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Published: 24th April, 2026
Contents
New from bpacnz – Pharmacological management of ADHD in adults and children: a new frontier for primary care
Prescribing restrictions and funding criteria were amended earlier this year to allow vocationally registered general practitioners and nurse practitioners working within their area of practice to initiate psychostimulant medicines for adults with ADHD. These changes are intended to increase access to treatment; however, it will take time for primary care clinicians to develop the necessary confidence/skills and establish the relevant systems and resources to be able to offer ADHD assessment and management. While not all primary care clinicians will choose to offer diagnostic services for people with ADHD, most will at some stage prescribe psychostimulant medicines.
bpacnz has developed a comprehensive resource to guide primary care clinicians when prescribing psychostimulant medicines for ADHD in adults. This includes a summary of funded medicines and their characteristics, pre-treatment considerations and investigations, initiation and dose titration, monitoring, switching between formulation types and treatment cessation. The extension of ADHD management into primary care presents a new opportunity for clinicians to address established treatment barriers and explore a new frontier. N.B. This article does not cover the diagnosis of ADHD or the use of psychostimulant medicines for other indications such as narcolepsy.
Read the article here. A B-QuiCK summary is also available.
In case you missed it – Management of genital herpes: reducing stigma
From a medical perspective, genital herpes is a straight-forward, easily treated condition for most patients. However, significant social stigma is often associated with a diagnosis. Effective management of genital herpes requires consideration of both medical and psychosocial implications. We present an overview of the management of patients with genital herpes, covering key clinical points from the 2024 New Zealand guidelines from the Sexually Transmitted Infections Education Foundation.
Read the article here. A B-QuiCK summary is also available.
Rewind: Wrap-up of recent key messages
Key dates and updates on news items from recent editions of Best Practice Bulletin:
- Pharmac consultation on medicine brand changes closes on Monday, 4th May; see Bulletin 145
- Stock of phenytoin sodium 30 mg capsules has arrived in the country. This follows a possible out of stock period (as reported in Bulletin 145).
- Progesterone 100 mg capsules (Utrogestan) will temporarily switch to monthly dispensing from 1st May due to supply issues (as reported in Bulletin 145)
- Supply issues affecting mometasone furoate remain ongoing (last reported in Bulletin 144). The 15 g cream and ointment and 30 mL lotion are currently out of stock; check Pharmac for latest supply information.
- The funded brand of varenicline is changing (as reported in Bulletin 142). Stock of the new brand (Pharmacor Varenicline) has now arrived; Champix will be delisted on 1st September.
Book competition winners: What was I thinking? How it feels to receive a complaint
Thank you to everyone who entered our competition for a copy of Dr Greg Judkin’s book, “What Was I Thinking?”. Entrants were asked to recount a time when they were on the receiving end of a formal complaint, and how this made them feel. We enjoyed reading every entry and are humbled that you entrusted us with your personal stories. Having a complaint made about your care is not something that people often feel comfortable discussing, but it’s important to be able to share and reflect on these experiences. We have selected the top three entries, and their prizes are on the way. Some of the winners gave us permission to use their names.
“Complaints are inherently triggering. They generate emotion and defensiveness because, ultimately, you are trying to act in your patients’ best interests. It is upsetting when a complaint is made, but the process of pausing, venting to the silent universe, reflecting and then responding remains important regardless of the outcome.” – Dr Stefan Fairweather
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A common theme that emerged from the responses was akin to the “five stages of grief”: denial, anger, bargaining, depression and acceptance. “I didn’t do this”, “How could they accuse me, I thought we had a good relationship”, “Maybe I did do something wrong, what if I had just checked that result sooner”, “I am incompetent, I am the worst doctor in the world, I should just quit now”, “Ok, I made a mistake, I learnt from it, I won’t do it again”.
When faced with a complaint, it is important to allow yourself time to process it before deciding how to proceed (respond, rather than react). Dr Stefan Fairweather explains this eloquently:
“My first reaction was defensiveness. I felt attacked. I felt I had done nothing wrong. It was a knee-jerk response, a spike of emotional energy that I needed to sit with for a while before responding.
Once that initial reaction settled, I had to step back and reflect. I had to ask myself whether I had done something wrong that had led to the complaint. The complaint, like any patient encounter in general practice that generates a strong emotional reaction, is a reason to stop and look in the mirror. Why am I reacting like this? Is it because of something in me? Is it because of something I have done? Why has it generated such a strong response?
