Belinda Badman
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[post_content] => One in 7 Australian women live with endometriosis, yet diagnosis can still take almost a decade. As awareness grows and new initiatives roll out, pharmacists play a pivotal role in early recognition, medicines management and compassionate care.
Jessica vividly remembers getting her first period at a sleepover when she was 13. The youngest of four girls, she was largely unfazed by what her mum had called ‘joining the sisterhood’. What she didn’t realise was that it would mark the start of a decades-long health struggle.
Now 35, Jessica has lived with frequent, heavy, painful periods for more than 22 years. There have been mornings she couldn’t get out of bed, workdays missed and social events abandoned at the last minute. She experiences pain during sex, which has caused strain in previous relationships, and she worries about her fertility. More than once, she’s been told this is simply ‘a woman’s lot’.
Jessica’s story may sound familiar to the nearly 1 million Australian girls, women and people assigned female at birth living with endometriosis.¹ Defined as ‘endometrial-like tissue proliferating outside the uterus’, endometriosis is a chronic, inflammatory, gynaecological disease with no known cure.² But it is also so much more, says Mónica Forlano, Chair of Endometriosis Australia.
‘The most important thing to understand is that endometriosis is not a reproductive condition – it is a whole body, lifelong chronic condition,’ Ms Forlano says. ‘Yes, it sometimes manifests as pain, bloating, brain fog, fatigue and for – 1 in 3 – fertility issues, but it’s an enigma that can curtail someone’s career, schooling and social life. It affects every aspect of a person’s existence, not just their periods or fertility.’
A national response
For much of human history, females have been taught to feel shame about their bodies and biological functions. Many have been told to bear debilitating periods in silence, have faced accusations of exaggerating – or even inventing – their pain.
These attitudes persist. A 2025 Victorian Government inquiry into women’s pain – the first of its kind in Australia – revealed 71% of respondents saw it as ‘widespread dismissal by healthcare professionals’ and a primary challenge when seeking help.³
More than half also reported delayed diagnoses that led to ‘years of unnecessary suffering and, sometimes, worsened health outcomes’.
Some progress is being made. The National Action Plan for Endometriosis,⁴ released in 2018, marked the first significant step forward in addressing endometriosis in Australia. It focuses on three priority areas: awareness and education, clinical management and care, and research.
A cornerstone initiative is the rollout of Endometriosis and Pelvic Pain Clinics across the country. At the time of writing, 22 clinics are operational, with 11 more planned to open in early 2026 – ensuring at least one in every Primary Health Network region. These clinics provide interdisciplinary care, referral services, access to early intervention and a range of treatment options.⁵
The federal government is also funding the development of an Endometriosis Management Plan⁶ for primary care, and has supported the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) to produce the Australian Living Evidence Guideline: Endometriosis,⁷ providing evidence-based recommendations for clinicians.
Will this make a difference? Chairperson of Chronic Pain Australia Nicolette Ellis MPS (she/her) says yes.
‘The pelvic pain clinics are a major step forward because they embed pelvic pain as core business in primary care. Their integrated, multidisciplinary approach aligns with best evidence and supports earlier intervention, reducing the chronicity of disease. We’re seeing clearer referral pathways and better collaboration across gynaecology, physiotherapy and psychology.’
Ms Forlano agrees the clinics are ‘exactly the kind of equitable access we need,’ particularly for patients who have struggled to navigate siloed systems. However, she says ‘fundamental challenges persist’, including a roughly 7-year diagnostic delay.⁸
‘We’d like to see continued investment in research, expanded access to interdisciplinary care, and most critically, urgent attention to that persistent 6–7-year diagnostic delay,’ she says. ‘Every year someone waits is another year of unnecessary suffering and disease progression.’
Inclusive endometriosis careEndometriosis is often framed solely as a “women’s health” condition. Nicolette Ellis MPS (she/her), Chairperson of Chronic Pain Australia, shares how pharmacists can help transgender and non-binary patients feel seen and safe. ‘Trans and non-binary people often face misgendering, discrimination and the misconception that only cis women experience endometriosis, leading to delayed or avoided care,’ Ms Ellis says. ‘Using terms like “people who menstruate” or “people with a uterus” and avoiding assumptions based on appearance or records helps ensure inclusivity. ‘Collecting pronouns, using inclusive signage, asking gender-neutral questions about pelvic or menstrual symptoms, and clearly signalling that care is available for people of all genders encourages trans and non-binary patients to access pelvic-pain support. ‘Stocking heat packs, TENS devices, period products and bladder/bowel aids, and providing information about local pelvic pain physiotherapists, clinics and support organisations shows that people of all genders living with endometriosis or pelvic pain are seen, believed and supported. ‘Conversations should take place in a private consultation area, not over the counter, as a standard for all sensitive health issues. Start with neutral, open questions such as, “Do you experience periods or pelvic pain?” Mirror the person’s preferred language, and if unsure, ask respectfully: “Is there a better way I can word this?” Avoid gendered terms like “ladies’ problems” in favour of “pelvic health” or “menstrual health”. ‘Gender-affirming hormones can mask or alter endometriosis symptoms. Pharmacists should check in about breakthrough bleeding, pelvic pain, mood changes, and potential interactions with hormonal or neuropathic pain medications. Where cyclical pain is clear, evidence supports a therapeutic trial of ovarian suppression before considering diagnostic laparoscopy. Shared care between GP, endocrinology and gynaecology teams is especially helpful in complex cases.’ |
Normalisation is medical misogyny and delays diagnosisSeveral systemic barriers contribute to the delayed diagnosis many patients have experienced. One is cultural: the normalisation of crippling period pain.
‘Medical misogyny still leads many people to be told their pain is “normal” or stress-related, or something pregnancy will fix,’ Ms Ellis says. ‘This erodes trust. When menstruation is trivialised, people minimise symptoms and often present only once the pain is severe or disabling.’
Limited access to specialists is another problem. Long waits to see gynaecologists – especially in regional and rural areas – delay diagnosis and treatment. Diagnosis remains complex. Although high-quality transvaginal ultrasound and MRI are increasingly used to detect endometriosis, many still rely on a laparoscopy, an invasive examination, for diagnosis.⁹
The financial burden also compounds inequity. People with endometriosis spend about $30,000 each year on direct and indirect costs, which only increases for those outside major cities.⁹
Co-Chair of the Access, Care and Outcomes Subcommittee for the National Women’s Health Advisory Council and immediate-past PSA National President Associate Professor Fei Sim FPS (she/her)says that while specialised clinics are a positive development, more needs to be done to improve access to care.
‘Australia is still falling short in equitable access, with long wait times, high out-of-pocket costs and limited availability outside metropolitan areas,’ she says. ‘What works well in the clinics is the team-based approach, but what needs improvement is affordability, inconsistent models of care and insufficient long-term funding.’
People living with chronic pain seek answers and reassurance and community pharmacies are often their first, and most frequent, touchpoint. ‘Pharmacists continue to be an underutilised resource,’ A/Prof Sim says. ‘Existing health infrastructure, including GP clinics and community pharmacies, should be empowered to deliver more care.’
In a health system which too often encourages non-pharmacological or simple analgesic interventions for complex pain – community pharmacists have an important role in being a circuit-breaker.
‘Pharmacists can help by recognising whether symptoms are cyclical, bowel-related, bladder-related or musculoskeletal, and supporting early medical management that reduces chronicity,’ Ms Ellis says.
‘Encouraging timely GP review and knowing a local pelvic pain physiotherapist – who are game-changers – helps ensure patients reach the right care earlier.’
And pharmacists shouldn’t underestimate the significance of what could seem like a really simple intervention:
‘Being listened to and believed is itself a therapeutic intervention,’ Ms Ellis adds. Validating language is critical. Just hearing the words ‘your pain is real and deserves proper assessment’ can make a difference.
[caption id="attachment_31514" align="aligncenter" width="500"]
Sharnelle Vella, ABC Radio Melbourne breakfast co-host[/caption]
‘Silent’ endometriosisIn November 2025, 774 ABC Radio Melbourne breakfast co-host Sharnelle Vella announced10 she was ‘beyond terrified’ but also overjoyed at finally becoming pregnant. Telling her audience she would be taking maternity leave in February 2026 to give birth to a baby girl, she also revealed how her pregnancy came after years of fertility issues, miscarriage and failed rounds of IVF treatment. The cause? Stage 4 endometriosis found during an exploratory laparoscopy in March 2025 to investigate mild pelvic inflammation that had been revealed by a blood test. Unlike many who live with the condition, the one pointer to Ms Vella’s endometriosis had been her infertility. ‘Put simply, I was riddled with it,’ she told listeners. But without the symptoms including the crippling pain that afflicts many women, she’d had no idea. She recalls talking to the surgeon afterwards. ‘I asked, “Did you find anything?” He half-laughed, shook his head and said a sentence that will stay with me forever: “Sharnelle, you have stage four endometriosis – we were cutting it out of you for 3 hours.”’ ‘How many stages are there?’ I asked. “There are four,” he replied.’ Having put her life on hold numerous times, not taken holidays, not taken jobs, ‘you commit to nothing – except this journey’, she tearfully explained, saying she had become pregnant without assisted reproduction therapies just 3 months later. Ms Vella wanted listeners who may be experiencing the same ‘unimaginable grief’ of infertility to know that they were not alone. While Australian Institute of Health and Welfare data shows that 1 in 7 people assigned female at birth in Australia have endometriosis,¹1 some, like Ms Vella, are asymptomatic and only discover there is a problem when trying to conceive. Dr Pav Nanayakkara, a gynaecologist at Jean Hailes for Women’s Health clinics in Melbourne says it’s important to remember endometriosis can affect people differently. ‘For some, it’s very mild, they might not know they have it at all. For others it can be very severe and really impact their daily life. Because of that lack of understanding around the condition, people don’t necessarily know how it can present,’ she says.¹ While ‘about 30–50% of people with endometriosis have some degree of infertility’, most people ‘will go on to fall pregnant by themselves,’ Dr Nanayakkara adds. ‘Sometimes that depends on what stage of endometriosis the patient has, but most people will go on to fall pregnant by themselves. So, it can have implications, but it doesn’t make them infertile.’ |
The RANZCOG guidelines suggest a short trial of a non-steroidal anti-inflammatory (NSAID) alone or in combination with paracetamol to manage pain.
But hormonal treatment is also recommended as a first-line therapy.
While the combined oral contraceptive pill and progestogens are usually the first step, second-line treatments, including gonadotropin-releasing hormone agonists and antagonists, should be initiated if symptoms don’t improve or adverse effects occur.⁷
The experience of many individuals with endometriosis is that shifting from first-line to second-line hormonal treatments takes too long and isn’t proactively offered.
Medical misogyny is part of the problem. The inertia of funding barriers is another. But some recent changes aim to tackle this challenge.
In 2024, the Therapeutic Goods Administration approved the fixed-dose combination of relugolix, estradiol and norethisterone (Ryeqo) to treat moderate to severe endometriosis-associated pain.
Aimed at patients with a history of medical or surgical treatment, the addition took the number of medicines indicated for the treatment of endometriosis in Australia to six.¹3
Later that year, dienogest (Visanne) was listed on the Pharmaceutical Benefits Scheme (PBS) – the first time in 30 years that individuals with endometriosis had access to a new PBS-subsidised treatment.¹⁴
New approaches are also being explored. A team at the Royal Adelaide Hospital is trialling a new intrauterine device¹⁵, while Western Sydney University is running a clinical trial to examine the efficacy of different medicinal cannabis interventions.¹⁶
Around 60–70% of people also use some form of complementary, non-pharmacological management, including acupuncture, Chinese herbal medicine, physiotherapy, exercise and nutrition strategies.⁷
However, these aren’t always accessible, says Grace Wong MPS, Medication Safety Pharmacist at The Royal Women’s Hospital in Melbourne.
‘Healthcare professionals often assume patients can easily access non-pharmacological interventions, but many require time, travel or out-of-pocket costs,’ she says.
‘Living with pain can be overwhelming. Making things easy and doable is key.’
With many patients navigating diagnostic uncertainty, Ms Wong says pharmacists should reassure them that ‘chronic pelvic or vaginal pain is not normal and women shouldn’t just “put up with it”.’
Policy efforts now need to ‘focus on sustainable funding, scaling access in regional and rural areas and using existing infrastructure to deliver enhanced care’, according to A/Prof Sim.
Research priorities should include earlier diagnostic biomarkers, long-term outcome studies of models of care, culturally safe models for First Nations peoples and interventions to build health literacy.
Education remains vital. Programs like PPEP Talk,¹⁹ run by the Pelvic Pain Association of Australia, help young people understand what’s normal when it comes to menstrual health – and what’s not.
‘Early education in schools is vital,’ A/Prof Sim says. ‘We need to reduce stigma, support earlier symptom recognition and empower girls and young women to speak up, seek care sooner and navigate the health system with confidence.’
HPV vaccination clinics and school-based health programs are ideal opportunities to explain what isn’t normal period pain and provide advice on where to get help, Ms Ellis says.
Incorporating menstrual health into medicine reviews with young people can also support earlier recognition of pelvic, bowel or bladder symptoms that often emerge in adolescence.
‘When close to 1 million Australians are affected by a condition, every healthcare touchpoint matters,’ Ms Forlano says.
‘Understanding and support can be the difference between someone suffering in silence or finding the help they need. Let’s work together to ensure no one has to wait 6–7 years for a diagnosis, and that every person with endometriosis has access to the care and support they deserve.’
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[post_content] => This National Close the Gap Day (19 March), experts highlight the important role pharmacists play in supporting and promoting equitable access to the Closing the Gap (CTG) PBS Co-payment Program.
While many Aboriginal and Torres Strait Islander people have already been registered for the CTG PBS Co-payment program, many are not accessing this support as intended – particularly those who travel from remote communities to receive health care, said Chastina Heck MPS, Chair of the PSA/NACCHO Aboriginal and Torres Strait Islander Pharmacy Practice Community of Specialty Interest (CSI).
‘[So] pharmacists play a critical role as trusted navigators through Australia’s complex healthcare ecosystem,’ she added.
[caption id="attachment_31556" align="alignright" width="263"]
Mike Stephens, Director, Medicines policy and Programs at the National Aboriginal Community Controlled Health Organisation (NACCHO)[/caption]
Bridging the gap in medicines access
Mike Stephens, Director, Medicines policy and Programs at the National Aboriginal Community Controlled Health Organisation (NACCHO) said it’s important pharmacists support equitable access to the CTG PBS Co-payment Program.
‘Pharmacists are medicines experts and patients accordingly rely on us to understand and navigate programs that help them access medicines – CTG scripts are no different,’ Mr Stephens said.
‘Though only some pharmacists’ practice may be directly focused on working with Aboriginal and Torres Strait Islander people, all pharmacists will deliver care to Aboriginal and Torres Strait Islander people within their practice from time to time.
‘This point is especially timely considering the current Australian campaign related to affordable medicines. Delivering culturally safe care is essential and embodied in every major pharmacy practice policy – it’s every pharmacist’s responsibility.’
Where access to CTG can fall short
Before the recent reforms, when the CTG co-payment expanded to all PBS medicines supplied through public hospitals, Ms Heck said working in a clinical setting was often frustrating.
‘The previous program often created more gaps than it closed in accessing health care. In turn, this would erode trust in the healthcare system because people would speak up about an invoice, or about their CTG registration, only to be told that hospitals were unable to dispense it as such,’ she said.
‘They would say, “If a hospital has these rules about me, then what other decisions are they making about my care that I’m not aware of?”
‘This was also exacerbated for remote patients who were not CTG registered and discharged from hospital in unfamiliar environments, often with long transit times home – so accessing medications only when they arrived home was not a suitable option.’
But there are still traps to avoid and issues to discuss with care and context in community and hospital settings alike.
‘Patients may not realise brand premium still apply to CTG co-payments. Explaining this may be important,’ he said.
‘Pharmacists can check Health Professional Online Services (HPOS) if they are not sure if someone is registered. They should also generally seek a discreet place to discuss CTG eligibility with a patient and can only register a patient if they have delegation from a doctor or AHP through HPOS.’
Mr Stephens stressed that while most pharmacists cannot register a patient, careful support to connect a client to a doctor or ACCHO for registration is crucial.
[caption id="attachment_31561" align="alignright" width="280"]
Chastina Heck MPS, Chair of the PSA/NACCHO Aboriginal and Torres Strait Islander Pharmacy Practice Community of Specialty Interest (CSI).[/caption]
Culturally safe care is more than good intentions
It’s not as simple as being nice to someone, Ms Heck said.
‘The beliefs and experiences we bring from our past, that have shaped our current “knowing”, often lead to unconscious biases,’ she said.
