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AUSTRALIAN PHARMACIST
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                  [post_content] => 

      Case scenario

      Alicia, 27, visits your pharmacy regularly for naproxen and heat patches to manage period pain. She confides that her pain has worsened over the past 2 years, radiates down her legs, interferes with work and affects intimacy.  Her periods are heavy, lasting around 9 days, and leave her feeling exhausted and sometimes even bedridden. Alicia has seen several GPs, who told her it was ‘normal for your age’. She says, ‘It feels like someone’s wringing out my insides – nothing helps much. Is this really normal?’

      Learning objectives

      After reading this article, pharmacists should be able to:
      • Describe the epidemiology, aetiology and pathophysiology of endometriosis
      • Identify key clinical features, risk factors and diagnostic considerations
      • Discuss pharmacological and non-pharmacological management options for endometriosis
      • Explain the pharmacist’s role in supporting patients with endometriosis through education, referral and holistic care.
      Competency standards (2016) addressed: 1.1, 1.4, 1.5, 2.2, 3.1, 3.5 Accreditation number: CAP2602DMED  Accreditation expiry: 31/01/2029 
      Already read the CPD in the journal? Scroll to the bottom to SUBMIT ANSWERS.

      Introduction

      Endometriosis is a chronic inflammatory condition characterised by the growth of endometrial-like tissue outside the uterus, commonly affecting the ovaries, fallopian tubes and pelvic peritoneum.1,2 It affects 10–15% of all reproductive-aged Australians who were assigned female at birth, and 70% of females with chronic pelvic pain.3 Yet it remains underdiagnosed, underfunded and often misunderstood. Symptoms such as pelvic pain, heavy periods, fatigue and infertility can significantly affect quality of life. Pharmacists, often the first point of contact for pain management and self-care advice, play an important role in recognising potential endometriosis, supporting early referral and helping patients navigate ongoing treatment.

      Epidemiology

      An estimated 1 in 7 females in Australia are currently living with endometriosis.4-6 Onset often begins in adolescence, yet diagnosis is delayed on average by 7–10 years,1,3,7 influenced by menstrual pain normalisation, stigma, and misdiagnosis as irritable bowel syndrome (IBS) or anxiety.1,3,4,7,8 The consequences of these delays extend beyond physical health, affecting fertility, education, relationships and employment, and increasing the likelihood of depression, anxiety and social withdrawal.6,9,10

      Aetiology and pathophysiology

      The pathogenesis of endometriosis is multifactorial. The leading theory is retrograde menstruation, where menstrual blood flows backwards through the fallopian tubes into the pelvic cavity, allowing endometrial cells to implant and grow outside the uterus.2,11 Other contributing mechanisms include2,5,11,12:
      • immune dysfunction
      • coelomic metaplasia (peritoneal cell transformation)
      • genetic predisposition
      • hormonal imbalances 
      • environmental triggers.

      Clinical features  

      Endometriosis occurs when hormonally responsive lesions develop on the ovaries, bowel, bladder, peritoneum, or other pelvic and abdominal structures.1,5,9,13,14 These lesions respond to oestrogen and undergo cyclical changes similar to the endometrial lining, which can trigger inflammation, bleeding, scarring and adhesions. This may lead to chronic pain, organ dysfunction and infertility. Importantly, symptom severity does not always correlate with the number or extent of lesions and may fluctuate with hormonal changes.8,12 Risk factors While the exact cause of endometriosis is unclear, certain factors increase the likelihood of developing the condition1,9,13,14:
      • early menarche
      • short menstrual cycles (<27 days)
      • heavy/prolonged periods
      • nulliparity
      • family history of endometriosis
      • low BMI.
      Clinical presentation1,5,9,13,14 Pharmacists should consider endometriosis in individuals presenting with2,7,8,11,12:
      • moderate-severe dysmenorrhoea 
      • chronic pelvic pain (cyclical or constant)
      • persistent or recurrent pain associated with sexual intercourse (dyspareunia) 
      • menstrual bowel/bladder pain 
      • fatigue, lethargy, irritability
      • bloating
      • painful or altered bowel movements, particularly around the time of menstruation (dyschezia)
      • abnormally heavy or prolonged menstrual bleeding (menorrhagia) or irregular cycles 
      • infertility/conception delays.
      Classification No universally agreed classification exists, though the American Society of Reproductive Medicine (ASRM) system is commonly used15:
      • Stage I (minimal): few superficial implants.
      • Stage II (mild): more, deep implants.
      • Stage III (moderate): many deep implants; filmy adhesions may be present.
      • Stage IV (severe): many deep implants, many dense adhesions.
      Pain mechanisms and central sensitisation Central sensitisation refers to heightened nervous system responsiveness, causing persistent, widespread pain even after lesion removal.16 This can manifest as pelvic floor dysfunction, visceral hypersensitivity, and fatigue, and often overlaps with conditions such as irritable bowel syndrome or bladder pain syndrome.11 Supporting patients involves validating their pain experiences, even when imaging is normal or lesions appear minimal.

      Diagnosis and differential diagnosis 

      Diagnosis of endometriosis is often significantly delayed, with an average lag of 7–10 years from symptom onset.3,7,17 These delays are influenced by multiple systemic and social factors, including1,7,9,17:
      • normalisation of menstrual pain
      • dismissal of symptoms, particularly in adolescents and people of colour
      • lack of rural/remote access to gynaecology services 
      • under-recognition of symptoms in trans, non-binary and gender-diverse individuals
      • cost barriers to imaging, specialist care and private laparoscopies.
      Endometriosis shares symptoms with several other conditions, making diagnosis difficult. Differential diagnoses include IBS, pelvic inflammatory disease, adenomyosis, interstitial cystitis, depression and anxiety.12 Current diagnostic approaches While laparoscopy remains the gold standard, Australian guidelines now support symptom-based clinical diagnosis to reduce delays and improve care.3,7,17 Imaging tools such as transvaginal ultrasound can identify ovarian endometriotic cysts, but a normal ultrasound or MRI does not rule out disease – especially in early-stage or superficial cases. Patients should therefore be encouraged to pursue further care if symptoms significantly impact quality of life.3 Emerging diagnostic tools To address diagnostic challenges, ongoing research is focused on earlier, less invasive detection.4 Emerging approaches include blood-based biomarkers (e.g. proteomic panels, metabolomic profiling, microRNA and menstrual-fluid analysis),18-21 as well as advanced imaging techniques such as transvaginal ultrasound and MRI, which may help reduce reliance on laparoscopy and accelerate accurate diagnosis.3,7,17 When it’s not endometriosis: validating pelvic pain without a diagnosis Pelvic pain affects up to 1 in 4 people assigned female at birth and has many possible causes – endometriosis being only one of them.7,11,22,23 For some, extensive investigations such as imaging or laparoscopy reveal no abnormalities, which can leave patients feeling dismissed, confused or invalidated. Pharmacists can help by acknowledging that pain is real and deserving of care, even in the absence of a definitive diagnosis. Symptom management is the first-line approach for both endometriosis and chronic pelvic pain, and care should aim to improve daily function and quality of life regardless of diagnostic certainty.3 Where appropriate, pharmacists can also support referral to other healthcare providers for further assessment or multidisciplinary management. Although endometriosis itself is not curable, symptoms and recurrences can be effectively managed through person-centred care that considers physical, emotional and reproductive health needs.8

      Management approaches 

      Non-pharmacological treatment  Current treatment is focused on symptom control, rather than elimination of the disease. Non-pharmacological approaches form an essential part of care, particularly for patients who experience persistent pain or treatment adverse effects. Key strategies include8,13,24:
      • pelvic physiotherapy and psychotherapy (e.g. cognitive behavioural therapy [CBT], acceptance and commitment therapy [ACT])
      • heat therapy, TENS and mindfulness-based movement (e.g. yoga, Pilates)
      • anti-inflammatory or low-FODMAP diets, particularly for patients with co-existing irritable bowel syndrome.
      Mental health and emotional wellbeing Chronic pain is both physically and psychologically exhausting. Anxiety and depression rates are significantly higher in people with endometriosis than in the general population.7 Contributing factors include3,5,6,8,10,12,14,25:
      • diagnostic delays and invalidation of symptoms 
      • chronic fatigue and disrupted sleep
      • missed school or work
      • sexual dysfunction and relationship strain
      • fertility concerns or trauma from medical procedures.
      Pharmacists can play an important role in recognising distress and prompting early mental health support. Simple, empathetic questions – such as ‘How’s your sleep been lately?’ or ‘Is the pain affecting your mood?’ – can open conversations and guide appropriate referrals. Support strategies include:
      • recommending mental health care plans via GPs
      • referring to psychologists with chronic pain expertise or interdisciplinary pain teams
      • encouraging peer support groups (e.g. EndoActive, Endometriosis Australia, QENDO)
      • suggesting low-stigma mental health apps (e.g. MindSpot, Smiling Mind)
      • avoiding statements that minimise pain (e.g. ‘it’s just anxiety’) and instead validating the complex relationship between mood and pain.
      Complementary therapies  Patients may enquire about supplements or alternative therapies. Pharmacists should validate interest while clarifying the limited evidence and screening for interactions. Commonly explored options include magnesium, omega-3 fatty acids, turmeric (curcumin), vitex agnus-castus, zinc, vitamin B6, diindolylmethane (DIM) and acupuncture.22,24,26

      Pharmacological treatment 

      Analgesia
      • NSAIDs (e.g. naproxen 500 mg twice daily or ibuprofen 400 mg three times daily) are first line. 
      • Paracetamol may be added for multimodal relief.1,12,13
      Counselling should cover dosing, GI protection and review of OTC combinations (e.g. ibuprofen/paracetamol). Hormonal therapies Hormonal therapies suppress oestrogen-driven growth and reduce pain.11,12,13,27,28 Table 1 provides an overview of commonly used hormonal therapies in endometriosis management. Add-back therapy Treatment with gonadotrophin-releasing hormone (GnRH) analogues induces a temporary, reversible menopause to suppress oestrogen production and reduce endometriosis symptoms.30 However, this hypo-estrogenic state can cause side effects such as vasomotor symptoms, vaginal dryness and bone mineral density loss.30 Add-back therapy involves giving small ‘add-back’ doses of oestrogen, progestogen, or a combination of both, to counteract these effects while maintaining the efficacy of GnRH analogue treatment.13,28 Options include1,12,13,27: 
      • Continuous combined HRT – low-dose estrogen + progestogen. Use in patients with a uterus to protect the endometrium.
      • Sequential combined HRT – estrogen daily + cyclical progestogen. Less preferred, as cyclical hormones may worsen endometriosis symptoms.
      • Progestogen-only – continuous progestogen. Used when estrogen contraindicated.
      • Tibolone – synthetic steroid: estrogenic, progestogenic, and androgenic activity. Often used post-menopause; caution in estrogen-sensitive conditions.
      For add-back therapy, ensure to: 
      • use continuous regimens (not cyclical) to avoid stimulating endometriotic tissue
      • monitor BMD regularly if GnRH therapy continues >6 months
      • start add-back therapy generally at the same time as the GnRH analogue.
      Fertility considerations Up to half of people with endometriosis experience fertility issues, and pain suppression does not necessarily improve fertility.2,3,6,12 Pharmacists can:
      • counsel on hormonal therapy effects on ovulation 
      • encourage early specialist referral if conception delayed >12 months
      • support patients undergoing IVF or assisted reproductive treatment 
      • provide reassurance and empathy around fertility-related distress. 
      Table 1 – Overview of hormonal therapies for endometriosis References: Therapeutic Guidelines1, Buggio et al12, Rossi13 Hornstein26, Vercellini27 Note: Bone mineral density typically recovers within two years of cessation of GnRH therapies.27 Drospirenone currently off-label for endometriosis in Australia.1 The addition of Ryeqo (relugolix, estradiol, norethisterone) (July 2022) and Visanne (dienogest) (December 2024) to the PBS expands accessible hormonal therapy options for endometriosis.29

      The role of the pharmacist in endometriosis care

      Pharmacists play a vital role in improving care for people with endometriosis by addressing barriers through education, advocacy and person-centred support. Key strategies include1,5,8,12:
      • using inclusive language and avoiding assumptions about gender identity or reproductive goals
      • proactively exploring the impact of symptoms on daily life, including school, work and relationships
      • offering accessible symptom-tracking tools to support self-monitoring
      • referring patients to culturally safe services, including First Nations-specific clinics when appropriate
      • advocating for patients and providing education to dispel misconceptions about endometriosis.
      Given the impact of endometriosis on mental health, it is essential for pharmacists to use affirmative language that validates the patient’s experience.  For example, acknowledging that a patient’s pain is real fosters trust, signals active listening and supports collaborative care. Avoiding dismissive statements such as ‘pain is normal for women’ is crucial, as these can reinforce shame and self-doubt, and discourage timely help-seeking.10,14,31 Pharmacists are integral members of multidisciplinary teams managing endometriosis. They facilitate early identification and timely referrals to general practitioners, specialists, pelvic physiotherapists, psychologists and dietitians. The upcoming Endometriosis Management Plan (EMP), a digital clinical tool launching in 2026, is designed to enhance care coordination, streamline documentation, and align treatment goals across providers.4,32 Pharmacists can support EMP implementation through patient counselling, comprehensive medicines reviews and ongoing follow-up.  Pharmacists are also well-positioned to assist patients in navigating newly established specialist clinics funded under the 2025–26 federal health budget.4,32 Home Medicines Reviews (HMRs) can further optimise medicines management and should be actively recommended as part of a comprehensive care strategy. Pharmacists can support shared decision-making by explaining treatment mechanisms, expected onset of action and common adverse effects, helping patients make informed choices.

      Patient resources  

      Pharmacist follow-up and recommendations of patient support resources are beneficial for ongoing management. These include10,12,25,33:
      • inviting patients to check in monthly during early therapy
      • reassessing symptoms, tolerance and goals
      • encouraging use of symptom tracker apps to record symptoms, menstrual changes and evaluate therapy success (e.g. Phendo, Clue, EndoMeter)
      • referring to organisations for education/peer support
      • recommending organisations6,9,10,14,23,34,35:
        • Endometriosis Australia – advocacy/awareness
        • Jean Hailes for Women’s Health – tools/info
        • Pelvic Pain Foundation of Australia – clinician and patient info
        • QENDO – peer support, lived experience, free tracking app
        • EndoZone – clinical decision support, patient-friendly explanations
        • ESHRE patient leaflet – print-friendly patient information.

      Knowledge to practice 

      Pharmacists in primary care can support people with endometriosis by providing early recognition of symptom impact, guidance on medicines and symptom management, and facilitating timely referrals to appropriate healthcare providers.  Pharmacists play a key role in validating patient experiences, promoting self-monitoring through symptom-tracking tools, explaining treatment options and adverse effects, and encouraging engagement with multidisciplinary care.  Pharmacists should also advocate for patients and provide education to dispel misconceptions, helping reduce delays in diagnosis and improving overall quality of care.

      Conclusion

      Endometriosis is far more than painful periods – it’s a complex, chronic condition requiring interdisciplinary, person-centred care. Pharmacists can make a profound difference by recognising early signs, validating lived experience, supporting evidence-based management and facilitating timely referral. Even a single empathetic conversation can empower a patient to seek help and change the trajectory of their care.

      Case scenario continued

      You reassure Alicia that severe period pain is not something she has to accept and suggest tracking her symptoms with a menstrual diary and consulting a women’s health GP. You also provide advice on safe NSAID use and non-pharmacological strategies. Alicia returns 2 months later, now diagnosed with endometriosis and receiving hormonal therapy and pelvic physiotherapy. She continues to experience chronic pelvic pain and questions her medicines, so you organise a Home Medicines Review, identifying potential naproxen overuse and interactions with her sertraline, prompting treatment adjustments. You also recommend a local endometriosis support group, which Alicia joins, and she has since referred two friends with similar symptoms. Through ongoing support, she feels more empowered to manage her condition.
        [cpd_submit_answer_button]

      Key points

      • Lesion severity does not predict pain intensity.
      • Recognise red flags (e.g. cyclical pain, GI symptoms) and enact early referral.
      • Support interdisciplinary, patient-centred management.
      • Review safety, adherence and contraceptive actions of hormonal therapy.
      • Use inclusive, supportive language to reduce stigma and diagnostic delay.
      • Encourage treatment continuity and shared decision-making.

      References

      References 
      1. Therapeutic Guidelines Limited. Endometriosis. In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2024. At: www.tg.org.au.
      2. Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril 2012;98(3):511–9. At: https://pubmed.ncbi.nlm.nih.gov/22819144/
      3. Parasar P, Ozcan P, Terry KL. Endometriosis: epidemiology, diagnosis and clinical management. Curr Obstet Gynecol Rep 2017;6(1):34–41. At: https://pubmed.ncbi.nlm.nih.gov/29276652/
      4. Australian Government Department of Health and Aged Care. National Action Plan for Endometriosis. Canberra: Department of Health; 2018. At: https://www.health.gov.au/resources/publications/national-action-plan-for-endometriosis?language=en
      5. RANZCOG. Endometriosis: a consensus guideline. Melbourne: Royal Australian and New Zealand College of Obstetricians and Gynaecologists; 2021. At: https://ranzcog.edu.au
      6. Endometriosis Australia. About Endometriosis. 2023. At: www.endometriosisaustralia.org/about-endometriosis
      7. Armour M et al. Endometriosis and chronic pelvic pain have similar impact on women, but time to diagnosis is decreasing: an Australian survey. Sci Rep 2020. At: https://pubmed.ncbi.nlm.nih.gov/33004965/
      8. Armour M, Sinclair J, Ng CHM, et al. A biopsychosocial approach to endometriosis management. Jean Hailes for Women’s Health; 2022. At: www.jeanhailes.org.au/uploads/Webinars/2022_PPP_final-handouts.pdf
      9. European Society of Human Reproduction and Embryology. ESHRE. Guideline on endometriosis: patient leaflet. 2022. At: www.eshre.eu/Guidelines-and-Legal/Guidelines/Endometriosis-guideline
      10. Jean Hailes for Women’s Health. Endometriosis. 2024. At: www.jeanhailes.org.au/health-a-z/endometriosis
      11. Morotti M, Vincent K, Becker CM. Mechanisms of pain in endometriosis. Eur J Obstet Gynecol Reprod Biol 2017;209:8–13. 
      12. Buggio L, Armour M, Evans S, et al. Endometriosis: a review of recent evidence and guidelines. Aust J Gen Pract 2024;53(1–2):22–8. At: www1.racgp.org.au/ajgp/2024/january-february/endometriosis
      13. Rossi S, ed. Australian Medicines Handbook. 2025. Endometriosis. At: https://amhonline.amh.net.au
      14. EndoZone. Clinical and patient tools. 2025. At: www.endozone.com.au
      15. Johnson NP, Hummelshoj L, Adamson GD, et al. World Endometriosis Society consensus on the classification of endometriosis. Hum Reprod 2017;32(2):315–24. At: https://academic.oup.com/humrep/article/32/2/315/2631390?login=false#116936554
      16. Alexander M, Dydyk EC, Michael F. Stretanski, et al. Central Pain Syndrome. StatPearls. 2025. At: www.ncbi.nlm.nih.gov/books/NBK553027/
      17. National Institute for Health and Care Excellence (NICE). Endometriosis: diagnosis and management. NICE guideline NG73. London: NICE; 2024. At: www.nice.org.uk/guidance/ng73/resources/endometriosis-diagnosis-and-management-pdf-1837632548293
      18. Endometriosis News. Current status of non-invasive biomarkers for endometriosis. 2024. At: www.endonews.com/current-status-of-non-invasive-biomarkers-for-endometriosis
      19. Gupta D, Hull ML, Fraser I, et al. Endometrial biomarkers for the non-invasive diagnosis of endometriosis. Cochrane Database of Systematic Reviews 2016. Issue 4. 
      20. Proteomics International. PromarkerEndo delivers breakthrough results for endometriosis blood test. Perth: PIQ; 2024. At: ASX-PIQ-Collaboration-expanded-to-advance-Endometriosis-blood-test-251015.pdf
      21. Evans‑Hoeker E, Senapati S, Behera MA. Serum markers for endometriosis: a critical appraisal of current literature. Fertil Steri 2024;121(5):943–56.
      22. Evans S. Introduction to pelvic pain: an introduction to pelvic pain for girls, women, men and families. Pelvic Pain Foundation of Australia; 2024. At: www.pelvicpain.org.au/wp-content/uploads/2024/01/Introduction-to-Pelvic-Pain.pdf
      23. Brown J, Crawford TJ, Allen C, et al. Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database of Systematic Reviews 2017;2017(1):CD004753. At: www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004753.pub4/full
      24. Villella S. The use of complementary medicines and therapies in women's health. Jean Hailes for Women’s Health; 2022. At: www.jeanhailes.org.au/uploads/Webinars/Complementary-medicine-and-therapies
      25. Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Hum Reprod Open 2022;2022(2):hoac009. https://doi.org/10.1093/hropen/hoac009
      26. Malik A, Sinclair J, Ng CHM, et al. Complementary medicine and chronic pelvic pain in Australian women: a national cross-sectional survey. BMJ Open 2021;11:e045768. At: https://pubmed.ncbi.nlm.nih.gov/35148773/
      27. Hornstein MD. Endometriosis: long-term treatment with gonadotropin-releasing hormone agonists. In: Barbieri RL, Eckler K, editors. UpToDate. Waltham (MA): UpToDate Inc.; 2023. At: www.uptodate.com
      28. Vercellini P, Buggio L, Berlanda N, et al. Estrogen-progestins and progestins for the management of endometriosis. Fertil Steril 2016;106(7):1552–71. At: https://pubmed.ncbi.nlm.nih.gov/27817837/.
      29. Australian Government Department of Health and Aged Care. Pharmaceutical Benefits Scheme: New listings and changes – December 2024. Canberra: PBS; 2024. www.pbs.gov.au
      30. Veth VB, van der Karr MM, Duffy JM, et al. Gonadotropin-releasing hormone analogues for endometriosis. Cochrane Database of Systematic Reviews 2023;6(6).
      31. Australian Commission on Safety and Quality in Health Care. Person-centred care: a toolkit for implementation. Sydney: ACSQHC; 2020.
      32. Australian Government Department of Health and Aged Care. Budget 2025–26: Women’s Health Package. 2025. At: Budget 2025–⁠26: Strengthening Medicare – Women's health | Australian Government Department of Health, Disability and Ageing
      33. Ferrero S, Evangelisti G, Barra F. Current and emerging treatment options for endometriosis. Expert Opin Pharmacother 2018;19(10):1109–25. At: https://pubmed.ncbi.nlm.nih.gov/29975553/
      34. Endometriosis Australia. Patient stories (2023). At: https://endometriosisaustralia.org/category/endo-stories/
      35. QENDO. About Us. 2025. At: https://www.qendo.org.au/

      Our author

      Erin Downey (she/her) BPharm, GCertDiabEd, CDE, MPS CredPharm (MMR), ANZCAP-Reg (Endo, Generalist) is a clinical pharmacist, credentialled diabetes educator, endocrinology and generalist ANZCAP registrar, practising hospital pharmacist, and private CDE/credentialled MMR pharmacist in Southern Tasmania. 

