In early August, almost 50 doctors (17), pharmacists (25), natural therapists and allied health professionals met in Lismore to discuss the management of menopause, with a particular interest in the role of hormone therapy (HT).

A panel comprising Dr Nicola Foster, Dr Jane Reffell, pharmacist Michael Serafin, and Cathy Avila, clinical educator, SCU School of Natural and Complementary Medicine, partook in a series of case discussions chaired by Dr Christine Read, medical director of FPA Health (Family Planning NSW).

The consensus from the evening was that practitioners are encouraged to take a holistic approach when offering advice and treatment to the woman experiencing menopause symptoms, as simple lifestyle changes can reduce discomfort and create many benefits. Menopause, and the milestone that it represents, can be used to motivate women to make positive changes regarding nutrition, exercise, smoking, alcohol and caffeine intake.

It was acknowledged that prescription of bioidentical hormones, while popular with some practitioners, and often administered in the form of lozenges, lacked a sound evidence base. Concern was expressed by medical practitioners about endometrial safety with these regimes.

Naturopathy, while also lacking a broad evidence base, was agreed to be useful and felt to be safe as long as red flag symptoms were referred to a medical practitioner.

Conventional HT certainly has a place in the short-term management of menopause symptoms for some women. It can be difficult to wean certain women off their HT, as quality of life, on occasions, can be greatly reduced without it. Informed consent is the key for those who wish to continue for periods that exceed the current recommendations of about five years.

Finally, an important point is the place of progesterone cream. While effectively reducing milder menopause symptoms for some women, it must never be used as the opposing progesterone in conventional HT regimes. There is good evidence that it is ineffective in protecting the endometrium from stimulation by oestrogens. Further it has no place in the treatment of osteoporosis.

Thanks to the NRDGP Home Medicines Review Program and National Prescribing Service for sponsoring this interactive event. A tasty meal, delightful company and the chance to meet with our allied health colleagues made the night most enjoyable as well as educational.

Dr Christine Ahern is a GP and the director of training at North Coast GP Training.

The discussion forum was hosted by the division and sponsored by the Home Medicines Review Program and National Prescribing Service.