’It’s imperative that pharmacists develop ways to recognise and respond to these. For example, this might manifest as deciding to not dispense a prescription for low-dose aspirin, instead directing the patient to buy it over the counter.’
Facilitating patient choice and autonomy by providing comprehensive information, upon which a decision can be made, is one way to deliver culturally safe care – rather than deciding what the best option for the patient is, Ms Heck reiterates.
Mr Stephens agrees. ‘It’s important pharmacists support Aboriginal and Torres Strait Islander people to feel comfortable and confident to say what they need, raise concerns and understand their medicines; take adequate time to meet the patient’s needs and consult in a way that is responsive to the local community’s needs.
‘This might include finding a more private setting in relation to someone’s CTG eligibility. All staff should periodically undertake cultural safety training (not just once), preferably delivered from a local community-level organisation, for example an ACCHO or Land Council. Pharmacists should also complete foundational pharmacist courses and learning, such as the co-designed modules by NACCHO and PSA – Deadly pharmacists training modules, as well as familiarise themselves with the PSA’s Guidelines for pharmacists supporting Aboriginal and Torres Strait Islander peoples with medicines management.’
[caption id="attachment_31555" align="alignright" width="233"]
Philippa Chigeza, pharmacist at Logan Hospital.[/caption]
Every conversation is an opportunity
Philippa Chigeza, a pharmacist at Logan Hospital in Queensland sees the impacts of the CTG program every day.
’Conversations about CTG are not just about eligibility or reducing medicine costs,’ she said.
‘They are also an opportunity to support culturally safe care, build trust, and ensure patients feel comfortable asking questions about their medicines.’
Pharmacists are in a strong position to help bridge this gap by proactively identifying eligible patients, explaining the program clearly, and working collaboratively with prescribers and Aboriginal health services,’ Ms Chigeza said.
‘Developing cultural awareness and communication skills is just as important as understanding the program itself,’ she said.
‘Training initiatives, such as our intern health promotion project, was an opportunity to deepen my understanding of the CTG program and support me to practice conversations on this topic with patients and families. It can help improve pharmacists’ confidence in having these conversations and is therefore extremely valuable in supporting better health outcomes for Aboriginal and Torres Strait Islander peoples.’
[post_title] => Closing the Gap starts at the pharmacy counter
[post_excerpt] => This National Close the Gap Day (19 March), experts highlight the important role pharmacists play in supporting and promoting equal access.
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[post_content] => With no mandated CPD requirement in ethics or legislation, some practitioners are entering complex practice environments without a current understanding of their professional obligations.
As pharmacists, we are disciplined about maintaining our clinical knowledge across evolving therapeutic areas, new medicines and updated guidelines. When disease states or treatments change, most of us retain a strong foundation because we engage with them in practice every day.
However, the same rigour is not consistently applied to legislation and ethics. For some practitioners, understanding of the legislative and ethical framework has gradually eroded, and in many cases not revisited or contemporised for 10, 20 or even 40 years. While medicines are regularly discussed with patients and colleagues, equivalent engagement with legal obligations and ethical principles does not occur – despite the fact that sound ethical decision-making depends on a solid grasp of the legislative framework governing practice.
What regulators are seeing in practice
Before my appointment as President of the International Pharmaceutical Federation (FIP), I spent nine years with the Pharmacy Council of New South Wales. In that role, I had oversight of pharmacists across practice settings – including community, hospital, education and research – from newly registered practitioners to those with decades of experience.
During that time, I observed a wide range of practice standards, with recurring themes emerging in some of the more serious matters before the Council. In a number of cases, there appeared to be limited familiarity with relevant legislation and relatively little engagement with ethics in day-to-day practice.
When questioned about legislation, many practitioners noted that it had been covered at university. And when asked whether it had been reviewed at any point since graduation, the answer was invariably no.
In complaint investigations and interviews – including matters where urgent intervention was required to protect public safety under Section 150 of the Health Practitioner Regulation National Law – it became clear that there was little understanding of the legislation.
Decisions were not always made with proper regard to core ethical responsibilities, including protecting patient wellbeing and exercising sound professional judgement. In some instances, pharmacists were not aware of the PSA Professional Practice Standards or the PSA Code of Ethics for Pharmacists. From a regulatory perspective, that raises serious concerns and suggests a broader gap within the profession in understanding these two essential pillars of practice.
The matters before the Council were not limited to one-off dispensing errors. In a number of cases, patterns of behaviour raised concerns.
This included dispensing Schedule 8 medicines or Schedule 4 benzodiazepines in volumes or circumstances where appropriate indication and professional judgement should have prompted closer scrutiny.
Habits can develop over time. If pharmacists base decisions on flawed inputs, those patterns will continue unchecked – often until a regulator intervenes.
Rethinking how we approach CPD
Under current requirements, pharmacists must complete 40 CPD credits each year, with 20 of those as assessable (Group 2) activities. There is no mandated requirement that any of those credits specifically address legislation or ethics.
But based on my experience, there is merit in introducing an annual, assessed CPD component focused on these areas.
This could take the form of structured case studies requiring pharmacists to apply relevant legislative provisions and ethical principles to practical scenarios, with a defined minimum number of Group 2 credits allocated each year.
The objective would be to ensure every pharmacist revisits the legislative and ethical foundations of practice regularly and tests their understanding in a practical context. If a practitioner can work through an ethical dilemma in a structured case study and apply the correct legislative framework, they are more likely to make sound decisions in real-world practice.
It is a practical and achievable step that could significantly strengthen how practitioners approach decision-making in the best interests of patients and in accordance with good pharmacy practice.
Expanded scope increases responsibility
As scope of practice expands, pharmacists are assuming more autonomous clinical roles, including prescribing. While this evolution is positive for the profession and patients, increased autonomy brings increased responsibility. Clinical authority must be matched by a strong understanding of the legislative and ethical framework that governs how that authority is used.
A baseline expectation across the profession would promote consistency and reinforce the importance of these competencies for all practitioners, regardless of scope or practice setting.
At the FIP World Congress, ethics is a key part of the program each year. We include ethics presentations at every congress in recognition of how important these considerations are in our daily practice.
Embedding competence in everyday practice
If an annual ethics and legislation requirement were introduced, I would hope it would become part of routine competency review, rather than something revisited only when a practitioner appears before a regulator. Embedding this into regular professional development would strengthen patient safety, ensuring that decisions are consistently aligned with the patient’s best interests.
Culturally, this would support a safer and stronger profession, with practitioners accepting responsibility for maintaining currency of practice – not only in medicines and dispensing processes, but also in understanding relevant state and Commonwealth legislation and the ethical basis of decision-making.
This is particularly important for early career pharmacists. Young practitioners learn by observing those around them. The most effective way to guide them is to ensure they see best practice consistently modelled. If that does not occur, ‘what I see, I do’ can become the norm, and ECPs may be reluctant to question senior pharmacists.
Pharmacy proprietors are responsible for what happens within their pharmacy, including the capability of employed pharmacists. So it’s reasonable for employers to ensure their staff not only meet registration requirements, but also understand the legislative frameworks.
By adhering to regulation, legislation and ethical decision-making processes, we reduce the likelihood of complaints – many of which arise from serious harm to patients, an outcome we all seek to avoid.
Maintaining competence in ethics and legislation is not an additional burden. It is part of maintaining the standard of practice that our patients and the community expect.
PSA has opened public consultation on its draft Code of Ethics for Pharmacists until 17 April. Click here to have your say.
[post_title] => A question of ethics: FIP President calls for annual review
[post_excerpt] => With no mandated CPD requirement in ethics or legislation, some pharmacists don't have an understanding of their professional obligations.
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[post_content] => Greater access to Home Medicines Reviews (HMRs) offers opportunities to intervene earlier, improve patient outcomes and use healthcare funding more effectively.
For Tasmanian-based Stewart Mearns MPS, HMRs are not an administrative program. They are an early warning system – preventing falls, reducing adverse drug events and averting hospital admissions.
When patients don’t have this opportunity, the consequences can be serious. And expensive.
[caption id="attachment_31483" align="alignright" width="200"]
Stewart Mearns MPS[/caption]
‘If I prevent one hospitalisation, there’s [around] $30,000 right there,’ Mr Mearns said. ‘That’s my funding for the next 6 months, which has to be cost positive.’
This blunt economic calculation reflects the realities of credentialed pharmacists in practice.
Catching problems before they escalate
When providing HMRs, Mr Mearns regularly identifies medicine-related risks that have gone unnoticed.
In one case, he arrived at a patient’s home to find she appeared confused and cognitively impaired. But the issue wasn’t dementia.
‘We’re having a medical emergency here,’ he realised.
The patient was experiencing hypoglycaemia and her husband hadn’t recognised the warning signs.
In another case, he discovered a patient had been taking aspirin without telling her doctors, worsening severe reflux.
‘None of her doctors were aware,’ he said. Once the aspirin was stopped, ‘she said I’d changed her life’.
These professional observations in living rooms help avoid escalation before an ambulance is called; this is the value of early intervention.
The hidden cost of delay
HMRs are designed to reduce medicine-related harm – one of Australia’s National Health Priority Areas. But access constraints mean some patients wait months for a review.
Like many other pharmacists, Mr Mearns sees the human cost of these restrictions. ‘I’ve had several patients die [while waiting for a HMR],’ Mr Mearns said of those referred but not seen in time due to the restrictive cap of 30 HMRs per month.
With medicines misadventure a known contributor to hospitalisations and deaths, particularly in older Australians and those with complex regimens, Mr Mearns sees the link clearly.
‘If they [Federal Government] are serious about improving Australian health, this is a good program to fund,’ he said.
The logic is simple: prevent harm upstream, reduce the downstream burden on hospitals.
Complex patients, preventable harm
Polypharmacy is common among the patients referred for HMRs. Multiple prescribers, fragmented care and long medicine lists increase the risk of duplication, interaction and adverse effects.
Mr Mearns recalls a young patient with autism and Tourette’s syndrome who was taking multiple antiepileptic medicines and was experiencing daily falls.
‘Once the aspirin was stopped, ‘she said I’d changed her life.'
Stewart Mearns MPS
‘She was getting pushed around in a wheelchair at 18 because she was taking six or so [different] antiepileptics. There was no one removing medications that weren’t effective.’
Rather than an access-to-care issue, the core problem was a lack of a coordinated medicines review.
HMRs allow credentialed pharmacists to step back, assess the full picture and make recommendations to optimise therapy.
While this intervention might not make headlines, preventing one serious fall or hospital admission has both human and financial implications.
The price of a single medicine-related hospital admission can far exceed the cost of dozens of HMRs, with medicine-related problems reported to cost the economy $1.4 billion annually.
Mr Mearns believes the economics are compelling.
‘We’re pretty well-studied as pharmacists. We’re a cost-saving intervention,’ he said. ‘[Improving HMR funding] seems like a bit of a no-brainer.’
Prevention before crisis
HMRs are not emergency medicine, they are preventive care. But delivering that care requires time, expertise and a system that allows pharmacists to intervene before problems escalate.
For Mr Mearns, the value of the service is clear even if the current funding model makes it difficult to sustain.
‘Trying to make money out of HMRs these days is very challenging,’ he said. ‘It’s absolutely a labour of love.’
Reform that matches need with value
PSA’s 2026–27 Federal Budget Submission, released 25 February 2026, identifies reform of HMRs as a priority under the First Pharmacy Programs Reform Package.
Recommendation 1.1 calls for removal of monthly provider caps re-basing and applying annual Wage Cost Index indexation to restore service viability, and improved support for rural delivery and complexity.
For patients at risk of medicine-related harm, these changes are not about expanding scope. They are about enabling earlier intervention and avoiding preventable hospitalisations.
Read PSA’s full 2026–27 Federal Budget Submission.
[post_title] => Early intervention through HMRs could save thousands per patient
[post_excerpt] => Greater access to Home Medicines Reviews (HMRs) offers opportunities to intervene earlier, improve patient outcomes and use healthcare funding more effectively.
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[post_content] => Respectful, culturally safe conversations can prevent self-adjusted dosing while supporting informed patient choice.
Each year during Ramadan*, Muslims fast from dawn to sunset, abstaining from food and drink during daylight hours, with this year’s fast taking place from 18 February to 20 March.
For many patients, this practice coincides with the management of acute or chronic diseases, creating medicines-related challenges.
At Emerton Amcal Pharmacy in Western Sydney – an area with a large Muslim community – pharmacist Zara Gul sees these challenges firsthand.
[caption id="attachment_31474" align="alignright" width="255"]
Zara Gul[/caption]
Before turning to dose timing or formulation adjustments, Ms Gul emphasises a key message that pharmacists should reinforce.
Health comes first
For patients managing chronic conditions, fasting is not mandatory if it compromises their health.
‘If you're on things like insulin and you need to be eating, you're not obliged to fast,’ Ms Gul said. ‘Or if you're on medications that you need to take at certain times – for example, epileptic medication or Parkinson’s-related medications, you're exempt from fasting.’
People who are pregnant, unwell, sick or elderly are also exempt. ‘You’re not any less of a good Muslim by not being able to fast because of your health.’
However, Ms Gul advised that some patients, particularly older people, may feel compelled to continue fasting.
‘Sometimes the older generation will try to push themselves, and think, “I can miss my dose and take it later,” and then they fall ill,’ she said. ‘So we have to remind them that their health comes first.’
Timing is everything
For those who are medically fit to fast, timing medicine doses becomes the primary challenge. During Ramadan, meals are limited to early morning (suhoor) and evening (iftar) – which makes midday dosing difficult.
In some cases, simple adjustments can maintain therapeutic coverage during the non-fasting window.
‘If patients are taking medicines such as antibiotics three times a day, they can take one while they’re having their morning meal, one when they break their fast and one before they go to bed,’ Ms Gul said.
Approaching chronic disease management
Managing conditions such as diabetes during Ramadan can prove to be a challenge, with patients using insulin or certain oral agents potentially at risk of hypoglycaemia if fasting without modification.
For patients who are highly motivated to fast, collaborating with prescribers can allow for regimen simplification.
‘For example, if someone wants to go on a longer-acting insulin and they’re only taking it at night, that could be an option,’ Ms Gul said.
‘You’re not any less of a good Muslim by not being able to fast because of your health.'
zara gul
But caution is essential.
‘You also don’t want to confuse the patient by changing things unnecessarily. If they switch insulin just for Ramadan and then go back afterwards, that can cause problems. And doctors might not want to change someone’s medicine if they’re already stable.’
But sometimes this may prompt a positive long-term change.
‘Perhaps the patient doesn't actually need to take a medicine three times per day, and they can switch to using it once daily long-term.’
Self-adjusted dosing
It’s common for patients to independently alter or omit doses during Ramadan, Ms Gul said.
‘People will definitely try. They might skip doses, or they’ll say, “My doctor told me to take it at lunch, but I’m fasting, so I’m not taking it”,’ she said.
‘So if you know someone is observing Ramadan, you could ask, ‘How are you going to manage your medication? Are you finding it easy to manage it with the times?” That can open the door for them to have a chat.’
Often, patients raise the issue directly when collecting prescriptions.
‘When we’re handing medication out and we’re talking to the patient about it, they’ll often tell us they’re fasting and ask how to manage it,’ Ms Gul said.
‘That’s a great opportunity for us to look at options – for example, if they’re taking Trajenta at lunchtime, you might be able to move it to the morning when they’re eating their early meal.’
Starting the conversation
While many patients initiate these conversations, others are not always so forthcoming. So, broaching the topic of Ramadan requires cultural sensitivity, acknowledging that not all Muslim patients fast.
‘It’s hard to identify who’s observing Ramadan and who’s not, so it’s good to ask – not just not assume,’ Ms Gul said. ‘Someone might not be fasting because they’re unwell, and you don’t want to make them feel worse by assuming they are.’
Rather than directly referencing fasting, she recommends broader open-ended questions.
‘An easy thing to ask would be “How is your Ramadan going?” Ms Gul said.
This allows patients to disclose relevant information at their own pace.
‘They might say, “I’m not able to fast this month because of my health,” or “I am fasting and I’m finding it difficult to manage my medicine”. Or they might say everything is going well.’
Knowing what invalidates a fast
Understanding dosage forms is another practical consideration, with some patients worrying that using medicines during daylight hours may invalidate their fast.
As a general rule, oral medicines and substances entering through open cavities invalidate fasting.
‘So you can’t use anything oral, or anything inside your nose or ear,’ Ms Gul said.
However pharmacists can reassure patients about non-oral options. ‘Using a topical cream or an eye drop is absolutely fine,’ she said.
For more information on providing care to culturally and linguistically diverse communities, watch the PSA webinar 'Interpreter services – what every pharmacist & GP should know'.