If I can get past the initial emotion and not react from it (not always easy to do), but instead examine it critically and reflectively, then I am in a position to respond appropriately.”
Everyone makes mistakes, it’s just that in some occupations, the stakes are much higher. When a complaint happens early in your career, it can often be a pivot point, where you must confront whether you are resilient enough to constantly dampen down that pervasive fear of inadvertently causing harm. Talking to senior colleagues who have most likely been through the same thing, can be valuable. Feeling ashamed can make some people reluctant to share what they are enduring, but this is a time when you should always seek support.
“Receiving my first complaint really made me second guess every aspect of my care provided to that patient. It was not one that I expected (they never seem to be!). I found it really difficult to read through all my notes and decide what I thought about the complaint with the benefit of hindsight. Initially I was really hard on myself thinking ‘man, maybe I didn't do enough in this case’. I was also quite junior at the time, and it did make me question my competence. But one of the SMOs looked through it all as well, and they helpfully thought as a second independent opinion that my care looked adequate and so they weren't concerned about my competence. This made me realise how important my good documentation was. It still played in my mind for a while. But I talked to colleagues and I think I accessed EAP at the time and processed it eventually which was helpful.”
Ultimately, making a mistake (actual or perceived), receiving a complaint and experiencing all the associated emotions, can often be a healing and cathartic experience. Just like Gaudi’s Sagrada Familia, we are always “under construction”, patching up pieces, adding new pieces and becoming something more.
The final words go to Dr Catherine McArthur who has courageously put her experience into verse; beautifully written and poignantly read.
I missed it.
I overlooked that spot!
Then after just six months
Metastases everywhere.
Just awful.
I missed it
O the shame!
Can I ever practise medicine again?
I missed it.
Too much to do in so little time.
But I should have looked at it,
Properly looked at it.
It was awful.
Atypical histology
But angry mitoses.
O the shame!
I missed it.
He was just in his thirties,
And he died.
Two-year-old twins, fatherless.
After, I saw his widow in the supermarket.
I turned my back.
Ashamed!
Surely, I cannot be a good doctor.
The letter from HDC came.
I hid it to open in private.
Couldn’t let my colleagues see
That I wasn’t a good doctor.
HDC required more study
And a written apology.
But that was ok.
It was private shame that threatened more.
Twenty-five years later
I spoke of it at peer group.
How awful it was.
How I missed that spot.
I wept tears of shame.
How could I be a good doctor?
HDC had censured me,
But my self-reproach was far worse.
Brain Injury Screening Tool (BIST) now live on BPAC CareSuite
In March, the Brain Injury Screening Tool (BIST) was added to BPAC CareSuite. BIST, developed by Auckland University of Technology (AUT), is a brief, evidence-based tool that provides clinical support for traumatic brain injury assessments (e.g. concussion). This digital version of the tool is quick to complete, automatically calculates an assessment score, tracks the patient’s recovery progression over time and updates the patient record.
BPAC CareSuite was launched earlier this year by BPAC Clinical Solutions as the new home for its healthcare decision support tools (as reported in Bulletin 141). BPAC CareSuite is free and can be integrated into Medtech or Indici patient management systems or is accessible via a web browser. Sign up here.
Users can also access the ACC Medical Certification dashboard in BPAC CareSuite (as reported in Bulletin 141). The rest of the range of BPAC Clinical Solutions decision support tools will migrate to BPAC CareSuite in the future.
For further information on concussion and BIST, see: https://bpac.org.nz/2022/concussion.aspx
New ACC Return to Work guidelines after surgery
ACC, in collaboration with the New Zealand Orthopaedic Association, has developed new evidence-based guidelines on returning to work following elective surgery. The guidelines are intended to support clinicians and patients with recommended return-to-work timeframes after ACL reconstruction, ankle lateral ligament reconstruction, knee arthroscopy, lumbar discectomy, lumbar fusion, rotator cuff repair and knee replacement surgery. View the guidelines here.
For further information on Recovery at Work, see the bpacnz suite of resources here
World Immunization Week: 24th – 30th April
World Immunization Week is being held from 24th – 30th April. The theme for this year is “For every generation, vaccines work”. This is a timely reminder to opportunistically check that patients are up to date with their immunisations as part of routine appointments, and to offer vaccination where appropriate. Resources to support the campaign are available here.
A list of available vaccinations for adults, including for special circumstances, e.g. overseas travel, can be found here. For more detailed recommendations and the National Immunisation Schedule, see the Immunisation Handbook.
