What 12 Years in Pharmacy Taught Me About Women's Health (That the Textbooks Didn't)

The dispensary counter is a strange place to receive a confession. But that is essentially what happens.

Women collect their prescriptions, check the bag is right, start to turn away, and then turn back. There is always a pause before the question. "Can I ask you something?" And then it comes: the thing they could not get a GP (general practitioner) appointment for, the symptom they have been dismissing for two years, the medication they have been taking but do not fully understand.

I have been behind that counter, in various pharmacies, for over 12 years. What those conversations taught me about women's health is something no textbook had covered.

The question I heard more than any other

It was not about blood pressure. It was not about antibiotics or statins or anything that features prominently in the BNF (British National Formulary, the prescribing reference book every pharmacy keeps to hand).

It was some version of this: "I have been feeling really off for months. Tired, anxious, not sleeping, mood all over the place. My GP put me on antidepressants but I do not feel any better. Is this normal?"

The honest answer, once I had asked a few more questions, was usually: no. It was not depression. It was perimenopause (the hormonal transition into menopause that can start in a woman's early 40s, and sometimes her late 30s). What she needed was not an antidepressant. It was an HRT (hormone replacement therapy, the treatment that replaces oestrogen and progesterone during perimenopause and menopause) conversation.

That pattern repeated itself more times than I can count.

What I saw at the dispensary

Twelve years is a long time to notice patterns. Here is what I noticed.

Women were handed prescriptions for antidepressants with very little exploration of why their mood had changed. The question "when did this start?" would often reveal a clear hormonal timeline: late 30s or early 40s, cycles becoming irregular, sleep getting worse, anxiety appearing seemingly out of nowhere. These are textbook perimenopause presentations. They are not textbook depression presentations.

Women were collecting long-term prescriptions for medications to manage symptoms that might have had a hormonal cause, without anyone in the system having joined those dots. Insomnia, joint pain, brain fog, recurrent UTIs (urinary tract infections, infections of the bladder and urethra that become more common as oestrogen decreases and the tissues of the urinary tract become less resilient). All of these can have a hormonal component, and all of these were being treated as individual, unconnected problems.

Women were collecting HRT prescriptions but had never been told which type they were on, why, or what to expect. I have spoken to women taking combined HRT for two years who did not know there was a separate oestrogen and progesterone component. Women who did not know that the patch and the gel deliver oestrogen differently to a tablet. Women who were struggling with side effects that could have been resolved with a simple dose adjustment, but nobody had told them adjustments were possible.

The gap between what women are prescribed and what they need

This is not a criticism of any individual clinician. General practice is under enormous pressure. A ten-minute appointment is not enough time to take a full hormonal history, especially when a woman comes in presenting with what looks, on the surface, like anxiety or low mood.

But there is a gap. As a women's health pharmacist in the UK, I have spent years standing in it.

The gap is this: women's hormonal health is not a niche. Perimenopause affects every woman who lives long enough to experience it. The hormonal changes it involves touch every system in the body, from cardiovascular health to bone density to brain function. The evidence shows, including the work of specialists like Dr Louise Newson (one of the leading menopause doctors in the UK, whose training programme I have completed), that the picture for HRT has been significantly updated since the early 2000s, when a misread study caused a generation of women to be told HRT was dangerous. Many of those women spent years without hormonal support that evidence suggests they could have benefited from.

Related reading: If you have ever wondered what HRT actually is and how it works, start here. HRT Explained: A Pharmacist's Guide to What It Is, How It Works, and Who It Is For.

Support for the women I see every day

Much of what women describe at the counter sits at the meeting point of hormones, skin, and inflammation. These are the clinic resources and skin-support products I point women towards most often when they want a clear, evidence-based starting place:

What the over-the-counter questions told me

Community pharmacy is often described as the most accessible part of the NHS (National Health Service, the UK's publicly funded healthcare system). Women who cannot get a GP appointment, or who feel dismissed when they do, frequently end up asking their pharmacist.

What they asked me told me a great deal about the information gap. They asked whether feeling this way in their 40s was "just getting older." They asked whether the brain fog they were experiencing could be perimenopause or whether they needed a dementia assessment. They asked whether their GP was right that they were "too young" for HRT. They asked whether there was anything they could take over the counter to help with hot flushes because they had been waiting six weeks for a GP appointment and had not slept properly in three months.

These were not questions from uninformed women. These were professional women, many of them high-achieving, carrying enormous workloads, trying to understand what was happening to their bodies and finding very few clear answers. The information existed. It just was not reaching them.

Why I decided to do something about it

I could have stayed behind the dispensary counter, answering questions as best I could within the limits of what a pharmacist can legally advise. I do still work in community pharmacy. There is real value in that role, and I am not going anywhere.

But I have been an Independent Prescriber Trainee for the past year, working toward a qualification that will allow me to assess, diagnose, and prescribe within a defined area of clinical practice. Women's health and hormonal health are central to that scope. The gap I have been describing is not going to close itself. It needs healthcare professionals who are specifically trained in this area, who take a thorough history, who understand how a woman's hormonal health changes across her life, and who have the time to have a real conversation.

That is why Debora Tentis Clinic exists. Not because there is no good care available, but because too many women are falling through the spaces between appointments, not getting the specialist attention their symptoms warrant.

Keep reading: The clinic is built around prescribing care for women. Here is what that actually means. What Independent Prescribing Means for Women's Health.

What this means for you

If any of this sounds familiar, you will want to know a few things.

First: you do not need to accept symptoms that are affecting your quality of life as simply part of getting older. Many perimenopausal and menopausal symptoms are treatable, and HRT is not the only tool, though it is an important one for many women.

Second: the conversation needs to start with a proper assessment, not a guess. Hormonal health is not one-size-fits-all. Your history, your current symptoms, your personal risk factors, and your goals all matter.

Third: you deserve someone who takes the time to explain your options in language that actually makes sense, without rushing you out the door after ten minutes.

The women at the dispensary counter taught me what was needed. I am doing my best to provide it.

Shop the products in this post

These are the clinic guides and skin-support products that women ask me about most when they are trying to get a handle on hormonal symptoms, inflammation, and skin changes:

Browse the full range at deboratentis.com. To start the conversation about your hormonal health, book a Health and Wellness Consultation at Debora Tentis Clinic (£60).

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Debora Tentis is a Women's Health Pharmacist and Independent Prescriber Trainee at Debora Tentis Clinic, Milton Keynes. This post is for educational purposes only and does not constitute medical advice.