*Australian Pharmacist apologises for the misspelling of Ramadan in our enewsletter.
[post_title] => Safe medicines management during Ramadan
[post_excerpt] => Respectful, culturally safe conversations can prevent self-adjusted dosing while supporting informed patient choice.
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[post_content] => One in 7 Australian women live with endometriosis, yet diagnosis can still take almost a decade. As awareness grows and new initiatives roll out, pharmacists play a pivotal role in early recognition, medicines management and compassionate care.
Jessica vividly remembers getting her first period at a sleepover when she was 13. The youngest of four girls, she was largely unfazed by what her mum had called ‘joining the sisterhood’. What she didn’t realise was that it would mark the start of a decades-long health struggle.
Now 35, Jessica has lived with frequent, heavy, painful periods for more than 22 years. There have been mornings she couldn’t get out of bed, workdays missed and social events abandoned at the last minute. She experiences pain during sex, which has caused strain in previous relationships, and she worries about her fertility. More than once, she’s been told this is simply ‘a woman’s lot’.
Jessica’s story may sound familiar to the nearly 1 million Australian girls, women and people assigned female at birth living with endometriosis.¹ Defined as ‘endometrial-like tissue proliferating outside the uterus’, endometriosis is a chronic, inflammatory, gynaecological disease with no known cure.² But it is also so much more, says Mónica Forlano, Chair of Endometriosis Australia.
‘The most important thing to understand is that endometriosis is not a reproductive condition – it is a whole body, lifelong chronic condition,’ Ms Forlano says. ‘Yes, it sometimes manifests as pain, bloating, brain fog, fatigue and for – 1 in 3 – fertility issues, but it’s an enigma that can curtail someone’s career, schooling and social life. It affects every aspect of a person’s existence, not just their periods or fertility.’
A national response
For much of human history, females have been taught to feel shame about their bodies and biological functions. Many have been told to bear debilitating periods in silence, have faced accusations of exaggerating – or even inventing – their pain.
These attitudes persist. A 2025 Victorian Government inquiry into women’s pain – the first of its kind in Australia – revealed 71% of respondents saw it as ‘widespread dismissal by healthcare professionals’ and a primary challenge when seeking help.³
More than half also reported delayed diagnoses that led to ‘years of unnecessary suffering and, sometimes, worsened health outcomes’.
Some progress is being made. The National Action Plan for Endometriosis,⁴ released in 2018, marked the first significant step forward in addressing endometriosis in Australia. It focuses on three priority areas: awareness and education, clinical management and care, and research.
A cornerstone initiative is the rollout of Endometriosis and Pelvic Pain Clinics across the country. At the time of writing, 22 clinics are operational, with 11 more planned to open in early 2026 – ensuring at least one in every Primary Health Network region. These clinics provide interdisciplinary care, referral services, access to early intervention and a range of treatment options.⁵
The federal government is also funding the development of an Endometriosis Management Plan⁶ for primary care, and has supported the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) to produce the Australian Living Evidence Guideline: Endometriosis,⁷ providing evidence-based recommendations for clinicians.
Will this make a difference? Chairperson of Chronic Pain Australia Nicolette Ellis MPS (she/her) says yes.
‘The pelvic pain clinics are a major step forward because they embed pelvic pain as core business in primary care. Their integrated, multidisciplinary approach aligns with best evidence and supports earlier intervention, reducing the chronicity of disease. We’re seeing clearer referral pathways and better collaboration across gynaecology, physiotherapy and psychology.’
Ms Forlano agrees the clinics are ‘exactly the kind of equitable access we need,’ particularly for patients who have struggled to navigate siloed systems. However, she says ‘fundamental challenges persist’, including a roughly 7-year diagnostic delay.⁸
‘We’d like to see continued investment in research, expanded access to interdisciplinary care, and most critically, urgent attention to that persistent 6–7-year diagnostic delay,’ she says. ‘Every year someone waits is another year of unnecessary suffering and disease progression.’
Inclusive endometriosis careEndometriosis is often framed solely as a “women’s health” condition. Nicolette Ellis MPS (she/her), Chairperson of Chronic Pain Australia, shares how pharmacists can help transgender and non-binary patients feel seen and safe. ‘Trans and non-binary people often face misgendering, discrimination and the misconception that only cis women experience endometriosis, leading to delayed or avoided care,’ Ms Ellis says. ‘Using terms like “people who menstruate” or “people with a uterus” and avoiding assumptions based on appearance or records helps ensure inclusivity. ‘Collecting pronouns, using inclusive signage, asking gender-neutral questions about pelvic or menstrual symptoms, and clearly signalling that care is available for people of all genders encourages trans and non-binary patients to access pelvic-pain support. ‘Stocking heat packs, TENS devices, period products and bladder/bowel aids, and providing information about local pelvic pain physiotherapists, clinics and support organisations shows that people of all genders living with endometriosis or pelvic pain are seen, believed and supported. ‘Conversations should take place in a private consultation area, not over the counter, as a standard for all sensitive health issues. Start with neutral, open questions such as, “Do you experience periods or pelvic pain?” Mirror the person’s preferred language, and if unsure, ask respectfully: “Is there a better way I can word this?” Avoid gendered terms like “ladies’ problems” in favour of “pelvic health” or “menstrual health”. ‘Gender-affirming hormones can mask or alter endometriosis symptoms. Pharmacists should check in about breakthrough bleeding, pelvic pain, mood changes, and potential interactions with hormonal or neuropathic pain medications. Where cyclical pain is clear, evidence supports a therapeutic trial of ovarian suppression before considering diagnostic laparoscopy. Shared care between GP, endocrinology and gynaecology teams is especially helpful in complex cases.’ |
Normalisation is medical misogyny and delays diagnosisSeveral systemic barriers contribute to the delayed diagnosis many patients have experienced. One is cultural: the normalisation of crippling period pain.
‘Medical misogyny still leads many people to be told their pain is “normal” or stress-related, or something pregnancy will fix,’ Ms Ellis says. ‘This erodes trust. When menstruation is trivialised, people minimise symptoms and often present only once the pain is severe or disabling.’
Limited access to specialists is another problem. Long waits to see gynaecologists – especially in regional and rural areas – delay diagnosis and treatment. Diagnosis remains complex. Although high-quality transvaginal ultrasound and MRI are increasingly used to detect endometriosis, many still rely on a laparoscopy, an invasive examination, for diagnosis.⁹
The financial burden also compounds inequity. People with endometriosis spend about $30,000 each year on direct and indirect costs, which only increases for those outside major cities.⁹
Co-Chair of the Access, Care and Outcomes Subcommittee for the National Women’s Health Advisory Council and immediate-past PSA National President Associate Professor Fei Sim FPS (she/her)says that while specialised clinics are a positive development, more needs to be done to improve access to care.
‘Australia is still falling short in equitable access, with long wait times, high out-of-pocket costs and limited availability outside metropolitan areas,’ she says. ‘What works well in the clinics is the team-based approach, but what needs improvement is affordability, inconsistent models of care and insufficient long-term funding.’
People living with chronic pain seek answers and reassurance and community pharmacies are often their first, and most frequent, touchpoint. ‘Pharmacists continue to be an underutilised resource,’ A/Prof Sim says. ‘Existing health infrastructure, including GP clinics and community pharmacies, should be empowered to deliver more care.’
In a health system which too often encourages non-pharmacological or simple analgesic interventions for complex pain – community pharmacists have an important role in being a circuit-breaker.
‘Pharmacists can help by recognising whether symptoms are cyclical, bowel-related, bladder-related or musculoskeletal, and supporting early medical management that reduces chronicity,’ Ms Ellis says.
‘Encouraging timely GP review and knowing a local pelvic pain physiotherapist – who are game-changers – helps ensure patients reach the right care earlier.’
And pharmacists shouldn’t underestimate the significance of what could seem like a really simple intervention:
‘Being listened to and believed is itself a therapeutic intervention,’ Ms Ellis adds. Validating language is critical. Just hearing the words ‘your pain is real and deserves proper assessment’ can make a difference.
[caption id="attachment_31514" align="aligncenter" width="500"] Sharnelle Vella, ABC Radio Melbourne breakfast co-host[/caption]
‘Silent’ endometriosisIn November 2025, 774 ABC Radio Melbourne breakfast co-host Sharnelle Vella announced10 she was ‘beyond terrified’ but also overjoyed at finally becoming pregnant. Telling her audience she would be taking maternity leave in February 2026 to give birth to a baby girl, she also revealed how her pregnancy came after years of fertility issues, miscarriage and failed rounds of IVF treatment. The cause? Stage 4 endometriosis found during an exploratory laparoscopy in March 2025 to investigate mild pelvic inflammation that had been revealed by a blood test. Unlike many who live with the condition, the one pointer to Ms Vella’s endometriosis had been her infertility. ‘Put simply, I was riddled with it,’ she told listeners. But without the symptoms including the crippling pain that afflicts many women, she’d had no idea. She recalls talking to the surgeon afterwards. ‘I asked, “Did you find anything?” He half-laughed, shook his head and said a sentence that will stay with me forever: “Sharnelle, you have stage four endometriosis – we were cutting it out of you for 3 hours.”’ ‘How many stages are there?’ I asked. “There are four,” he replied.’ Having put her life on hold numerous times, not taken holidays, not taken jobs, ‘you commit to nothing – except this journey’, she tearfully explained, saying she had become pregnant without assisted reproduction therapies just 3 months later. Ms Vella wanted listeners who may be experiencing the same ‘unimaginable grief’ of infertility to know that they were not alone. While Australian Institute of Health and Welfare data shows that 1 in 7 people assigned female at birth in Australia have endometriosis,¹1 some, like Ms Vella, are asymptomatic and only discover there is a problem when trying to conceive. Dr Pav Nanayakkara, a gynaecologist at Jean Hailes for Women’s Health clinics in Melbourne says it’s important to remember endometriosis can affect people differently. ‘For some, it’s very mild, they might not know they have it at all. For others it can be very severe and really impact their daily life. Because of that lack of understanding around the condition, people don’t necessarily know how it can present,’ she says.¹ While ‘about 30–50% of people with endometriosis have some degree of infertility’, most people ‘will go on to fall pregnant by themselves,’ Dr Nanayakkara adds. ‘Sometimes that depends on what stage of endometriosis the patient has, but most people will go on to fall pregnant by themselves. So, it can have implications, but it doesn’t make them infertile.’ |
The RANZCOG guidelines suggest a short trial of a non-steroidal anti-inflammatory (NSAID) alone or in combination with paracetamol to manage pain.
But hormonal treatment is also recommended as a first-line therapy.
While the combined oral contraceptive pill and progestogens are usually the first step, second-line treatments, including gonadotropin-releasing hormone agonists and antagonists, should be initiated if symptoms don’t improve or adverse effects occur.⁷
The experience of many individuals with endometriosis is that shifting from first-line to second-line hormonal treatments takes too long and isn’t proactively offered.
Medical misogyny is part of the problem. The inertia of funding barriers is another. But some recent changes aim to tackle this challenge.
In 2024, the Therapeutic Goods Administration approved the fixed-dose combination of relugolix, estradiol and norethisterone (Ryeqo) to treat moderate to severe endometriosis-associated pain.
Aimed at patients with a history of medical or surgical treatment, the addition took the number of medicines indicated for the treatment of endometriosis in Australia to six.¹3
Later that year, dienogest (Visanne) was listed on the Pharmaceutical Benefits Scheme (PBS) – the first time in 30 years that individuals with endometriosis had access to a new PBS-subsidised treatment.¹⁴
New approaches are also being explored. A team at the Royal Adelaide Hospital is trialling a new intrauterine device¹⁵, while Western Sydney University is running a clinical trial to examine the efficacy of different medicinal cannabis interventions.¹⁶
Around 60–70% of people also use some form of complementary, non-pharmacological management, including acupuncture, Chinese herbal medicine, physiotherapy, exercise and nutrition strategies.⁷
However, these aren’t always accessible, says Grace Wong MPS, Medication Safety Pharmacist at The Royal Women’s Hospital in Melbourne.
‘Healthcare professionals often assume patients can easily access non-pharmacological interventions, but many require time, travel or out-of-pocket costs,’ she says.
‘Living with pain can be overwhelming. Making things easy and doable is key.’
With many patients navigating diagnostic uncertainty, Ms Wong says pharmacists should reassure them that ‘chronic pelvic or vaginal pain is not normal and women shouldn’t just “put up with it”.’
Policy efforts now need to ‘focus on sustainable funding, scaling access in regional and rural areas and using existing infrastructure to deliver enhanced care’, according to A/Prof Sim.
Research priorities should include earlier diagnostic biomarkers, long-term outcome studies of models of care, culturally safe models for First Nations peoples and interventions to build health literacy.
Education remains vital. Programs like PPEP Talk,¹⁹ run by the Pelvic Pain Association of Australia, help young people understand what’s normal when it comes to menstrual health – and what’s not.
‘Early education in schools is vital,’ A/Prof Sim says. ‘We need to reduce stigma, support earlier symptom recognition and empower girls and young women to speak up, seek care sooner and navigate the health system with confidence.’
HPV vaccination clinics and school-based health programs are ideal opportunities to explain what isn’t normal period pain and provide advice on where to get help, Ms Ellis says.
Incorporating menstrual health into medicine reviews with young people can also support earlier recognition of pelvic, bowel or bladder symptoms that often emerge in adolescence.
‘When close to 1 million Australians are affected by a condition, every healthcare touchpoint matters,’ Ms Forlano says.
‘Understanding and support can be the difference between someone suffering in silence or finding the help they need. Let’s work together to ensure no one has to wait 6–7 years for a diagnosis, and that every person with endometriosis has access to the care and support they deserve.’
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[post_content] => This National Close the Gap Day (19 March), experts highlight the important role pharmacists play in supporting and promoting equitable access to the Closing the Gap (CTG) PBS Co-payment Program.
While many Aboriginal and Torres Strait Islander people have already been registered for the CTG PBS Co-payment program, many are not accessing this support as intended – particularly those who travel from remote communities to receive health care, said Chastina Heck MPS, Chair of the PSA/NACCHO Aboriginal and Torres Strait Islander Pharmacy Practice Community of Specialty Interest (CSI).
‘[So] pharmacists play a critical role as trusted navigators through Australia’s complex healthcare ecosystem,’ she added.
[caption id="attachment_31556" align="alignright" width="263"] Mike Stephens, Director, Medicines policy and Programs at the National Aboriginal Community Controlled Health Organisation (NACCHO)[/caption]
Bridging the gap in medicines access
Mike Stephens, Director, Medicines policy and Programs at the National Aboriginal Community Controlled Health Organisation (NACCHO) said it’s important pharmacists support equitable access to the CTG PBS Co-payment Program.
‘Pharmacists are medicines experts and patients accordingly rely on us to understand and navigate programs that help them access medicines – CTG scripts are no different,’ Mr Stephens said.
‘Though only some pharmacists’ practice may be directly focused on working with Aboriginal and Torres Strait Islander people, all pharmacists will deliver care to Aboriginal and Torres Strait Islander people within their practice from time to time.
‘This point is especially timely considering the current Australian campaign related to affordable medicines. Delivering culturally safe care is essential and embodied in every major pharmacy practice policy – it’s every pharmacist’s responsibility.’
Where access to CTG can fall short
Before the recent reforms, when the CTG co-payment expanded to all PBS medicines supplied through public hospitals, Ms Heck said working in a clinical setting was often frustrating.
‘The previous program often created more gaps than it closed in accessing health care. In turn, this would erode trust in the healthcare system because people would speak up about an invoice, or about their CTG registration, only to be told that hospitals were unable to dispense it as such,’ she said.
‘They would say, “If a hospital has these rules about me, then what other decisions are they making about my care that I’m not aware of?”
‘This was also exacerbated for remote patients who were not CTG registered and discharged from hospital in unfamiliar environments, often with long transit times home – so accessing medications only when they arrived home was not a suitable option.’
But there are still traps to avoid and issues to discuss with care and context in community and hospital settings alike.
‘Patients may not realise brand premium still apply to CTG co-payments. Explaining this may be important,’ he said.
‘Pharmacists can check Health Professional Online Services (HPOS) if they are not sure if someone is registered. They should also generally seek a discreet place to discuss CTG eligibility with a patient and can only register a patient if they have delegation from a doctor or AHP through HPOS.’
Mr Stephens stressed that while most pharmacists cannot register a patient, careful support to connect a client to a doctor or ACCHO for registration is crucial.
[caption id="attachment_31561" align="alignright" width="280"] Chastina Heck MPS, Chair of the PSA/NACCHO Aboriginal and Torres Strait Islander Pharmacy Practice Community of Specialty Interest (CSI).[/caption]
Culturally safe care is more than good intentions
It’s not as simple as being nice to someone, Ms Heck said.