Measles case in Wellington. A new case of measles has been confirmed in New Zealand. The case is unrelated to overseas travel or linked to a previous case, which may suggest undetected community transmission. Locations of interest are listed here. Healthcare professionals should be alert for symptoms and signs of measles in patients, e.g. generalised maculopapular rash, fever > 38°C, cough, conjunctivitis. The latest MMR vaccination guidance from IMAC is available here.
Anyone for a flu vaccine?
Influvac Tetra (quadrivalent vaccine) is the sole funded influenza vaccine for children aged six months and over and adults who meet eligibility criteria. Eligibility criteria for vaccination have not changed in 2026, and include: people aged ≥ 65 years, people aged < 65 years with long-term conditions or specific mental health conditions or addictions, people who are pregnant and children aged ≤ 4 years who have been hospitalised for, or have a history of, significant respiratory illness (click here for details). Three other brands of influenza vaccine are also available to purchase; see Bulletin 144 for more information.
Medicine news
The following news relating to medicine supply has recently been announced. These items are selected based on their relevance to primary care and where issues for patients are anticipated, e.g. no alternative medicine available or changing to the alternative presents issues. Information about medicine supply is available in the New Zealand Formulary at the top of the individual monograph for any affected medicine and summarised here.
Supply issue affecting imiquimod (Padagis)
Recent conflict in the Middle East has caused disruptions to the latest shipment of imiquimod cream 5% (Padagis) arriving in New Zealand. Imiquimod is a topical treatment for warts, superficial basal cell carcinoma and actinic keratosis. An alternative brand (Aldara) has been listed on the Pharmaceutical Schedule and is expected to be available by the end of April, however, it is not Medsafe approved and so will need to be prescribed for supply under Section 29A of the Medicines Act. Patients can be reassured that there is no change to the active ingredient, however, the quantity supplied per box will be different (12 sachets, rather than 24).
A patient information sheet is available here
Nitrofurantoin immediate-release tablets (Nifuran) brand change
The funded brand of nitrofurantoin immediate-release tablets (50 mg and 100 mg), most often used in the treatment of urinary tract infection, is changing from Nifuran to Nitrofurantoin Clinect. Nitrofurantoin Clinect will be listed on the Pharmaceutical Schedule from 1st May, however stock will not be available until the end of May. Stock of Nifuran 100 mg tablets ran out in 2025; there is still stock of 50 mg tablets, but this will expire in October. Both strengths of Nifuran immediate-release tablets will be delisted from the Pharmaceutical Schedule on 1st November. Reassure patients that there has been no change to the active ingredient, but tablet appearance will be different (rounded rather than flat, but a similar colour).
A patient information sheet about the brand change is available here
Reminder: Prescribe nitrofurantoin by brand to avoid confusion between immediate-release and modified-release formulations which have different administration frequencies.
Low stock of isosorbide mononitrate 40 mg tablets
Recent conflict in the Middle East and increased demand has resulted in a supply issue affecting isosorbide mononitrate 40 mg long-acting tablets (Ismo 40 Retard); as reported in Bulletin 145. Isosorbide mononitrate is primarily used for the prophylaxis of angina. Pharmac has received clinical advice that 60 mg modified-release tablets (Duride) may be a suitable alternative (or half a tablet for ~30 mg dose), however, a new prescription will be required. The Duride data sheet states that the tablet can be halved without affecting the modified-release properties if the tablet is not crushed or chewed.
Ezetimibe + simvastatin supply issue
There is a supply issue affecting ezetimibe 10 mg + simvastatin 40 mg combination tablets (Zimybe) due to manufacturing delays. Ezetimibe + simvastatin is used as a lipid-lowering treatment. An alternative brand (Vytorin) will be listed on the Pharmaceutical Schedule from May, however, it is not approved by Medsafe, therefore will need to be prescribed for supply under Section 29A of the Medicines Act. Alternatively, patients could be prescribed ezetimibe and simvastatin separately; a new prescription will be required and two co-payments will apply. Other strengths of ezetimibe + simvastatin are not currently affected by this supply issue.
Estradot 75 microgram patches out of stock
There is a supply issue affecting the Estradot brand of oestradiol 75 microgram patches. Other strengths of this brand are not currently affected, and some pharmacies may still have stock remaining. Supply issues affecting oestradiol patches have been ongoing since 2022. Pharmac advises that all strengths of TDP Mylan, the other funded brand of oestradiol patches, are available. Re-supply of Estradot oestradiol patches is expected late April/early May; it may take a further one to two weeks for this stock to reach pharmacies.
