Providing over-the-counter vaginal oestrogen in New Zealand: a cross-sectional study of pharmacists' views.

Abstract

Introduction: Genitourinary symptoms of menopause (GSM) affect a large proportion of women and can worsen over time if left untreated. In New Zealand, effective treatment with low-dose vaginal oestrogen is available only by prescription, limiting timely access. Internationally, such treatments have been reclassified for supply by pharmacists, but there are no studies examining New Zealand pharmacists' perspectives on this.

Aim: This study aimed to determine pharmacists' confidence in treating GSM and their perspectives on supplying an over-the-counter (OTC) vaginal oestrogen.

Methods: A cross-sectional survey was distributed by the research team to 2762 registered pharmacists. The survey explored confidence in GSM management, opinions on OTC vaginal oestrogen supply, perceptions of patient preferences, and barriers and facilitators to service delivery. Quantitative data were analysed descriptively, and open-ended responses were reviewed using descriptive thematic analysis.

Results: A total of 299 pharmacists responded (response rate 10.8%). While only 46.8% felt confident in recommending currently available OTC products for GSM, 61.2% reported they would be confident supplying low-dose vaginal oestrogen OTC. Pharmacists believed that supplying OTC oestrogen would improve accessibility, reduce the burden on general practice, and support patient-centred care. Key barriers included cost to patients, lack of specific knowledge of GSM, and limited time or resources in the pharmacy setting.

Discussion: Pharmacists in New Zealand support expanding their role to supply low-dose OTC vaginal oestrogen for GSM, provided that appropriate tools and training are implemented. This service could improve access, address health disparities, and significantly enhance menopause care in New Zealand.