      Our reviewer

      Elke Smith (she/her) BPharm, MHlthMgt [post_title] => Endometriosis: More than just a bad period [post_excerpt] => Endometriosis is a chronic inflammatory condition which affects 10–15% of all reproductive-aged Australians who were assigned female at birth. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => endometriosis-more-than-just-a-bad-period-cpd [to_ping] => [pinged] => [post_modified] => 2026-02-06 10:09:22 [post_modified_gmt] => 2026-02-05 23:09:22 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=31273 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Endometriosis: More than just a bad period [title] => Endometriosis: More than just a bad period [href] => https://www.australianpharmacist.com.au/endometriosis-more-than-just-a-bad-period-cpd/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( [td_post_template] => single_template_4 ) [is_review:protected] => [post_thumb_id:protected] => 31300 [authorType] => )

      Endometriosis: More than just a bad period

      PBAC
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                  [post_content] => New Pharmaceutical Benefits Advisory Committee (PBAC) recommendations could significantly change who can access funded COVID-19 and RSV vaccines.
      
      At its December 2025 meeting, PBAC considered applications for funding COVID-19 vaccines and RSV vaccines on the National Immunisation Program (NIP). While both recommendations were positive, how would they apply in practice?
      

      Smaller cohort recommended for COVID-19 vaccine eligibility

      PBAC recommended significantly tighter eligibility criteria for COVID-19 vaccines going forward. The National COVID-19 Vaccination Program – including the community pharmacy program is scheduled to end on 30 June 2026. While no announcements have yet been made, the PBAC outcomes signal COVID-19 vaccination will be incorporated into the NIP. PBAC recommendation is an important step to enable this NIP listing. PBAC considered a proposal to fund Pfizer’s Comirnaty COVID-19 vaccines in a smaller population cohort. The proposal has been supported by PBAC, recommending NIP funding for four cohorts of adults as requested by Pfizer, the product sponsor.

      Who would be eligible for funded COVID-19 vaccination?

      For current and future Comirnaty COVID-19 vaccines, PBAC’s recommendation supports NIP funding in specific age and risk groups only. Under this framework, NIP-funded doses would only be available for patients who are:
      • 75 years and over (two doses per year)
      • 65–74 years (one dose per year)
      • 18–64 years with severe immunocompromise (one dose per year)
      • Aboriginal and Torres Strait Islander peoples aged 50–74 years (one dose per year).
      Patients outside these groups would not be eligible for NIP-funded COVID-19 vaccination, including healthy adults aged 18–64 years, children, and Aboriginal and Torres Strait Islander peoples under 50 who do not meet the high-risk criteria. The proposed dosing schedule reflects an endemic management approach, with annual vaccination for most eligible groups. ‘PBAC noted the requested populations and doses were based on updated advice from the Australian Technical Advisory Group on Immunisation (ATAGI),’ the committee said. ‘This is a smaller group than current arrangements under the National COVID-19 Vaccination Program (NCVP).’

      What did PBAC recommend for RSV vaccination on the NIP?

      PBAC considered a submission from GSK to fund their RSV vaccine Arexvy on the NIP for prevention of RSV-related lower respiratory tract disease in at-risk adults susceptible to severe complications. The recommendation supports funded access for the Arexvy RSV vaccine for:
      • adults aged 75 years and over
      • Aboriginal and Torres Strait Islander peoples aged 60–74 years.
      If adopted, this would see two additional population cohorts currently recommended for RSV vaccination by the Australian Immunisation Handbook able to access the vaccine free-of-charge on the NIP. However, the recommendation does not extend to all people currently recommended for RSV vaccination – such as adults aged 60–74 years who have medical conditions which increase their risk of severe RSV disease. PBAC also confirmed that one dose of Arexvy is considered equivalent to one dose of Pfizer’s Abrysvo vaccine under the proposed NIP listing. The proposed NIP listing would still involve a substantial cost to government, even after revised assumptions and a price reduction. However, the committee considered the sponsor’s updated cost inputs acceptable and concluded the vaccine was cost-effective in the proposed populations. PBAC also noted that no new clinical evidence had been submitted, but that revised pricing and cost data supported its previous conclusions on clinical benefit and value for money. ‘Consistent with previous advice, PBAC considered there is a high clinical need for vaccines, such as Arexvy, to reduce the risk of RSV in adults,’ the committee said.

      When would these changes take effect?

      There’s no clear timeframe. PBAC recommendations for vaccines require price negotiation, government approval, procurement and regulatory listing to become funded on the NIP.

      Given the expiry of COVID-19 immunisation program funding, 1 July 2026 could be a potential implementation date for the COVID-19 NIP funding. Current COVID-19 vaccine program eligibility is based on ATAGI advice, so changes could happen at any time ATAGI chooses to provide updated advice.

      And as for patients asking when the RSV vaccine may be funded on the NIP? They probably could be encouraged to keep their eye on the TV news for any future announcements!

      Upskill in vaccination administration and legislation by visiting the PSA Vaccination (immunisation) Education Hub. [post_title] => PBAC recommends new NIP adult vaccine listings [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => pbac-recommends-new-nip-adult-vaccine-listings [to_ping] => [pinged] => [post_modified] => 2026-02-04 15:42:54 [post_modified_gmt] => 2026-02-04 04:42:54 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=31280 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => PBAC recommends new NIP adult vaccine listings [title] => PBAC recommends new NIP adult vaccine listings [href] => https://www.australianpharmacist.com.au/pbac-recommends-new-nip-adult-vaccine-listings/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 31282 [authorType] => )

      PBAC recommends new NIP adult vaccine listings

      poisons information
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                  [post_content] => Genevieve Adamo MPS did not set out to work in poisons information. After beginning her career in community pharmacy as an assistant pharmacist and progressing into management, Ms Adamo joined the New South Wales Poisons Information Centre in 2004. 
      
      ‘I sort of fell into poisons,’ she said. ‘After having a few children, I had some time off and wanted to do something where I was learning again.’
      
      Each call is different, providing a continuous learning opportunity, said Ms Adamo, who took on a role with the National Poisons Register in 2023.
      
      ‘You don’t know what you’re going to get at the end of the phone when you pick it up,’ she added.
      
      Because so many of the calls to the poisons centre related to medicines poisoning, whether overdoses or errors, being a pharmacist is a distinct advantage.
      
      ‘We have really extensive knowledge of the drugs, as well as a really good base in physiology and pharmacology,’ Ms Adamo said.
      
      [caption id="attachment_18818" align="aligncenter" width="600"] Genevieve Adamo MPS (Image: Steve Christo Photography)[/caption]
      
      Here, she outlines what’s needed to enter and flourish in the space, as told to delegates at PSA’s Voices of Pharmacy – Passion, Purpose and Possibility webinar, held on 26 November 2025.
      

      Core skills for poisons information practice

      Poisons information demands a distinct skill set, combining deep scientific knowledge with the ability to work confidently under pressure. Calls are often urgent, information may be incomplete and decisions must be made quickly. ‘Every call provides a clinical problem that you’ve got to solve. Many of which there’s no clear answer,’ Ms Adamo said. ‘And we can't always look something up in a reference [because] not everything is listed there.’ Because it’s neither ethical nor feasible to conduct controlled trials in poisoning, evidence gaps are common.  ‘We can’t go and poison a whole lot of people to create clinical trials to find the answers for poisoning questions. We have to wait until these situations happen and then turn those into research themselves,’ she said. ‘So because of that, we often have to go back to basics, and use those pharmacology principles we learned way back in uni.’ This includes:
      • thinking about what chemical the patient has been exposed to and how it will impact normal physiology
      • what response the body could have
      • how the potential risks can be minimised. 
      Equally important is the ability to tolerate, or even be ‘excited by’, uncertainty.  ‘If you’re somebody who gets terrified by the fact that you can’t find an answer, this is not the job for you,’ Ms Adamo said. ‘There’s a lot of unknown … That’s what makes it challenging and interesting.’ While communication skills are important for all pharmacists, they are particularly pertinent in poisons information. Because advice is delivered remotely, pharmacists must rely entirely on what they hear over the phone. ‘We don’t see the patients, we’re only hearing them,’ she said. ‘So we must be really good at listening and at receptive communication.’ Calls often begin with anxiety rather than a clear clinical question. So allowing callers to fully explain the event is central to safe and effective care. ‘I’ll often start a call by saying, “Just tell me what happened,” and listen until they finish talking,’ she said. ‘That helps them feel heard and validated, and then they’re more likely to listen to the advice I give.’ The pace of work adds further pressure. Average call times are short, requiring pharmacists to rapidly gather information, consult resources where possible and provide clear guidance. ‘You’ve got to get all the history, work out what you know, look things up and provide advice all within about 5 minutes,’ Ms Adamo said.

      Building the right foundation

      Because poisons information pharmacy has no formal training pathway, pharmacists interested in the field should build relevant knowledge and exposure well before applying. ‘What we would look for would be a minimum of 3 years experience as a pharmacist, and ideally a combination of community and hospital pharmacy,’ Ms Adamo said. ‘Community brings a lot of skills in communication and history taking, but [the role] is very clinical, so having that hospital knowledge is also important.’ One of the most important resources is Therapeutic Guidelines, which supports much of the clinical advice provided by poisons centres. ‘There’s a Therapeutic Guideline for toxicology and toxinology,’ she said. ‘We use that a lot, so having a good understanding of it is really beneficial.’ With many calls related to exposures that occur in domestic settings, familiarity with over-the-counter products and household chemicals is also essential.  ‘I often tell new staff to go and check out the cleaning aisle,’ Ms Adamo said. ‘It’s really hard to give advice on household poisons if you don’t know what any of them are.’

      From individual cases to national policy

      While providing advice over the phone is the most visible aspect of poisons information, there’s much more to the role.  Poisons centres play a critical role in generating real-world evidence, with calls providing a continuous stream of data that can be analysed to identify new risks or changing patterns of exposure.
      ‘You’ve got to get all the history, work out what you know, look things up and provide advice all within about 5 minutes.' Genevieve Adamo MPS
      ‘We all have the ability to be involved in research, because we're recruiting patients through our calls,’ Ms Adamo said. ‘Our staff also create new guidelines for education and training, supporting both external poisoning prevention initiatives and the ongoing training of new and existing staff.’ Another major function is toxicovigilance – the systematic monitoring of poisoning trends with a focus on prevention and risk reduction. ‘That can involve all sorts of things [including] media and education,’ she said. ‘There’s often a lot of number crunching as well, and then working with regulators to change the laws to restrict access, because we know that one of the best ways to minimise harm and exposures is to restrict access.’ A key scheduling change Ms Adamo and her team were involved in was the changes to paracetamol regulations that were ushered in early last year. ‘We were contracted by the TGA to collect extra information about all the paracetamol calls we got,’ Ms Adamo said. ‘Paracetamol calls are the most common call to the poison centre every year, and all of that information was collated by our Head of Research and our consultant toxicologists – with the report used as the basis for the proposed scheduling changes that occurred.’ Sometimes individual cases can lead to broader system change. ‘I was involved in a case with a mum whose little one got really sick, and it was eventually worked out that it was a chronic choline salicylate toxicity,’ she said. ‘She couldn’t believe she’d been giving this poison to her kid and didn’t realise it was poisonous, because she bought it from [a supermarket] and thought it must be safe.’  In response, Adamo submitted an application to reschedule choline salicylate to Schedule 2. ‘Now it has to have more labelling, and it can only be available in a pharmacy,’ she said. ‘Those are the really interesting and rewarding aspects of poisoning work.’ For pharmacists considering the field, Ms Adamo believes the appeal lies in its tangible public health impact – shaping national safety standards and preventing future harm, particularly among children. ‘You know the work you’re doing actually changes outcomes.’ Read PSA’s Medicine Safety: Child and adolescent care report to understand the key poisoning risks and how pharmacists can help mitigate them. [post_title] => How pharmacists can prepare for poisons information roles [post_excerpt] => Poisons information pharmacists turn individual calls into population-level insights that inform regulatory and scheduling decisions. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => how-pharmacists-can-prepare-for-poisons-information-roles [to_ping] => [pinged] => [post_modified] => 2026-02-02 18:25:34 [post_modified_gmt] => 2026-02-02 07:25:34 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=31254 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => How pharmacists can prepare for poisons information roles [title] => How pharmacists can prepare for poisons information roles [href] => https://www.australianpharmacist.com.au/how-pharmacists-can-prepare-for-poisons-information-roles/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 31258 [authorType] => )

      How pharmacists can prepare for poisons information roles

      Early career pharmacist
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                  [post_content] => 

      Victoria Chisari MPS is an early career pharmacist and researcher on the move, working across clinical areas of practice to hone her skills.

      What’s beneficial about learning different specialties in pharmacy?

      Each specialty offers a unique focus, with the learning from each area building upon the others to create a comprehensive understanding of clinical pharmacy service delivery.

      I am currently a clinical pharmacist with Western Sydney Local Health District and a research team member and practice change facilitator at the University of Technology Sydney. But I have worked in many different clinical roles. My experience in the intensive care unit, for example, helped develop my ability to review acutely unwell patients – including those with infections, trauma, respiratory failure and organ failure.

      In this setting, I managed a diverse range of critically ill patients with complex medicines regimens – involving supportive therapies such as inotropes and vasopressors, sedation and antimicrobials.

      My practice involved designing individualised treatment plans for patients, particularly those receiving extracorporeal therapies such as renal replacement therapy and extracorporeal membrane oxygenation.

      This background informed my practice in the emergency department, where sound clinical reasoning was vital to delivering effective advice and interventions in fast-paced, high- pressure situations.

      Can you describe your global research review of pharmacist-prescribed contraception services?

      In response to barriers accessing contraception, such as the need for a prescription, pharmacist-prescribed contraception has been widely implemented and one common model of care delivers this service using clinical protocols. The review highlighted that the overall scope of these services includes both the prescribing (initiating) and continuation of various contraceptive methods, such as oral contraceptive pills, vaginal rings, transdermal patches and injections. A key finding was that the scope of practice varies internationally, depending on local authorisation and regulatory frameworks.

      It was recognised that while conceptually, the clinical protocol is one part of the intervention, education is another important part of the overall provision of care.

      This includes recognition of the importance of both foundational education and additional training for pharmacists.

      It was evident that authorising pharmacists to prescribe and continue a range of contraception options ultimately offers the best access for women.

      At the same time, pharmacist education and training is an important part of the broader piece in pharmacist prescribing – particularly in the current Australian context, as pharmacist prescribing continues to develop and expand.

      Your advice for other early ECPs interested in clinical pharmacy?

      Seek out opportunities to broaden your knowledge and skills.

      If you’re a pharmacy student or ECP interested in hospital pharmacy, look for courses, mentorship programs and professional development opportunities that align with your goals.

      Hospital pharmacy is dynamic, exciting and rewarding – there’s a lot to learn and a lot that we as pharmacists can contribute to.

      Ask questions and say yes to challenges that push you to grow. Be curious, be kind and keep learning. 

      [post_title] => Expanding clinical judgement beyond a single specialty [post_excerpt] => Victoria Chisari MPS is an early career pharmacist and researcher on the move, working across clinical areas of practice to hone her skills. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => expanding-clinical-judgement-beyond-a-single-specialty [to_ping] => [pinged] => [post_modified] => 2026-02-02 18:25:57 [post_modified_gmt] => 2026-02-02 07:25:57 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=31248 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Expanding clinical judgement beyond a single specialty [title] => Expanding clinical judgement beyond a single specialty [href] => https://www.australianpharmacist.com.au/expanding-clinical-judgement-beyond-a-single-specialty/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 31253 [authorType] => )

      Expanding clinical judgement beyond a single specialty

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                  [post_content] => Australia's Minister for Health has announced a National Medicines Record. What is it, and what will it achieve?
      
      Medicine safety has long depended on pharmacists making critical decisions with incomplete information. As prescribing becomes increasingly fragmented across face-to-face care, telehealth and digital platforms, those gaps are widening – with serious consequences for patients. 
      
      Reforms announced by Minister for Health and Ageing Mark Butler this morning aim to address this issue, eventually leading to a National Medicines Record. 
      
      The announcement follows advocacy by Alison Collins after the death of her daughter Erin, who died in 2024 after being prescribed medicines through multiple digital health platforms without a complete view of her medical history.
      

      Erin’s story

      Erin was 24 years old and had been taking multiple medicines for her mental health. She had been hospitalised multiple times for problems stemming from medicine misuse and was placed on daily staged supply pickup of her medicines.  The hospital care teams were so concerned they placed multiple warning messages in her My Health Record. However, these warnings were not accessed by telehealth services or local pharmacies prior to her fatal overdose. Erin’s case highlighted systemic vulnerabilities that pharmacists have warned about for years, particularly as digital prescribing expands faster than the safeguards designed to support safe, coordinated care.

      The first step

      Initially, the reforms would require all medicines information from online prescribers to be uploaded to My Health Record For pharmacists, this will make a fuller picture of all the medicines a patient has been prescribed more visible. This is critical given the increasing number of prescribers an individual may have with the rise of telehealth and condition-specific providers.  Under the proposed changes, medicines prescribed and dispensed through online platforms – including the clinical context for prescribing – would be made available through My Health Record. This is intended to help reduce the risk of medicine  errors, adverse drug reactions and inappropriate use by ensuring healthcare professionals have access to more complete and timely information.

      The path to a National Medicines Record

      The reforms also commit the Government to designing and developing a National Medicines Record using existing digital health infrastructure, including electronic prescribing, the Active Script List and My Health Record.  While details are still emerging, the proposal has the potential to address a core challenge for pharmacists: how to identify and resolve medicines-related risks without a reliable, up-to-date picture of a patient’s full medicines history. Welcoming the announcement, PSA National President Professor Mark Naunton MPS noted it aligns with the profession's long standing advocacy. 'Pharmacists have consistently sought better-connected digital health systems to improve patient safety with medicines. It’s something PSA has been advocating for over many years, including through our flagship medicine safety report series,” Prof. Naunton said. 'Access to a more complete and reliable medicines record has the potential to significantly improve patient safety and strengthen clinical decision-making.' 'The announcement is fully aligned with PSA’s ongoing advocacy to improve medicines safety systems and ensure pharmacists are supported as medicines experts across all settings of care,' he continued. 'PSA will engage in the consultation for these proposals and continue to work with the Government to support system improvements that make medicine use in Australia safer.' A consultation period is now underway to guide the inclusion of medicines information from all online prescribers by default, with the first phase expected to be completed by December 2026. The Government has also flagged ongoing enhancements to the 1800MEDICARE app to support medicines management. [post_title] => What a National Medicines Record might mean for patient safety and pharmacy practice [post_excerpt] => Australia's Minister for Health has announced a National Medicines Record. What is it, and what will it achieve? [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => towards-a-national-medicines-record [to_ping] => [pinged] => [post_modified] => 2026-01-30 16:02:41 [post_modified_gmt] => 2026-01-30 05:02:41 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=31238 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => What a National Medicines Record might mean for patient safety and pharmacy practice [title] => What a National Medicines Record might mean for patient safety and pharmacy practice [href] => https://www.australianpharmacist.com.au/towards-a-national-medicines-record/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 31240 [authorType] => )

      What a National Medicines Record might mean for patient safety and…

  • Clinical
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                  [post_content] => 

      Case scenario

      Alicia, 27, visits your pharmacy regularly for naproxen and heat patches to manage period pain. She confides that her pain has worsened over the past 2 years, radiates down her legs, interferes with work and affects intimacy.  Her periods are heavy, lasting around 9 days, and leave her feeling exhausted and sometimes even bedridden. Alicia has seen several GPs, who told her it was ‘normal for your age’. She says, ‘It feels like someone’s wringing out my insides – nothing helps much. Is this really normal?’