Consultation to widen pharmacy services
Pharmac and Health New Zealand are seeking feedback on a proposal to widen the range of clinical services and funded medicines offered in community pharmacy for some people with certain conditions, e.g. scabies, headlice, acute oral rehydration and fever management in children. The changes are intended to facilitate more timely access to health care for some groups. If the proposal is accepted, the changes would come into effect on 1st June.
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Under the proposal, pharmacists could supply the following medicines directly to a patient for specific indications without a prescription. Pharmacists may already provide some of these medicines/services to certain groups of patients, e.g. chloramphenicol; if the proposal is accepted, the difference is that these medicines would be funded when supplied by a pharmacist. Health New Zealand would also fund consultations provided by pharmacists for eligible people. An extended pharmacy service consultation fee may apply to people accessing these services and prescription co-payments would remain.
- Permethrin 5% lotion for the treatment of scabies in children aged under 14 years and their family/whānau
- Dimethicone 4% lotion for the treatment of headlice in children aged under 14 years and their family/whānau
- Paracetamol (120 mg/5 mL oral liquid, 250 mg/5 mL oral liquid, 500 mg tablets) and ibuprofen (20 mg/mL oral liquid, i.e. 100 mg/5 mL) for acute analgesia and fever management in children aged under 14 years
- Powder for oral solution (Electral) and solution with electrolytes (Pedialyte, 2 x 500 mL) for acute oral rehydration in children aged under 14 years
- Chloramphenicol 0.5% eye drops and 1% eye ointment for acute bacteria conjunctivitis in children aged 2 – 14 years
- Nitrofurantoin 100 mg capsules and trimethoprim 300 mg tablets for acute uncomplicated UTIs in females aged 16 – 65 years
- Levonorgestrel 1.5 mg tablet for emergency contraception in females aged under 25 years. N.B. This medicine can already be provided directly by pharmacists to people of any age (funded). It is proposed that the consultation required to supply it to females aged under 25 years would be funded for pharmacies.
Consultation closes Thursday, 30th April. Feedback can be submitted here.
Amendments to Cremation Regulations formalised from May
The Ministry of Health, Manatū Hauora, has announced that amendments to some aspects of the Cremation Regulations 1973 will be formalised from 7th May, 2026. Some of these changes are new and some have been in place since 2020 (when temporary Ministerial authorisations were implemented). The amendments are intended to reflect more modern practices, ease paperwork requirements regarding deaths that occur in low-risk settings and reduce delays for family/whānau.
A key change being formalised is that a medical or nurse practitioner will not be required to examine and identify a body to authorise cremation when the person’s identity and medical history is known, the death is due to natural causes and has occurred in a low-risk setting, e.g. aged residential care.
Read about key changes
Key amendments being made to the Cremation Regulations from 7th May, 2026, include:
- Revised definition of low-risk setting – this will mean age-related residential care and specialist palliative care (previously termed long-term inpatient facilities)
- Introduction of a new form (Form BA) for deaths that occur in low-risk settings. Body examination will not be required. In low-risk settings, a medical or nurse practitioner can receive verification from another health practitioner (e.g. registered nurse) on the identity of the deceased and that the health practitioner has considered the circumstances of the death to be consistent with natural causes.
- Where a death does not meet the low-risk definition, a medical examination will still be required before cremation can be authorised
- Clarification about battery-powered devices:
- Some newer pacemakers and similar battery-powered devices will be considered safe to remain in place for cremation (information on whether a device is safe for cremation will likely be provided in the patient’s cardiology discharge summary after insertion of the device)
- The role of a health practitioner in relation to battery-powered devices is to confirm their presence in a body, not to remove them
CPD Corner: Upcoming Goodfellow Unit webinar + latest podcast episodes from The Specialist GP
Listening to a Goodfellow Unit webinar or podcast from The Specialist GP is a CPD-eligible activity.
Upcoming Goodfellow Unit webinar
The Goodfellow Unit, University of Auckland, is hosting an upcoming free webinar covering two topics: Roadside testing and Advance Care Planning. This is a Health New Zealand; Te Tiri Whakāro: Sharing Knowledge session. Dr Anna Skinner will cover the new roadside drug testing process and Jane Goodwin (National Advance Care Planning Programme Lead) will provide an overview of advance care planning. Dr Sue Tutty will also give general updates at the end of the session. The webinar will be held on Tuesday, 28th April, from 7:30 pm. Click here to register.
