Pharmacist Graham MacKenzie Tackles Menopause Myths in His Latest Book

Pharmacist and author Graham MacKenzie has published his third book, Menopause Logic: The Straight-Talking Guide to Hormones, Healing and Balance, examining the evidence around menopause treatment, including hormone therapy, non-hormonal prescription options, and the supplements and over-the-counter products marketed to women for menopause symptoms. The book is most relevant to community pharmacists who field questions about menopause symptom management and hormone therapy, an area the book's contributors say remains clouded by outdated fears more than two decades after the Women's Health Initiative findings reshaped perceptions of hormone therapy.

The topic was suggested by clinical pharmacist Dragana Skokovic-Sunjic, who collaborated with MacKenzie on his previous book, Gut Logic, and wrote this book's introduction; it also features a foreword by Dr. Henry Muggah, professor emeritus of obstetrics and gynecology at McMaster University. MacKenzie, who continues to work about one day a week in a community pharmacy in Baddeck, Nova Scotia, said he wasn't sure how the topic would be received coming from a male pharmacist, "but . . . the information is going to be evidence-based either way, so that's what I relied on." He says he regularly encounters women seeking help managing menopause symptoms in his own practice.

At just over 100 pages, the book covers first- and second-line therapies for menopause-related challenges including genitourinary syndrome, cognition, mood, hot flashes and osteoporosis risk, as well as non-hormonal treatments for women who cannot or choose not to use hormone therapy. MacKenzie also takes a critical look at supplements, nutraceuticals and OTC products marketed for menopause symptoms, saying he found limited evidence to support many of them; he acknowledges some readers may be disappointed by that conclusion but felt it was important to distinguish products backed by research from those that are not. The book took approximately two years to complete and follows MacKenzie's Healthy Logic (2021) and Gut Logic (2023), completing a three-book arrangement with his publisher. It is available on Amazon and in major bookstores across Canada.

Practice guidance for pharmacists

• Use the book's evidence-based framing as a talking point with patients who remain fearful of hormone therapy because of decades-old Women's Health Initiative headlines, since subsequent evidence has produced a more nuanced risk-benefit picture.
• When patients ask about menopause supplements and OTC products, be ready to distinguish those with actual supporting evidence from the many that are marketed without it -- a distinction this book makes explicit and could serve as a patient-facing reference.
• Consider the book (or its underlying evidence base) as a resource for structuring menopause counselling around specific symptom domains -- genitourinary syndrome, mood, hot flashes, osteoporosis risk -- rather than treating menopause as a single undifferentiated complaint.
• Remember non-hormonal options exist and are covered for patients who cannot or choose not to use hormone therapy; being able to discuss both pathways credibly supports shared decision-making.

MacKenzie says his goal is to help counter menopause misconceptions that have persisted for decades and give readers "a clearer picture of their options," for both healthcare professionals and the general public.