      Learning objectives

      After reading this article, pharmacists should be able to:
      • Describe the epidemiology, aetiology and pathophysiology of endometriosis
      • Identify key clinical features, risk factors and diagnostic considerations
      • Discuss pharmacological and non-pharmacological management options for endometriosis
      • Explain the pharmacist’s role in supporting patients with endometriosis through education, referral and holistic care.
      Competency standards (2016) addressed: 1.1, 1.4, 1.5, 2.2, 3.1, 3.5 Accreditation number: CAP2602DMED  Accreditation expiry: 31/01/2029 
      Already read the CPD in the journal? Scroll to the bottom to SUBMIT ANSWERS.

      Introduction

      Endometriosis is a chronic inflammatory condition characterised by the growth of endometrial-like tissue outside the uterus, commonly affecting the ovaries, fallopian tubes and pelvic peritoneum.1,2 It affects 10–15% of all reproductive-aged Australians who were assigned female at birth, and 70% of females with chronic pelvic pain.3 Yet it remains underdiagnosed, underfunded and often misunderstood. Symptoms such as pelvic pain, heavy periods, fatigue and infertility can significantly affect quality of life. Pharmacists, often the first point of contact for pain management and self-care advice, play an important role in recognising potential endometriosis, supporting early referral and helping patients navigate ongoing treatment.

      Epidemiology

      An estimated 1 in 7 females in Australia are currently living with endometriosis.4-6 Onset often begins in adolescence, yet diagnosis is delayed on average by 7–10 years,1,3,7 influenced by menstrual pain normalisation, stigma, and misdiagnosis as irritable bowel syndrome (IBS) or anxiety.1,3,4,7,8 The consequences of these delays extend beyond physical health, affecting fertility, education, relationships and employment, and increasing the likelihood of depression, anxiety and social withdrawal.6,9,10

      Aetiology and pathophysiology

      The pathogenesis of endometriosis is multifactorial. The leading theory is retrograde menstruation, where menstrual blood flows backwards through the fallopian tubes into the pelvic cavity, allowing endometrial cells to implant and grow outside the uterus.2,11 Other contributing mechanisms include2,5,11,12:
      • immune dysfunction
      • coelomic metaplasia (peritoneal cell transformation)
      • genetic predisposition
      • hormonal imbalances 
      • environmental triggers.

      Clinical features  

      Endometriosis occurs when hormonally responsive lesions develop on the ovaries, bowel, bladder, peritoneum, or other pelvic and abdominal structures.1,5,9,13,14 These lesions respond to oestrogen and undergo cyclical changes similar to the endometrial lining, which can trigger inflammation, bleeding, scarring and adhesions. This may lead to chronic pain, organ dysfunction and infertility. Importantly, symptom severity does not always correlate with the number or extent of lesions and may fluctuate with hormonal changes.8,12 Risk factors While the exact cause of endometriosis is unclear, certain factors increase the likelihood of developing the condition1,9,13,14:
      • early menarche
      • short menstrual cycles (<27 days)
      • heavy/prolonged periods
      • nulliparity
      • family history of endometriosis
      • low BMI.
      Clinical presentation1,5,9,13,14 Pharmacists should consider endometriosis in individuals presenting with2,7,8,11,12:
      • moderate-severe dysmenorrhoea 
      • chronic pelvic pain (cyclical or constant)
      • persistent or recurrent pain associated with sexual intercourse (dyspareunia) 
      • menstrual bowel/bladder pain 
      • fatigue, lethargy, irritability
      • bloating
      • painful or altered bowel movements, particularly around the time of menstruation (dyschezia)
      • abnormally heavy or prolonged menstrual bleeding (menorrhagia) or irregular cycles 
      • infertility/conception delays.
      Classification No universally agreed classification exists, though the American Society of Reproductive Medicine (ASRM) system is commonly used15:
      • Stage I (minimal): few superficial implants.
      • Stage II (mild): more, deep implants.
      • Stage III (moderate): many deep implants; filmy adhesions may be present.
      • Stage IV (severe): many deep implants, many dense adhesions.
      Pain mechanisms and central sensitisation Central sensitisation refers to heightened nervous system responsiveness, causing persistent, widespread pain even after lesion removal.16 This can manifest as pelvic floor dysfunction, visceral hypersensitivity, and fatigue, and often overlaps with conditions such as irritable bowel syndrome or bladder pain syndrome.11 Supporting patients involves validating their pain experiences, even when imaging is normal or lesions appear minimal.

      Diagnosis and differential diagnosis 

      Diagnosis of endometriosis is often significantly delayed, with an average lag of 7–10 years from symptom onset.3,7,17 These delays are influenced by multiple systemic and social factors, including1,7,9,17:
      • normalisation of menstrual pain
      • dismissal of symptoms, particularly in adolescents and people of colour
      • lack of rural/remote access to gynaecology services 
      • under-recognition of symptoms in trans, non-binary and gender-diverse individuals
      • cost barriers to imaging, specialist care and private laparoscopies.
      Endometriosis shares symptoms with several other conditions, making diagnosis difficult. Differential diagnoses include IBS, pelvic inflammatory disease, adenomyosis, interstitial cystitis, depression and anxiety.12 Current diagnostic approaches While laparoscopy remains the gold standard, Australian guidelines now support symptom-based clinical diagnosis to reduce delays and improve care.3,7,17 Imaging tools such as transvaginal ultrasound can identify ovarian endometriotic cysts, but a normal ultrasound or MRI does not rule out disease – especially in early-stage or superficial cases. Patients should therefore be encouraged to pursue further care if symptoms significantly impact quality of life.3 Emerging diagnostic tools To address diagnostic challenges, ongoing research is focused on earlier, less invasive detection.4 Emerging approaches include blood-based biomarkers (e.g. proteomic panels, metabolomic profiling, microRNA and menstrual-fluid analysis),18-21 as well as advanced imaging techniques such as transvaginal ultrasound and MRI, which may help reduce reliance on laparoscopy and accelerate accurate diagnosis.3,7,17 When it’s not endometriosis: validating pelvic pain without a diagnosis Pelvic pain affects up to 1 in 4 people assigned female at birth and has many possible causes – endometriosis being only one of them.7,11,22,23 For some, extensive investigations such as imaging or laparoscopy reveal no abnormalities, which can leave patients feeling dismissed, confused or invalidated. Pharmacists can help by acknowledging that pain is real and deserving of care, even in the absence of a definitive diagnosis. Symptom management is the first-line approach for both endometriosis and chronic pelvic pain, and care should aim to improve daily function and quality of life regardless of diagnostic certainty.3 Where appropriate, pharmacists can also support referral to other healthcare providers for further assessment or multidisciplinary management. Although endometriosis itself is not curable, symptoms and recurrences can be effectively managed through person-centred care that considers physical, emotional and reproductive health needs.8

      Management approaches 

      Non-pharmacological treatment  Current treatment is focused on symptom control, rather than elimination of the disease. Non-pharmacological approaches form an essential part of care, particularly for patients who experience persistent pain or treatment adverse effects. Key strategies include8,13,24:
      • pelvic physiotherapy and psychotherapy (e.g. cognitive behavioural therapy [CBT], acceptance and commitment therapy [ACT])
      • heat therapy, TENS and mindfulness-based movement (e.g. yoga, Pilates)
      • anti-inflammatory or low-FODMAP diets, particularly for patients with co-existing irritable bowel syndrome.
      Mental health and emotional wellbeing Chronic pain is both physically and psychologically exhausting. Anxiety and depression rates are significantly higher in people with endometriosis than in the general population.7 Contributing factors include3,5,6,8,10,12,14,25:
      • diagnostic delays and invalidation of symptoms 
      • chronic fatigue and disrupted sleep
      • missed school or work
      • sexual dysfunction and relationship strain
      • fertility concerns or trauma from medical procedures.
      Pharmacists can play an important role in recognising distress and prompting early mental health support. Simple, empathetic questions – such as ‘How’s your sleep been lately?’ or ‘Is the pain affecting your mood?’ – can open conversations and guide appropriate referrals. Support strategies include:
      • recommending mental health care plans via GPs
      • referring to psychologists with chronic pain expertise or interdisciplinary pain teams
      • encouraging peer support groups (e.g. EndoActive, Endometriosis Australia, QENDO)
      • suggesting low-stigma mental health apps (e.g. MindSpot, Smiling Mind)
      • avoiding statements that minimise pain (e.g. ‘it’s just anxiety’) and instead validating the complex relationship between mood and pain.
      Complementary therapies  Patients may enquire about supplements or alternative therapies. Pharmacists should validate interest while clarifying the limited evidence and screening for interactions. Commonly explored options include magnesium, omega-3 fatty acids, turmeric (curcumin), vitex agnus-castus, zinc, vitamin B6, diindolylmethane (DIM) and acupuncture.22,24,26

      Pharmacological treatment 

      Analgesia
      • NSAIDs (e.g. naproxen 500 mg twice daily or ibuprofen 400 mg three times daily) are first line. 
      • Paracetamol may be added for multimodal relief.1,12,13
      Counselling should cover dosing, GI protection and review of OTC combinations (e.g. ibuprofen/paracetamol). Hormonal therapies Hormonal therapies suppress oestrogen-driven growth and reduce pain.11,12,13,27,28 Table 1 provides an overview of commonly used hormonal therapies in endometriosis management. Add-back therapy Treatment with gonadotrophin-releasing hormone (GnRH) analogues induces a temporary, reversible menopause to suppress oestrogen production and reduce endometriosis symptoms.30 However, this hypo-estrogenic state can cause side effects such as vasomotor symptoms, vaginal dryness and bone mineral density loss.30 Add-back therapy involves giving small ‘add-back’ doses of oestrogen, progestogen, or a combination of both, to counteract these effects while maintaining the efficacy of GnRH analogue treatment.13,28 Options include1,12,13,27: 
      • Continuous combined HRT – low-dose estrogen + progestogen. Use in patients with a uterus to protect the endometrium.
      • Sequential combined HRT – estrogen daily + cyclical progestogen. Less preferred, as cyclical hormones may worsen endometriosis symptoms.
      • Progestogen-only – continuous progestogen. Used when estrogen contraindicated.
      • Tibolone – synthetic steroid: estrogenic, progestogenic, and androgenic activity. Often used post-menopause; caution in estrogen-sensitive conditions.
      For add-back therapy, ensure to: 
      • use continuous regimens (not cyclical) to avoid stimulating endometriotic tissue
      • monitor BMD regularly if GnRH therapy continues >6 months
      • start add-back therapy generally at the same time as the GnRH analogue.
      Fertility considerations Up to half of people with endometriosis experience fertility issues, and pain suppression does not necessarily improve fertility.2,3,6,12 Pharmacists can:
      • counsel on hormonal therapy effects on ovulation 
      • encourage early specialist referral if conception delayed >12 months
      • support patients undergoing IVF or assisted reproductive treatment 
      • provide reassurance and empathy around fertility-related distress. 
      Table 1 – Overview of hormonal therapies for endometriosis References: Therapeutic Guidelines1, Buggio et al12, Rossi13 Hornstein26, Vercellini27 Note: Bone mineral density typically recovers within two years of cessation of GnRH therapies.27 Drospirenone currently off-label for endometriosis in Australia.1 The addition of Ryeqo (relugolix, estradiol, norethisterone) (July 2022) and Visanne (dienogest) (December 2024) to the PBS expands accessible hormonal therapy options for endometriosis.29

      The role of the pharmacist in endometriosis care

      Pharmacists play a vital role in improving care for people with endometriosis by addressing barriers through education, advocacy and person-centred support. Key strategies include1,5,8,12:
      • using inclusive language and avoiding assumptions about gender identity or reproductive goals
      • proactively exploring the impact of symptoms on daily life, including school, work and relationships
      • offering accessible symptom-tracking tools to support self-monitoring
      • referring patients to culturally safe services, including First Nations-specific clinics when appropriate
      • advocating for patients and providing education to dispel misconceptions about endometriosis.
      Given the impact of endometriosis on mental health, it is essential for pharmacists to use affirmative language that validates the patient’s experience.  For example, acknowledging that a patient’s pain is real fosters trust, signals active listening and supports collaborative care. Avoiding dismissive statements such as ‘pain is normal for women’ is crucial, as these can reinforce shame and self-doubt, and discourage timely help-seeking.10,14,31 Pharmacists are integral members of multidisciplinary teams managing endometriosis. They facilitate early identification and timely referrals to general practitioners, specialists, pelvic physiotherapists, psychologists and dietitians. The upcoming Endometriosis Management Plan (EMP), a digital clinical tool launching in 2026, is designed to enhance care coordination, streamline documentation, and align treatment goals across providers.4,32 Pharmacists can support EMP implementation through patient counselling, comprehensive medicines reviews and ongoing follow-up.  Pharmacists are also well-positioned to assist patients in navigating newly established specialist clinics funded under the 2025–26 federal health budget.4,32 Home Medicines Reviews (HMRs) can further optimise medicines management and should be actively recommended as part of a comprehensive care strategy. Pharmacists can support shared decision-making by explaining treatment mechanisms, expected onset of action and common adverse effects, helping patients make informed choices.

      Patient resources  

      Pharmacist follow-up and recommendations of patient support resources are beneficial for ongoing management. These include10,12,25,33:
      • inviting patients to check in monthly during early therapy
      • reassessing symptoms, tolerance and goals
      • encouraging use of symptom tracker apps to record symptoms, menstrual changes and evaluate therapy success (e.g. Phendo, Clue, EndoMeter)
      • referring to organisations for education/peer support
      • recommending organisations6,9,10,14,23,34,35:
        • Endometriosis Australia – advocacy/awareness
        • Jean Hailes for Women’s Health – tools/info
        • Pelvic Pain Foundation of Australia – clinician and patient info
        • QENDO – peer support, lived experience, free tracking app
        • EndoZone – clinical decision support, patient-friendly explanations
        • ESHRE patient leaflet – print-friendly patient information.

      Knowledge to practice 

      Pharmacists in primary care can support people with endometriosis by providing early recognition of symptom impact, guidance on medicines and symptom management, and facilitating timely referrals to appropriate healthcare providers.  Pharmacists play a key role in validating patient experiences, promoting self-monitoring through symptom-tracking tools, explaining treatment options and adverse effects, and encouraging engagement with multidisciplinary care.  Pharmacists should also advocate for patients and provide education to dispel misconceptions, helping reduce delays in diagnosis and improving overall quality of care.

      Conclusion

      Endometriosis is far more than painful periods – it’s a complex, chronic condition requiring interdisciplinary, person-centred care. Pharmacists can make a profound difference by recognising early signs, validating lived experience, supporting evidence-based management and facilitating timely referral. Even a single empathetic conversation can empower a patient to seek help and change the trajectory of their care.

      Case scenario continued

      You reassure Alicia that severe period pain is not something she has to accept and suggest tracking her symptoms with a menstrual diary and consulting a women’s health GP. You also provide advice on safe NSAID use and non-pharmacological strategies. Alicia returns 2 months later, now diagnosed with endometriosis and receiving hormonal therapy and pelvic physiotherapy. She continues to experience chronic pelvic pain and questions her medicines, so you organise a Home Medicines Review, identifying potential naproxen overuse and interactions with her sertraline, prompting treatment adjustments. You also recommend a local endometriosis support group, which Alicia joins, and she has since referred two friends with similar symptoms. Through ongoing support, she feels more empowered to manage her condition.
        [cpd_submit_answer_button]

      Key points

      • Lesion severity does not predict pain intensity.
      • Recognise red flags (e.g. cyclical pain, GI symptoms) and enact early referral.
      • Support interdisciplinary, patient-centred management.
      • Review safety, adherence and contraceptive actions of hormonal therapy.
      • Use inclusive, supportive language to reduce stigma and diagnostic delay.
      • Encourage treatment continuity and shared decision-making.

      References

      References 
      1. Therapeutic Guidelines Limited. Endometriosis. In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2024. At: www.tg.org.au.
      2. Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril 2012;98(3):511–9. At: https://pubmed.ncbi.nlm.nih.gov/22819144/
      3. Parasar P, Ozcan P, Terry KL. Endometriosis: epidemiology, diagnosis and clinical management. Curr Obstet Gynecol Rep 2017;6(1):34–41. At: https://pubmed.ncbi.nlm.nih.gov/29276652/
      4. Australian Government Department of Health and Aged Care. National Action Plan for Endometriosis. Canberra: Department of Health; 2018. At: https://www.health.gov.au/resources/publications/national-action-plan-for-endometriosis?language=en
      5. RANZCOG. Endometriosis: a consensus guideline. Melbourne: Royal Australian and New Zealand College of Obstetricians and Gynaecologists; 2021. At: https://ranzcog.edu.au
      6. Endometriosis Australia. About Endometriosis. 2023. At: www.endometriosisaustralia.org/about-endometriosis
      7. Armour M et al. Endometriosis and chronic pelvic pain have similar impact on women, but time to diagnosis is decreasing: an Australian survey. Sci Rep 2020. At: https://pubmed.ncbi.nlm.nih.gov/33004965/
      8. Armour M, Sinclair J, Ng CHM, et al. A biopsychosocial approach to endometriosis management. Jean Hailes for Women’s Health; 2022. At: www.jeanhailes.org.au/uploads/Webinars/2022_PPP_final-handouts.pdf
      9. European Society of Human Reproduction and Embryology. ESHRE. Guideline on endometriosis: patient leaflet. 2022. At: www.eshre.eu/Guidelines-and-Legal/Guidelines/Endometriosis-guideline
      10. Jean Hailes for Women’s Health. Endometriosis. 2024. At: www.jeanhailes.org.au/health-a-z/endometriosis
      11. Morotti M, Vincent K, Becker CM. Mechanisms of pain in endometriosis. Eur J Obstet Gynecol Reprod Biol 2017;209:8–13. 
      12. Buggio L, Armour M, Evans S, et al. Endometriosis: a review of recent evidence and guidelines. Aust J Gen Pract 2024;53(1–2):22–8. At: www1.racgp.org.au/ajgp/2024/january-february/endometriosis
      13. Rossi S, ed. Australian Medicines Handbook. 2025. Endometriosis. At: https://amhonline.amh.net.au
      14. EndoZone. Clinical and patient tools. 2025. At: www.endozone.com.au
      15. Johnson NP, Hummelshoj L, Adamson GD, et al. World Endometriosis Society consensus on the classification of endometriosis. Hum Reprod 2017;32(2):315–24. At: https://academic.oup.com/humrep/article/32/2/315/2631390?login=false#116936554
      16. Alexander M, Dydyk EC, Michael F. Stretanski, et al. Central Pain Syndrome. StatPearls. 2025. At: www.ncbi.nlm.nih.gov/books/NBK553027/
      17. National Institute for Health and Care Excellence (NICE). Endometriosis: diagnosis and management. NICE guideline NG73. London: NICE; 2024. At: www.nice.org.uk/guidance/ng73/resources/endometriosis-diagnosis-and-management-pdf-1837632548293
      18. Endometriosis News. Current status of non-invasive biomarkers for endometriosis. 2024. At: www.endonews.com/current-status-of-non-invasive-biomarkers-for-endometriosis
      19. Gupta D, Hull ML, Fraser I, et al. Endometrial biomarkers for the non-invasive diagnosis of endometriosis. Cochrane Database of Systematic Reviews 2016. Issue 4. 
      20. Proteomics International. PromarkerEndo delivers breakthrough results for endometriosis blood test. Perth: PIQ; 2024. At: ASX-PIQ-Collaboration-expanded-to-advance-Endometriosis-blood-test-251015.pdf
      21. Evans‑Hoeker E, Senapati S, Behera MA. Serum markers for endometriosis: a critical appraisal of current literature. Fertil Steri 2024;121(5):943–56.
      22. Evans S. Introduction to pelvic pain: an introduction to pelvic pain for girls, women, men and families. Pelvic Pain Foundation of Australia; 2024. At: www.pelvicpain.org.au/wp-content/uploads/2024/01/Introduction-to-Pelvic-Pain.pdf
      23. Brown J, Crawford TJ, Allen C, et al. Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database of Systematic Reviews 2017;2017(1):CD004753. At: www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004753.pub4/full
      24. Villella S. The use of complementary medicines and therapies in women's health. Jean Hailes for Women’s Health; 2022. At: www.jeanhailes.org.au/uploads/Webinars/Complementary-medicine-and-therapies
      25. Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Hum Reprod Open 2022;2022(2):hoac009. https://doi.org/10.1093/hropen/hoac009
      26. Malik A, Sinclair J, Ng CHM, et al. Complementary medicine and chronic pelvic pain in Australian women: a national cross-sectional survey. BMJ Open 2021;11:e045768. At: https://pubmed.ncbi.nlm.nih.gov/35148773/
      27. Hornstein MD. Endometriosis: long-term treatment with gonadotropin-releasing hormone agonists. In: Barbieri RL, Eckler K, editors. UpToDate. Waltham (MA): UpToDate Inc.; 2023. At: www.uptodate.com
      28. Vercellini P, Buggio L, Berlanda N, et al. Estrogen-progestins and progestins for the management of endometriosis. Fertil Steril 2016;106(7):1552–71. At: https://pubmed.ncbi.nlm.nih.gov/27817837/.
      29. Australian Government Department of Health and Aged Care. Pharmaceutical Benefits Scheme: New listings and changes – December 2024. Canberra: PBS; 2024. www.pbs.gov.au
      30. Veth VB, van der Karr MM, Duffy JM, et al. Gonadotropin-releasing hormone analogues for endometriosis. Cochrane Database of Systematic Reviews 2023;6(6).
      31. Australian Commission on Safety and Quality in Health Care. Person-centred care: a toolkit for implementation. Sydney: ACSQHC; 2020.
      32. Australian Government Department of Health and Aged Care. Budget 2025–26: Women’s Health Package. 2025. At: Budget 2025–⁠26: Strengthening Medicare – Women's health | Australian Government Department of Health, Disability and Ageing
      33. Ferrero S, Evangelisti G, Barra F. Current and emerging treatment options for endometriosis. Expert Opin Pharmacother 2018;19(10):1109–25. At: https://pubmed.ncbi.nlm.nih.gov/29975553/
      34. Endometriosis Australia. Patient stories (2023). At: https://endometriosisaustralia.org/category/endo-stories/
      35. QENDO. About Us. 2025. At: https://www.qendo.org.au/

      Our author

      Erin Downey (she/her) BPharm, GCertDiabEd, CDE, MPS CredPharm (MMR), ANZCAP-Reg (Endo, Generalist) is a clinical pharmacist, credentialled diabetes educator, endocrinology and generalist ANZCAP registrar, practising hospital pharmacist, and private CDE/credentialled MMR pharmacist in Southern Tasmania. 