‘The beliefs and experiences we bring from our past, that have shaped our current “knowing”, often lead to unconscious biases,’ she said.
’It’s imperative that pharmacists develop ways to recognise and respond to these. For example, this might manifest as deciding to not dispense a prescription for low-dose aspirin, instead directing the patient to buy it over the counter.’
Facilitating patient choice and autonomy by providing comprehensive information, upon which a decision can be made, is one way to deliver culturally safe care – rather than deciding what the best option for the patient is, Ms Heck reiterates.
Mr Stephens agrees. ‘It’s important pharmacists support Aboriginal and Torres Strait Islander people to feel comfortable and confident to say what they need, raise concerns and understand their medicines; take adequate time to meet the patient’s needs and consult in a way that is responsive to the local community’s needs.
‘This might include finding a more private setting in relation to someone’s CTG eligibility. All staff should periodically undertake cultural safety training (not just once), preferably delivered from a local community-level organisation, for example an ACCHO or Land Council. Pharmacists should also complete foundational pharmacist courses and learning, such as the co-designed modules by NACCHO and PSA – Deadly pharmacists training modules, as well as familiarise themselves with the PSA’s Guidelines for pharmacists supporting Aboriginal and Torres Strait Islander peoples with medicines management.’
[caption id="attachment_31555" align="alignright" width="233"] Philippa Chigeza, pharmacist at Logan Hospital.[/caption]
Every conversation is an opportunity
Philippa Chigeza, a pharmacist at Logan Hospital in Queensland sees the impacts of the CTG program every day.
’Conversations about CTG are not just about eligibility or reducing medicine costs,’ she said.
‘They are also an opportunity to support culturally safe care, build trust, and ensure patients feel comfortable asking questions about their medicines.’
Pharmacists are in a strong position to help bridge this gap by proactively identifying eligible patients, explaining the program clearly, and working collaboratively with prescribers and Aboriginal health services,’ Ms Chigeza said.
‘Developing cultural awareness and communication skills is just as important as understanding the program itself,’ she said.
‘Training initiatives, such as our intern health promotion project, was an opportunity to deepen my understanding of the CTG program and support me to practice conversations on this topic with patients and families. It can help improve pharmacists’ confidence in having these conversations and is therefore extremely valuable in supporting better health outcomes for Aboriginal and Torres Strait Islander peoples.’
[post_title] => Closing the Gap starts at the pharmacy counter
[post_excerpt] => This National Close the Gap Day (19 March), experts highlight the important role pharmacists play in supporting and promoting equal access.
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[post_content] => With no mandated CPD requirement in ethics or legislation, some practitioners are entering complex practice environments without a current understanding of their professional obligations.
As pharmacists, we are disciplined about maintaining our clinical knowledge across evolving therapeutic areas, new medicines and updated guidelines. When disease states or treatments change, most of us retain a strong foundation because we engage with them in practice every day.
However, the same rigour is not consistently applied to legislation and ethics. For some practitioners, understanding of the legislative and ethical framework has gradually eroded, and in many cases not revisited or contemporised for 10, 20 or even 40 years. While medicines are regularly discussed with patients and colleagues, equivalent engagement with legal obligations and ethical principles does not occur – despite the fact that sound ethical decision-making depends on a solid grasp of the legislative framework governing practice.
What regulators are seeing in practice
Before my appointment as President of the International Pharmaceutical Federation (FIP), I spent nine years with the Pharmacy Council of New South Wales. In that role, I had oversight of pharmacists across practice settings – including community, hospital, education and research – from newly registered practitioners to those with decades of experience.
During that time, I observed a wide range of practice standards, with recurring themes emerging in some of the more serious matters before the Council. In a number of cases, there appeared to be limited familiarity with relevant legislation and relatively little engagement with ethics in day-to-day practice.
When questioned about legislation, many practitioners noted that it had been covered at university. And when asked whether it had been reviewed at any point since graduation, the answer was invariably no.
In complaint investigations and interviews – including matters where urgent intervention was required to protect public safety under Section 150 of the Health Practitioner Regulation National Law – it became clear that there was little understanding of the legislation.
Decisions were not always made with proper regard to core ethical responsibilities, including protecting patient wellbeing and exercising sound professional judgement. In some instances, pharmacists were not aware of the PSA Professional Practice Standards or the PSA Code of Ethics for Pharmacists. From a regulatory perspective, that raises serious concerns and suggests a broader gap within the profession in understanding these two essential pillars of practice.
The matters before the Council were not limited to one-off dispensing errors. In a number of cases, patterns of behaviour raised concerns.
This included dispensing Schedule 8 medicines or Schedule 4 benzodiazepines in volumes or circumstances where appropriate indication and professional judgement should have prompted closer scrutiny.
Habits can develop over time. If pharmacists base decisions on flawed inputs, those patterns will continue unchecked – often until a regulator intervenes.
Rethinking how we approach CPD
Under current requirements, pharmacists must complete 40 CPD credits each year, with 20 of those as assessable (Group 2) activities. There is no mandated requirement that any of those credits specifically address legislation or ethics.
But based on my experience, there is merit in introducing an annual, assessed CPD component focused on these areas.
This could take the form of structured case studies requiring pharmacists to apply relevant legislative provisions and ethical principles to practical scenarios, with a defined minimum number of Group 2 credits allocated each year.
The objective would be to ensure every pharmacist revisits the legislative and ethical foundations of practice regularly and tests their understanding in a practical context. If a practitioner can work through an ethical dilemma in a structured case study and apply the correct legislative framework, they are more likely to make sound decisions in real-world practice.
It is a practical and achievable step that could significantly strengthen how practitioners approach decision-making in the best interests of patients and in accordance with good pharmacy practice.
Expanded scope increases responsibility
As scope of practice expands, pharmacists are assuming more autonomous clinical roles, including prescribing. While this evolution is positive for the profession and patients, increased autonomy brings increased responsibility. Clinical authority must be matched by a strong understanding of the legislative and ethical framework that governs how that authority is used.
A baseline expectation across the profession would promote consistency and reinforce the importance of these competencies for all practitioners, regardless of scope or practice setting.
At the FIP World Congress, ethics is a key part of the program each year. We include ethics presentations at every congress in recognition of how important these considerations are in our daily practice.
Embedding competence in everyday practice
If an annual ethics and legislation requirement were introduced, I would hope it would become part of routine competency review, rather than something revisited only when a practitioner appears before a regulator. Embedding this into regular professional development would strengthen patient safety, ensuring that decisions are consistently aligned with the patient’s best interests.
Culturally, this would support a safer and stronger profession, with practitioners accepting responsibility for maintaining currency of practice – not only in medicines and dispensing processes, but also in understanding relevant state and Commonwealth legislation and the ethical basis of decision-making.
This is particularly important for early career pharmacists. Young practitioners learn by observing those around them. The most effective way to guide them is to ensure they see best practice consistently modelled. If that does not occur, ‘what I see, I do’ can become the norm, and ECPs may be reluctant to question senior pharmacists.
Pharmacy proprietors are responsible for what happens within their pharmacy, including the capability of employed pharmacists. So it’s reasonable for employers to ensure their staff not only meet registration requirements, but also understand the legislative frameworks.
By adhering to regulation, legislation and ethical decision-making processes, we reduce the likelihood of complaints – many of which arise from serious harm to patients, an outcome we all seek to avoid.
Maintaining competence in ethics and legislation is not an additional burden. It is part of maintaining the standard of practice that our patients and the community expect.
PSA has opened public consultation on its draft Code of Ethics for Pharmacists until 17 April. Click here to have your say.
[post_title] => A question of ethics: FIP President calls for annual review
[post_excerpt] => With no mandated CPD requirement in ethics or legislation, some pharmacists don't have an understanding of their professional obligations.
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[post_content] => Greater access to Home Medicines Reviews (HMRs) offers opportunities to intervene earlier, improve patient outcomes and use healthcare funding more effectively.
For Tasmanian-based Stewart Mearns MPS, HMRs are not an administrative program. They are an early warning system – preventing falls, reducing adverse drug events and averting hospital admissions.
When patients don’t have this opportunity, the consequences can be serious. And expensive.
[caption id="attachment_31483" align="alignright" width="200"] Stewart Mearns MPS[/caption]
‘If I prevent one hospitalisation, there’s [around] $30,000 right there,’ Mr Mearns said. ‘That’s my funding for the next 6 months, which has to be cost positive.’
This blunt economic calculation reflects the realities of credentialed pharmacists in practice.
Catching problems before they escalate
When providing HMRs, Mr Mearns regularly identifies medicine-related risks that have gone unnoticed.
In one case, he arrived at a patient’s home to find she appeared confused and cognitively impaired. But the issue wasn’t dementia.
‘We’re having a medical emergency here,’ he realised.
The patient was experiencing hypoglycaemia and her husband hadn’t recognised the warning signs.
In another case, he discovered a patient had been taking aspirin without telling her doctors, worsening severe reflux.
‘None of her doctors were aware,’ he said. Once the aspirin was stopped, ‘she said I’d changed her life’.
These professional observations in living rooms help avoid escalation before an ambulance is called; this is the value of early intervention.
The hidden cost of delay
HMRs are designed to reduce medicine-related harm – one of Australia’s National Health Priority Areas. But access constraints mean some patients wait months for a review.
Like many other pharmacists, Mr Mearns sees the human cost of these restrictions. ‘I’ve had several patients die [while waiting for a HMR],’ Mr Mearns said of those referred but not seen in time due to the restrictive cap of 30 HMRs per month.
With medicines misadventure a known contributor to hospitalisations and deaths, particularly in older Australians and those with complex regimens, Mr Mearns sees the link clearly.
‘If they [Federal Government] are serious about improving Australian health, this is a good program to fund,’ he said.
The logic is simple: prevent harm upstream, reduce the downstream burden on hospitals.
Complex patients, preventable harm
Polypharmacy is common among the patients referred for HMRs. Multiple prescribers, fragmented care and long medicine lists increase the risk of duplication, interaction and adverse effects.
Mr Mearns recalls a young patient with autism and Tourette’s syndrome who was taking multiple antiepileptic medicines and was experiencing daily falls.
‘Once the aspirin was stopped, ‘she said I’d changed her life.'
Stewart Mearns MPS
‘She was getting pushed around in a wheelchair at 18 because she was taking six or so [different] antiepileptics. There was no one removing medications that weren’t effective.’
Rather than an access-to-care issue, the core problem was a lack of a coordinated medicines review.
HMRs allow credentialed pharmacists to step back, assess the full picture and make recommendations to optimise therapy.
While this intervention might not make headlines, preventing one serious fall or hospital admission has both human and financial implications.
The price of a single medicine-related hospital admission can far exceed the cost of dozens of HMRs, with medicine-related problems reported to cost the economy $1.4 billion annually.
Mr Mearns believes the economics are compelling.
‘We’re pretty well-studied as pharmacists. We’re a cost-saving intervention,’ he said. ‘[Improving HMR funding] seems like a bit of a no-brainer.’
Prevention before crisis
HMRs are not emergency medicine, they are preventive care. But delivering that care requires time, expertise and a system that allows pharmacists to intervene before problems escalate.
For Mr Mearns, the value of the service is clear even if the current funding model makes it difficult to sustain.
‘Trying to make money out of HMRs these days is very challenging,’ he said. ‘It’s absolutely a labour of love.’
Reform that matches need with value
PSA’s 2026–27 Federal Budget Submission, released 25 February 2026, identifies reform of HMRs as a priority under the First Pharmacy Programs Reform Package.
Recommendation 1.1 calls for removal of monthly provider caps re-basing and applying annual Wage Cost Index indexation to restore service viability, and improved support for rural delivery and complexity.
For patients at risk of medicine-related harm, these changes are not about expanding scope. They are about enabling earlier intervention and avoiding preventable hospitalisations.
Read PSA’s full 2026–27 Federal Budget Submission.
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[post_content] => Respectful, culturally safe conversations can prevent self-adjusted dosing while supporting informed patient choice.
Each year during Ramadan*, Muslims fast from dawn to sunset, abstaining from food and drink during daylight hours, with this year’s fast taking place from 18 February to 20 March.
For many patients, this practice coincides with the management of acute or chronic diseases, creating medicines-related challenges.
At Emerton Amcal Pharmacy in Western Sydney – an area with a large Muslim community – pharmacist Zara Gul sees these challenges firsthand.
[caption id="attachment_31474" align="alignright" width="255"] Zara Gul[/caption]
Before turning to dose timing or formulation adjustments, Ms Gul emphasises a key message that pharmacists should reinforce.
Health comes first
For patients managing chronic conditions, fasting is not mandatory if it compromises their health.
‘If you're on things like insulin and you need to be eating, you're not obliged to fast,’ Ms Gul said. ‘Or if you're on medications that you need to take at certain times – for example, epileptic medication or Parkinson’s-related medications, you're exempt from fasting.’
People who are pregnant, unwell, sick or elderly are also exempt. ‘You’re not any less of a good Muslim by not being able to fast because of your health.’
However, Ms Gul advised that some patients, particularly older people, may feel compelled to continue fasting.
‘Sometimes the older generation will try to push themselves, and think, “I can miss my dose and take it later,” and then they fall ill,’ she said. ‘So we have to remind them that their health comes first.’
Timing is everything
For those who are medically fit to fast, timing medicine doses becomes the primary challenge. During Ramadan, meals are limited to early morning (suhoor) and evening (iftar) – which makes midday dosing difficult.
In some cases, simple adjustments can maintain therapeutic coverage during the non-fasting window.
‘If patients are taking medicines such as antibiotics three times a day, they can take one while they’re having their morning meal, one when they break their fast and one before they go to bed,’ Ms Gul said.
Approaching chronic disease management
Managing conditions such as diabetes during Ramadan can prove to be a challenge, with patients using insulin or certain oral agents potentially at risk of hypoglycaemia if fasting without modification.
For patients who are highly motivated to fast, collaborating with prescribers can allow for regimen simplification.
‘For example, if someone wants to go on a longer-acting insulin and they’re only taking it at night, that could be an option,’ Ms Gul said.
‘You’re not any less of a good Muslim by not being able to fast because of your health.'
zara gul
But caution is essential.
‘You also don’t want to confuse the patient by changing things unnecessarily. If they switch insulin just for Ramadan and then go back afterwards, that can cause problems. And doctors might not want to change someone’s medicine if they’re already stable.’
But sometimes this may prompt a positive long-term change.
‘Perhaps the patient doesn't actually need to take a medicine three times per day, and they can switch to using it once daily long-term.’
Self-adjusted dosing
It’s common for patients to independently alter or omit doses during Ramadan, Ms Gul said.
‘People will definitely try. They might skip doses, or they’ll say, “My doctor told me to take it at lunch, but I’m fasting, so I’m not taking it”,’ she said.
‘So if you know someone is observing Ramadan, you could ask, ‘How are you going to manage your medication? Are you finding it easy to manage it with the times?” That can open the door for them to have a chat.’
Often, patients raise the issue directly when collecting prescriptions.
‘When we’re handing medication out and we’re talking to the patient about it, they’ll often tell us they’re fasting and ask how to manage it,’ Ms Gul said.
‘That’s a great opportunity for us to look at options – for example, if they’re taking Trajenta at lunchtime, you might be able to move it to the morning when they’re eating their early meal.’
Starting the conversation
While many patients initiate these conversations, others are not always so forthcoming. So, broaching the topic of Ramadan requires cultural sensitivity, acknowledging that not all Muslim patients fast.
‘It’s hard to identify who’s observing Ramadan and who’s not, so it’s good to ask – not just not assume,’ Ms Gul said. ‘Someone might not be fasting because they’re unwell, and you don’t want to make them feel worse by assuming they are.’
Rather than directly referencing fasting, she recommends broader open-ended questions.
‘An easy thing to ask would be “How is your Ramadan going?” Ms Gul said.
This allows patients to disclose relevant information at their own pace.
‘They might say, “I’m not able to fast this month because of my health,” or “I am fasting and I’m finding it difficult to manage my medicine”. Or they might say everything is going well.’
Knowing what invalidates a fast
Understanding dosage forms is another practical consideration, with some patients worrying that using medicines during daylight hours may invalidate their fast.
As a general rule, oral medicines and substances entering through open cavities invalidate fasting.
‘So you can’t use anything oral, or anything inside your nose or ear,’ Ms Gul said.
However pharmacists can reassure patients about non-oral options. ‘Using a topical cream or an eye drop is absolutely fine,’ she said.
For more information on providing care to culturally and linguistically diverse communities, watch the PSA webinar 'Interpreter services – what every pharmacist & GP should know'.
