changes in bowel habits, extreme tiredness, and back pain.

About 7,000 new cases of ovarian cancer are diagnosed in the UK each year, most of them in post-menopausal women. Women who've been feeling bloated most days for the past three weeks should see their GP.

Iron is the only mineral where women's requirements are greater than men's, due to menstrual blood loss and pregnancy, comments a spokesperson for Spatone, yet it is a difficult mineral for the body to absorb. Remind people that iron supplements, if required, should be taken on an empty stomach or at least 45 minutes before or after food, as some foods, such as tea and coffee, dairy, and carbonated drinks can inhibit absorption. Pregnant women, long-distance runners, vegetarians, teenagers, and the over 60s are among those who may experience iron deficiency, suggests the brand.

Women's health category

"Stock a good range of products for both bladder weakness and vaginal dryness, as the pharmacy is the first port of call for these problems," comments Ms. Baco. "Have a good range of women's vitamins, especially for menopause symptoms, but also for hair, skin, and nails," she suggests.

"There is a wide range of products, so it's worth being selective," comments Mr. Stakim.

"I find keeping the first-line treatments is essential. This would include sachet treatments for cystitis, creams, pessaries, and oral treatments for thrush, and one of the leading brands of incontinence pads." Communication is vital and having an area where leaflets can be displayed will encourage customers to browse for information and can trigger discussions, he says.

"Bladder weakness products are viewed as everyday essentials, so a limited product offering could alienate customers and encourage them to seek advice elsewhere," says Ms. Wilson. "They should be visible from the front of the pharmacy but in a discreet enough position to encourage those who want to spend more time browsing."

"Pharmacists should avoid placing products for medium to heavy incontinence on the bottom shelf as these will be hard to reach or out of sight for those experiencing incontinence," comments Ms. Zhuang. "Pharmacists can help women to find the right product for them by countering the misconception that incontinence products are only for older women," she says.

"Display vaginal moisturizers next to lubricants," says Ms. Martin. "This will help to normalize the condition, making it less taboo."

"Intimate health is a sensitive area and women may prefer self-selecting products to avoid embarrassment," suggests Mr. Mendez.

"Creating an in-store women's intimate health category and sitting it within the GSL area minimizes awkwardness."