      Our reviewer

      Elke Smith (she/her) BPharm, MHlthMgt [post_title] => Endometriosis: More than just a bad period [post_excerpt] => Endometriosis is a chronic inflammatory condition which affects 10–15% of all reproductive-aged Australians who were assigned female at birth. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => endometriosis-more-than-just-a-bad-period-cpd [to_ping] => [pinged] => [post_modified] => 2026-02-06 10:09:22 [post_modified_gmt] => 2026-02-05 23:09:22 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=31273 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Endometriosis: More than just a bad period [title] => Endometriosis: More than just a bad period [href] => https://www.australianpharmacist.com.au/endometriosis-more-than-just-a-bad-period-cpd/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( [td_post_template] => single_template_4 ) [is_review:protected] => [post_thumb_id:protected] => 31300 [authorType] => )

      Endometriosis: More than just a bad period

      PBAC
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                  [post_content] => New Pharmaceutical Benefits Advisory Committee (PBAC) recommendations could significantly change who can access funded COVID-19 and RSV vaccines.
      
      At its December 2025 meeting, PBAC considered applications for funding COVID-19 vaccines and RSV vaccines on the National Immunisation Program (NIP). While both recommendations were positive, how would they apply in practice?
      

      Smaller cohort recommended for COVID-19 vaccine eligibility

      PBAC recommended significantly tighter eligibility criteria for COVID-19 vaccines going forward. The National COVID-19 Vaccination Program – including the community pharmacy program is scheduled to end on 30 June 2026. While no announcements have yet been made, the PBAC outcomes signal COVID-19 vaccination will be incorporated into the NIP. PBAC recommendation is an important step to enable this NIP listing. PBAC considered a proposal to fund Pfizer’s Comirnaty COVID-19 vaccines in a smaller population cohort. The proposal has been supported by PBAC, recommending NIP funding for four cohorts of adults as requested by Pfizer, the product sponsor.

      Who would be eligible for funded COVID-19 vaccination?

      For current and future Comirnaty COVID-19 vaccines, PBAC’s recommendation supports NIP funding in specific age and risk groups only. Under this framework, NIP-funded doses would only be available for patients who are:
      • 75 years and over (two doses per year)
      • 65–74 years (one dose per year)
      • 18–64 years with severe immunocompromise (one dose per year)
      • Aboriginal and Torres Strait Islander peoples aged 50–74 years (one dose per year).
      Patients outside these groups would not be eligible for NIP-funded COVID-19 vaccination, including healthy adults aged 18–64 years, children, and Aboriginal and Torres Strait Islander peoples under 50 who do not meet the high-risk criteria. The proposed dosing schedule reflects an endemic management approach, with annual vaccination for most eligible groups. ‘PBAC noted the requested populations and doses were based on updated advice from the Australian Technical Advisory Group on Immunisation (ATAGI),’ the committee said. ‘This is a smaller group than current arrangements under the National COVID-19 Vaccination Program (NCVP).’

      What did PBAC recommend for RSV vaccination on the NIP?

      PBAC considered a submission from GSK to fund their RSV vaccine Arexvy on the NIP for prevention of RSV-related lower respiratory tract disease in at-risk adults susceptible to severe complications. The recommendation supports funded access for the Arexvy RSV vaccine for:
      • adults aged 75 years and over
      • Aboriginal and Torres Strait Islander peoples aged 60–74 years.
      If adopted, this would see two additional population cohorts currently recommended for RSV vaccination by the Australian Immunisation Handbook able to access the vaccine free-of-charge on the NIP. However, the recommendation does not extend to all people currently recommended for RSV vaccination – such as adults aged 60–74 years who have medical conditions which increase their risk of severe RSV disease. PBAC also confirmed that one dose of Arexvy is considered equivalent to one dose of Pfizer’s Abrysvo vaccine under the proposed NIP listing. The proposed NIP listing would still involve a substantial cost to government, even after revised assumptions and a price reduction. However, the committee considered the sponsor’s updated cost inputs acceptable and concluded the vaccine was cost-effective in the proposed populations. PBAC also noted that no new clinical evidence had been submitted, but that revised pricing and cost data supported its previous conclusions on clinical benefit and value for money. ‘Consistent with previous advice, PBAC considered there is a high clinical need for vaccines, such as Arexvy, to reduce the risk of RSV in adults,’ the committee said.

      When would these changes take effect?

      There’s no clear timeframe. PBAC recommendations for vaccines require price negotiation, government approval, procurement and regulatory listing to become funded on the NIP.

      Given the expiry of COVID-19 immunisation program funding, 1 July 2026 could be a potential implementation date for the COVID-19 NIP funding. Current COVID-19 vaccine program eligibility is based on ATAGI advice, so changes could happen at any time ATAGI chooses to provide updated advice.

      And as for patients asking when the RSV vaccine may be funded on the NIP? They probably could be encouraged to keep their eye on the TV news for any future announcements!

      Upskill in vaccination administration and legislation by visiting the PSA Vaccination (immunisation) Education Hub. [post_title] => PBAC recommends new NIP adult vaccine listings [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => pbac-recommends-new-nip-adult-vaccine-listings [to_ping] => [pinged] => [post_modified] => 2026-02-04 15:42:54 [post_modified_gmt] => 2026-02-04 04:42:54 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=31280 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => PBAC recommends new NIP adult vaccine listings [title] => PBAC recommends new NIP adult vaccine listings [href] => https://www.australianpharmacist.com.au/pbac-recommends-new-nip-adult-vaccine-listings/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 31282 [authorType] => )

      PBAC recommends new NIP adult vaccine listings

      poisons information
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                  [post_content] => Genevieve Adamo MPS did not set out to work in poisons information. After beginning her career in community pharmacy as an assistant pharmacist and progressing into management, Ms Adamo joined the New South Wales Poisons Information Centre in 2004. 
      
      ‘I sort of fell into poisons,’ she said. ‘After having a few children, I had some time off and wanted to do something where I was learning again.’
      
      Each call is different, providing a continuous learning opportunity, said Ms Adamo, who took on a role with the National Poisons Register in 2023.
      
      ‘You don’t know what you’re going to get at the end of the phone when you pick it up,’ she added.
      
      Because so many of the calls to the poisons centre related to medicines poisoning, whether overdoses or errors, being a pharmacist is a distinct advantage.
      
      ‘We have really extensive knowledge of the drugs, as well as a really good base in physiology and pharmacology,’ Ms Adamo said.
      
      [caption id="attachment_18818" align="aligncenter" width="600"] Genevieve Adamo MPS (Image: Steve Christo Photography)[/caption]
      
      Here, she outlines what’s needed to enter and flourish in the space, as told to delegates at PSA’s Voices of Pharmacy – Passion, Purpose and Possibility webinar, held on 26 November 2025.
      

      Core skills for poisons information practice

      Poisons information demands a distinct skill set, combining deep scientific knowledge with the ability to work confidently under pressure. Calls are often urgent, information may be incomplete and decisions must be made quickly. ‘Every call provides a clinical problem that you’ve got to solve. Many of which there’s no clear answer,’ Ms Adamo said. ‘And we can't always look something up in a reference [because] not everything is listed there.’ Because it’s neither ethical nor feasible to conduct controlled trials in poisoning, evidence gaps are common.  ‘We can’t go and poison a whole lot of people to create clinical trials to find the answers for poisoning questions. We have to wait until these situations happen and then turn those into research themselves,’ she said. ‘So because of that, we often have to go back to basics, and use those pharmacology principles we learned way back in uni.’ This includes:
      • thinking about what chemical the patient has been exposed to and how it will impact normal physiology
      • what response the body could have
      • how the potential risks can be minimised. 
      Equally important is the ability to tolerate, or even be ‘excited by’, uncertainty.  ‘If you’re somebody who gets terrified by the fact that you can’t find an answer, this is not the job for you,’ Ms Adamo said. ‘There’s a lot of unknown … That’s what makes it challenging and interesting.’ While communication skills are important for all pharmacists, they are particularly pertinent in poisons information. Because advice is delivered remotely, pharmacists must rely entirely on what they hear over the phone. ‘We don’t see the patients, we’re only hearing them,’ she said. ‘So we must be really good at listening and at receptive communication.’ Calls often begin with anxiety rather than a clear clinical question. So allowing callers to fully explain the event is central to safe and effective care. ‘I’ll often start a call by saying, “Just tell me what happened,” and listen until they finish talking,’ she said. ‘That helps them feel heard and validated, and then they’re more likely to listen to the advice I give.’ The pace of work adds further pressure. Average call times are short, requiring pharmacists to rapidly gather information, consult resources where possible and provide clear guidance. ‘You’ve got to get all the history, work out what you know, look things up and provide advice all within about 5 minutes,’ Ms Adamo said.

      Building the right foundation

      Because poisons information pharmacy has no formal training pathway, pharmacists interested in the field should build relevant knowledge and exposure well before applying. ‘What we would look for would be a minimum of 3 years experience as a pharmacist, and ideally a combination of community and hospital pharmacy,’ Ms Adamo said. ‘Community brings a lot of skills in communication and history taking, but [the role] is very clinical, so having that hospital knowledge is also important.’ One of the most important resources is Therapeutic Guidelines, which supports much of the clinical advice provided by poisons centres. ‘There’s a Therapeutic Guideline for toxicology and toxinology,’ she said. ‘We use that a lot, so having a good understanding of it is really beneficial.’ With many calls related to exposures that occur in domestic settings, familiarity with over-the-counter products and household chemicals is also essential.  ‘I often tell new staff to go and check out the cleaning aisle,’ Ms Adamo said. ‘It’s really hard to give advice on household poisons if you don’t know what any of them are.’

      From individual cases to national policy

      While providing advice over the phone is the most visible aspect of poisons information, there’s much more to the role.  Poisons centres play a critical role in generating real-world evidence, with calls providing a continuous stream of data that can be analysed to identify new risks or changing patterns of exposure.
      ‘You’ve got to get all the history, work out what you know, look things up and provide advice all within about 5 minutes.' Genevieve Adamo MPS
      ‘We all have the ability to be involved in research, because we're recruiting patients through our calls,’ Ms Adamo said. ‘Our staff also create new guidelines for education and training, supporting both external poisoning prevention initiatives and the ongoing training of new and existing staff.’ Another major function is toxicovigilance – the systematic monitoring of poisoning trends with a focus on prevention and risk reduction. ‘That can involve all sorts of things [including] media and education,’ she said. ‘There’s often a lot of number crunching as well, and then working with regulators to change the laws to restrict access, because we know that one of the best ways to minimise harm and exposures is to restrict access.’ A key scheduling change Ms Adamo and her team were involved in was the changes to paracetamol regulations that were ushered in early last year. ‘We were contracted by the TGA to collect extra information about all the paracetamol calls we got,’ Ms Adamo said. ‘Paracetamol calls are the most common call to the poison centre every year, and all of that information was collated by our Head of Research and our consultant toxicologists – with the report used as the basis for the proposed scheduling changes that occurred.’ Sometimes individual cases can lead to broader system change. ‘I was involved in a case with a mum whose little one got really sick, and it was eventually worked out that it was a chronic choline salicylate toxicity,’ she said. ‘She couldn’t believe she’d been giving this poison to her kid and didn’t realise it was poisonous, because she bought it from [a supermarket] and thought it must be safe.’  In response, Adamo submitted an application to reschedule choline salicylate to Schedule 2. ‘Now it has to have more labelling, and it can only be available in a pharmacy,’ she said. ‘Those are the really interesting and rewarding aspects of poisoning work.’ For pharmacists considering the field, Ms Adamo believes the appeal lies in its tangible public health impact – shaping national safety standards and preventing future harm, particularly among children. ‘You know the work you’re doing actually changes outcomes.’ Read PSA’s Medicine Safety: Child and adolescent care report to understand the key poisoning risks and how pharmacists can help mitigate them. [post_title] => How pharmacists can prepare for poisons information roles [post_excerpt] => Poisons information pharmacists turn individual calls into population-level insights that inform regulatory and scheduling decisions. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => how-pharmacists-can-prepare-for-poisons-information-roles [to_ping] => [pinged] => [post_modified] => 2026-02-02 18:25:34 [post_modified_gmt] => 2026-02-02 07:25:34 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=31254 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => How pharmacists can prepare for poisons information roles [title] => How pharmacists can prepare for poisons information roles [href] => https://www.australianpharmacist.com.au/how-pharmacists-can-prepare-for-poisons-information-roles/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 31258 [authorType] => )

      How pharmacists can prepare for poisons information roles

      Early career pharmacist
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                  [post_content] => 

      Victoria Chisari MPS is an early career pharmacist and researcher on the move, working across clinical areas of practice to hone her skills.

      What’s beneficial about learning different specialties in pharmacy?

      Each specialty offers a unique focus, with the learning from each area building upon the others to create a comprehensive understanding of clinical pharmacy service delivery.

      I am currently a clinical pharmacist with Western Sydney Local Health District and a research team member and practice change facilitator at the University of Technology Sydney. But I have worked in many different clinical roles. My experience in the intensive care unit, for example, helped develop my ability to review acutely unwell patients – including those with infections, trauma, respiratory failure and organ failure.

      In this setting, I managed a diverse range of critically ill patients with complex medicines regimens – involving supportive therapies such as inotropes and vasopressors, sedation and antimicrobials.

      My practice involved designing individualised treatment plans for patients, particularly those receiving extracorporeal therapies such as renal replacement therapy and extracorporeal membrane oxygenation.

      This background informed my practice in the emergency department, where sound clinical reasoning was vital to delivering effective advice and interventions in fast-paced, high- pressure situations.

      Can you describe your global research review of pharmacist-prescribed contraception services?

      In response to barriers accessing contraception, such as the need for a prescription, pharmacist-prescribed contraception has been widely implemented and one common model of care delivers this service using clinical protocols. The review highlighted that the overall scope of these services includes both the prescribing (initiating) and continuation of various contraceptive methods, such as oral contraceptive pills, vaginal rings, transdermal patches and injections. A key finding was that the scope of practice varies internationally, depending on local authorisation and regulatory frameworks.

      It was recognised that while conceptually, the clinical protocol is one part of the intervention, education is another important part of the overall provision of care.

      This includes recognition of the importance of both foundational education and additional training for pharmacists.

      It was evident that authorising pharmacists to prescribe and continue a range of contraception options ultimately offers the best access for women.

      At the same time, pharmacist education and training is an important part of the broader piece in pharmacist prescribing – particularly in the current Australian context, as pharmacist prescribing continues to develop and expand.

      Your advice for other early ECPs interested in clinical pharmacy?

      Seek out opportunities to broaden your knowledge and skills.

      If you’re a pharmacy student or ECP interested in hospital pharmacy, look for courses, mentorship programs and professional development opportunities that align with your goals.

      Hospital pharmacy is dynamic, exciting and rewarding – there’s a lot to learn and a lot that we as pharmacists can contribute to.

      Ask questions and say yes to challenges that push you to grow. Be curious, be kind and keep learning. 

      [post_title] => Expanding clinical judgement beyond a single specialty [post_excerpt] => Victoria Chisari MPS is an early career pharmacist and researcher on the move, working across clinical areas of practice to hone her skills. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => expanding-clinical-judgement-beyond-a-single-specialty [to_ping] => [pinged] => [post_modified] => 2026-02-02 18:25:57 [post_modified_gmt] => 2026-02-02 07:25:57 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=31248 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Expanding clinical judgement beyond a single specialty [title] => Expanding clinical judgement beyond a single specialty [href] => https://www.australianpharmacist.com.au/expanding-clinical-judgement-beyond-a-single-specialty/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 31253 [authorType] => )

      Expanding clinical judgement beyond a single specialty

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                  [post_content] => Australia's Minister for Health has announced a National Medicines Record. What is it, and what will it achieve?
      
      Medicine safety has long depended on pharmacists making critical decisions with incomplete information. As prescribing becomes increasingly fragmented across face-to-face care, telehealth and digital platforms, those gaps are widening – with serious consequences for patients. 
      
      Reforms announced by Minister for Health and Ageing Mark Butler this morning aim to address this issue, eventually leading to a National Medicines Record. 
      
      The announcement follows advocacy by Alison Collins after the death of her daughter Erin, who died in 2024 after being prescribed medicines through multiple digital health platforms without a complete view of her medical history.
      

      Erin’s story

      Erin was 24 years old and had been taking multiple medicines for her mental health. She had been hospitalised multiple times for problems stemming from medicine misuse and was placed on daily staged supply pickup of her medicines.  The hospital care teams were so concerned they placed multiple warning messages in her My Health Record. However, these warnings were not accessed by telehealth services or local pharmacies prior to her fatal overdose. Erin’s case highlighted systemic vulnerabilities that pharmacists have warned about for years, particularly as digital prescribing expands faster than the safeguards designed to support safe, coordinated care.

      The first step

      Initially, the reforms would require all medicines information from online prescribers to be uploaded to My Health Record For pharmacists, this will make a fuller picture of all the medicines a patient has been prescribed more visible. This is critical given the increasing number of prescribers an individual may have with the rise of telehealth and condition-specific providers.  Under the proposed changes, medicines prescribed and dispensed through online platforms – including the clinical context for prescribing – would be made available through My Health Record. This is intended to help reduce the risk of medicine  errors, adverse drug reactions and inappropriate use by ensuring healthcare professionals have access to more complete and timely information.

      The path to a National Medicines Record

      The reforms also commit the Government to designing and developing a National Medicines Record using existing digital health infrastructure, including electronic prescribing, the Active Script List and My Health Record.  While details are still emerging, the proposal has the potential to address a core challenge for pharmacists: how to identify and resolve medicines-related risks without a reliable, up-to-date picture of a patient’s full medicines history. Welcoming the announcement, PSA National President Professor Mark Naunton MPS noted it aligns with the profession's long standing advocacy. 'Pharmacists have consistently sought better-connected digital health systems to improve patient safety with medicines. It’s something PSA has been advocating for over many years, including through our flagship medicine safety report series,” Prof. Naunton said. 'Access to a more complete and reliable medicines record has the potential to significantly improve patient safety and strengthen clinical decision-making.' 'The announcement is fully aligned with PSA’s ongoing advocacy to improve medicines safety systems and ensure pharmacists are supported as medicines experts across all settings of care,' he continued. 'PSA will engage in the consultation for these proposals and continue to work with the Government to support system improvements that make medicine use in Australia safer.' A consultation period is now underway to guide the inclusion of medicines information from all online prescribers by default, with the first phase expected to be completed by December 2026. The Government has also flagged ongoing enhancements to the 1800MEDICARE app to support medicines management. [post_title] => What a National Medicines Record might mean for patient safety and pharmacy practice [post_excerpt] => Australia's Minister for Health has announced a National Medicines Record. What is it, and what will it achieve? [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => towards-a-national-medicines-record [to_ping] => [pinged] => [post_modified] => 2026-01-30 16:02:41 [post_modified_gmt] => 2026-01-30 05:02:41 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=31238 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => What a National Medicines Record might mean for patient safety and pharmacy practice [title] => What a National Medicines Record might mean for patient safety and pharmacy practice [href] => https://www.australianpharmacist.com.au/towards-a-national-medicines-record/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 31240 [authorType] => )

      What a National Medicines Record might mean for patient safety and…

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      Case scenario

      Alicia, 27, visits your pharmacy regularly for naproxen and heat patches to manage period pain. She confides that her pain has worsened over the past 2 years, radiates down her legs, interferes with work and affects intimacy.  Her periods are heavy, lasting around 9 days, and leave her feeling exhausted and sometimes even bedridden. Alicia has seen several GPs, who told her it was ‘normal for your age’. She says, ‘It feels like someone’s wringing out my insides – nothing helps much. Is this really normal?’