*Australian Pharmacist apologises for the misspelling of Ramadan in our enewsletter.
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[post_content] => One in 7 Australian women live with endometriosis, yet diagnosis can still take almost a decade. As awareness grows and new initiatives roll out, pharmacists play a pivotal role in early recognition, medicines management and compassionate care.
Jessica vividly remembers getting her first period at a sleepover when she was 13. The youngest of four girls, she was largely unfazed by what her mum had called ‘joining the sisterhood’. What she didn’t realise was that it would mark the start of a decades-long health struggle.
Now 35, Jessica has lived with frequent, heavy, painful periods for more than 22 years. There have been mornings she couldn’t get out of bed, workdays missed and social events abandoned at the last minute. She experiences pain during sex, which has caused strain in previous relationships, and she worries about her fertility. More than once, she’s been told this is simply ‘a woman’s lot’.
Jessica’s story may sound familiar to the nearly 1 million Australian girls, women and people assigned female at birth living with endometriosis.¹ Defined as ‘endometrial-like tissue proliferating outside the uterus’, endometriosis is a chronic, inflammatory, gynaecological disease with no known cure.² But it is also so much more, says Mónica Forlano, Chair of Endometriosis Australia.
‘The most important thing to understand is that endometriosis is not a reproductive condition – it is a whole body, lifelong chronic condition,’ Ms Forlano says. ‘Yes, it sometimes manifests as pain, bloating, brain fog, fatigue and for – 1 in 3 – fertility issues, but it’s an enigma that can curtail someone’s career, schooling and social life. It affects every aspect of a person’s existence, not just their periods or fertility.’
A national response
For much of human history, females have been taught to feel shame about their bodies and biological functions. Many have been told to bear debilitating periods in silence, have faced accusations of exaggerating – or even inventing – their pain.
These attitudes persist. A 2025 Victorian Government inquiry into women’s pain – the first of its kind in Australia – revealed 71% of respondents saw it as ‘widespread dismissal by healthcare professionals’ and a primary challenge when seeking help.³
More than half also reported delayed diagnoses that led to ‘years of unnecessary suffering and, sometimes, worsened health outcomes’.
Some progress is being made. The National Action Plan for Endometriosis,⁴ released in 2018, marked the first significant step forward in addressing endometriosis in Australia. It focuses on three priority areas: awareness and education, clinical management and care, and research.
A cornerstone initiative is the rollout of Endometriosis and Pelvic Pain Clinics across the country. At the time of writing, 22 clinics are operational, with 11 more planned to open in early 2026 – ensuring at least one in every Primary Health Network region. These clinics provide interdisciplinary care, referral services, access to early intervention and a range of treatment options.⁵
The federal government is also funding the development of an Endometriosis Management Plan⁶ for primary care, and has supported the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) to produce the Australian Living Evidence Guideline: Endometriosis,⁷ providing evidence-based recommendations for clinicians.
Will this make a difference? Chairperson of Chronic Pain Australia Nicolette Ellis MPS (she/her) says yes.
‘The pelvic pain clinics are a major step forward because they embed pelvic pain as core business in primary care. Their integrated, multidisciplinary approach aligns with best evidence and supports earlier intervention, reducing the chronicity of disease. We’re seeing clearer referral pathways and better collaboration across gynaecology, physiotherapy and psychology.’
Ms Forlano agrees the clinics are ‘exactly the kind of equitable access we need,’ particularly for patients who have struggled to navigate siloed systems. However, she says ‘fundamental challenges persist’, including a roughly 7-year diagnostic delay.⁸
‘We’d like to see continued investment in research, expanded access to interdisciplinary care, and most critically, urgent attention to that persistent 6–7-year diagnostic delay,’ she says. ‘Every year someone waits is another year of unnecessary suffering and disease progression.’
Inclusive endometriosis careEndometriosis is often framed solely as a “women’s health” condition. Nicolette Ellis MPS (she/her), Chairperson of Chronic Pain Australia, shares how pharmacists can help transgender and non-binary patients feel seen and safe. ‘Trans and non-binary people often face misgendering, discrimination and the misconception that only cis women experience endometriosis, leading to delayed or avoided care,’ Ms Ellis says. ‘Using terms like “people who menstruate” or “people with a uterus” and avoiding assumptions based on appearance or records helps ensure inclusivity. ‘Collecting pronouns, using inclusive signage, asking gender-neutral questions about pelvic or menstrual symptoms, and clearly signalling that care is available for people of all genders encourages trans and non-binary patients to access pelvic-pain support. ‘Stocking heat packs, TENS devices, period products and bladder/bowel aids, and providing information about local pelvic pain physiotherapists, clinics and support organisations shows that people of all genders living with endometriosis or pelvic pain are seen, believed and supported. ‘Conversations should take place in a private consultation area, not over the counter, as a standard for all sensitive health issues. Start with neutral, open questions such as, “Do you experience periods or pelvic pain?” Mirror the person’s preferred language, and if unsure, ask respectfully: “Is there a better way I can word this?” Avoid gendered terms like “ladies’ problems” in favour of “pelvic health” or “menstrual health”. ‘Gender-affirming hormones can mask or alter endometriosis symptoms. Pharmacists should check in about breakthrough bleeding, pelvic pain, mood changes, and potential interactions with hormonal or neuropathic pain medications. Where cyclical pain is clear, evidence supports a therapeutic trial of ovarian suppression before considering diagnostic laparoscopy. Shared care between GP, endocrinology and gynaecology teams is especially helpful in complex cases.’ |
Normalisation is medical misogyny and delays diagnosisSeveral systemic barriers contribute to the delayed diagnosis many patients have experienced. One is cultural: the normalisation of crippling period pain.
‘Medical misogyny still leads many people to be told their pain is “normal” or stress-related, or something pregnancy will fix,’ Ms Ellis says. ‘This erodes trust. When menstruation is trivialised, people minimise symptoms and often present only once the pain is severe or disabling.’
Limited access to specialists is another problem. Long waits to see gynaecologists – especially in regional and rural areas – delay diagnosis and treatment. Diagnosis remains complex. Although high-quality transvaginal ultrasound and MRI are increasingly used to detect endometriosis, many still rely on a laparoscopy, an invasive examination, for diagnosis.⁹
The financial burden also compounds inequity. People with endometriosis spend about $30,000 each year on direct and indirect costs, which only increases for those outside major cities.⁹
Co-Chair of the Access, Care and Outcomes Subcommittee for the National Women’s Health Advisory Council and immediate-past PSA National President Associate Professor Fei Sim FPS (she/her)says that while specialised clinics are a positive development, more needs to be done to improve access to care.
‘Australia is still falling short in equitable access, with long wait times, high out-of-pocket costs and limited availability outside metropolitan areas,’ she says. ‘What works well in the clinics is the team-based approach, but what needs improvement is affordability, inconsistent models of care and insufficient long-term funding.’
People living with chronic pain seek answers and reassurance and community pharmacies are often their first, and most frequent, touchpoint. ‘Pharmacists continue to be an underutilised resource,’ A/Prof Sim says. ‘Existing health infrastructure, including GP clinics and community pharmacies, should be empowered to deliver more care.’
In a health system which too often encourages non-pharmacological or simple analgesic interventions for complex pain – community pharmacists have an important role in being a circuit-breaker.
‘Pharmacists can help by recognising whether symptoms are cyclical, bowel-related, bladder-related or musculoskeletal, and supporting early medical management that reduces chronicity,’ Ms Ellis says.
‘Encouraging timely GP review and knowing a local pelvic pain physiotherapist – who are game-changers – helps ensure patients reach the right care earlier.’
And pharmacists shouldn’t underestimate the significance of what could seem like a really simple intervention:
‘Being listened to and believed is itself a therapeutic intervention,’ Ms Ellis adds. Validating language is critical. Just hearing the words ‘your pain is real and deserves proper assessment’ can make a difference.
[caption id="attachment_31514" align="aligncenter" width="500"] Sharnelle Vella, ABC Radio Melbourne breakfast co-host[/caption]
‘Silent’ endometriosisIn November 2025, 774 ABC Radio Melbourne breakfast co-host Sharnelle Vella announced10 she was ‘beyond terrified’ but also overjoyed at finally becoming pregnant. Telling her audience she would be taking maternity leave in February 2026 to give birth to a baby girl, she also revealed how her pregnancy came after years of fertility issues, miscarriage and failed rounds of IVF treatment. The cause? Stage 4 endometriosis found during an exploratory laparoscopy in March 2025 to investigate mild pelvic inflammation that had been revealed by a blood test. Unlike many who live with the condition, the one pointer to Ms Vella’s endometriosis had been her infertility. ‘Put simply, I was riddled with it,’ she told listeners. But without the symptoms including the crippling pain that afflicts many women, she’d had no idea. She recalls talking to the surgeon afterwards. ‘I asked, “Did you find anything?” He half-laughed, shook his head and said a sentence that will stay with me forever: “Sharnelle, you have stage four endometriosis – we were cutting it out of you for 3 hours.”’ ‘How many stages are there?’ I asked. “There are four,” he replied.’ Having put her life on hold numerous times, not taken holidays, not taken jobs, ‘you commit to nothing – except this journey’, she tearfully explained, saying she had become pregnant without assisted reproduction therapies just 3 months later. Ms Vella wanted listeners who may be experiencing the same ‘unimaginable grief’ of infertility to know that they were not alone. While Australian Institute of Health and Welfare data shows that 1 in 7 people assigned female at birth in Australia have endometriosis,¹1 some, like Ms Vella, are asymptomatic and only discover there is a problem when trying to conceive. Dr Pav Nanayakkara, a gynaecologist at Jean Hailes for Women’s Health clinics in Melbourne says it’s important to remember endometriosis can affect people differently. ‘For some, it’s very mild, they might not know they have it at all. For others it can be very severe and really impact their daily life. Because of that lack of understanding around the condition, people don’t necessarily know how it can present,’ she says.¹ While ‘about 30–50% of people with endometriosis have some degree of infertility’, most people ‘will go on to fall pregnant by themselves,’ Dr Nanayakkara adds. ‘Sometimes that depends on what stage of endometriosis the patient has, but most people will go on to fall pregnant by themselves. So, it can have implications, but it doesn’t make them infertile.’ |
The RANZCOG guidelines suggest a short trial of a non-steroidal anti-inflammatory (NSAID) alone or in combination with paracetamol to manage pain.
But hormonal treatment is also recommended as a first-line therapy.
While the combined oral contraceptive pill and progestogens are usually the first step, second-line treatments, including gonadotropin-releasing hormone agonists and antagonists, should be initiated if symptoms don’t improve or adverse effects occur.⁷
The experience of many individuals with endometriosis is that shifting from first-line to second-line hormonal treatments takes too long and isn’t proactively offered.
Medical misogyny is part of the problem. The inertia of funding barriers is another. But some recent changes aim to tackle this challenge.
In 2024, the Therapeutic Goods Administration approved the fixed-dose combination of relugolix, estradiol and norethisterone (Ryeqo) to treat moderate to severe endometriosis-associated pain.
Aimed at patients with a history of medical or surgical treatment, the addition took the number of medicines indicated for the treatment of endometriosis in Australia to six.¹3
Later that year, dienogest (Visanne) was listed on the Pharmaceutical Benefits Scheme (PBS) – the first time in 30 years that individuals with endometriosis had access to a new PBS-subsidised treatment.¹⁴
New approaches are also being explored. A team at the Royal Adelaide Hospital is trialling a new intrauterine device¹⁵, while Western Sydney University is running a clinical trial to examine the efficacy of different medicinal cannabis interventions.¹⁶
Around 60–70% of people also use some form of complementary, non-pharmacological management, including acupuncture, Chinese herbal medicine, physiotherapy, exercise and nutrition strategies.⁷
However, these aren’t always accessible, says Grace Wong MPS, Medication Safety Pharmacist at The Royal Women’s Hospital in Melbourne.
‘Healthcare professionals often assume patients can easily access non-pharmacological interventions, but many require time, travel or out-of-pocket costs,’ she says.
‘Living with pain can be overwhelming. Making things easy and doable is key.’
With many patients navigating diagnostic uncertainty, Ms Wong says pharmacists should reassure them that ‘chronic pelvic or vaginal pain is not normal and women shouldn’t just “put up with it”.’
Policy efforts now need to ‘focus on sustainable funding, scaling access in regional and rural areas and using existing infrastructure to deliver enhanced care’, according to A/Prof Sim.
Research priorities should include earlier diagnostic biomarkers, long-term outcome studies of models of care, culturally safe models for First Nations peoples and interventions to build health literacy.
Education remains vital. Programs like PPEP Talk,¹⁹ run by the Pelvic Pain Association of Australia, help young people understand what’s normal when it comes to menstrual health – and what’s not.
‘Early education in schools is vital,’ A/Prof Sim says. ‘We need to reduce stigma, support earlier symptom recognition and empower girls and young women to speak up, seek care sooner and navigate the health system with confidence.’
HPV vaccination clinics and school-based health programs are ideal opportunities to explain what isn’t normal period pain and provide advice on where to get help, Ms Ellis says.
Incorporating menstrual health into medicine reviews with young people can also support earlier recognition of pelvic, bowel or bladder symptoms that often emerge in adolescence.
‘When close to 1 million Australians are affected by a condition, every healthcare touchpoint matters,’ Ms Forlano says.
‘Understanding and support can be the difference between someone suffering in silence or finding the help they need. Let’s work together to ensure no one has to wait 6–7 years for a diagnosis, and that every person with endometriosis has access to the care and support they deserve.’
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[post_content] => This National Close the Gap Day (19 March), experts highlight the important role pharmacists play in supporting and promoting equitable access to the Closing the Gap (CTG) PBS Co-payment Program.
While many Aboriginal and Torres Strait Islander people have already been registered for the CTG PBS Co-payment program, many are not accessing this support as intended – particularly those who travel from remote communities to receive health care, said Chastina Heck MPS, Chair of the PSA/NACCHO Aboriginal and Torres Strait Islander Pharmacy Practice Community of Specialty Interest (CSI).
‘[So] pharmacists play a critical role as trusted navigators through Australia’s complex healthcare ecosystem,’ she added.
[caption id="attachment_31556" align="alignright" width="263"] Mike Stephens, Director, Medicines policy and Programs at the National Aboriginal Community Controlled Health Organisation (NACCHO)[/caption]
Bridging the gap in medicines access
Mike Stephens, Director, Medicines policy and Programs at the National Aboriginal Community Controlled Health Organisation (NACCHO) said it’s important pharmacists support equitable access to the CTG PBS Co-payment Program.
‘Pharmacists are medicines experts and patients accordingly rely on us to understand and navigate programs that help them access medicines – CTG scripts are no different,’ Mr Stephens said.
‘Though only some pharmacists’ practice may be directly focused on working with Aboriginal and Torres Strait Islander people, all pharmacists will deliver care to Aboriginal and Torres Strait Islander people within their practice from time to time.
‘This point is especially timely considering the current Australian campaign related to affordable medicines. Delivering culturally safe care is essential and embodied in every major pharmacy practice policy – it’s every pharmacist’s responsibility.’
Where access to CTG can fall short
Before the recent reforms, when the CTG co-payment expanded to all PBS medicines supplied through public hospitals, Ms Heck said working in a clinical setting was often frustrating.
‘The previous program often created more gaps than it closed in accessing health care. In turn, this would erode trust in the healthcare system because people would speak up about an invoice, or about their CTG registration, only to be told that hospitals were unable to dispense it as such,’ she said.
‘They would say, “If a hospital has these rules about me, then what other decisions are they making about my care that I’m not aware of?”
‘This was also exacerbated for remote patients who were not CTG registered and discharged from hospital in unfamiliar environments, often with long transit times home – so accessing medications only when they arrived home was not a suitable option.’
But there are still traps to avoid and issues to discuss with care and context in community and hospital settings alike.
‘Patients may not realise brand premium still apply to CTG co-payments. Explaining this may be important,’ he said.
‘Pharmacists can check Health Professional Online Services (HPOS) if they are not sure if someone is registered. They should also generally seek a discreet place to discuss CTG eligibility with a patient and can only register a patient if they have delegation from a doctor or AHP through HPOS.’
Mr Stephens stressed that while most pharmacists cannot register a patient, careful support to connect a client to a doctor or ACCHO for registration is crucial.
[caption id="attachment_31561" align="alignright" width="280"] Chastina Heck MPS, Chair of the PSA/NACCHO Aboriginal and Torres Strait Islander Pharmacy Practice Community of Specialty Interest (CSI).[/caption]
Culturally safe care is more than good intentions
It’s not as simple as being nice to someone, Ms Heck said.