A webinar on redefining insomnia management, presented by Specialist Sleep Physician Dr David Cunnington, was recently held by the Goodfellow Unit. If you missed it, view a recording of the webinar here.
Latest podcast episodes from The Specialist GP
‘The Specialist GP' is a New Zealand–based podcast for primary care health professionals, created and hosted by Dr Louise Kuegler (as reported in Bulletin 142). Recent episodes include:
Paper of the Week: A moment for menopause - consultation tips and a discussion about non-hormonal treatments
Three out of four females experience symptoms related to hormone changes during perimenopause/menopause and for many, this has a significant impact on their quality of life. Historically, menopause was viewed as something to just be tolerated but increasing awareness due to education (and social media) enables earlier recognition of symptoms and empowers people to initiate discussions with health professionals. For many years, conflicting research and “bad press” about hormonal treatments for menopause meant that many people were reluctant, or even afraid, to seek treatment for their symptoms (and some clinicians may have been hesitant to prescribe hormonal treatment for the same reasons), but the evidence around benefits and harms is now well established and the conversation is changing. Primary care is often the first point of contact, therefore, clinicians should be well prepared for these conversations when they arise, and where required, be ready to initiate discussions.
A series of articles recently published in the Australian Journal of General Practice provides pragmatic advice for primary care clinicians about menopause treatment. The first describes a framework for a menopause consultation in primary care. Patients can present with variable clinical features; a focused assessment establishes the extent of symptoms and impact on quality of life. Ideally, this is revisited over several consultations and involves discussion around patient expectations and priorities, the effects of menopause on future disease risk and a tailored treatment regimen including pharmacological, psychological and lifestyle interventions as needed.
Menopause hormone therapy (MHT) is typically the first-line option for vasomotor symptoms, however, several key contraindications mean that up to 11% of patients require non-hormonal treatment strategies. Some patients may also prefer to use non-hormonal treatments or add them alongside their MHT regimen. The second article discusses non-hormonal treatments for vasomotor symptoms. Pharmacological options, with the exception of clonidine, are prescribed off-label, and while CBT and hypnotherapy may be beneficial for some patients, there is limited evidence to support complementary and alternative medicines.
Have you noticed an increase in the number of patients presenting to primary care who want to discuss symptoms of perimenopause or menopause? Do you find patients are presenting earlier, as opposed to just tolerating their symptoms for extended periods? Do you feel confident in prescribing a treatment regimen to manage the variety of symptoms that patients may present with? What non-hormonal treatment options do you typically prescribe and how effective do patients find these for managing vasomotor symptoms?
Read more
The menopause consultation
- Begin conversations about menopause early and revisit this topic often; an empathetic and proactive approach to acknowledging and managing symptoms is essential
- When a patient presents with potentially menopause-related symptoms, firstly establish what concerns are of most importance to them, what their expectations are for management, and if there are any other factors present that may explain or contribute to their symptoms
- Menstruation changes related to menopause may include changes in bleeding frequency (i.e. longer, shorter or variable cycles), pattern (i.e. heavier or lighter bleeding) or a combination of changes due to fluctuating hormone levels
- Menstruation changes are not the primary indicator of menopause for all females, e.g. those using continuous oral contraception, have an intra-uterine device in-situ or those who have a history of uterine ablation or hysterectomy
- Abnormal bleeding, including menorrhagia, post-coital or intermenstrual bleeding should be investigated
- Oestrogen and progesterone receptors are widespread throughout the body and hormone fluctuations affect many tissues. Ask about other symptoms the patient may be experiencing:
- Vasomotor symptoms, e.g. hot flushes, sweating, feeling like the “thermostat is set higher”, are estimated to affect more than half of females at mid-life, continuing for up to 7 - 8 years and in some cases persisting for 4 - 5 years after their last menstrual period
- Sleep disturbances, including insomnia, restless sleep, restless legs syndrome and sleep apnoea, may be related to vasomotor symptoms or mood changes (see below)
- Mood changes, e.g. anxiety, irritability, mood lability, depression, can be both caused by, and exacerbated by, hormonal changes, or occur independently of menopause (e.g. due to life stress); a focused patient history is crucial to ascertain the likely cause, and therefore the appropriate treatment
- Cognitive changes, such as difficulty concentrating or memory issues are common and often referred to as brain fog. Reassure patients that these are caused by changes in hormone levels and are generally transient and not signs that they are at increased risk of developing dementia.
- Genitourinary symptoms, as a result of reduced oestrogen, are very common and increase with age. This includes urinary urgency and frequency, incontinence, recurrent urinary tract infections, vulval discomfort, dryness, itch and dyspareunia.