      Learning objectives

      After reading this article, pharmacists should be able to:
      • Describe the epidemiology, aetiology and pathophysiology of endometriosis
      • Identify key clinical features, risk factors and diagnostic considerations
      • Discuss pharmacological and non-pharmacological management options for endometriosis
      • Explain the pharmacist’s role in supporting patients with endometriosis through education, referral and holistic care.
      Competency standards (2016) addressed: 1.1, 1.4, 1.5, 2.2, 3.1, 3.5 Accreditation number: CAP2602DMED  Accreditation expiry: 31/01/2029 
      Already read the CPD in the journal? Scroll to the bottom to SUBMIT ANSWERS.

      Introduction

      Endometriosis is a chronic inflammatory condition characterised by the growth of endometrial-like tissue outside the uterus, commonly affecting the ovaries, fallopian tubes and pelvic peritoneum.1,2 It affects 10–15% of all reproductive-aged Australians who were assigned female at birth, and 70% of females with chronic pelvic pain.3 Yet it remains underdiagnosed, underfunded and often misunderstood. Symptoms such as pelvic pain, heavy periods, fatigue and infertility can significantly affect quality of life. Pharmacists, often the first point of contact for pain management and self-care advice, play an important role in recognising potential endometriosis, supporting early referral and helping patients navigate ongoing treatment.

      Epidemiology

      An estimated 1 in 7 females in Australia are currently living with endometriosis.4-6 Onset often begins in adolescence, yet diagnosis is delayed on average by 7–10 years,1,3,7 influenced by menstrual pain normalisation, stigma, and misdiagnosis as irritable bowel syndrome (IBS) or anxiety.1,3,4,7,8 The consequences of these delays extend beyond physical health, affecting fertility, education, relationships and employment, and increasing the likelihood of depression, anxiety and social withdrawal.6,9,10

      Aetiology and pathophysiology

      The pathogenesis of endometriosis is multifactorial. The leading theory is retrograde menstruation, where menstrual blood flows backwards through the fallopian tubes into the pelvic cavity, allowing endometrial cells to implant and grow outside the uterus.2,11 Other contributing mechanisms include2,5,11,12:
      • immune dysfunction
      • coelomic metaplasia (peritoneal cell transformation)
      • genetic predisposition
      • hormonal imbalances 
      • environmental triggers.

      Clinical features  

      Endometriosis occurs when hormonally responsive lesions develop on the ovaries, bowel, bladder, peritoneum, or other pelvic and abdominal structures.1,5,9,13,14 These lesions respond to oestrogen and undergo cyclical changes similar to the endometrial lining, which can trigger inflammation, bleeding, scarring and adhesions. This may lead to chronic pain, organ dysfunction and infertility. Importantly, symptom severity does not always correlate with the number or extent of lesions and may fluctuate with hormonal changes.8,12 Risk factors While the exact cause of endometriosis is unclear, certain factors increase the likelihood of developing the condition1,9,13,14:
      • early menarche
      • short menstrual cycles (<27 days)
      • heavy/prolonged periods
      • nulliparity
      • family history of endometriosis
      • low BMI.
      Clinical presentation1,5,9,13,14 Pharmacists should consider endometriosis in individuals presenting with2,7,8,11,12:
      • moderate-severe dysmenorrhoea 
      • chronic pelvic pain (cyclical or constant)
      • persistent or recurrent pain associated with sexual intercourse (dyspareunia) 
      • menstrual bowel/bladder pain 
      • fatigue, lethargy, irritability
      • bloating
      • painful or altered bowel movements, particularly around the time of menstruation (dyschezia)
      • abnormally heavy or prolonged menstrual bleeding (menorrhagia) or irregular cycles 
      • infertility/conception delays.
      Classification No universally agreed classification exists, though the American Society of Reproductive Medicine (ASRM) system is commonly used15:
      • Stage I (minimal): few superficial implants.
      • Stage II (mild): more, deep implants.
      • Stage III (moderate): many deep implants; filmy adhesions may be present.
      • Stage IV (severe): many deep implants, many dense adhesions.
      Pain mechanisms and central sensitisation Central sensitisation refers to heightened nervous system responsiveness, causing persistent, widespread pain even after lesion removal.16 This can manifest as pelvic floor dysfunction, visceral hypersensitivity, and fatigue, and often overlaps with conditions such as irritable bowel syndrome or bladder pain syndrome.11 Supporting patients involves validating their pain experiences, even when imaging is normal or lesions appear minimal.

      Diagnosis and differential diagnosis 

      Diagnosis of endometriosis is often significantly delayed, with an average lag of 7–10 years from symptom onset.3,7,17 These delays are influenced by multiple systemic and social factors, including1,7,9,17:
      • normalisation of menstrual pain
      • dismissal of symptoms, particularly in adolescents and people of colour
      • lack of rural/remote access to gynaecology services 
      • under-recognition of symptoms in trans, non-binary and gender-diverse individuals
      • cost barriers to imaging, specialist care and private laparoscopies.
      Endometriosis shares symptoms with several other conditions, making diagnosis difficult. Differential diagnoses include IBS, pelvic inflammatory disease, adenomyosis, interstitial cystitis, depression and anxiety.12 Current diagnostic approaches While laparoscopy remains the gold standard, Australian guidelines now support symptom-based clinical diagnosis to reduce delays and improve care.3,7,17 Imaging tools such as transvaginal ultrasound can identify ovarian endometriotic cysts, but a normal ultrasound or MRI does not rule out disease – especially in early-stage or superficial cases. Patients should therefore be encouraged to pursue further care if symptoms significantly impact quality of life.3 Emerging diagnostic tools To address diagnostic challenges, ongoing research is focused on earlier, less invasive detection.4 Emerging approaches include blood-based biomarkers (e.g. proteomic panels, metabolomic profiling, microRNA and menstrual-fluid analysis),18-21 as well as advanced imaging techniques such as transvaginal ultrasound and MRI, which may help reduce reliance on laparoscopy and accelerate accurate diagnosis.3,7,17 When it’s not endometriosis: validating pelvic pain without a diagnosis Pelvic pain affects up to 1 in 4 people assigned female at birth and has many possible causes – endometriosis being only one of them.7,11,22,23 For some, extensive investigations such as imaging or laparoscopy reveal no abnormalities, which can leave patients feeling dismissed, confused or invalidated. Pharmacists can help by acknowledging that pain is real and deserving of care, even in the absence of a definitive diagnosis. Symptom management is the first-line approach for both endometriosis and chronic pelvic pain, and care should aim to improve daily function and quality of life regardless of diagnostic certainty.3 Where appropriate, pharmacists can also support referral to other healthcare providers for further assessment or multidisciplinary management. Although endometriosis itself is not curable, symptoms and recurrences can be effectively managed through person-centred care that considers physical, emotional and reproductive health needs.8

      Management approaches 

      Non-pharmacological treatment  Current treatment is focused on symptom control, rather than elimination of the disease. Non-pharmacological approaches form an essential part of care, particularly for patients who experience persistent pain or treatment adverse effects. Key strategies include8,13,24:
      • pelvic physiotherapy and psychotherapy (e.g. cognitive behavioural therapy [CBT], acceptance and commitment therapy [ACT])
      • heat therapy, TENS and mindfulness-based movement (e.g. yoga, Pilates)
      • anti-inflammatory or low-FODMAP diets, particularly for patients with co-existing irritable bowel syndrome.
      Mental health and emotional wellbeing Chronic pain is both physically and psychologically exhausting. Anxiety and depression rates are significantly higher in people with endometriosis than in the general population.7 Contributing factors include3,5,6,8,10,12,14,25:
      • diagnostic delays and invalidation of symptoms 
      • chronic fatigue and disrupted sleep
      • missed school or work
      • sexual dysfunction and relationship strain
      • fertility concerns or trauma from medical procedures.
      Pharmacists can play an important role in recognising distress and prompting early mental health support. Simple, empathetic questions – such as ‘How’s your sleep been lately?’ or ‘Is the pain affecting your mood?’ – can open conversations and guide appropriate referrals. Support strategies include:
      • recommending mental health care plans via GPs
      • referring to psychologists with chronic pain expertise or interdisciplinary pain teams
      • encouraging peer support groups (e.g. EndoActive, Endometriosis Australia, QENDO)
      • suggesting low-stigma mental health apps (e.g. MindSpot, Smiling Mind)
      • avoiding statements that minimise pain (e.g. ‘it’s just anxiety’) and instead validating the complex relationship between mood and pain.
      Complementary therapies  Patients may enquire about supplements or alternative therapies. Pharmacists should validate interest while clarifying the limited evidence and screening for interactions. Commonly explored options include magnesium, omega-3 fatty acids, turmeric (curcumin), vitex agnus-castus, zinc, vitamin B6, diindolylmethane (DIM) and acupuncture.22,24,26

      Pharmacological treatment 

      Analgesia
      • NSAIDs (e.g. naproxen 500 mg twice daily or ibuprofen 400 mg three times daily) are first line. 
      • Paracetamol may be added for multimodal relief.1,12,13
      Counselling should cover dosing, GI protection and review of OTC combinations (e.g. ibuprofen/paracetamol). Hormonal therapies Hormonal therapies suppress oestrogen-driven growth and reduce pain.11,12,13,27,28 Table 1 provides an overview of commonly used hormonal therapies in endometriosis management. Add-back therapy Treatment with gonadotrophin-releasing hormone (GnRH) analogues induces a temporary, reversible menopause to suppress oestrogen production and reduce endometriosis symptoms.30 However, this hypo-estrogenic state can cause side effects such as vasomotor symptoms, vaginal dryness and bone mineral density loss.30 Add-back therapy involves giving small ‘add-back’ doses of oestrogen, progestogen, or a combination of both, to counteract these effects while maintaining the efficacy of GnRH analogue treatment.13,28 Options include1,12,13,27: 
      • Continuous combined HRT – low-dose estrogen + progestogen. Use in patients with a uterus to protect the endometrium.
      • Sequential combined HRT – estrogen daily + cyclical progestogen. Less preferred, as cyclical hormones may worsen endometriosis symptoms.
      • Progestogen-only – continuous progestogen. Used when estrogen contraindicated.
      • Tibolone – synthetic steroid: estrogenic, progestogenic, and androgenic activity. Often used post-menopause; caution in estrogen-sensitive conditions.
      For add-back therapy, ensure to: 
      • use continuous regimens (not cyclical) to avoid stimulating endometriotic tissue
      • monitor BMD regularly if GnRH therapy continues >6 months
      • start add-back therapy generally at the same time as the GnRH analogue.
      Fertility considerations Up to half of people with endometriosis experience fertility issues, and pain suppression does not necessarily improve fertility.2,3,6,12 Pharmacists can:
      • counsel on hormonal therapy effects on ovulation 
      • encourage early specialist referral if conception delayed >12 months
      • support patients undergoing IVF or assisted reproductive treatment 
      • provide reassurance and empathy around fertility-related distress. 
      Table 1 – Overview of hormonal therapies for endometriosis References: Therapeutic Guidelines1, Buggio et al12, Rossi13 Hornstein26, Vercellini27 Note: Bone mineral density typically recovers within two years of cessation of GnRH therapies.27 Drospirenone currently off-label for endometriosis in Australia.1 The addition of Ryeqo (relugolix, estradiol, norethisterone) (July 2022) and Visanne (dienogest) (December 2024) to the PBS expands accessible hormonal therapy options for endometriosis.29

      The role of the pharmacist in endometriosis care

      Pharmacists play a vital role in improving care for people with endometriosis by addressing barriers through education, advocacy and person-centred support. Key strategies include1,5,8,12:
      • using inclusive language and avoiding assumptions about gender identity or reproductive goals
      • proactively exploring the impact of symptoms on daily life, including school, work and relationships
      • offering accessible symptom-tracking tools to support self-monitoring
      • referring patients to culturally safe services, including First Nations-specific clinics when appropriate
      • advocating for patients and providing education to dispel misconceptions about endometriosis.
      Given the impact of endometriosis on mental health, it is essential for pharmacists to use affirmative language that validates the patient’s experience.  For example, acknowledging that a patient’s pain is real fosters trust, signals active listening and supports collaborative care. Avoiding dismissive statements such as ‘pain is normal for women’ is crucial, as these can reinforce shame and self-doubt, and discourage timely help-seeking.10,14,31 Pharmacists are integral members of multidisciplinary teams managing endometriosis. They facilitate early identification and timely referrals to general practitioners, specialists, pelvic physiotherapists, psychologists and dietitians. The upcoming Endometriosis Management Plan (EMP), a digital clinical tool launching in 2026, is designed to enhance care coordination, streamline documentation, and align treatment goals across providers.4,32 Pharmacists can support EMP implementation through patient counselling, comprehensive medicines reviews and ongoing follow-up.  Pharmacists are also well-positioned to assist patients in navigating newly established specialist clinics funded under the 2025–26 federal health budget.4,32 Home Medicines Reviews (HMRs) can further optimise medicines management and should be actively recommended as part of a comprehensive care strategy. Pharmacists can support shared decision-making by explaining treatment mechanisms, expected onset of action and common adverse effects, helping patients make informed choices.

      Patient resources  

      Pharmacist follow-up and recommendations of patient support resources are beneficial for ongoing management. These include10,12,25,33:
      • inviting patients to check in monthly during early therapy
      • reassessing symptoms, tolerance and goals
      • encouraging use of symptom tracker apps to record symptoms, menstrual changes and evaluate therapy success (e.g. Phendo, Clue, EndoMeter)
      • referring to organisations for education/peer support
      • recommending organisations6,9,10,14,23,34,35:
        • Endometriosis Australia – advocacy/awareness
        • Jean Hailes for Women’s Health – tools/info
        • Pelvic Pain Foundation of Australia – clinician and patient info
        • QENDO – peer support, lived experience, free tracking app
        • EndoZone – clinical decision support, patient-friendly explanations
        • ESHRE patient leaflet – print-friendly patient information.

      Knowledge to practice 

      Pharmacists in primary care can support people with endometriosis by providing early recognition of symptom impact, guidance on medicines and symptom management, and facilitating timely referrals to appropriate healthcare providers.  Pharmacists play a key role in validating patient experiences, promoting self-monitoring through symptom-tracking tools, explaining treatment options and adverse effects, and encouraging engagement with multidisciplinary care.  Pharmacists should also advocate for patients and provide education to dispel misconceptions, helping reduce delays in diagnosis and improving overall quality of care.

      Conclusion

      Endometriosis is far more than painful periods – it’s a complex, chronic condition requiring interdisciplinary, person-centred care. Pharmacists can make a profound difference by recognising early signs, validating lived experience, supporting evidence-based management and facilitating timely referral. Even a single empathetic conversation can empower a patient to seek help and change the trajectory of their care.

      Case scenario continued

      You reassure Alicia that severe period pain is not something she has to accept and suggest tracking her symptoms with a menstrual diary and consulting a women’s health GP. You also provide advice on safe NSAID use and non-pharmacological strategies. Alicia returns 2 months later, now diagnosed with endometriosis and receiving hormonal therapy and pelvic physiotherapy. She continues to experience chronic pelvic pain and questions her medicines, so you organise a Home Medicines Review, identifying potential naproxen overuse and interactions with her sertraline, prompting treatment adjustments. You also recommend a local endometriosis support group, which Alicia joins, and she has since referred two friends with similar symptoms. Through ongoing support, she feels more empowered to manage her condition.
        [cpd_submit_answer_button]

      Key points

      • Lesion severity does not predict pain intensity.
      • Recognise red flags (e.g. cyclical pain, GI symptoms) and enact early referral.
      • Support interdisciplinary, patient-centred management.
      • Review safety, adherence and contraceptive actions of hormonal therapy.
      • Use inclusive, supportive language to reduce stigma and diagnostic delay.
      • Encourage treatment continuity and shared decision-making.

      References

      References 
      1. Therapeutic Guidelines Limited. Endometriosis. In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2024. At: www.tg.org.au.
      2. Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril 2012;98(3):511–9. At: https://pubmed.ncbi.nlm.nih.gov/22819144/
      3. Parasar P, Ozcan P, Terry KL. Endometriosis: epidemiology, diagnosis and clinical management. Curr Obstet Gynecol Rep 2017;6(1):34–41. At: https://pubmed.ncbi.nlm.nih.gov/29276652/
      4. Australian Government Department of Health and Aged Care. National Action Plan for Endometriosis. Canberra: Department of Health; 2018. At: https://www.health.gov.au/resources/publications/national-action-plan-for-endometriosis?language=en
      5. RANZCOG. Endometriosis: a consensus guideline. Melbourne: Royal Australian and New Zealand College of Obstetricians and Gynaecologists; 2021. At: https://ranzcog.edu.au
      6. Endometriosis Australia. About Endometriosis. 2023. At: www.endometriosisaustralia.org/about-endometriosis
      7. Armour M et al. Endometriosis and chronic pelvic pain have similar impact on women, but time to diagnosis is decreasing: an Australian survey. Sci Rep 2020. At: https://pubmed.ncbi.nlm.nih.gov/33004965/
      8. Armour M, Sinclair J, Ng CHM, et al. A biopsychosocial approach to endometriosis management. Jean Hailes for Women’s Health; 2022. At: www.jeanhailes.org.au/uploads/Webinars/2022_PPP_final-handouts.pdf
      9. European Society of Human Reproduction and Embryology. ESHRE. Guideline on endometriosis: patient leaflet. 2022. At: www.eshre.eu/Guidelines-and-Legal/Guidelines/Endometriosis-guideline
      10. Jean Hailes for Women’s Health. Endometriosis. 2024. At: www.jeanhailes.org.au/health-a-z/endometriosis
      11. Morotti M, Vincent K, Becker CM. Mechanisms of pain in endometriosis. Eur J Obstet Gynecol Reprod Biol 2017;209:8–13. 
      12. Buggio L, Armour M, Evans S, et al. Endometriosis: a review of recent evidence and guidelines. Aust J Gen Pract 2024;53(1–2):22–8. At: www1.racgp.org.au/ajgp/2024/january-february/endometriosis
      13. Rossi S, ed. Australian Medicines Handbook. 2025. Endometriosis. At: https://amhonline.amh.net.au
      14. EndoZone. Clinical and patient tools. 2025. At: www.endozone.com.au
      15. Johnson NP, Hummelshoj L, Adamson GD, et al. World Endometriosis Society consensus on the classification of endometriosis. Hum Reprod 2017;32(2):315–24. At: https://academic.oup.com/humrep/article/32/2/315/2631390?login=false#116936554
      16. Alexander M, Dydyk EC, Michael F. Stretanski, et al. Central Pain Syndrome. StatPearls. 2025. At: www.ncbi.nlm.nih.gov/books/NBK553027/
      17. National Institute for Health and Care Excellence (NICE). Endometriosis: diagnosis and management. NICE guideline NG73. London: NICE; 2024. At: www.nice.org.uk/guidance/ng73/resources/endometriosis-diagnosis-and-management-pdf-1837632548293
      18. Endometriosis News. Current status of non-invasive biomarkers for endometriosis. 2024. At: www.endonews.com/current-status-of-non-invasive-biomarkers-for-endometriosis
      19. Gupta D, Hull ML, Fraser I, et al. Endometrial biomarkers for the non-invasive diagnosis of endometriosis. Cochrane Database of Systematic Reviews 2016. Issue 4. 
      20. Proteomics International. PromarkerEndo delivers breakthrough results for endometriosis blood test. Perth: PIQ; 2024. At: ASX-PIQ-Collaboration-expanded-to-advance-Endometriosis-blood-test-251015.pdf
      21. Evans‑Hoeker E, Senapati S, Behera MA. Serum markers for endometriosis: a critical appraisal of current literature. Fertil Steri 2024;121(5):943–56.
      22. Evans S. Introduction to pelvic pain: an introduction to pelvic pain for girls, women, men and families. Pelvic Pain Foundation of Australia; 2024. At: www.pelvicpain.org.au/wp-content/uploads/2024/01/Introduction-to-Pelvic-Pain.pdf
      23. Brown J, Crawford TJ, Allen C, et al. Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database of Systematic Reviews 2017;2017(1):CD004753. At: www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004753.pub4/full
      24. Villella S. The use of complementary medicines and therapies in women's health. Jean Hailes for Women’s Health; 2022. At: www.jeanhailes.org.au/uploads/Webinars/Complementary-medicine-and-therapies
      25. Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Hum Reprod Open 2022;2022(2):hoac009. https://doi.org/10.1093/hropen/hoac009
      26. Malik A, Sinclair J, Ng CHM, et al. Complementary medicine and chronic pelvic pain in Australian women: a national cross-sectional survey. BMJ Open 2021;11:e045768. At: https://pubmed.ncbi.nlm.nih.gov/35148773/
      27. Hornstein MD. Endometriosis: long-term treatment with gonadotropin-releasing hormone agonists. In: Barbieri RL, Eckler K, editors. UpToDate. Waltham (MA): UpToDate Inc.; 2023. At: www.uptodate.com
      28. Vercellini P, Buggio L, Berlanda N, et al. Estrogen-progestins and progestins for the management of endometriosis. Fertil Steril 2016;106(7):1552–71. At: https://pubmed.ncbi.nlm.nih.gov/27817837/.
      29. Australian Government Department of Health and Aged Care. Pharmaceutical Benefits Scheme: New listings and changes – December 2024. Canberra: PBS; 2024. www.pbs.gov.au
      30. Veth VB, van der Karr MM, Duffy JM, et al. Gonadotropin-releasing hormone analogues for endometriosis. Cochrane Database of Systematic Reviews 2023;6(6).
      31. Australian Commission on Safety and Quality in Health Care. Person-centred care: a toolkit for implementation. Sydney: ACSQHC; 2020.
      32. Australian Government Department of Health and Aged Care. Budget 2025–26: Women’s Health Package. 2025. At: Budget 2025–⁠26: Strengthening Medicare – Women's health | Australian Government Department of Health, Disability and Ageing
      33. Ferrero S, Evangelisti G, Barra F. Current and emerging treatment options for endometriosis. Expert Opin Pharmacother 2018;19(10):1109–25. At: https://pubmed.ncbi.nlm.nih.gov/29975553/
      34. Endometriosis Australia. Patient stories (2023). At: https://endometriosisaustralia.org/category/endo-stories/
      35. QENDO. About Us. 2025. At: https://www.qendo.org.au/

      Our author

      Erin Downey (she/her) BPharm, GCertDiabEd, CDE, MPS CredPharm (MMR), ANZCAP-Reg (Endo, Generalist) is a clinical pharmacist, credentialled diabetes educator, endocrinology and generalist ANZCAP registrar, practising hospital pharmacist, and private CDE/credentialled MMR pharmacist in Southern Tasmania. 