‘The beliefs and experiences we bring from our past, that have shaped our current “knowing”, often lead to unconscious biases,’ she said.
’It’s imperative that pharmacists develop ways to recognise and respond to these. For example, this might manifest as deciding to not dispense a prescription for low-dose aspirin, instead directing the patient to buy it over the counter.’
Facilitating patient choice and autonomy by providing comprehensive information, upon which a decision can be made, is one way to deliver culturally safe care – rather than deciding what the best option for the patient is, Ms Heck reiterates.
Mr Stephens agrees. ‘It’s important pharmacists support Aboriginal and Torres Strait Islander people to feel comfortable and confident to say what they need, raise concerns and understand their medicines; take adequate time to meet the patient’s needs and consult in a way that is responsive to the local community’s needs.
‘This might include finding a more private setting in relation to someone’s CTG eligibility. All staff should periodically undertake cultural safety training (not just once), preferably delivered from a local community-level organisation, for example an ACCHO or Land Council. Pharmacists should also complete foundational pharmacist courses and learning, such as the co-designed modules by NACCHO and PSA – Deadly pharmacists training modules, as well as familiarise themselves with the PSA’s Guidelines for pharmacists supporting Aboriginal and Torres Strait Islander peoples with medicines management.’
[caption id="attachment_31555" align="alignright" width="233"] Philippa Chigeza, pharmacist at Logan Hospital.[/caption]
Every conversation is an opportunity
Philippa Chigeza, a pharmacist at Logan Hospital in Queensland sees the impacts of the CTG program every day.
’Conversations about CTG are not just about eligibility or reducing medicine costs,’ she said.
‘They are also an opportunity to support culturally safe care, build trust, and ensure patients feel comfortable asking questions about their medicines.’
Pharmacists are in a strong position to help bridge this gap by proactively identifying eligible patients, explaining the program clearly, and working collaboratively with prescribers and Aboriginal health services,’ Ms Chigeza said.
‘Developing cultural awareness and communication skills is just as important as understanding the program itself,’ she said.
‘Training initiatives, such as our intern health promotion project, was an opportunity to deepen my understanding of the CTG program and support me to practice conversations on this topic with patients and families. It can help improve pharmacists’ confidence in having these conversations and is therefore extremely valuable in supporting better health outcomes for Aboriginal and Torres Strait Islander peoples.’
[post_title] => Closing the Gap starts at the pharmacy counter
[post_excerpt] => This National Close the Gap Day (19 March), experts highlight the important role pharmacists play in supporting and promoting equal access.
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[post_content] => With no mandated CPD requirement in ethics or legislation, some practitioners are entering complex practice environments without a current understanding of their professional obligations.
As pharmacists, we are disciplined about maintaining our clinical knowledge across evolving therapeutic areas, new medicines and updated guidelines. When disease states or treatments change, most of us retain a strong foundation because we engage with them in practice every day.
However, the same rigour is not consistently applied to legislation and ethics. For some practitioners, understanding of the legislative and ethical framework has gradually eroded, and in many cases not revisited or contemporised for 10, 20 or even 40 years. While medicines are regularly discussed with patients and colleagues, equivalent engagement with legal obligations and ethical principles does not occur – despite the fact that sound ethical decision-making depends on a solid grasp of the legislative framework governing practice.
What regulators are seeing in practice
Before my appointment as President of the International Pharmaceutical Federation (FIP), I spent nine years with the Pharmacy Council of New South Wales. In that role, I had oversight of pharmacists across practice settings – including community, hospital, education and research – from newly registered practitioners to those with decades of experience.
During that time, I observed a wide range of practice standards, with recurring themes emerging in some of the more serious matters before the Council. In a number of cases, there appeared to be limited familiarity with relevant legislation and relatively little engagement with ethics in day-to-day practice.
When questioned about legislation, many practitioners noted that it had been covered at university. And when asked whether it had been reviewed at any point since graduation, the answer was invariably no.
In complaint investigations and interviews – including matters where urgent intervention was required to protect public safety under Section 150 of the Health Practitioner Regulation National Law – it became clear that there was little understanding of the legislation.
Decisions were not always made with proper regard to core ethical responsibilities, including protecting patient wellbeing and exercising sound professional judgement. In some instances, pharmacists were not aware of the PSA Professional Practice Standards or the PSA Code of Ethics for Pharmacists. From a regulatory perspective, that raises serious concerns and suggests a broader gap within the profession in understanding these two essential pillars of practice.
The matters before the Council were not limited to one-off dispensing errors. In a number of cases, patterns of behaviour raised concerns.
This included dispensing Schedule 8 medicines or Schedule 4 benzodiazepines in volumes or circumstances where appropriate indication and professional judgement should have prompted closer scrutiny.
Habits can develop over time. If pharmacists base decisions on flawed inputs, those patterns will continue unchecked – often until a regulator intervenes.
Rethinking how we approach CPD
Under current requirements, pharmacists must complete 40 CPD credits each year, with 20 of those as assessable (Group 2) activities. There is no mandated requirement that any of those credits specifically address legislation or ethics.
But based on my experience, there is merit in introducing an annual, assessed CPD component focused on these areas.
This could take the form of structured case studies requiring pharmacists to apply relevant legislative provisions and ethical principles to practical scenarios, with a defined minimum number of Group 2 credits allocated each year.
The objective would be to ensure every pharmacist revisits the legislative and ethical foundations of practice regularly and tests their understanding in a practical context. If a practitioner can work through an ethical dilemma in a structured case study and apply the correct legislative framework, they are more likely to make sound decisions in real-world practice.
It is a practical and achievable step that could significantly strengthen how practitioners approach decision-making in the best interests of patients and in accordance with good pharmacy practice.
Expanded scope increases responsibility
As scope of practice expands, pharmacists are assuming more autonomous clinical roles, including prescribing. While this evolution is positive for the profession and patients, increased autonomy brings increased responsibility. Clinical authority must be matched by a strong understanding of the legislative and ethical framework that governs how that authority is used.
A baseline expectation across the profession would promote consistency and reinforce the importance of these competencies for all practitioners, regardless of scope or practice setting.
At the FIP World Congress, ethics is a key part of the program each year. We include ethics presentations at every congress in recognition of how important these considerations are in our daily practice.
Embedding competence in everyday practice
If an annual ethics and legislation requirement were introduced, I would hope it would become part of routine competency review, rather than something revisited only when a practitioner appears before a regulator. Embedding this into regular professional development would strengthen patient safety, ensuring that decisions are consistently aligned with the patient’s best interests.
Culturally, this would support a safer and stronger profession, with practitioners accepting responsibility for maintaining currency of practice – not only in medicines and dispensing processes, but also in understanding relevant state and Commonwealth legislation and the ethical basis of decision-making.
This is particularly important for early career pharmacists. Young practitioners learn by observing those around them. The most effective way to guide them is to ensure they see best practice consistently modelled. If that does not occur, ‘what I see, I do’ can become the norm, and ECPs may be reluctant to question senior pharmacists.
Pharmacy proprietors are responsible for what happens within their pharmacy, including the capability of employed pharmacists. So it’s reasonable for employers to ensure their staff not only meet registration requirements, but also understand the legislative frameworks.
By adhering to regulation, legislation and ethical decision-making processes, we reduce the likelihood of complaints – many of which arise from serious harm to patients, an outcome we all seek to avoid.
Maintaining competence in ethics and legislation is not an additional burden. It is part of maintaining the standard of practice that our patients and the community expect.
PSA has opened public consultation on its draft Code of Ethics for Pharmacists until 17 April. Click here to have your say.
[post_title] => A question of ethics: FIP President calls for annual review
[post_excerpt] => With no mandated CPD requirement in ethics or legislation, some pharmacists don't have an understanding of their professional obligations.
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[post_content] => Greater access to Home Medicines Reviews (HMRs) offers opportunities to intervene earlier, improve patient outcomes and use healthcare funding more effectively.
For Tasmanian-based Stewart Mearns MPS, HMRs are not an administrative program. They are an early warning system – preventing falls, reducing adverse drug events and averting hospital admissions.
When patients don’t have this opportunity, the consequences can be serious. And expensive.
[caption id="attachment_31483" align="alignright" width="200"] Stewart Mearns MPS[/caption]
‘If I prevent one hospitalisation, there’s [around] $30,000 right there,’ Mr Mearns said. ‘That’s my funding for the next 6 months, which has to be cost positive.’
This blunt economic calculation reflects the realities of credentialed pharmacists in practice.
Catching problems before they escalate
When providing HMRs, Mr Mearns regularly identifies medicine-related risks that have gone unnoticed.
In one case, he arrived at a patient’s home to find she appeared confused and cognitively impaired. But the issue wasn’t dementia.
‘We’re having a medical emergency here,’ he realised.
The patient was experiencing hypoglycaemia and her husband hadn’t recognised the warning signs.
In another case, he discovered a patient had been taking aspirin without telling her doctors, worsening severe reflux.
‘None of her doctors were aware,’ he said. Once the aspirin was stopped, ‘she said I’d changed her life’.
These professional observations in living rooms help avoid escalation before an ambulance is called; this is the value of early intervention.
The hidden cost of delay
HMRs are designed to reduce medicine-related harm – one of Australia’s National Health Priority Areas. But access constraints mean some patients wait months for a review.
Like many other pharmacists, Mr Mearns sees the human cost of these restrictions. ‘I’ve had several patients die [while waiting for a HMR],’ Mr Mearns said of those referred but not seen in time due to the restrictive cap of 30 HMRs per month.
With medicines misadventure a known contributor to hospitalisations and deaths, particularly in older Australians and those with complex regimens, Mr Mearns sees the link clearly.
‘If they [Federal Government] are serious about improving Australian health, this is a good program to fund,’ he said.
The logic is simple: prevent harm upstream, reduce the downstream burden on hospitals.
Complex patients, preventable harm
Polypharmacy is common among the patients referred for HMRs. Multiple prescribers, fragmented care and long medicine lists increase the risk of duplication, interaction and adverse effects.
Mr Mearns recalls a young patient with autism and Tourette’s syndrome who was taking multiple antiepileptic medicines and was experiencing daily falls.
‘Once the aspirin was stopped, ‘she said I’d changed her life.'
Stewart Mearns MPS
‘She was getting pushed around in a wheelchair at 18 because she was taking six or so [different] antiepileptics. There was no one removing medications that weren’t effective.’
Rather than an access-to-care issue, the core problem was a lack of a coordinated medicines review.
HMRs allow credentialed pharmacists to step back, assess the full picture and make recommendations to optimise therapy.
While this intervention might not make headlines, preventing one serious fall or hospital admission has both human and financial implications.
The price of a single medicine-related hospital admission can far exceed the cost of dozens of HMRs, with medicine-related problems reported to cost the economy $1.4 billion annually.
Mr Mearns believes the economics are compelling.
‘We’re pretty well-studied as pharmacists. We’re a cost-saving intervention,’ he said. ‘[Improving HMR funding] seems like a bit of a no-brainer.’
Prevention before crisis
HMRs are not emergency medicine, they are preventive care. But delivering that care requires time, expertise and a system that allows pharmacists to intervene before problems escalate.
For Mr Mearns, the value of the service is clear even if the current funding model makes it difficult to sustain.
‘Trying to make money out of HMRs these days is very challenging,’ he said. ‘It’s absolutely a labour of love.’
Reform that matches need with value
PSA’s 2026–27 Federal Budget Submission, released 25 February 2026, identifies reform of HMRs as a priority under the First Pharmacy Programs Reform Package.
Recommendation 1.1 calls for removal of monthly provider caps re-basing and applying annual Wage Cost Index indexation to restore service viability, and improved support for rural delivery and complexity.
For patients at risk of medicine-related harm, these changes are not about expanding scope. They are about enabling earlier intervention and avoiding preventable hospitalisations.
Read PSA’s full 2026–27 Federal Budget Submission.
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[post_content] => Respectful, culturally safe conversations can prevent self-adjusted dosing while supporting informed patient choice.
Each year during Ramadan*, Muslims fast from dawn to sunset, abstaining from food and drink during daylight hours, with this year’s fast taking place from 18 February to 20 March.
For many patients, this practice coincides with the management of acute or chronic diseases, creating medicines-related challenges.
At Emerton Amcal Pharmacy in Western Sydney – an area with a large Muslim community – pharmacist Zara Gul sees these challenges firsthand.
[caption id="attachment_31474" align="alignright" width="255"] Zara Gul[/caption]
Before turning to dose timing or formulation adjustments, Ms Gul emphasises a key message that pharmacists should reinforce.
Health comes first
For patients managing chronic conditions, fasting is not mandatory if it compromises their health.
‘If you're on things like insulin and you need to be eating, you're not obliged to fast,’ Ms Gul said. ‘Or if you're on medications that you need to take at certain times – for example, epileptic medication or Parkinson’s-related medications, you're exempt from fasting.’
People who are pregnant, unwell, sick or elderly are also exempt. ‘You’re not any less of a good Muslim by not being able to fast because of your health.’
However, Ms Gul advised that some patients, particularly older people, may feel compelled to continue fasting.
‘Sometimes the older generation will try to push themselves, and think, “I can miss my dose and take it later,” and then they fall ill,’ she said. ‘So we have to remind them that their health comes first.’
Timing is everything
For those who are medically fit to fast, timing medicine doses becomes the primary challenge. During Ramadan, meals are limited to early morning (suhoor) and evening (iftar) – which makes midday dosing difficult.
In some cases, simple adjustments can maintain therapeutic coverage during the non-fasting window.
‘If patients are taking medicines such as antibiotics three times a day, they can take one while they’re having their morning meal, one when they break their fast and one before they go to bed,’ Ms Gul said.
Approaching chronic disease management
Managing conditions such as diabetes during Ramadan can prove to be a challenge, with patients using insulin or certain oral agents potentially at risk of hypoglycaemia if fasting without modification.
For patients who are highly motivated to fast, collaborating with prescribers can allow for regimen simplification.
‘For example, if someone wants to go on a longer-acting insulin and they’re only taking it at night, that could be an option,’ Ms Gul said.
‘You’re not any less of a good Muslim by not being able to fast because of your health.'
zara gul
But caution is essential.
‘You also don’t want to confuse the patient by changing things unnecessarily. If they switch insulin just for Ramadan and then go back afterwards, that can cause problems. And doctors might not want to change someone’s medicine if they’re already stable.’
But sometimes this may prompt a positive long-term change.
‘Perhaps the patient doesn't actually need to take a medicine three times per day, and they can switch to using it once daily long-term.’
Self-adjusted dosing
It’s common for patients to independently alter or omit doses during Ramadan, Ms Gul said.
‘People will definitely try. They might skip doses, or they’ll say, “My doctor told me to take it at lunch, but I’m fasting, so I’m not taking it”,’ she said.
‘So if you know someone is observing Ramadan, you could ask, ‘How are you going to manage your medication? Are you finding it easy to manage it with the times?” That can open the door for them to have a chat.’
Often, patients raise the issue directly when collecting prescriptions.
‘When we’re handing medication out and we’re talking to the patient about it, they’ll often tell us they’re fasting and ask how to manage it,’ Ms Gul said.
‘That’s a great opportunity for us to look at options – for example, if they’re taking Trajenta at lunchtime, you might be able to move it to the morning when they’re eating their early meal.’
Starting the conversation
While many patients initiate these conversations, others are not always so forthcoming. So, broaching the topic of Ramadan requires cultural sensitivity, acknowledging that not all Muslim patients fast.
‘It’s hard to identify who’s observing Ramadan and who’s not, so it’s good to ask – not just not assume,’ Ms Gul said. ‘Someone might not be fasting because they’re unwell, and you don’t want to make them feel worse by assuming they are.’
Rather than directly referencing fasting, she recommends broader open-ended questions.
‘An easy thing to ask would be “How is your Ramadan going?” Ms Gul said.
This allows patients to disclose relevant information at their own pace.
‘They might say, “I’m not able to fast this month because of my health,” or “I am fasting and I’m finding it difficult to manage my medicine”. Or they might say everything is going well.’
Knowing what invalidates a fast
Understanding dosage forms is another practical consideration, with some patients worrying that using medicines during daylight hours may invalidate their fast.
As a general rule, oral medicines and substances entering through open cavities invalidate fasting.
‘So you can’t use anything oral, or anything inside your nose or ear,’ Ms Gul said.
However pharmacists can reassure patients about non-oral options. ‘Using a topical cream or an eye drop is absolutely fine,’ she said.
For more information on providing care to culturally and linguistically diverse communities, watch the PSA webinar 'Interpreter services – what every pharmacist & GP should know'.
*Australian Pharmacist apologises for the misspelling of Ramadan in our enewsletter.