- Atrophy, petechiae, lichen sclerosis, eczema and irritant dermatitis due to urine are common findings related to vulval discomfort
- Libido, intercourse and relationships. Often patients will be reluctant to raise this topic, so clinicians should ask about sexual dysfunction and its impact on their life (without making assumptions about sexual practices).
- Contraception needs could also be addressed at this time
- Other reported symptoms related to menopause include musculoskeletal and joint pain, headaches, dry skin, formication (sensation of crawling skin – a type of paraesthesia) and a general loss of vitality
- Avoid attributing all complaints to perimenopause/menopause until other causes of symptoms have been excluded. Also consider the impact of psychosocial factors, e.g. life stressors.
- Use clinical judgement when deciding what aspects of a physical examination are required, e.g. blood pressure, height/weight/waist circumference, pelvic examination (if the patient has abnormal bleeding)
- Request appropriate investigations as needed (e.g. renal function, lipids and HbA1c for cardiovascular risk assessment, iron studies and thyroid function if persistent fatigue and menstruation changes). Testing reproductive hormone levels is generally not required in most patients aged 45 years and over with typical menopause symptoms.
- Follicle-stimulating hormone (FSH) levels should be requested if premature ovarian insufficiency is suspected, e.g. amenorrhoea or oligomenorrhoea in a patient aged under 40 years
- Hormone changes are also associated with changes in long-term disease risk. A menopause consultation provides an opportunity to assess and address any concerns relating to cardiovascular, bone and general health and implement lifestyle changes where appropriate, e.g. exercise, diet, alcohol intake.
- Management of menopausal symptoms involves a combination of patient education, pharmacological intervention, lifestyle advice and psychosocial support
- Follow-up is recommended every three months after starting treatment and once optimised, review patients at least annually
Non-hormonal treatment options for vasomotor symptoms
- MHT is the first-line treatment option for vasomotor symptoms, however, it is contraindicated in some patients, including those with:
- A history of hormone-dependent breast, endocrine or reproductive cancer
- Undiagnosed vaginal bleeding
- Active/recent cardiovascular disease, e.g. heart attack, stroke
- Current blood clots
- Active liver disease
- Untreated hypertension
- Some patients may also prefer not to use hormonal treatment; ensure they understand the benefits and risks, and address any misconceptions
- Clonidine is the only medicine approved in New Zealand for menopausal flushing, however, it is potentially less effective than other (unapproved) options and adverse effects, e.g. dizziness, hypotension, drowsiness, may limit use
- Other medicines that may reduce vasomotor symptoms (unapproved indication) include:
- Lower dose escitalopram, paroxetine and venlafaxine may be useful in patients with concomitant anxiety or depression associated with menopause. Avoid abrupt cessation; short-acting SSRIs and venlafaxine typically require a gradual reduction to avoid discontinuation symptoms.
- Gabapentin can be useful for patients experiencing sleep disturbances in addition to vasomotor symptoms. Multiple daily dosing (if required) and adverse effects can be challenging for some patients.
- Oxybutynin is effective for reducing “hot flushes” but may not be suitable for patients prescribed concomitant medicines with anticholinergic effects
- Fezolinetant (Section 29), a neurokinin 3 (NK3) receptor antagonist, reduces the production of neurokinin B in the hypothalamus reducing flushing and sweating. It is not funded therefore cost may be a barrier for some patients. N.B. Fezolinetant should not be prescribed in combination with oestrogen or progesterone.
- Validated cognitive behavioural therapy and/or clinical hypnotherapy have been shown to reduce vasomotor symptoms and improve sleep
- Despite widespread promotion (and use) of complementary and alternative medicines for vasomotor symptoms, there is limited evidence to support their use, e.g. black cohosh (Cimicifuga racemosa), phytoestrogen foods such as soy products, flax seeds and legumes
- A patient information sheet discussing complementary and alternative medicines for menopause symptoms is available here
Spencer R, Newman A. The menopause consultation. Aust J Gen Pract 2026;55:189–94. doi:10.31128/AJGP-09-25-7834.
Farrell E, Severin K. An update on the use of non-hormonal therapies for vasomotor symptoms of menopause. Aust J Gen Pract 2026;55:203–6. doi:10.31128/AJGP-08-25-7809.
For further information on managing menopause in primary care, see: Menopausal hormone therapy: where are we now? and bpacnz focus: Ask about menopause
This Bulletin is supported by the South Link Education Trust
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