      Our reviewer

      Elke Smith (she/her) BPharm, MHlthMgt [post_title] => Endometriosis: More than just a bad period [post_excerpt] => Endometriosis is a chronic inflammatory condition which affects 10–15% of all reproductive-aged Australians who were assigned female at birth. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => endometriosis-more-than-just-a-bad-period-cpd [to_ping] => [pinged] => [post_modified] => 2026-02-06 10:09:22 [post_modified_gmt] => 2026-02-05 23:09:22 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=31273 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Endometriosis: More than just a bad period [title] => Endometriosis: More than just a bad period [href] => https://www.australianpharmacist.com.au/endometriosis-more-than-just-a-bad-period-cpd/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( [td_post_template] => single_template_4 ) [is_review:protected] => [post_thumb_id:protected] => 31300 [authorType] => )

      Endometriosis: More than just a bad period

      PBAC
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                  [post_content] => New Pharmaceutical Benefits Advisory Committee (PBAC) recommendations could significantly change who can access funded COVID-19 and RSV vaccines.
      
      At its December 2025 meeting, PBAC considered applications for funding COVID-19 vaccines and RSV vaccines on the National Immunisation Program (NIP). While both recommendations were positive, how would they apply in practice?
      

      Smaller cohort recommended for COVID-19 vaccine eligibility

      PBAC recommended significantly tighter eligibility criteria for COVID-19 vaccines going forward. The National COVID-19 Vaccination Program – including the community pharmacy program is scheduled to end on 30 June 2026. While no announcements have yet been made, the PBAC outcomes signal COVID-19 vaccination will be incorporated into the NIP. PBAC recommendation is an important step to enable this NIP listing. PBAC considered a proposal to fund Pfizer’s Comirnaty COVID-19 vaccines in a smaller population cohort. The proposal has been supported by PBAC, recommending NIP funding for four cohorts of adults as requested by Pfizer, the product sponsor.

      Who would be eligible for funded COVID-19 vaccination?

      For current and future Comirnaty COVID-19 vaccines, PBAC’s recommendation supports NIP funding in specific age and risk groups only. Under this framework, NIP-funded doses would only be available for patients who are:
      • 75 years and over (two doses per year)
      • 65–74 years (one dose per year)
      • 18–64 years with severe immunocompromise (one dose per year)
      • Aboriginal and Torres Strait Islander peoples aged 50–74 years (one dose per year).
      Patients outside these groups would not be eligible for NIP-funded COVID-19 vaccination, including healthy adults aged 18–64 years, children, and Aboriginal and Torres Strait Islander peoples under 50 who do not meet the high-risk criteria. The proposed dosing schedule reflects an endemic management approach, with annual vaccination for most eligible groups. ‘PBAC noted the requested populations and doses were based on updated advice from the Australian Technical Advisory Group on Immunisation (ATAGI),’ the committee said. ‘This is a smaller group than current arrangements under the National COVID-19 Vaccination Program (NCVP).’

      What did PBAC recommend for RSV vaccination on the NIP?

      PBAC considered a submission from GSK to fund their RSV vaccine Arexvy on the NIP for prevention of RSV-related lower respiratory tract disease in at-risk adults susceptible to severe complications. The recommendation supports funded access for the Arexvy RSV vaccine for:
      • adults aged 75 years and over
      • Aboriginal and Torres Strait Islander peoples aged 60–74 years.
      If adopted, this would see two additional population cohorts currently recommended for RSV vaccination by the Australian Immunisation Handbook able to access the vaccine free-of-charge on the NIP. However, the recommendation does not extend to all people currently recommended for RSV vaccination – such as adults aged 60–74 years who have medical conditions which increase their risk of severe RSV disease. PBAC also confirmed that one dose of Arexvy is considered equivalent to one dose of Pfizer’s Abrysvo vaccine under the proposed NIP listing. The proposed NIP listing would still involve a substantial cost to government, even after revised assumptions and a price reduction. However, the committee considered the sponsor’s updated cost inputs acceptable and concluded the vaccine was cost-effective in the proposed populations. PBAC also noted that no new clinical evidence had been submitted, but that revised pricing and cost data supported its previous conclusions on clinical benefit and value for money. ‘Consistent with previous advice, PBAC considered there is a high clinical need for vaccines, such as Arexvy, to reduce the risk of RSV in adults,’ the committee said.

      When would these changes take effect?

      There’s no clear timeframe. PBAC recommendations for vaccines require price negotiation, government approval, procurement and regulatory listing to become funded on the NIP.

      Given the expiry of COVID-19 immunisation program funding, 1 July 2026 could be a potential implementation date for the COVID-19 NIP funding. Current COVID-19 vaccine program eligibility is based on ATAGI advice, so changes could happen at any time ATAGI chooses to provide updated advice.

      And as for patients asking when the RSV vaccine may be funded on the NIP? They probably could be encouraged to keep their eye on the TV news for any future announcements!

      Upskill in vaccination administration and legislation by visiting the PSA Vaccination (immunisation) Education Hub. [post_title] => PBAC recommends new NIP adult vaccine listings [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => pbac-recommends-new-nip-adult-vaccine-listings [to_ping] => [pinged] => [post_modified] => 2026-02-04 15:42:54 [post_modified_gmt] => 2026-02-04 04:42:54 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=31280 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => PBAC recommends new NIP adult vaccine listings [title] => PBAC recommends new NIP adult vaccine listings [href] => https://www.australianpharmacist.com.au/pbac-recommends-new-nip-adult-vaccine-listings/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 31282 [authorType] => )

      PBAC recommends new NIP adult vaccine listings

      poisons information
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                  [post_content] => Genevieve Adamo MPS did not set out to work in poisons information. After beginning her career in community pharmacy as an assistant pharmacist and progressing into management, Ms Adamo joined the New South Wales Poisons Information Centre in 2004. 
      
      ‘I sort of fell into poisons,’ she said. ‘After having a few children, I had some time off and wanted to do something where I was learning again.’
      
      Each call is different, providing a continuous learning opportunity, said Ms Adamo, who took on a role with the National Poisons Register in 2023.
      
      ‘You don’t know what you’re going to get at the end of the phone when you pick it up,’ she added.
      
      Because so many of the calls to the poisons centre related to medicines poisoning, whether overdoses or errors, being a pharmacist is a distinct advantage.
      
      ‘We have really extensive knowledge of the drugs, as well as a really good base in physiology and pharmacology,’ Ms Adamo said.
      
      [caption id="attachment_18818" align="aligncenter" width="600"] Genevieve Adamo MPS (Image: Steve Christo Photography)[/caption]
      
      Here, she outlines what’s needed to enter and flourish in the space, as told to delegates at PSA’s Voices of Pharmacy – Passion, Purpose and Possibility webinar, held on 26 November 2025.
      

      Core skills for poisons information practice

      Poisons information demands a distinct skill set, combining deep scientific knowledge with the ability to work confidently under pressure. Calls are often urgent, information may be incomplete and decisions must be made quickly. ‘Every call provides a clinical problem that you’ve got to solve. Many of which there’s no clear answer,’ Ms Adamo said. ‘And we can't always look something up in a reference [because] not everything is listed there.’ Because it’s neither ethical nor feasible to conduct controlled trials in poisoning, evidence gaps are common.  ‘We can’t go and poison a whole lot of people to create clinical trials to find the answers for poisoning questions. We have to wait until these situations happen and then turn those into research themselves,’ she said. ‘So because of that, we often have to go back to basics, and use those pharmacology principles we learned way back in uni.’ This includes:
      • thinking about what chemical the patient has been exposed to and how it will impact normal physiology
      • what response the body could have
      • how the potential risks can be minimised. 
      Equally important is the ability to tolerate, or even be ‘excited by’, uncertainty.  ‘If you’re somebody who gets terrified by the fact that you can’t find an answer, this is not the job for you,’ Ms Adamo said. ‘There’s a lot of unknown … That’s what makes it challenging and interesting.’ While communication skills are important for all pharmacists, they are particularly pertinent in poisons information. Because advice is delivered remotely, pharmacists must rely entirely on what they hear over the phone. ‘We don’t see the patients, we’re only hearing them,’ she said. ‘So we must be really good at listening and at receptive communication.’ Calls often begin with anxiety rather than a clear clinical question. So allowing callers to fully explain the event is central to safe and effective care. ‘I’ll often start a call by saying, “Just tell me what happened,” and listen until they finish talking,’ she said. ‘That helps them feel heard and validated, and then they’re more likely to listen to the advice I give.’ The pace of work adds further pressure. Average call times are short, requiring pharmacists to rapidly gather information, consult resources where possible and provide clear guidance. ‘You’ve got to get all the history, work out what you know, look things up and provide advice all within about 5 minutes,’ Ms Adamo said.

      Building the right foundation

      Because poisons information pharmacy has no formal training pathway, pharmacists interested in the field should build relevant knowledge and exposure well before applying. ‘What we would look for would be a minimum of 3 years experience as a pharmacist, and ideally a combination of community and hospital pharmacy,’ Ms Adamo said. ‘Community brings a lot of skills in communication and history taking, but [the role] is very clinical, so having that hospital knowledge is also important.’ One of the most important resources is Therapeutic Guidelines, which supports much of the clinical advice provided by poisons centres. ‘There’s a Therapeutic Guideline for toxicology and toxinology,’ she said. ‘We use that a lot, so having a good understanding of it is really beneficial.’ With many calls related to exposures that occur in domestic settings, familiarity with over-the-counter products and household chemicals is also essential.  ‘I often tell new staff to go and check out the cleaning aisle,’ Ms Adamo said. ‘It’s really hard to give advice on household poisons if you don’t know what any of them are.’

      From individual cases to national policy

      While providing advice over the phone is the most visible aspect of poisons information, there’s much more to the role.  Poisons centres play a critical role in generating real-world evidence, with calls providing a continuous stream of data that can be analysed to identify new risks or changing patterns of exposure.
      ‘You’ve got to get all the history, work out what you know, look things up and provide advice all within about 5 minutes.' Genevieve Adamo MPS
      ‘We all have the ability to be involved in research, because we're recruiting patients through our calls,’ Ms Adamo said. ‘Our staff also create new guidelines for education and training, supporting both external poisoning prevention initiatives and the ongoing training of new and existing staff.’ Another major function is toxicovigilance – the systematic monitoring of poisoning trends with a focus on prevention and risk reduction. ‘That can involve all sorts of things [including] media and education,’ she said. ‘There’s often a lot of number crunching as well, and then working with regulators to change the laws to restrict access, because we know that one of the best ways to minimise harm and exposures is to restrict access.’ A key scheduling change Ms Adamo and her team were involved in was the changes to paracetamol regulations that were ushered in early last year. ‘We were contracted by the TGA to collect extra information about all the paracetamol calls we got,’ Ms Adamo said. ‘Paracetamol calls are the most common call to the poison centre every year, and all of that information was collated by our Head of Research and our consultant toxicologists – with the report used as the basis for the proposed scheduling changes that occurred.’ Sometimes individual cases can lead to broader system change. ‘I was involved in a case with a mum whose little one got really sick, and it was eventually worked out that it was a chronic choline salicylate toxicity,’ she said. ‘She couldn’t believe she’d been giving this poison to her kid and didn’t realise it was poisonous, because she bought it from [a supermarket] and thought it must be safe.’  In response, Adamo submitted an application to reschedule choline salicylate to Schedule 2. ‘Now it has to have more labelling, and it can only be available in a pharmacy,’ she said. ‘Those are the really interesting and rewarding aspects of poisoning work.’ For pharmacists considering the field, Ms Adamo believes the appeal lies in its tangible public health impact – shaping national safety standards and preventing future harm, particularly among children. ‘You know the work you’re doing actually changes outcomes.’ Read PSA’s Medicine Safety: Child and adolescent care report to understand the key poisoning risks and how pharmacists can help mitigate them. [post_title] => How pharmacists can prepare for poisons information roles [post_excerpt] => Poisons information pharmacists turn individual calls into population-level insights that inform regulatory and scheduling decisions. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => how-pharmacists-can-prepare-for-poisons-information-roles [to_ping] => [pinged] => [post_modified] => 2026-02-02 18:25:34 [post_modified_gmt] => 2026-02-02 07:25:34 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=31254 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => How pharmacists can prepare for poisons information roles [title] => How pharmacists can prepare for poisons information roles [href] => https://www.australianpharmacist.com.au/how-pharmacists-can-prepare-for-poisons-information-roles/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 31258 [authorType] => )

      How pharmacists can prepare for poisons information roles

      Early career pharmacist
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                  [post_content] => 

      Victoria Chisari MPS is an early career pharmacist and researcher on the move, working across clinical areas of practice to hone her skills.

      What’s beneficial about learning different specialties in pharmacy?

      Each specialty offers a unique focus, with the learning from each area building upon the others to create a comprehensive understanding of clinical pharmacy service delivery.

      I am currently a clinical pharmacist with Western Sydney Local Health District and a research team member and practice change facilitator at the University of Technology Sydney. But I have worked in many different clinical roles. My experience in the intensive care unit, for example, helped develop my ability to review acutely unwell patients – including those with infections, trauma, respiratory failure and organ failure.

      In this setting, I managed a diverse range of critically ill patients with complex medicines regimens – involving supportive therapies such as inotropes and vasopressors, sedation and antimicrobials.

      My practice involved designing individualised treatment plans for patients, particularly those receiving extracorporeal therapies such as renal replacement therapy and extracorporeal membrane oxygenation.

      This background informed my practice in the emergency department, where sound clinical reasoning was vital to delivering effective advice and interventions in fast-paced, high- pressure situations.

      Can you describe your global research review of pharmacist-prescribed contraception services?

      In response to barriers accessing contraception, such as the need for a prescription, pharmacist-prescribed contraception has been widely implemented and one common model of care delivers this service using clinical protocols. The review highlighted that the overall scope of these services includes both the prescribing (initiating) and continuation of various contraceptive methods, such as oral contraceptive pills, vaginal rings, transdermal patches and injections. A key finding was that the scope of practice varies internationally, depending on local authorisation and regulatory frameworks.

      It was recognised that while conceptually, the clinical protocol is one part of the intervention, education is another important part of the overall provision of care.

      This includes recognition of the importance of both foundational education and additional training for pharmacists.

      It was evident that authorising pharmacists to prescribe and continue a range of contraception options ultimately offers the best access for women.

      At the same time, pharmacist education and training is an important part of the broader piece in pharmacist prescribing – particularly in the current Australian context, as pharmacist prescribing continues to develop and expand.

      Your advice for other early ECPs interested in clinical pharmacy?

      Seek out opportunities to broaden your knowledge and skills.

      If you’re a pharmacy student or ECP interested in hospital pharmacy, look for courses, mentorship programs and professional development opportunities that align with your goals.

      Hospital pharmacy is dynamic, exciting and rewarding – there’s a lot to learn and a lot that we as pharmacists can contribute to.

      Ask questions and say yes to challenges that push you to grow. Be curious, be kind and keep learning. 

      [post_title] => Expanding clinical judgement beyond a single specialty [post_excerpt] => Victoria Chisari MPS is an early career pharmacist and researcher on the move, working across clinical areas of practice to hone her skills. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => expanding-clinical-judgement-beyond-a-single-specialty [to_ping] => [pinged] => [post_modified] => 2026-02-02 18:25:57 [post_modified_gmt] => 2026-02-02 07:25:57 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=31248 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Expanding clinical judgement beyond a single specialty [title] => Expanding clinical judgement beyond a single specialty [href] => https://www.australianpharmacist.com.au/expanding-clinical-judgement-beyond-a-single-specialty/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 31253 [authorType] => )

      Expanding clinical judgement beyond a single specialty

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                  [post_date] => 2026-01-28 14:00:38
                  [post_date_gmt] => 2026-01-28 03:00:38
                  [post_content] => Australia's Minister for Health has announced a National Medicines Record. What is it, and what will it achieve?
      
      Medicine safety has long depended on pharmacists making critical decisions with incomplete information. As prescribing becomes increasingly fragmented across face-to-face care, telehealth and digital platforms, those gaps are widening – with serious consequences for patients. 
      
      Reforms announced by Minister for Health and Ageing Mark Butler this morning aim to address this issue, eventually leading to a National Medicines Record. 
      
      The announcement follows advocacy by Alison Collins after the death of her daughter Erin, who died in 2024 after being prescribed medicines through multiple digital health platforms without a complete view of her medical history.
      

      Erin’s story

      Erin was 24 years old and had been taking multiple medicines for her mental health. She had been hospitalised multiple times for problems stemming from medicine misuse and was placed on daily staged supply pickup of her medicines.  The hospital care teams were so concerned they placed multiple warning messages in her My Health Record. However, these warnings were not accessed by telehealth services or local pharmacies prior to her fatal overdose. Erin’s case highlighted systemic vulnerabilities that pharmacists have warned about for years, particularly as digital prescribing expands faster than the safeguards designed to support safe, coordinated care.

      The first step

      Initially, the reforms would require all medicines information from online prescribers to be uploaded to My Health Record For pharmacists, this will make a fuller picture of all the medicines a patient has been prescribed more visible. This is critical given the increasing number of prescribers an individual may have with the rise of telehealth and condition-specific providers.  Under the proposed changes, medicines prescribed and dispensed through online platforms – including the clinical context for prescribing – would be made available through My Health Record. This is intended to help reduce the risk of medicine  errors, adverse drug reactions and inappropriate use by ensuring healthcare professionals have access to more complete and timely information.

      The path to a National Medicines Record

      The reforms also commit the Government to designing and developing a National Medicines Record using existing digital health infrastructure, including electronic prescribing, the Active Script List and My Health Record.  While details are still emerging, the proposal has the potential to address a core challenge for pharmacists: how to identify and resolve medicines-related risks without a reliable, up-to-date picture of a patient’s full medicines history. Welcoming the announcement, PSA National President Professor Mark Naunton MPS noted it aligns with the profession's long standing advocacy. 'Pharmacists have consistently sought better-connected digital health systems to improve patient safety with medicines. It’s something PSA has been advocating for over many years, including through our flagship medicine safety report series,” Prof. Naunton said. 'Access to a more complete and reliable medicines record has the potential to significantly improve patient safety and strengthen clinical decision-making.' 'The announcement is fully aligned with PSA’s ongoing advocacy to improve medicines safety systems and ensure pharmacists are supported as medicines experts across all settings of care,' he continued. 'PSA will engage in the consultation for these proposals and continue to work with the Government to support system improvements that make medicine use in Australia safer.' A consultation period is now underway to guide the inclusion of medicines information from all online prescribers by default, with the first phase expected to be completed by December 2026. The Government has also flagged ongoing enhancements to the 1800MEDICARE app to support medicines management. [post_title] => What a National Medicines Record might mean for patient safety and pharmacy practice [post_excerpt] => Australia's Minister for Health has announced a National Medicines Record. What is it, and what will it achieve? [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => towards-a-national-medicines-record [to_ping] => [pinged] => [post_modified] => 2026-01-30 16:02:41 [post_modified_gmt] => 2026-01-30 05:02:41 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=31238 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => What a National Medicines Record might mean for patient safety and pharmacy practice [title] => What a National Medicines Record might mean for patient safety and pharmacy practice [href] => https://www.australianpharmacist.com.au/towards-a-national-medicines-record/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 31240 [authorType] => )

      What a National Medicines Record might mean for patient safety and…

  • People
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                  [post_content] => 

      Case scenario

      Alicia, 27, visits your pharmacy regularly for naproxen and heat patches to manage period pain. She confides that her pain has worsened over the past 2 years, radiates down her legs, interferes with work and affects intimacy.  Her periods are heavy, lasting around 9 days, and leave her feeling exhausted and sometimes even bedridden. Alicia has seen several GPs, who told her it was ‘normal for your age’. She says, ‘It feels like someone’s wringing out my insides – nothing helps much. Is this really normal?’