[post_title] => Safe medicines management during Ramadan
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[post_content] => One in 7 Australian women live with endometriosis, yet diagnosis can still take almost a decade. As awareness grows and new initiatives roll out, pharmacists play a pivotal role in early recognition, medicines management and compassionate care.
Jessica vividly remembers getting her first period at a sleepover when she was 13. The youngest of four girls, she was largely unfazed by what her mum had called ‘joining the sisterhood’. What she didn’t realise was that it would mark the start of a decades-long health struggle.
Now 35, Jessica has lived with frequent, heavy, painful periods for more than 22 years. There have been mornings she couldn’t get out of bed, workdays missed and social events abandoned at the last minute. She experiences pain during sex, which has caused strain in previous relationships, and she worries about her fertility. More than once, she’s been told this is simply ‘a woman’s lot’.
Jessica’s story may sound familiar to the nearly 1 million Australian girls, women and people assigned female at birth living with endometriosis.¹ Defined as ‘endometrial-like tissue proliferating outside the uterus’, endometriosis is a chronic, inflammatory, gynaecological disease with no known cure.² But it is also so much more, says Mónica Forlano, Chair of Endometriosis Australia.
‘The most important thing to understand is that endometriosis is not a reproductive condition – it is a whole body, lifelong chronic condition,’ Ms Forlano says. ‘Yes, it sometimes manifests as pain, bloating, brain fog, fatigue and for – 1 in 3 – fertility issues, but it’s an enigma that can curtail someone’s career, schooling and social life. It affects every aspect of a person’s existence, not just their periods or fertility.’
A national response
For much of human history, females have been taught to feel shame about their bodies and biological functions. Many have been told to bear debilitating periods in silence, have faced accusations of exaggerating – or even inventing – their pain.
These attitudes persist. A 2025 Victorian Government inquiry into women’s pain – the first of its kind in Australia – revealed 71% of respondents saw it as ‘widespread dismissal by healthcare professionals’ and a primary challenge when seeking help.³
More than half also reported delayed diagnoses that led to ‘years of unnecessary suffering and, sometimes, worsened health outcomes’.
Some progress is being made. The National Action Plan for Endometriosis,⁴ released in 2018, marked the first significant step forward in addressing endometriosis in Australia. It focuses on three priority areas: awareness and education, clinical management and care, and research.
A cornerstone initiative is the rollout of Endometriosis and Pelvic Pain Clinics across the country. At the time of writing, 22 clinics are operational, with 11 more planned to open in early 2026 – ensuring at least one in every Primary Health Network region. These clinics provide interdisciplinary care, referral services, access to early intervention and a range of treatment options.⁵
The federal government is also funding the development of an Endometriosis Management Plan⁶ for primary care, and has supported the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) to produce the Australian Living Evidence Guideline: Endometriosis,⁷ providing evidence-based recommendations for clinicians.
Will this make a difference? Chairperson of Chronic Pain Australia Nicolette Ellis MPS (she/her) says yes.
‘The pelvic pain clinics are a major step forward because they embed pelvic pain as core business in primary care. Their integrated, multidisciplinary approach aligns with best evidence and supports earlier intervention, reducing the chronicity of disease. We’re seeing clearer referral pathways and better collaboration across gynaecology, physiotherapy and psychology.’
Ms Forlano agrees the clinics are ‘exactly the kind of equitable access we need,’ particularly for patients who have struggled to navigate siloed systems. However, she says ‘fundamental challenges persist’, including a roughly 7-year diagnostic delay.⁸
‘We’d like to see continued investment in research, expanded access to interdisciplinary care, and most critically, urgent attention to that persistent 6–7-year diagnostic delay,’ she says. ‘Every year someone waits is another year of unnecessary suffering and disease progression.’
Inclusive endometriosis careEndometriosis is often framed solely as a “women’s health” condition. Nicolette Ellis MPS (she/her), Chairperson of Chronic Pain Australia, shares how pharmacists can help transgender and non-binary patients feel seen and safe. ‘Trans and non-binary people often face misgendering, discrimination and the misconception that only cis women experience endometriosis, leading to delayed or avoided care,’ Ms Ellis says. ‘Using terms like “people who menstruate” or “people with a uterus” and avoiding assumptions based on appearance or records helps ensure inclusivity. ‘Collecting pronouns, using inclusive signage, asking gender-neutral questions about pelvic or menstrual symptoms, and clearly signalling that care is available for people of all genders encourages trans and non-binary patients to access pelvic-pain support. ‘Stocking heat packs, TENS devices, period products and bladder/bowel aids, and providing information about local pelvic pain physiotherapists, clinics and support organisations shows that people of all genders living with endometriosis or pelvic pain are seen, believed and supported. ‘Conversations should take place in a private consultation area, not over the counter, as a standard for all sensitive health issues. Start with neutral, open questions such as, “Do you experience periods or pelvic pain?” Mirror the person’s preferred language, and if unsure, ask respectfully: “Is there a better way I can word this?” Avoid gendered terms like “ladies’ problems” in favour of “pelvic health” or “menstrual health”. ‘Gender-affirming hormones can mask or alter endometriosis symptoms. Pharmacists should check in about breakthrough bleeding, pelvic pain, mood changes, and potential interactions with hormonal or neuropathic pain medications. Where cyclical pain is clear, evidence supports a therapeutic trial of ovarian suppression before considering diagnostic laparoscopy. Shared care between GP, endocrinology and gynaecology teams is especially helpful in complex cases.’ |
Normalisation is medical misogyny and delays diagnosisSeveral systemic barriers contribute to the delayed diagnosis many patients have experienced. One is cultural: the normalisation of crippling period pain.
‘Medical misogyny still leads many people to be told their pain is “normal” or stress-related, or something pregnancy will fix,’ Ms Ellis says. ‘This erodes trust. When menstruation is trivialised, people minimise symptoms and often present only once the pain is severe or disabling.’
Limited access to specialists is another problem. Long waits to see gynaecologists – especially in regional and rural areas – delay diagnosis and treatment. Diagnosis remains complex. Although high-quality transvaginal ultrasound and MRI are increasingly used to detect endometriosis, many still rely on a laparoscopy, an invasive examination, for diagnosis.⁹
The financial burden also compounds inequity. People with endometriosis spend about $30,000 each year on direct and indirect costs, which only increases for those outside major cities.⁹
Co-Chair of the Access, Care and Outcomes Subcommittee for the National Women’s Health Advisory Council and immediate-past PSA National President Associate Professor Fei Sim FPS (she/her)says that while specialised clinics are a positive development, more needs to be done to improve access to care.
‘Australia is still falling short in equitable access, with long wait times, high out-of-pocket costs and limited availability outside metropolitan areas,’ she says. ‘What works well in the clinics is the team-based approach, but what needs improvement is affordability, inconsistent models of care and insufficient long-term funding.’
People living with chronic pain seek answers and reassurance and community pharmacies are often their first, and most frequent, touchpoint. ‘Pharmacists continue to be an underutilised resource,’ A/Prof Sim says. ‘Existing health infrastructure, including GP clinics and community pharmacies, should be empowered to deliver more care.’
In a health system which too often encourages non-pharmacological or simple analgesic interventions for complex pain – community pharmacists have an important role in being a circuit-breaker.
‘Pharmacists can help by recognising whether symptoms are cyclical, bowel-related, bladder-related or musculoskeletal, and supporting early medical management that reduces chronicity,’ Ms Ellis says.
‘Encouraging timely GP review and knowing a local pelvic pain physiotherapist – who are game-changers – helps ensure patients reach the right care earlier.’
And pharmacists shouldn’t underestimate the significance of what could seem like a really simple intervention:
‘Being listened to and believed is itself a therapeutic intervention,’ Ms Ellis adds. Validating language is critical. Just hearing the words ‘your pain is real and deserves proper assessment’ can make a difference.
[caption id="attachment_31514" align="aligncenter" width="500"] Sharnelle Vella, ABC Radio Melbourne breakfast co-host[/caption]
‘Silent’ endometriosisIn November 2025, 774 ABC Radio Melbourne breakfast co-host Sharnelle Vella announced10 she was ‘beyond terrified’ but also overjoyed at finally becoming pregnant. Telling her audience she would be taking maternity leave in February 2026 to give birth to a baby girl, she also revealed how her pregnancy came after years of fertility issues, miscarriage and failed rounds of IVF treatment. The cause? Stage 4 endometriosis found during an exploratory laparoscopy in March 2025 to investigate mild pelvic inflammation that had been revealed by a blood test. Unlike many who live with the condition, the one pointer to Ms Vella’s endometriosis had been her infertility. ‘Put simply, I was riddled with it,’ she told listeners. But without the symptoms including the crippling pain that afflicts many women, she’d had no idea. She recalls talking to the surgeon afterwards. ‘I asked, “Did you find anything?” He half-laughed, shook his head and said a sentence that will stay with me forever: “Sharnelle, you have stage four endometriosis – we were cutting it out of you for 3 hours.”’ ‘How many stages are there?’ I asked. “There are four,” he replied.’ Having put her life on hold numerous times, not taken holidays, not taken jobs, ‘you commit to nothing – except this journey’, she tearfully explained, saying she had become pregnant without assisted reproduction therapies just 3 months later. Ms Vella wanted listeners who may be experiencing the same ‘unimaginable grief’ of infertility to know that they were not alone. While Australian Institute of Health and Welfare data shows that 1 in 7 people assigned female at birth in Australia have endometriosis,¹1 some, like Ms Vella, are asymptomatic and only discover there is a problem when trying to conceive. Dr Pav Nanayakkara, a gynaecologist at Jean Hailes for Women’s Health clinics in Melbourne says it’s important to remember endometriosis can affect people differently. ‘For some, it’s very mild, they might not know they have it at all. For others it can be very severe and really impact their daily life. Because of that lack of understanding around the condition, people don’t necessarily know how it can present,’ she says.¹ While ‘about 30–50% of people with endometriosis have some degree of infertility’, most people ‘will go on to fall pregnant by themselves,’ Dr Nanayakkara adds. ‘Sometimes that depends on what stage of endometriosis the patient has, but most people will go on to fall pregnant by themselves. So, it can have implications, but it doesn’t make them infertile.’ |
The RANZCOG guidelines suggest a short trial of a non-steroidal anti-inflammatory (NSAID) alone or in combination with paracetamol to manage pain.
But hormonal treatment is also recommended as a first-line therapy.
While the combined oral contraceptive pill and progestogens are usually the first step, second-line treatments, including gonadotropin-releasing hormone agonists and antagonists, should be initiated if symptoms don’t improve or adverse effects occur.⁷
The experience of many individuals with endometriosis is that shifting from first-line to second-line hormonal treatments takes too long and isn’t proactively offered.
Medical misogyny is part of the problem. The inertia of funding barriers is another. But some recent changes aim to tackle this challenge.
In 2024, the Therapeutic Goods Administration approved the fixed-dose combination of relugolix, estradiol and norethisterone (Ryeqo) to treat moderate to severe endometriosis-associated pain.
Aimed at patients with a history of medical or surgical treatment, the addition took the number of medicines indicated for the treatment of endometriosis in Australia to six.¹3
Later that year, dienogest (Visanne) was listed on the Pharmaceutical Benefits Scheme (PBS) – the first time in 30 years that individuals with endometriosis had access to a new PBS-subsidised treatment.¹⁴
New approaches are also being explored. A team at the Royal Adelaide Hospital is trialling a new intrauterine device¹⁵, while Western Sydney University is running a clinical trial to examine the efficacy of different medicinal cannabis interventions.¹⁶
Around 60–70% of people also use some form of complementary, non-pharmacological management, including acupuncture, Chinese herbal medicine, physiotherapy, exercise and nutrition strategies.⁷
However, these aren’t always accessible, says Grace Wong MPS, Medication Safety Pharmacist at The Royal Women’s Hospital in Melbourne.
‘Healthcare professionals often assume patients can easily access non-pharmacological interventions, but many require time, travel or out-of-pocket costs,’ she says.
‘Living with pain can be overwhelming. Making things easy and doable is key.’
With many patients navigating diagnostic uncertainty, Ms Wong says pharmacists should reassure them that ‘chronic pelvic or vaginal pain is not normal and women shouldn’t just “put up with it”.’
Policy efforts now need to ‘focus on sustainable funding, scaling access in regional and rural areas and using existing infrastructure to deliver enhanced care’, according to A/Prof Sim.
Research priorities should include earlier diagnostic biomarkers, long-term outcome studies of models of care, culturally safe models for First Nations peoples and interventions to build health literacy.
Education remains vital. Programs like PPEP Talk,¹⁹ run by the Pelvic Pain Association of Australia, help young people understand what’s normal when it comes to menstrual health – and what’s not.
‘Early education in schools is vital,’ A/Prof Sim says. ‘We need to reduce stigma, support earlier symptom recognition and empower girls and young women to speak up, seek care sooner and navigate the health system with confidence.’
HPV vaccination clinics and school-based health programs are ideal opportunities to explain what isn’t normal period pain and provide advice on where to get help, Ms Ellis says.
Incorporating menstrual health into medicine reviews with young people can also support earlier recognition of pelvic, bowel or bladder symptoms that often emerge in adolescence.
‘When close to 1 million Australians are affected by a condition, every healthcare touchpoint matters,’ Ms Forlano says.
‘Understanding and support can be the difference between someone suffering in silence or finding the help they need. Let’s work together to ensure no one has to wait 6–7 years for a diagnosis, and that every person with endometriosis has access to the care and support they deserve.’
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[post_content] => This National Close the Gap Day (19 March), experts highlight the important role pharmacists play in supporting and promoting equitable access to the Closing the Gap (CTG) PBS Co-payment Program.
While many Aboriginal and Torres Strait Islander people have already been registered for the CTG PBS Co-payment program, many are not accessing this support as intended – particularly those who travel from remote communities to receive health care, said Chastina Heck MPS, Chair of the PSA/NACCHO Aboriginal and Torres Strait Islander Pharmacy Practice Community of Specialty Interest (CSI).
‘[So] pharmacists play a critical role as trusted navigators through Australia’s complex healthcare ecosystem,’ she added.
[caption id="attachment_31556" align="alignright" width="263"] Mike Stephens, Director, Medicines policy and Programs at the National Aboriginal Community Controlled Health Organisation (NACCHO)[/caption]
Bridging the gap in medicines access
Mike Stephens, Director, Medicines policy and Programs at the National Aboriginal Community Controlled Health Organisation (NACCHO) said it’s important pharmacists support equitable access to the CTG PBS Co-payment Program.
‘Pharmacists are medicines experts and patients accordingly rely on us to understand and navigate programs that help them access medicines – CTG scripts are no different,’ Mr Stephens said.
‘Though only some pharmacists’ practice may be directly focused on working with Aboriginal and Torres Strait Islander people, all pharmacists will deliver care to Aboriginal and Torres Strait Islander people within their practice from time to time.
‘This point is especially timely considering the current Australian campaign related to affordable medicines. Delivering culturally safe care is essential and embodied in every major pharmacy practice policy – it’s every pharmacist’s responsibility.’
Where access to CTG can fall short
Before the recent reforms, when the CTG co-payment expanded to all PBS medicines supplied through public hospitals, Ms Heck said working in a clinical setting was often frustrating.
‘The previous program often created more gaps than it closed in accessing health care. In turn, this would erode trust in the healthcare system because people would speak up about an invoice, or about their CTG registration, only to be told that hospitals were unable to dispense it as such,’ she said.
‘They would say, “If a hospital has these rules about me, then what other decisions are they making about my care that I’m not aware of?”
‘This was also exacerbated for remote patients who were not CTG registered and discharged from hospital in unfamiliar environments, often with long transit times home – so accessing medications only when they arrived home was not a suitable option.’
But there are still traps to avoid and issues to discuss with care and context in community and hospital settings alike.
‘Patients may not realise brand premium still apply to CTG co-payments. Explaining this may be important,’ he said.
‘Pharmacists can check Health Professional Online Services (HPOS) if they are not sure if someone is registered. They should also generally seek a discreet place to discuss CTG eligibility with a patient and can only register a patient if they have delegation from a doctor or AHP through HPOS.’
Mr Stephens stressed that while most pharmacists cannot register a patient, careful support to connect a client to a doctor or ACCHO for registration is crucial.
[caption id="attachment_31561" align="alignright" width="280"] Chastina Heck MPS, Chair of the PSA/NACCHO Aboriginal and Torres Strait Islander Pharmacy Practice Community of Specialty Interest (CSI).[/caption]
Culturally safe care is more than good intentions
It’s not as simple as being nice to someone, Ms Heck said.
‘The beliefs and experiences we bring from our past, that have shaped our current “knowing”, often lead to unconscious biases,’ she said.
