Nesé Yuksel, BScPharm, PharmD, FCSHP, NCMP
Associate Professor
Faculty of Pharmacy and Pharmaceutical Sciences
University of Alberta
Edmonton, Alberta
The 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 20261), 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 a reproductive mental health team and can refer patients to uro-gynecology and chronic pelvic pain clinics. Team members from the 2 programs collaborate to develop clinic procedures, patient education material, and treatment protocols.
The pharmacist is responsible for discussing options for managing menopause symptoms and long-term health concerns with each patient, for reviewing the risks and benefits associated with each option, and for providing individualized patient education. The pharmacist collaborates with the other team members to develop a care plan that best suits the needs of the patient. The focus is on helping women navigate through the available information and empowering them to make informed decisions about their own care. Women presenting to the clinic may have considerable apprehension about hormone therapy. Balanced information, based on guidelines from the Society of Obstetricians and Gynaecologists of Canada (SOGC)3 and the North American Menopause Society (NAMS),4 is presented to help women understand both the risks and the benefits of that treatment option.
The current pharmacist for the Menopause Clinic at the Lois Hole Hospital for Women, Dr Nesé Yuksel, as well as a number of the other clinic team members, are NAMS Certified Menopause Practitioners (NCMP). The NCMP program, developed in 2002, is open to any licensed health care practitioner. One unique aspect of Dr Yuksel’s practice is that she was 1 of the first 15 pharmacists to receive additional prescribing authorization through the Alberta College of Pharmacists.5 As such, since early 2008, she has been initiating prescriptions, as well as modifying treatment and adjusting doses on the basis of patient response. The most common prescriptions provided to patients in the Menopause Clinic are for medications to treat menopausal symptoms, such as hormone therapy, antidepressants, and sleeping aids.
Dr Yuksel’s position at the Menopause Clinic represents a 0.2 full-time equivalent (FTE) commitment and is part of her full-time academic position in the Faculty of Pharmacy and Pharmaceutical Sciences at the University of Alberta. Her position is supported by a formal agreement between the Faculty and Pharmacy Services, Alberta Health Services, the organization that is responsible for the delivery of health programs and services throughout the province. Dr Yuksel has been practising in the area of menopause and osteoporosis since 1997, starting at the clinic at the Grey Nuns Community Hospital, then moving to the Lois Hole Hospital for Women when its Menopause Clinic opened in early 2008. The Grey Nuns Community Hospital now has a 0.4-FTE pharmacist position to support its menopause clinic.
Dr Yuksel uses her practice in the Menopause Clinic to provide experiential opportunities for undergraduate students, PharmD students, and pharmacy residents. In addition, Dr Yuksel offers a course in women’s health for third-year pharmacy students6 and has delivered many presentations on menopause and osteoporosis to pharmacists, physicians, and other health care providers. Dr Yuksel also collaborated with the Practice Development division of the Faculty of Pharmacy and Pharmaceutical Sciences to develop a continuing education program on menopause that has been demonstrated to result in lasting changes in participants’ practice 1 year after course completion.7
Clinical research and scholarly work form another area of focus for the Menopause Clinic. Team members have collaborated on a number of research studies over the years8,9 and have published several articles, such as papers on menopause and osteoporosis appearing in supplements to the Canadian Pharmacists Journal .10–12
Professional involvement is another important role for any pharmacist working in women’s health. Dr Yuksel serves with various organizations dedicated to menopausal care, including the SOGC Menopause Coalition (as the representative from the Canadian Pharmacists Association) and the NAMS Professional Education Committee (as a committee member). Through these organizations, she works to raise awareness about menopause among the public, her pharmacist colleagues, and other health care professionals.
Published reports have described the key role that pharmacists can play in supporting women who are suffering with menopausal symptoms.13 The interdisciplinary Menopause Clinic at the Lois Hole Hospital for Women is one example of a truly collaborative team where the pharmacist works to the full scope of pharmacy practice.
The Practice Spotlight series highlights the accomplishments of Canadian pharmacists with unique practices in hospitals and related health care settings. If you have a unique or innovative practice, or you know someone else who should be profiled, please submit your contact information to Mary Ensom, Editor of CJHP ( cjhpedit@cshp.ca ), and one of our Associate Editors will be in touch with you.
1 Annual demographic statistics 2005. Ottawa (ON): Statistics Canada; 2006 Mar [cited 2011 Oct 10]. Catalogue no. 91-213-X1B:6. Available from: www.statcan.gc.ca/ads-annonces/91-213-x/index-eng.htm
2
Leblanc CD. An interdisciplinary approach to closing a care gap.
Can Pharm J
2011;144(Suppl 1):S22.
3 Reid RL, Blake J, Abramson B, Khan A, Senikas V, Fortier M. SOGC menopause and osteoporosis update 2009. J Obstet Gynaecol Can 2009; 31(1 Suppl 1):S1–S46.
4
North American Menopause Society. Estrogen and progestogen use in postmenopausal women: 2010 position statement of the North American Menopause Society.
Menopause
2010;17(2):242–255.
5
Yuksel N, Eberhart G, Bungard TJ. Prescribing by pharmacists in Alberta.
Am J Health Syst Pharm
2008;65(22):2126–2132.
6
Yuksel N. Pharmacy course in women’s and men’s health.
Am J Pharm Educ
2011;75(6):119. 
7 Yuksel N, Schindel TJ. Changing perceptions of practice following a continuing professional development program in menopause: a qualitative study [poster abstract P85]. Menopause 2010;17(6):1246.
8
Chubaty A, Shandro MT, Schuurmans N, Yuksel N. Practice patterns with hormone therapy after surgical menopause.
Maturitas
2011;69(1): 69–73.
9 Yuksel N, Xu J, Wilkie J, Shandro MT, Schuurmans N. Evaluation of testosterone therapy in menopausal women: a chart review [poster abstract P66]. Menopause 2008;15(6):1226.
10 Shandro MTL. Evaluating fracture risk. Can Pharm J 2011;144(Suppl 1):S19–S21.
11
Hagen S. Osteoporosis: nutrition and lifestyle.
Can Pharm J
2011; 144(Suppl 1):S14–S16.
12
Yuksel N. Helping women navigate through menopause: role of pharmacists.
Can Pharm J
2010;143(Suppl 2):S19.
13 Zoella MM, Ceruli J. Assessment of the effects of a community pharmacy women’s health education program on management of menopause survey scores. J Manag Care Pharm 2004;10(5):42–48.
Canadian Journal of Hospital Pharmacy , VOLUME 65 , NUMBER 1 , January-February 2012