      Learning objectives

      After reading this article, pharmacists should be able to:
      • Describe the epidemiology, aetiology and pathophysiology of endometriosis
      • Identify key clinical features, risk factors and diagnostic considerations
      • Discuss pharmacological and non-pharmacological management options for endometriosis
      • Explain the pharmacist’s role in supporting patients with endometriosis through education, referral and holistic care.
      Competency standards (2016) addressed: 1.1, 1.4, 1.5, 2.2, 3.1, 3.5 Accreditation number: CAP2602DMED  Accreditation expiry: 31/01/2029 
      Already read the CPD in the journal? Scroll to the bottom to SUBMIT ANSWERS.

      Introduction

      Endometriosis is a chronic inflammatory condition characterised by the growth of endometrial-like tissue outside the uterus, commonly affecting the ovaries, fallopian tubes and pelvic peritoneum.1,2 It affects 10–15% of all reproductive-aged Australians who were assigned female at birth, and 70% of females with chronic pelvic pain.3 Yet it remains underdiagnosed, underfunded and often misunderstood. Symptoms such as pelvic pain, heavy periods, fatigue and infertility can significantly affect quality of life. Pharmacists, often the first point of contact for pain management and self-care advice, play an important role in recognising potential endometriosis, supporting early referral and helping patients navigate ongoing treatment.

      Epidemiology

      An estimated 1 in 7 females in Australia are currently living with endometriosis.4-6 Onset often begins in adolescence, yet diagnosis is delayed on average by 7–10 years,1,3,7 influenced by menstrual pain normalisation, stigma, and misdiagnosis as irritable bowel syndrome (IBS) or anxiety.1,3,4,7,8 The consequences of these delays extend beyond physical health, affecting fertility, education, relationships and employment, and increasing the likelihood of depression, anxiety and social withdrawal.6,9,10

      Aetiology and pathophysiology

      The pathogenesis of endometriosis is multifactorial. The leading theory is retrograde menstruation, where menstrual blood flows backwards through the fallopian tubes into the pelvic cavity, allowing endometrial cells to implant and grow outside the uterus.2,11 Other contributing mechanisms include2,5,11,12:
      • immune dysfunction
      • coelomic metaplasia (peritoneal cell transformation)
      • genetic predisposition
      • hormonal imbalances 
      • environmental triggers.

      Clinical features  

      Endometriosis occurs when hormonally responsive lesions develop on the ovaries, bowel, bladder, peritoneum, or other pelvic and abdominal structures.1,5,9,13,14 These lesions respond to oestrogen and undergo cyclical changes similar to the endometrial lining, which can trigger inflammation, bleeding, scarring and adhesions. This may lead to chronic pain, organ dysfunction and infertility. Importantly, symptom severity does not always correlate with the number or extent of lesions and may fluctuate with hormonal changes.8,12 Risk factors While the exact cause of endometriosis is unclear, certain factors increase the likelihood of developing the condition1,9,13,14:
      • early menarche
      • short menstrual cycles (<27 days)
      • heavy/prolonged periods
      • nulliparity
      • family history of endometriosis
      • low BMI.
      Clinical presentation1,5,9,13,14 Pharmacists should consider endometriosis in individuals presenting with2,7,8,11,12:
      • moderate-severe dysmenorrhoea 
      • chronic pelvic pain (cyclical or constant)
      • persistent or recurrent pain associated with sexual intercourse (dyspareunia) 
      • menstrual bowel/bladder pain 
      • fatigue, lethargy, irritability
      • bloating
      • painful or altered bowel movements, particularly around the time of menstruation (dyschezia)
      • abnormally heavy or prolonged menstrual bleeding (menorrhagia) or irregular cycles 
      • infertility/conception delays.
      Classification No universally agreed classification exists, though the American Society of Reproductive Medicine (ASRM) system is commonly used15:
      • Stage I (minimal): few superficial implants.
      • Stage II (mild): more, deep implants.
      • Stage III (moderate): many deep implants; filmy adhesions may be present.
      • Stage IV (severe): many deep implants, many dense adhesions.
      Pain mechanisms and central sensitisation Central sensitisation refers to heightened nervous system responsiveness, causing persistent, widespread pain even after lesion removal.16 This can manifest as pelvic floor dysfunction, visceral hypersensitivity, and fatigue, and often overlaps with conditions such as irritable bowel syndrome or bladder pain syndrome.11 Supporting patients involves validating their pain experiences, even when imaging is normal or lesions appear minimal.

      Diagnosis and differential diagnosis 

      Diagnosis of endometriosis is often significantly delayed, with an average lag of 7–10 years from symptom onset.3,7,17 These delays are influenced by multiple systemic and social factors, including1,7,9,17:
      • normalisation of menstrual pain
      • dismissal of symptoms, particularly in adolescents and people of colour
      • lack of rural/remote access to gynaecology services 
      • under-recognition of symptoms in trans, non-binary and gender-diverse individuals
      • cost barriers to imaging, specialist care and private laparoscopies.
      Endometriosis shares symptoms with several other conditions, making diagnosis difficult. Differential diagnoses include IBS, pelvic inflammatory disease, adenomyosis, interstitial cystitis, depression and anxiety.12 Current diagnostic approaches While laparoscopy remains the gold standard, Australian guidelines now support symptom-based clinical diagnosis to reduce delays and improve care.3,7,17 Imaging tools such as transvaginal ultrasound can identify ovarian endometriotic cysts, but a normal ultrasound or MRI does not rule out disease – especially in early-stage or superficial cases. Patients should therefore be encouraged to pursue further care if symptoms significantly impact quality of life.3 Emerging diagnostic tools To address diagnostic challenges, ongoing research is focused on earlier, less invasive detection.4 Emerging approaches include blood-based biomarkers (e.g. proteomic panels, metabolomic profiling, microRNA and menstrual-fluid analysis),18-21 as well as advanced imaging techniques such as transvaginal ultrasound and MRI, which may help reduce reliance on laparoscopy and accelerate accurate diagnosis.3,7,17 When it’s not endometriosis: validating pelvic pain without a diagnosis Pelvic pain affects up to 1 in 4 people assigned female at birth and has many possible causes – endometriosis being only one of them.7,11,22,23 For some, extensive investigations such as imaging or laparoscopy reveal no abnormalities, which can leave patients feeling dismissed, confused or invalidated. Pharmacists can help by acknowledging that pain is real and deserving of care, even in the absence of a definitive diagnosis. Symptom management is the first-line approach for both endometriosis and chronic pelvic pain, and care should aim to improve daily function and quality of life regardless of diagnostic certainty.3 Where appropriate, pharmacists can also support referral to other healthcare providers for further assessment or multidisciplinary management. Although endometriosis itself is not curable, symptoms and recurrences can be effectively managed through person-centred care that considers physical, emotional and reproductive health needs.8

      Management approaches 

      Non-pharmacological treatment  Current treatment is focused on symptom control, rather than elimination of the disease. Non-pharmacological approaches form an essential part of care, particularly for patients who experience persistent pain or treatment adverse effects. Key strategies include8,13,24:
      • pelvic physiotherapy and psychotherapy (e.g. cognitive behavioural therapy [CBT], acceptance and commitment therapy [ACT])
      • heat therapy, TENS and mindfulness-based movement (e.g. yoga, Pilates)
      • anti-inflammatory or low-FODMAP diets, particularly for patients with co-existing irritable bowel syndrome.
      Mental health and emotional wellbeing Chronic pain is both physically and psychologically exhausting. Anxiety and depression rates are significantly higher in people with endometriosis than in the general population.7 Contributing factors include3,5,6,8,10,12,14,25:
      • diagnostic delays and invalidation of symptoms 
      • chronic fatigue and disrupted sleep
      • missed school or work
      • sexual dysfunction and relationship strain
      • fertility concerns or trauma from medical procedures.
      Pharmacists can play an important role in recognising distress and prompting early mental health support. Simple, empathetic questions – such as ‘How’s your sleep been lately?’ or ‘Is the pain affecting your mood?’ – can open conversations and guide appropriate referrals. Support strategies include:
      • recommending mental health care plans via GPs
      • referring to psychologists with chronic pain expertise or interdisciplinary pain teams
      • encouraging peer support groups (e.g. EndoActive, Endometriosis Australia, QENDO)
      • suggesting low-stigma mental health apps (e.g. MindSpot, Smiling Mind)
      • avoiding statements that minimise pain (e.g. ‘it’s just anxiety’) and instead validating the complex relationship between mood and pain.
      Complementary therapies  Patients may enquire about supplements or alternative therapies. Pharmacists should validate interest while clarifying the limited evidence and screening for interactions. Commonly explored options include magnesium, omega-3 fatty acids, turmeric (curcumin), vitex agnus-castus, zinc, vitamin B6, diindolylmethane (DIM) and acupuncture.22,24,26

      Pharmacological treatment 

      Analgesia
      • NSAIDs (e.g. naproxen 500 mg twice daily or ibuprofen 400 mg three times daily) are first line. 
      • Paracetamol may be added for multimodal relief.1,12,13
      Counselling should cover dosing, GI protection and review of OTC combinations (e.g. ibuprofen/paracetamol). Hormonal therapies Hormonal therapies suppress oestrogen-driven growth and reduce pain.11,12,13,27,28 Table 1 provides an overview of commonly used hormonal therapies in endometriosis management. Add-back therapy Treatment with gonadotrophin-releasing hormone (GnRH) analogues induces a temporary, reversible menopause to suppress oestrogen production and reduce endometriosis symptoms.30 However, this hypo-estrogenic state can cause side effects such as vasomotor symptoms, vaginal dryness and bone mineral density loss.30 Add-back therapy involves giving small ‘add-back’ doses of oestrogen, progestogen, or a combination of both, to counteract these effects while maintaining the efficacy of GnRH analogue treatment.13,28 Options include1,12,13,27: 
      • Continuous combined HRT – low-dose estrogen + progestogen. Use in patients with a uterus to protect the endometrium.
      • Sequential combined HRT – estrogen daily + cyclical progestogen. Less preferred, as cyclical hormones may worsen endometriosis symptoms.
      • Progestogen-only – continuous progestogen. Used when estrogen contraindicated.
      • Tibolone – synthetic steroid: estrogenic, progestogenic, and androgenic activity. Often used post-menopause; caution in estrogen-sensitive conditions.
      For add-back therapy, ensure to: 
      • use continuous regimens (not cyclical) to avoid stimulating endometriotic tissue
      • monitor BMD regularly if GnRH therapy continues >6 months
      • start add-back therapy generally at the same time as the GnRH analogue.
      Fertility considerations Up to half of people with endometriosis experience fertility issues, and pain suppression does not necessarily improve fertility.2,3,6,12 Pharmacists can:
      • counsel on hormonal therapy effects on ovulation 
      • encourage early specialist referral if conception delayed >12 months
      • support patients undergoing IVF or assisted reproductive treatment 
      • provide reassurance and empathy around fertility-related distress. 
      Table 1 – Overview of hormonal therapies for endometriosis References: Therapeutic Guidelines1, Buggio et al12, Rossi13 Hornstein26, Vercellini27 Note: Bone mineral density typically recovers within two years of cessation of GnRH therapies.27 Drospirenone currently off-label for endometriosis in Australia.1 The addition of Ryeqo (relugolix, estradiol, norethisterone) (July 2022) and Visanne (dienogest) (December 2024) to the PBS expands accessible hormonal therapy options for endometriosis.29

      The role of the pharmacist in endometriosis care

      Pharmacists play a vital role in improving care for people with endometriosis by addressing barriers through education, advocacy and person-centred support. Key strategies include1,5,8,12:
      • using inclusive language and avoiding assumptions about gender identity or reproductive goals
      • proactively exploring the impact of symptoms on daily life, including school, work and relationships
      • offering accessible symptom-tracking tools to support self-monitoring
      • referring patients to culturally safe services, including First Nations-specific clinics when appropriate
      • advocating for patients and providing education to dispel misconceptions about endometriosis.
      Given the impact of endometriosis on mental health, it is essential for pharmacists to use affirmative language that validates the patient’s experience.  For example, acknowledging that a patient’s pain is real fosters trust, signals active listening and supports collaborative care. Avoiding dismissive statements such as ‘pain is normal for women’ is crucial, as these can reinforce shame and self-doubt, and discourage timely help-seeking.10,14,31 Pharmacists are integral members of multidisciplinary teams managing endometriosis. They facilitate early identification and timely referrals to general practitioners, specialists, pelvic physiotherapists, psychologists and dietitians. The upcoming Endometriosis Management Plan (EMP), a digital clinical tool launching in 2026, is designed to enhance care coordination, streamline documentation, and align treatment goals across providers.4,32 Pharmacists can support EMP implementation through patient counselling, comprehensive medicines reviews and ongoing follow-up.  Pharmacists are also well-positioned to assist patients in navigating newly established specialist clinics funded under the 2025–26 federal health budget.4,32 Home Medicines Reviews (HMRs) can further optimise medicines management and should be actively recommended as part of a comprehensive care strategy. Pharmacists can support shared decision-making by explaining treatment mechanisms, expected onset of action and common adverse effects, helping patients make informed choices.

      Patient resources  

      Pharmacist follow-up and recommendations of patient support resources are beneficial for ongoing management. These include10,12,25,33:
      • inviting patients to check in monthly during early therapy
      • reassessing symptoms, tolerance and goals
      • encouraging use of symptom tracker apps to record symptoms, menstrual changes and evaluate therapy success (e.g. Phendo, Clue, EndoMeter)
      • referring to organisations for education/peer support
      • recommending organisations6,9,10,14,23,34,35:
        • Endometriosis Australia – advocacy/awareness
        • Jean Hailes for Women’s Health – tools/info
        • Pelvic Pain Foundation of Australia – clinician and patient info
        • QENDO – peer support, lived experience, free tracking app
        • EndoZone – clinical decision support, patient-friendly explanations
        • ESHRE patient leaflet – print-friendly patient information.

      Knowledge to practice 

      Pharmacists in primary care can support people with endometriosis by providing early recognition of symptom impact, guidance on medicines and symptom management, and facilitating timely referrals to appropriate healthcare providers.  Pharmacists play a key role in validating patient experiences, promoting self-monitoring through symptom-tracking tools, explaining treatment options and adverse effects, and encouraging engagement with multidisciplinary care.  Pharmacists should also advocate for patients and provide education to dispel misconceptions, helping reduce delays in diagnosis and improving overall quality of care.

      Conclusion

      Endometriosis is far more than painful periods – it’s a complex, chronic condition requiring interdisciplinary, person-centred care. Pharmacists can make a profound difference by recognising early signs, validating lived experience, supporting evidence-based management and facilitating timely referral. Even a single empathetic conversation can empower a patient to seek help and change the trajectory of their care.

      Case scenario continued

      You reassure Alicia that severe period pain is not something she has to accept and suggest tracking her symptoms with a menstrual diary and consulting a women’s health GP. You also provide advice on safe NSAID use and non-pharmacological strategies. Alicia returns 2 months later, now diagnosed with endometriosis and receiving hormonal therapy and pelvic physiotherapy. She continues to experience chronic pelvic pain and questions her medicines, so you organise a Home Medicines Review, identifying potential naproxen overuse and interactions with her sertraline, prompting treatment adjustments. You also recommend a local endometriosis support group, which Alicia joins, and she has since referred two friends with similar symptoms. Through ongoing support, she feels more empowered to manage her condition.
        [cpd_submit_answer_button]

      Key points

      • Lesion severity does not predict pain intensity.
      • Recognise red flags (e.g. cyclical pain, GI symptoms) and enact early referral.
      • Support interdisciplinary, patient-centred management.
      • Review safety, adherence and contraceptive actions of hormonal therapy.
      • Use inclusive, supportive language to reduce stigma and diagnostic delay.
      • Encourage treatment continuity and shared decision-making.

      References

      References 
      1. Therapeutic Guidelines Limited. Endometriosis. In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2024. At: www.tg.org.au.
      2. Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril 2012;98(3):511–9. At: https://pubmed.ncbi.nlm.nih.gov/22819144/
      3. Parasar P, Ozcan P, Terry KL. Endometriosis: epidemiology, diagnosis and clinical management. Curr Obstet Gynecol Rep 2017;6(1):34–41. At: https://pubmed.ncbi.nlm.nih.gov/29276652/
      4. Australian Government Department of Health and Aged Care. National Action Plan for Endometriosis. Canberra: Department of Health; 2018. At: https://www.health.gov.au/resources/publications/national-action-plan-for-endometriosis?language=en
      5. RANZCOG. Endometriosis: a consensus guideline. Melbourne: Royal Australian and New Zealand College of Obstetricians and Gynaecologists; 2021. At: https://ranzcog.edu.au
      6. Endometriosis Australia. About Endometriosis. 2023. At: www.endometriosisaustralia.org/about-endometriosis
      7. Armour M et al. Endometriosis and chronic pelvic pain have similar impact on women, but time to diagnosis is decreasing: an Australian survey. Sci Rep 2020. At: https://pubmed.ncbi.nlm.nih.gov/33004965/
      8. Armour M, Sinclair J, Ng CHM, et al. A biopsychosocial approach to endometriosis management. Jean Hailes for Women’s Health; 2022. At: www.jeanhailes.org.au/uploads/Webinars/2022_PPP_final-handouts.pdf
      9. European Society of Human Reproduction and Embryology. ESHRE. Guideline on endometriosis: patient leaflet. 2022. At: www.eshre.eu/Guidelines-and-Legal/Guidelines/Endometriosis-guideline
      10. Jean Hailes for Women’s Health. Endometriosis. 2024. At: www.jeanhailes.org.au/health-a-z/endometriosis
      11. Morotti M, Vincent K, Becker CM. Mechanisms of pain in endometriosis. Eur J Obstet Gynecol Reprod Biol 2017;209:8–13. 
      12. Buggio L, Armour M, Evans S, et al. Endometriosis: a review of recent evidence and guidelines. Aust J Gen Pract 2024;53(1–2):22–8. At: www1.racgp.org.au/ajgp/2024/january-february/endometriosis
      13. Rossi S, ed. Australian Medicines Handbook. 2025. Endometriosis. At: https://amhonline.amh.net.au
      14. EndoZone. Clinical and patient tools. 2025. At: www.endozone.com.au
      15. Johnson NP, Hummelshoj L, Adamson GD, et al. World Endometriosis Society consensus on the classification of endometriosis. Hum Reprod 2017;32(2):315–24. At: https://academic.oup.com/humrep/article/32/2/315/2631390?login=false#116936554
      16. Alexander M, Dydyk EC, Michael F. Stretanski, et al. Central Pain Syndrome. StatPearls. 2025. At: www.ncbi.nlm.nih.gov/books/NBK553027/
      17. National Institute for Health and Care Excellence (NICE). Endometriosis: diagnosis and management. NICE guideline NG73. London: NICE; 2024. At: www.nice.org.uk/guidance/ng73/resources/endometriosis-diagnosis-and-management-pdf-1837632548293
      18. Endometriosis News. Current status of non-invasive biomarkers for endometriosis. 2024. At: www.endonews.com/current-status-of-non-invasive-biomarkers-for-endometriosis
      19. Gupta D, Hull ML, Fraser I, et al. Endometrial biomarkers for the non-invasive diagnosis of endometriosis. Cochrane Database of Systematic Reviews 2016. Issue 4. 
      20. Proteomics International. PromarkerEndo delivers breakthrough results for endometriosis blood test. Perth: PIQ; 2024. At: ASX-PIQ-Collaboration-expanded-to-advance-Endometriosis-blood-test-251015.pdf
      21. Evans‑Hoeker E, Senapati S, Behera MA. Serum markers for endometriosis: a critical appraisal of current literature. Fertil Steri 2024;121(5):943–56.
      22. Evans S. Introduction to pelvic pain: an introduction to pelvic pain for girls, women, men and families. Pelvic Pain Foundation of Australia; 2024. At: www.pelvicpain.org.au/wp-content/uploads/2024/01/Introduction-to-Pelvic-Pain.pdf
      23. Brown J, Crawford TJ, Allen C, et al. Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database of Systematic Reviews 2017;2017(1):CD004753. At: www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004753.pub4/full
      24. Villella S. The use of complementary medicines and therapies in women's health. Jean Hailes for Women’s Health; 2022. At: www.jeanhailes.org.au/uploads/Webinars/Complementary-medicine-and-therapies
      25. Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Hum Reprod Open 2022;2022(2):hoac009. https://doi.org/10.1093/hropen/hoac009
      26. Malik A, Sinclair J, Ng CHM, et al. Complementary medicine and chronic pelvic pain in Australian women: a national cross-sectional survey. BMJ Open 2021;11:e045768. At: https://pubmed.ncbi.nlm.nih.gov/35148773/
      27. Hornstein MD. Endometriosis: long-term treatment with gonadotropin-releasing hormone agonists. In: Barbieri RL, Eckler K, editors. UpToDate. Waltham (MA): UpToDate Inc.; 2023. At: www.uptodate.com
      28. Vercellini P, Buggio L, Berlanda N, et al. Estrogen-progestins and progestins for the management of endometriosis. Fertil Steril 2016;106(7):1552–71. At: https://pubmed.ncbi.nlm.nih.gov/27817837/.
      29. Australian Government Department of Health and Aged Care. Pharmaceutical Benefits Scheme: New listings and changes – December 2024. Canberra: PBS; 2024. www.pbs.gov.au
      30. Veth VB, van der Karr MM, Duffy JM, et al. Gonadotropin-releasing hormone analogues for endometriosis. Cochrane Database of Systematic Reviews 2023;6(6).
      31. Australian Commission on Safety and Quality in Health Care. Person-centred care: a toolkit for implementation. Sydney: ACSQHC; 2020.
      32. Australian Government Department of Health and Aged Care. Budget 2025–26: Women’s Health Package. 2025. At: Budget 2025–⁠26: Strengthening Medicare – Women's health | Australian Government Department of Health, Disability and Ageing
      33. Ferrero S, Evangelisti G, Barra F. Current and emerging treatment options for endometriosis. Expert Opin Pharmacother 2018;19(10):1109–25. At: https://pubmed.ncbi.nlm.nih.gov/29975553/
      34. Endometriosis Australia. Patient stories (2023). At: https://endometriosisaustralia.org/category/endo-stories/
      35. QENDO. About Us. 2025. At: https://www.qendo.org.au/

      Our author

      Erin Downey (she/her) BPharm, GCertDiabEd, CDE, MPS CredPharm (MMR), ANZCAP-Reg (Endo, Generalist) is a clinical pharmacist, credentialled diabetes educator, endocrinology and generalist ANZCAP registrar, practising hospital pharmacist, and private CDE/credentialled MMR pharmacist in Southern Tasmania. 