’It’s imperative that pharmacists develop ways to recognise and respond to these. For example, this might manifest as deciding to not dispense a prescription for low-dose aspirin, instead directing the patient to buy it over the counter.’
Facilitating patient choice and autonomy by providing comprehensive information, upon which a decision can be made, is one way to deliver culturally safe care – rather than deciding what the best option for the patient is, Ms Heck reiterates.
Mr Stephens agrees. ‘It’s important pharmacists support Aboriginal and Torres Strait Islander people to feel comfortable and confident to say what they need, raise concerns and understand their medicines; take adequate time to meet the patient’s needs and consult in a way that is responsive to the local community’s needs.
‘This might include finding a more private setting in relation to someone’s CTG eligibility. All staff should periodically undertake cultural safety training (not just once), preferably delivered from a local community-level organisation, for example an ACCHO or Land Council. Pharmacists should also complete foundational pharmacist courses and learning, such as the co-designed modules by NACCHO and PSA – Deadly pharmacists training modules, as well as familiarise themselves with the PSA’s Guidelines for pharmacists supporting Aboriginal and Torres Strait Islander peoples with medicines management.’
[caption id="attachment_31555" align="alignright" width="233"] Philippa Chigeza, pharmacist at Logan Hospital.[/caption]
Every conversation is an opportunity
Philippa Chigeza, a pharmacist at Logan Hospital in Queensland sees the impacts of the CTG program every day.
’Conversations about CTG are not just about eligibility or reducing medicine costs,’ she said.
‘They are also an opportunity to support culturally safe care, build trust, and ensure patients feel comfortable asking questions about their medicines.’
Pharmacists are in a strong position to help bridge this gap by proactively identifying eligible patients, explaining the program clearly, and working collaboratively with prescribers and Aboriginal health services,’ Ms Chigeza said.
‘Developing cultural awareness and communication skills is just as important as understanding the program itself,’ she said.
‘Training initiatives, such as our intern health promotion project, was an opportunity to deepen my understanding of the CTG program and support me to practice conversations on this topic with patients and families. It can help improve pharmacists’ confidence in having these conversations and is therefore extremely valuable in supporting better health outcomes for Aboriginal and Torres Strait Islander peoples.’
[post_title] => Closing the Gap starts at the pharmacy counter
[post_excerpt] => This National Close the Gap Day (19 March), experts highlight the important role pharmacists play in supporting and promoting equal access.
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[post_content] => With no mandated CPD requirement in ethics or legislation, some practitioners are entering complex practice environments without a current understanding of their professional obligations.
As pharmacists, we are disciplined about maintaining our clinical knowledge across evolving therapeutic areas, new medicines and updated guidelines. When disease states or treatments change, most of us retain a strong foundation because we engage with them in practice every day.
However, the same rigour is not consistently applied to legislation and ethics. For some practitioners, understanding of the legislative and ethical framework has gradually eroded, and in many cases not revisited or contemporised for 10, 20 or even 40 years. While medicines are regularly discussed with patients and colleagues, equivalent engagement with legal obligations and ethical principles does not occur – despite the fact that sound ethical decision-making depends on a solid grasp of the legislative framework governing practice.
What regulators are seeing in practice
Before my appointment as President of the International Pharmaceutical Federation (FIP), I spent nine years with the Pharmacy Council of New South Wales. In that role, I had oversight of pharmacists across practice settings – including community, hospital, education and research – from newly registered practitioners to those with decades of experience.
During that time, I observed a wide range of practice standards, with recurring themes emerging in some of the more serious matters before the Council. In a number of cases, there appeared to be limited familiarity with relevant legislation and relatively little engagement with ethics in day-to-day practice.
When questioned about legislation, many practitioners noted that it had been covered at university. And when asked whether it had been reviewed at any point since graduation, the answer was invariably no.
In complaint investigations and interviews – including matters where urgent intervention was required to protect public safety under Section 150 of the Health Practitioner Regulation National Law – it became clear that there was little understanding of the legislation.
Decisions were not always made with proper regard to core ethical responsibilities, including protecting patient wellbeing and exercising sound professional judgement. In some instances, pharmacists were not aware of the PSA Professional Practice Standards or the PSA Code of Ethics for Pharmacists. From a regulatory perspective, that raises serious concerns and suggests a broader gap within the profession in understanding these two essential pillars of practice.
The matters before the Council were not limited to one-off dispensing errors. In a number of cases, patterns of behaviour raised concerns.
This included dispensing Schedule 8 medicines or Schedule 4 benzodiazepines in volumes or circumstances where appropriate indication and professional judgement should have prompted closer scrutiny.
Habits can develop over time. If pharmacists base decisions on flawed inputs, those patterns will continue unchecked – often until a regulator intervenes.
Rethinking how we approach CPD
Under current requirements, pharmacists must complete 40 CPD credits each year, with 20 of those as assessable (Group 2) activities. There is no mandated requirement that any of those credits specifically address legislation or ethics.
But based on my experience, there is merit in introducing an annual, assessed CPD component focused on these areas.
This could take the form of structured case studies requiring pharmacists to apply relevant legislative provisions and ethical principles to practical scenarios, with a defined minimum number of Group 2 credits allocated each year.
The objective would be to ensure every pharmacist revisits the legislative and ethical foundations of practice regularly and tests their understanding in a practical context. If a practitioner can work through an ethical dilemma in a structured case study and apply the correct legislative framework, they are more likely to make sound decisions in real-world practice.
It is a practical and achievable step that could significantly strengthen how practitioners approach decision-making in the best interests of patients and in accordance with good pharmacy practice.
Expanded scope increases responsibility
As scope of practice expands, pharmacists are assuming more autonomous clinical roles, including prescribing. While this evolution is positive for the profession and patients, increased autonomy brings increased responsibility. Clinical authority must be matched by a strong understanding of the legislative and ethical framework that governs how that authority is used.
A baseline expectation across the profession would promote consistency and reinforce the importance of these competencies for all practitioners, regardless of scope or practice setting.
At the FIP World Congress, ethics is a key part of the program each year. We include ethics presentations at every congress in recognition of how important these considerations are in our daily practice.
Embedding competence in everyday practice
If an annual ethics and legislation requirement were introduced, I would hope it would become part of routine competency review, rather than something revisited only when a practitioner appears before a regulator. Embedding this into regular professional development would strengthen patient safety, ensuring that decisions are consistently aligned with the patient’s best interests.
Culturally, this would support a safer and stronger profession, with practitioners accepting responsibility for maintaining currency of practice – not only in medicines and dispensing processes, but also in understanding relevant state and Commonwealth legislation and the ethical basis of decision-making.
This is particularly important for early career pharmacists. Young practitioners learn by observing those around them. The most effective way to guide them is to ensure they see best practice consistently modelled. If that does not occur, ‘what I see, I do’ can become the norm, and ECPs may be reluctant to question senior pharmacists.
Pharmacy proprietors are responsible for what happens within their pharmacy, including the capability of employed pharmacists. So it’s reasonable for employers to ensure their staff not only meet registration requirements, but also understand the legislative frameworks.
By adhering to regulation, legislation and ethical decision-making processes, we reduce the likelihood of complaints – many of which arise from serious harm to patients, an outcome we all seek to avoid.
Maintaining competence in ethics and legislation is not an additional burden. It is part of maintaining the standard of practice that our patients and the community expect.
PSA has opened public consultation on its draft Code of Ethics for Pharmacists until 17 April. Click here to have your say.
[post_title] => A question of ethics: FIP President calls for annual review
[post_excerpt] => With no mandated CPD requirement in ethics or legislation, some pharmacists don't have an understanding of their professional obligations.
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[post_content] => Greater access to Home Medicines Reviews (HMRs) offers opportunities to intervene earlier, improve patient outcomes and use healthcare funding more effectively.
For Tasmanian-based Stewart Mearns MPS, HMRs are not an administrative program. They are an early warning system – preventing falls, reducing adverse drug events and averting hospital admissions.
When patients don’t have this opportunity, the consequences can be serious. And expensive.
[caption id="attachment_31483" align="alignright" width="200"] Stewart Mearns MPS[/caption]
‘If I prevent one hospitalisation, there’s [around] $30,000 right there,’ Mr Mearns said. ‘That’s my funding for the next 6 months, which has to be cost positive.’
This blunt economic calculation reflects the realities of credentialed pharmacists in practice.
Catching problems before they escalate
When providing HMRs, Mr Mearns regularly identifies medicine-related risks that have gone unnoticed.
In one case, he arrived at a patient’s home to find she appeared confused and cognitively impaired. But the issue wasn’t dementia.
‘We’re having a medical emergency here,’ he realised.
The patient was experiencing hypoglycaemia and her husband hadn’t recognised the warning signs.
In another case, he discovered a patient had been taking aspirin without telling her doctors, worsening severe reflux.
‘None of her doctors were aware,’ he said. Once the aspirin was stopped, ‘she said I’d changed her life’.
These professional observations in living rooms help avoid escalation before an ambulance is called; this is the value of early intervention.
The hidden cost of delay
HMRs are designed to reduce medicine-related harm – one of Australia’s National Health Priority Areas. But access constraints mean some patients wait months for a review.
Like many other pharmacists, Mr Mearns sees the human cost of these restrictions. ‘I’ve had several patients die [while waiting for a HMR],’ Mr Mearns said of those referred but not seen in time due to the restrictive cap of 30 HMRs per month.
With medicines misadventure a known contributor to hospitalisations and deaths, particularly in older Australians and those with complex regimens, Mr Mearns sees the link clearly.
‘If they [Federal Government] are serious about improving Australian health, this is a good program to fund,’ he said.
The logic is simple: prevent harm upstream, reduce the downstream burden on hospitals.
Complex patients, preventable harm
Polypharmacy is common among the patients referred for HMRs. Multiple prescribers, fragmented care and long medicine lists increase the risk of duplication, interaction and adverse effects.
Mr Mearns recalls a young patient with autism and Tourette’s syndrome who was taking multiple antiepileptic medicines and was experiencing daily falls.
‘Once the aspirin was stopped, ‘she said I’d changed her life.'
Stewart Mearns MPS
‘She was getting pushed around in a wheelchair at 18 because she was taking six or so [different] antiepileptics. There was no one removing medications that weren’t effective.’
Rather than an access-to-care issue, the core problem was a lack of a coordinated medicines review.
HMRs allow credentialed pharmacists to step back, assess the full picture and make recommendations to optimise therapy.
While this intervention might not make headlines, preventing one serious fall or hospital admission has both human and financial implications.
The price of a single medicine-related hospital admission can far exceed the cost of dozens of HMRs, with medicine-related problems reported to cost the economy $1.4 billion annually.
Mr Mearns believes the economics are compelling.
‘We’re pretty well-studied as pharmacists. We’re a cost-saving intervention,’ he said. ‘[Improving HMR funding] seems like a bit of a no-brainer.’
Prevention before crisis
HMRs are not emergency medicine, they are preventive care. But delivering that care requires time, expertise and a system that allows pharmacists to intervene before problems escalate.
For Mr Mearns, the value of the service is clear even if the current funding model makes it difficult to sustain.
‘Trying to make money out of HMRs these days is very challenging,’ he said. ‘It’s absolutely a labour of love.’
Reform that matches need with value
PSA’s 2026–27 Federal Budget Submission, released 25 February 2026, identifies reform of HMRs as a priority under the First Pharmacy Programs Reform Package.
Recommendation 1.1 calls for removal of monthly provider caps re-basing and applying annual Wage Cost Index indexation to restore service viability, and improved support for rural delivery and complexity.
For patients at risk of medicine-related harm, these changes are not about expanding scope. They are about enabling earlier intervention and avoiding preventable hospitalisations.
Read PSA’s full 2026–27 Federal Budget Submission.
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[post_date] => 2026-03-04 10:35:37
[post_date_gmt] => 2026-03-03 23:35:37
[post_content] => Respectful, culturally safe conversations can prevent self-adjusted dosing while supporting informed patient choice.
Each year during Ramadan*, Muslims fast from dawn to sunset, abstaining from food and drink during daylight hours, with this year’s fast taking place from 18 February to 20 March.
For many patients, this practice coincides with the management of acute or chronic diseases, creating medicines-related challenges.
At Emerton Amcal Pharmacy in Western Sydney – an area with a large Muslim community – pharmacist Zara Gul sees these challenges firsthand.
[caption id="attachment_31474" align="alignright" width="255"] Zara Gul[/caption]
Before turning to dose timing or formulation adjustments, Ms Gul emphasises a key message that pharmacists should reinforce.
Health comes first
For patients managing chronic conditions, fasting is not mandatory if it compromises their health.
‘If you're on things like insulin and you need to be eating, you're not obliged to fast,’ Ms Gul said. ‘Or if you're on medications that you need to take at certain times – for example, epileptic medication or Parkinson’s-related medications, you're exempt from fasting.’
People who are pregnant, unwell, sick or elderly are also exempt. ‘You’re not any less of a good Muslim by not being able to fast because of your health.’
However, Ms Gul advised that some patients, particularly older people, may feel compelled to continue fasting.
‘Sometimes the older generation will try to push themselves, and think, “I can miss my dose and take it later,” and then they fall ill,’ she said. ‘So we have to remind them that their health comes first.’
Timing is everything
For those who are medically fit to fast, timing medicine doses becomes the primary challenge. During Ramadan, meals are limited to early morning (suhoor) and evening (iftar) – which makes midday dosing difficult.
In some cases, simple adjustments can maintain therapeutic coverage during the non-fasting window.
‘If patients are taking medicines such as antibiotics three times a day, they can take one while they’re having their morning meal, one when they break their fast and one before they go to bed,’ Ms Gul said.
Approaching chronic disease management
Managing conditions such as diabetes during Ramadan can prove to be a challenge, with patients using insulin or certain oral agents potentially at risk of hypoglycaemia if fasting without modification.
For patients who are highly motivated to fast, collaborating with prescribers can allow for regimen simplification.
‘For example, if someone wants to go on a longer-acting insulin and they’re only taking it at night, that could be an option,’ Ms Gul said.
‘You’re not any less of a good Muslim by not being able to fast because of your health.'
zara gul
But caution is essential.
‘You also don’t want to confuse the patient by changing things unnecessarily. If they switch insulin just for Ramadan and then go back afterwards, that can cause problems. And doctors might not want to change someone’s medicine if they’re already stable.’
But sometimes this may prompt a positive long-term change.
‘Perhaps the patient doesn't actually need to take a medicine three times per day, and they can switch to using it once daily long-term.’
Self-adjusted dosing
It’s common for patients to independently alter or omit doses during Ramadan, Ms Gul said.
‘People will definitely try. They might skip doses, or they’ll say, “My doctor told me to take it at lunch, but I’m fasting, so I’m not taking it”,’ she said.
‘So if you know someone is observing Ramadan, you could ask, ‘How are you going to manage your medication? Are you finding it easy to manage it with the times?” That can open the door for them to have a chat.’
Often, patients raise the issue directly when collecting prescriptions.
‘When we’re handing medication out and we’re talking to the patient about it, they’ll often tell us they’re fasting and ask how to manage it,’ Ms Gul said.
‘That’s a great opportunity for us to look at options – for example, if they’re taking Trajenta at lunchtime, you might be able to move it to the morning when they’re eating their early meal.’
Starting the conversation
While many patients initiate these conversations, others are not always so forthcoming. So, broaching the topic of Ramadan requires cultural sensitivity, acknowledging that not all Muslim patients fast.
‘It’s hard to identify who’s observing Ramadan and who’s not, so it’s good to ask – not just not assume,’ Ms Gul said. ‘Someone might not be fasting because they’re unwell, and you don’t want to make them feel worse by assuming they are.’
Rather than directly referencing fasting, she recommends broader open-ended questions.
‘An easy thing to ask would be “How is your Ramadan going?” Ms Gul said.
This allows patients to disclose relevant information at their own pace.
‘They might say, “I’m not able to fast this month because of my health,” or “I am fasting and I’m finding it difficult to manage my medicine”. Or they might say everything is going well.’
Knowing what invalidates a fast
Understanding dosage forms is another practical consideration, with some patients worrying that using medicines during daylight hours may invalidate their fast.
As a general rule, oral medicines and substances entering through open cavities invalidate fasting.
‘So you can’t use anything oral, or anything inside your nose or ear,’ Ms Gul said.
However pharmacists can reassure patients about non-oral options. ‘Using a topical cream or an eye drop is absolutely fine,’ she said.
For more information on providing care to culturally and linguistically diverse communities, watch the PSA webinar 'Interpreter services – what every pharmacist & GP should know'.
*Australian Pharmacist apologises for the misspelling of Ramadan in our enewsletter.
[post_title] => Safe medicines management during Ramadan
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