Refine Your Counseling During Women’s Health Month

May is Women’s Health Month. The idea of looking at women’s health emerged from the realization that throughout history researchers conducted most medical research using male bodies. They may have assumed men and women were fundamentally the same, or perhaps they thought that women were too fragile or not interested in participating in research. What we now know is that when it comes to health care, men really are from Mars and women from Venus. Women need—and want—a number of unique things. Pharmacy teams can be at the forefront of delivering them.

Image credit: Syda Productions | stock.adobe.com

REASONABLE REPRESENTATION IN RESEARCH

The National Institutes of Health (NIH) has required NIH-funded clinical research to include women and members of racial/ethnic minority populations only for the past 31 years.¹ The NIH Revitalization Act of 1993 addressed the fact that most clinical trials had until then excluded women and members of ethnic minority populations.¹

NIH took a significant step in 2016 when it established a policy stating that study researchers needed to consider the assigned birth of both animals and humans as a biological variable.² Subsequently, NIH-funded researchers had to consider sex from hypothesis and study design through results and reporting.² Regardless, women are still underrepresented in the earliest phases of clinical trials, whereas men make up 64.1% of participants.³

These actions helped elucidate subtleties that have importance to pharmacists. Table 1^4-12 lists medications that act differently in women than in men. Pharmacists can monitor women taking these medications and recommend dose adjustments as necessary. They should also suggest clinical study enrollment when possible.

A ROBUST PRIMARY HEALTH CARE SYSTEM

Women often receive care from specialists (eg, obstetricians/ gynecologists, cardiologists, immunologists), but specialists rarely have the time or expertise to address women’s broad and intersecting health concerns and preventive care in detail.¹³

Women need a primary health care provider who can monitor their evolving needs as they age. Ideally, a primary care provider would connect providers across specialty services and identify health changes that may indicate future health risks.¹³

Pharmacies have increasingly become primary care locations by offering vaccinations, point-of-care testing, and, in many states, contraceptives. Although they cannot fulfill the entire primary care provider role, they can provide many needed services. Pharmacists should recommend screenings and educate women about various health conditions.

GENDER-SPECIFIC HEALTH CARE

Women’s gender-specific health issues include pregnancy, childbirth, and menopause. The unintended pregnancy rate in the United States is approximately 50% and has hovered at that rate for years.¹⁴ Pregnancy and childbirth can lead to serious long-term health problems for women. Recent legislative changes at the state and federal level have increased women’s access to contraceptives with pharmacist prescribing and the introduction of an OTC 0.075-mg norgestrel contraceptive.¹⁵

Women also have concerns—verbalized or not—about safety throughout their lives. Some women feel unsafe at home or are actively trafficked, so many states now require pharmacists and technicians to receive continuing education on human trafficking and domestic violence. Educate pharmacy team members so they can be on the lookout for women who want or need help.^16,17

HEALTHY PEOPLE 2030 OBJECTIVES

Healthy People 2030 is addressing many sex-specific concerns, including family planning. Table 2¹⁸ lists some of these priority areas. In many of these areas, an astute pharmacist can suggest when a woman needs to be seen by a prescriber or provide counseling on screening and treatment. One specific way they can help is by encouraging maternal vaccination in pregnant women, particularly the tetanus, diphtheria, and pertussis vaccine.

CONCLUSION

Improving women’s health can be done by increasing awareness. By taking time to actively look for information about unique aspects of health care for women, pharmacists can elevate care and point to small but meaningful ways to give women what they want and need.

REFERENCES

1. NIH policy and guidelines on the inclusion of women and minorities as subjects in clinical research. National Institutes of Health Grants & Funding Information. Updated December 6, 2017. Accessed April 4, 2024. https://grants.nih.gov/policy/inclusion/women-and-minorities/guidelines.htm

2. NIH policy on sex as a biologic variable. National Institutes of Health Office of Research on Women’s Health. Accessed April 4, 2024. https://orwh.od.nih.gov/sex-gender/orwh-mission-area-sex-gender-in-research/nih-policy-on-sex-asbiological-variable

3. Henry BV, Chen H, Edwards MA, Faber L, Freischlag JA. A new look at an old problem: improving diversity, equity, and inclusion in scientific research. Am Surg. 2021;87(11):1722-1726. doi:10.1177/00031348211029853

4. Seeland U, Regitz-Zagrosek V. Sex and gender differences in cardiovascular drug therapy. Handb Exp Pharmacol. 2012;(214):211-236. doi:10.1007/978-3-642-30726-3_11

5. Ueno K, Sato H. Sex-related differences in pharmacokinetics and pharmacodynamics of anti-hypertensive drugs. Hypertens Res. 2012;35(3):245-250. doi:10.1038/hr.2011.189

6. Moulton VR. Sex hormones in acquired immunity and autoimmune disease. Front Immunol. 2018;9:2279. doi:10.3389/fimmu.2018.02279

7. Bupp MRG, Potluri T, Fink AL, Klein SL. The confluence of sex hormones and aging on immunity. Front Immunol. 2018;9:1269. doi:10.3389/fimmu.2018.01269

8. Fischinger S, Boudreau CM, Butler AL, Streeck H, Alter G. Sex differences in vaccine-induced humoral immunity. Semin Immunopathol. 2019;41(2):239-249.doi:10.1007/s00281-018-0726-5

9. Triggianese P, Novelli L, Galdiero MR, et al. Immune checkpoint inhibitors-induced autoimmunity: the impact of gender. Autoimmun Rev. 2020;19(8):102590. doi:10.1016/j.autrev.2020.102590

10. Irelli A, Sirufo MM, D’Ugo C, Ginaldi L, De Martinis M. Sex and gender influences on cancer immunotherapy response. Biomedicines. 2020;8(7):232.doi:10.3390/biomedicines8070232

11. Loke YK, Singh S, Furberg CD. Long-term use of thiazolidinediones and fractures in type 2 diabetes: a meta-analysis. CMAJ. 2009;180(1):32-39. doi:10.1503/cmaj.080486

12. Rizos CV, Elisaf MS, Mikhailidis DP, Liberopoulos EN. How safe is the use of thiazolidinediones in clinical practice? Expert Opin Drug Saf. 2009;8(1):15-32.doi:10.1517/14740330802597821

13. McClellan S. Women’s health is about more than gynecology. Quartz. December 9, 2019. Accessed April 4, 2024. https://qz.com/1763135/how-ushealthcare-is-failing-women

14. Unplanned pregnancy. US Department of Health & Human Services Office on Women’s Health. Updated February 22, 2021. Accessed April 4, 2024. https://www.womenshealth.gov/pregnancy/you-get-pregnant/unplanned-pregnancy

15. Opill. Accessed April 4, 2024. https://opill.com/

16. Nordstrom BM. Multidisciplinary human trafficking education: inpatient and outpatient healthcare settings. J Hum Traff. 2022;8(2):184-194. doi:10.1080/23322705.2020.1775049

17. Indicators of human trafficking. Blue Campaign. Updated March 21, 2022. Accessed April 4, 2024. https://www.dhs.gov/blue-campaign/indicators-human-trafficking

18. Women. Healthy People 2030. Accessed April 4, 2024. https://health.gov/healthypeople/objectives-and-data/browse-objectives/women