      Our reviewer

      Elke Smith (she/her) BPharm, MHlthMgt [post_title] => Endometriosis: More than just a bad period [post_excerpt] => Endometriosis is a chronic inflammatory condition which affects 10–15% of all reproductive-aged Australians who were assigned female at birth. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => endometriosis-more-than-just-a-bad-period-cpd [to_ping] => [pinged] => [post_modified] => 2026-02-06 10:09:22 [post_modified_gmt] => 2026-02-05 23:09:22 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=31273 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Endometriosis: More than just a bad period [title] => Endometriosis: More than just a bad period [href] => https://www.australianpharmacist.com.au/endometriosis-more-than-just-a-bad-period-cpd/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( [td_post_template] => single_template_4 ) [is_review:protected] => [post_thumb_id:protected] => 31300 [authorType] => )

      Endometriosis: More than just a bad period

      PBAC
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                  [post_content] => New Pharmaceutical Benefits Advisory Committee (PBAC) recommendations could significantly change who can access funded COVID-19 and RSV vaccines.
      
      At its December 2025 meeting, PBAC considered applications for funding COVID-19 vaccines and RSV vaccines on the National Immunisation Program (NIP). While both recommendations were positive, how would they apply in practice?
      

      Smaller cohort recommended for COVID-19 vaccine eligibility

      PBAC recommended significantly tighter eligibility criteria for COVID-19 vaccines going forward. The National COVID-19 Vaccination Program – including the community pharmacy program is scheduled to end on 30 June 2026. While no announcements have yet been made, the PBAC outcomes signal COVID-19 vaccination will be incorporated into the NIP. PBAC recommendation is an important step to enable this NIP listing. PBAC considered a proposal to fund Pfizer’s Comirnaty COVID-19 vaccines in a smaller population cohort. The proposal has been supported by PBAC, recommending NIP funding for four cohorts of adults as requested by Pfizer, the product sponsor.

      Who would be eligible for funded COVID-19 vaccination?

      For current and future Comirnaty COVID-19 vaccines, PBAC’s recommendation supports NIP funding in specific age and risk groups only. Under this framework, NIP-funded doses would only be available for patients who are:
      • 75 years and over (two doses per year)
      • 65–74 years (one dose per year)
      • 18–64 years with severe immunocompromise (one dose per year)
      • Aboriginal and Torres Strait Islander peoples aged 50–74 years (one dose per year).
      Patients outside these groups would not be eligible for NIP-funded COVID-19 vaccination, including healthy adults aged 18–64 years, children, and Aboriginal and Torres Strait Islander peoples under 50 who do not meet the high-risk criteria. The proposed dosing schedule reflects an endemic management approach, with annual vaccination for most eligible groups. ‘PBAC noted the requested populations and doses were based on updated advice from the Australian Technical Advisory Group on Immunisation (ATAGI),’ the committee said. ‘This is a smaller group than current arrangements under the National COVID-19 Vaccination Program (NCVP).’

      What did PBAC recommend for RSV vaccination on the NIP?

      PBAC considered a submission from GSK to fund their RSV vaccine Arexvy on the NIP for prevention of RSV-related lower respiratory tract disease in at-risk adults susceptible to severe complications. The recommendation supports funded access for the Arexvy RSV vaccine for:
      • adults aged 75 years and over
      • Aboriginal and Torres Strait Islander peoples aged 60–74 years.
      If adopted, this would see two additional population cohorts currently recommended for RSV vaccination by the Australian Immunisation Handbook able to access the vaccine free-of-charge on the NIP. However, the recommendation does not extend to all people currently recommended for RSV vaccination – such as adults aged 60–74 years who have medical conditions which increase their risk of severe RSV disease. PBAC also confirmed that one dose of Arexvy is considered equivalent to one dose of Pfizer’s Abrysvo vaccine under the proposed NIP listing. The proposed NIP listing would still involve a substantial cost to government, even after revised assumptions and a price reduction. However, the committee considered the sponsor’s updated cost inputs acceptable and concluded the vaccine was cost-effective in the proposed populations. PBAC also noted that no new clinical evidence had been submitted, but that revised pricing and cost data supported its previous conclusions on clinical benefit and value for money. ‘Consistent with previous advice, PBAC considered there is a high clinical need for vaccines, such as Arexvy, to reduce the risk of RSV in adults,’ the committee said.

      When would these changes take effect?

      There’s no clear timeframe. PBAC recommendations for vaccines require price negotiation, government approval, procurement and regulatory listing to become funded on the NIP.

      Given the expiry of COVID-19 immunisation program funding, 1 July 2026 could be a potential implementation date for the COVID-19 NIP funding. Current COVID-19 vaccine program eligibility is based on ATAGI advice, so changes could happen at any time ATAGI chooses to provide updated advice.

      And as for patients asking when the RSV vaccine may be funded on the NIP? They probably could be encouraged to keep their eye on the TV news for any future announcements!

      Upskill in vaccination administration and legislation by visiting the PSA Vaccination (immunisation) Education Hub. [post_title] => PBAC recommends new NIP adult vaccine listings [post_excerpt] => [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => pbac-recommends-new-nip-adult-vaccine-listings [to_ping] => [pinged] => [post_modified] => 2026-02-04 15:42:54 [post_modified_gmt] => 2026-02-04 04:42:54 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=31280 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => PBAC recommends new NIP adult vaccine listings [title] => PBAC recommends new NIP adult vaccine listings [href] => https://www.australianpharmacist.com.au/pbac-recommends-new-nip-adult-vaccine-listings/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 31282 [authorType] => )

      PBAC recommends new NIP adult vaccine listings

      poisons information
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                  [post_content] => Genevieve Adamo MPS did not set out to work in poisons information. After beginning her career in community pharmacy as an assistant pharmacist and progressing into management, Ms Adamo joined the New South Wales Poisons Information Centre in 2004. 
      
      ‘I sort of fell into poisons,’ she said. ‘After having a few children, I had some time off and wanted to do something where I was learning again.’
      
      Each call is different, providing a continuous learning opportunity, said Ms Adamo, who took on a role with the National Poisons Register in 2023.
      
      ‘You don’t know what you’re going to get at the end of the phone when you pick it up,’ she added.
      
      Because so many of the calls to the poisons centre related to medicines poisoning, whether overdoses or errors, being a pharmacist is a distinct advantage.
      
      ‘We have really extensive knowledge of the drugs, as well as a really good base in physiology and pharmacology,’ Ms Adamo said.
      
      [caption id="attachment_18818" align="aligncenter" width="600"] Genevieve Adamo MPS (Image: Steve Christo Photography)[/caption]
      
      Here, she outlines what’s needed to enter and flourish in the space, as told to delegates at PSA’s Voices of Pharmacy – Passion, Purpose and Possibility webinar, held on 26 November 2025.
      

      Core skills for poisons information practice

      Poisons information demands a distinct skill set, combining deep scientific knowledge with the ability to work confidently under pressure. Calls are often urgent, information may be incomplete and decisions must be made quickly. ‘Every call provides a clinical problem that you’ve got to solve. Many of which there’s no clear answer,’ Ms Adamo said. ‘And we can't always look something up in a reference [because] not everything is listed there.’ Because it’s neither ethical nor feasible to conduct controlled trials in poisoning, evidence gaps are common.  ‘We can’t go and poison a whole lot of people to create clinical trials to find the answers for poisoning questions. We have to wait until these situations happen and then turn those into research themselves,’ she said. ‘So because of that, we often have to go back to basics, and use those pharmacology principles we learned way back in uni.’ This includes:
      • thinking about what chemical the patient has been exposed to and how it will impact normal physiology
      • what response the body could have
      • how the potential risks can be minimised. 
      Equally important is the ability to tolerate, or even be ‘excited by’, uncertainty.  ‘If you’re somebody who gets terrified by the fact that you can’t find an answer, this is not the job for you,’ Ms Adamo said. ‘There’s a lot of unknown … That’s what makes it challenging and interesting.’ While communication skills are important for all pharmacists, they are particularly pertinent in poisons information. Because advice is delivered remotely, pharmacists must rely entirely on what they hear over the phone. ‘We don’t see the patients, we’re only hearing them,’ she said. ‘So we must be really good at listening and at receptive communication.’ Calls often begin with anxiety rather than a clear clinical question. So allowing callers to fully explain the event is central to safe and effective care. ‘I’ll often start a call by saying, “Just tell me what happened,” and listen until they finish talking,’ she said. ‘That helps them feel heard and validated, and then they’re more likely to listen to the advice I give.’ The pace of work adds further pressure. Average call times are short, requiring pharmacists to rapidly gather information, consult resources where possible and provide clear guidance. ‘You’ve got to get all the history, work out what you know, look things up and provide advice all within about 5 minutes,’ Ms Adamo said.

      Building the right foundation

      Because poisons information pharmacy has no formal training pathway, pharmacists interested in the field should build relevant knowledge and exposure well before applying. ‘What we would look for would be a minimum of 3 years experience as a pharmacist, and ideally a combination of community and hospital pharmacy,’ Ms Adamo said. ‘Community brings a lot of skills in communication and history taking, but [the role] is very clinical, so having that hospital knowledge is also important.’ One of the most important resources is Therapeutic Guidelines, which supports much of the clinical advice provided by poisons centres. ‘There’s a Therapeutic Guideline for toxicology and toxinology,’ she said. ‘We use that a lot, so having a good understanding of it is really beneficial.’ With many calls related to exposures that occur in domestic settings, familiarity with over-the-counter products and household chemicals is also essential.  ‘I often tell new staff to go and check out the cleaning aisle,’ Ms Adamo said. ‘It’s really hard to give advice on household poisons if you don’t know what any of them are.’

      From individual cases to national policy

      While providing advice over the phone is the most visible aspect of poisons information, there’s much more to the role.  Poisons centres play a critical role in generating real-world evidence, with calls providing a continuous stream of data that can be analysed to identify new risks or changing patterns of exposure.
      ‘You’ve got to get all the history, work out what you know, look things up and provide advice all within about 5 minutes.' Genevieve Adamo MPS
      ‘We all have the ability to be involved in research, because we're recruiting patients through our calls,’ Ms Adamo said. ‘Our staff also create new guidelines for education and training, supporting both external poisoning prevention initiatives and the ongoing training of new and existing staff.’ Another major function is toxicovigilance – the systematic monitoring of poisoning trends with a focus on prevention and risk reduction. ‘That can involve all sorts of things [including] media and education,’ she said. ‘There’s often a lot of number crunching as well, and then working with regulators to change the laws to restrict access, because we know that one of the best ways to minimise harm and exposures is to restrict access.’ A key scheduling change Ms Adamo and her team were involved in was the changes to paracetamol regulations that were ushered in early last year. ‘We were contracted by the TGA to collect extra information about all the paracetamol calls we got,’ Ms Adamo said. ‘Paracetamol calls are the most common call to the poison centre every year, and all of that information was collated by our Head of Research and our consultant toxicologists – with the report used as the basis for the proposed scheduling changes that occurred.’ Sometimes individual cases can lead to broader system change. ‘I was involved in a case with a mum whose little one got really sick, and it was eventually worked out that it was a chronic choline salicylate toxicity,’ she said. ‘She couldn’t believe she’d been giving this poison to her kid and didn’t realise it was poisonous, because she bought it from [a supermarket] and thought it must be safe.’  In response, Adamo submitted an application to reschedule choline salicylate to Schedule 2. ‘Now it has to have more labelling, and it can only be available in a pharmacy,’ she said. ‘Those are the really interesting and rewarding aspects of poisoning work.’ For pharmacists considering the field, Ms Adamo believes the appeal lies in its tangible public health impact – shaping national safety standards and preventing future harm, particularly among children. ‘You know the work you’re doing actually changes outcomes.’ Read PSA’s Medicine Safety: Child and adolescent care report to understand the key poisoning risks and how pharmacists can help mitigate them. [post_title] => How pharmacists can prepare for poisons information roles [post_excerpt] => Poisons information pharmacists turn individual calls into population-level insights that inform regulatory and scheduling decisions. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => how-pharmacists-can-prepare-for-poisons-information-roles [to_ping] => [pinged] => [post_modified] => 2026-02-02 18:25:34 [post_modified_gmt] => 2026-02-02 07:25:34 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=31254 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => How pharmacists can prepare for poisons information roles [title] => How pharmacists can prepare for poisons information roles [href] => https://www.australianpharmacist.com.au/how-pharmacists-can-prepare-for-poisons-information-roles/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 31258 [authorType] => )

      How pharmacists can prepare for poisons information roles

      Early career pharmacist
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                  [post_content] => 

      Victoria Chisari MPS is an early career pharmacist and researcher on the move, working across clinical areas of practice to hone her skills.

      What’s beneficial about learning different specialties in pharmacy?

      Each specialty offers a unique focus, with the learning from each area building upon the others to create a comprehensive understanding of clinical pharmacy service delivery.

      I am currently a clinical pharmacist with Western Sydney Local Health District and a research team member and practice change facilitator at the University of Technology Sydney. But I have worked in many different clinical roles. My experience in the intensive care unit, for example, helped develop my ability to review acutely unwell patients – including those with infections, trauma, respiratory failure and organ failure.

      In this setting, I managed a diverse range of critically ill patients with complex medicines regimens – involving supportive therapies such as inotropes and vasopressors, sedation and antimicrobials.

      My practice involved designing individualised treatment plans for patients, particularly those receiving extracorporeal therapies such as renal replacement therapy and extracorporeal membrane oxygenation.

      This background informed my practice in the emergency department, where sound clinical reasoning was vital to delivering effective advice and interventions in fast-paced, high- pressure situations.

      Can you describe your global research review of pharmacist-prescribed contraception services?

      In response to barriers accessing contraception, such as the need for a prescription, pharmacist-prescribed contraception has been widely implemented and one common model of care delivers this service using clinical protocols. The review highlighted that the overall scope of these services includes both the prescribing (initiating) and continuation of various contraceptive methods, such as oral contraceptive pills, vaginal rings, transdermal patches and injections. A key finding was that the scope of practice varies internationally, depending on local authorisation and regulatory frameworks.

      It was recognised that while conceptually, the clinical protocol is one part of the intervention, education is another important part of the overall provision of care.

      This includes recognition of the importance of both foundational education and additional training for pharmacists.

      It was evident that authorising pharmacists to prescribe and continue a range of contraception options ultimately offers the best access for women.

      At the same time, pharmacist education and training is an important part of the broader piece in pharmacist prescribing – particularly in the current Australian context, as pharmacist prescribing continues to develop and expand.

      Your advice for other early ECPs interested in clinical pharmacy?

      Seek out opportunities to broaden your knowledge and skills.

      If you’re a pharmacy student or ECP interested in hospital pharmacy, look for courses, mentorship programs and professional development opportunities that align with your goals.

      Hospital pharmacy is dynamic, exciting and rewarding – there’s a lot to learn and a lot that we as pharmacists can contribute to.

      Ask questions and say yes to challenges that push you to grow. Be curious, be kind and keep learning. 

      [post_title] => Expanding clinical judgement beyond a single specialty [post_excerpt] => Victoria Chisari MPS is an early career pharmacist and researcher on the move, working across clinical areas of practice to hone her skills. [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => expanding-clinical-judgement-beyond-a-single-specialty [to_ping] => [pinged] => [post_modified] => 2026-02-02 18:25:57 [post_modified_gmt] => 2026-02-02 07:25:57 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=31248 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => Expanding clinical judgement beyond a single specialty [title] => Expanding clinical judgement beyond a single specialty [href] => https://www.australianpharmacist.com.au/expanding-clinical-judgement-beyond-a-single-specialty/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 31253 [authorType] => )

      Expanding clinical judgement beyond a single specialty

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                  [post_content] => Australia's Minister for Health has announced a National Medicines Record. What is it, and what will it achieve?
      
      Medicine safety has long depended on pharmacists making critical decisions with incomplete information. As prescribing becomes increasingly fragmented across face-to-face care, telehealth and digital platforms, those gaps are widening – with serious consequences for patients. 
      
      Reforms announced by Minister for Health and Ageing Mark Butler this morning aim to address this issue, eventually leading to a National Medicines Record. 
      
      The announcement follows advocacy by Alison Collins after the death of her daughter Erin, who died in 2024 after being prescribed medicines through multiple digital health platforms without a complete view of her medical history.
      

      Erin’s story

      Erin was 24 years old and had been taking multiple medicines for her mental health. She had been hospitalised multiple times for problems stemming from medicine misuse and was placed on daily staged supply pickup of her medicines.  The hospital care teams were so concerned they placed multiple warning messages in her My Health Record. However, these warnings were not accessed by telehealth services or local pharmacies prior to her fatal overdose. Erin’s case highlighted systemic vulnerabilities that pharmacists have warned about for years, particularly as digital prescribing expands faster than the safeguards designed to support safe, coordinated care.

      The first step

      Initially, the reforms would require all medicines information from online prescribers to be uploaded to My Health Record For pharmacists, this will make a fuller picture of all the medicines a patient has been prescribed more visible. This is critical given the increasing number of prescribers an individual may have with the rise of telehealth and condition-specific providers.  Under the proposed changes, medicines prescribed and dispensed through online platforms – including the clinical context for prescribing – would be made available through My Health Record. This is intended to help reduce the risk of medicine  errors, adverse drug reactions and inappropriate use by ensuring healthcare professionals have access to more complete and timely information.

      The path to a National Medicines Record

      The reforms also commit the Government to designing and developing a National Medicines Record using existing digital health infrastructure, including electronic prescribing, the Active Script List and My Health Record.  While details are still emerging, the proposal has the potential to address a core challenge for pharmacists: how to identify and resolve medicines-related risks without a reliable, up-to-date picture of a patient’s full medicines history. Welcoming the announcement, PSA National President Professor Mark Naunton MPS noted it aligns with the profession's long standing advocacy. 'Pharmacists have consistently sought better-connected digital health systems to improve patient safety with medicines. It’s something PSA has been advocating for over many years, including through our flagship medicine safety report series,” Prof. Naunton said. 'Access to a more complete and reliable medicines record has the potential to significantly improve patient safety and strengthen clinical decision-making.' 'The announcement is fully aligned with PSA’s ongoing advocacy to improve medicines safety systems and ensure pharmacists are supported as medicines experts across all settings of care,' he continued. 'PSA will engage in the consultation for these proposals and continue to work with the Government to support system improvements that make medicine use in Australia safer.' A consultation period is now underway to guide the inclusion of medicines information from all online prescribers by default, with the first phase expected to be completed by December 2026. The Government has also flagged ongoing enhancements to the 1800MEDICARE app to support medicines management. [post_title] => What a National Medicines Record might mean for patient safety and pharmacy practice [post_excerpt] => Australia's Minister for Health has announced a National Medicines Record. What is it, and what will it achieve? [post_status] => publish [comment_status] => open [ping_status] => open [post_password] => [post_name] => towards-a-national-medicines-record [to_ping] => [pinged] => [post_modified] => 2026-01-30 16:02:41 [post_modified_gmt] => 2026-01-30 05:02:41 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.australianpharmacist.com.au/?p=31238 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [title_attribute] => What a National Medicines Record might mean for patient safety and pharmacy practice [title] => What a National Medicines Record might mean for patient safety and pharmacy practice [href] => https://www.australianpharmacist.com.au/towards-a-national-medicines-record/ [module_atts:td_module:private] => Array ( ) [td_review:protected] => Array ( ) [is_review:protected] => [post_thumb_id:protected] => 31240 [authorType] => )

      What a National Medicines Record might mean for patient safety and…

AUSTRALIAN PHARMACIST Australian Pharmacist

RB - 31 October 2000
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RB - 31 October 2000
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