The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (欧美AV, the College) welcomes the Aotearoa New Zealand Government’s launch of the , alongside its announcement that cervical screening will be free for all women aged 25 to 69 from 1 March 2027.

欧美AV has long advocated for free cervical screening for all women in Aotearoa New Zealand and highlighted it as one of the College鈥檚 four advocacy priorities for the 2026 New Zealand general election. The Labour Party has also committed to funding free cervical screening through its proposed Medicard scheme. Removing cost as a barrier to cervical screening is a vital step in improving equitable access for women across Aotearoa New Zealand, and the College looks forward to working constructively with the Government to support the implementation of the Plan through to 2040.

Dr Emma Jackson, 欧美AV Aotearoa New Zealand Vice-President says, 鈥淐ervical cancer can be eliminated, and we have the tools to achieve it. 欧美AV has long called for free cervical screening for all women, so it鈥檚 fantastic to see broad commitment to this, backed by a national elimination plan with clear targets and timeframes.鈥�

欧美AV acknowledges that M膩ori, Pacific Peoples, and people living in areas of deprivation continue to experience higher rates of cervical cancer, impacted by lower rates of vaccination, screening, and timely follow-up care. Achieving elimination requires meeting elimination targets across all population groups, not only in the national average, and 欧美AV will continue to advocate for equity of access and outcomes as this Plan is implemented.

Media enquiries

Catherine Cooper
欧美AV Executive Director, Aotearoa New Zealand
ccooper@ranzcog.org.nz
+64 21 137 0748

On 17 August 2026, Nationals MP Mr Llew O鈥橞rien introduced the Human Rights (Children Born Alive Protection) Bill 2026 into the Australian House of Representatives for consideration by Parliament.

The objective of the Bill is to legislate protections relating to live fetuses during an abortion across Australia. Similar bills introduced federally in 2021 and 2022 failed to gain sufficient parliamentary support and ultimately lapsed. Like prior attempts, the proposed Bill lacks medical, ethical, and legal grounds.

Drawing on clinical evidence and the expertise of specialists who provide reproductive healthcare, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (欧美AV, the College) strongly opposes the proposed Bill.

The proposed Bill insinuates that medical professionals may fail to provide care to a live fetus during an abortion. This is simply not true.

The proposed legislation does not address any demonstrated gap in the existing legal or professional framework governing healthcare. All healthcare professionals already operate under strict professional and regulatory standards, and with a duty of care to their patients.

 

What this Bill will do instead is add barriers to abortion access for women and vulnerable communities through creating fear and uncertainty amongst providers.

鈥� Dr Nisha Khot, 欧美AV President

Obstetricians and gynaecologists who care for women in these circumstances are concerned that the 2026 Bill fundamentally misrepresents clinical practice. Most abortions occur in the first trimester, well before 22 weeks. Before 22 weeks, a fetus is medically considered previable, regardless of the circumstances, so life sustaining medical care is not possible. In these situations, the provision of palliative care for the fetus is already current practice.

Abortions after 22 weeks are rare and require support from two medical practitioners in most jurisdictions in Australia. These decisions are often due to fetal anomalies, that present a substantially reduced likelihood of survival after birth, even with medical intervention.^[1],[2] This context is important when considering the Human Rights (Children Born Alive Protection) Bill 2026, as later abortions often involve complex medical situations and very poor fetal prognoses.

Further legal regulation will be confusing and unhelpful, leading to practitioner anxiety. If a clinician is found liable for an offence, the Bill outlines that they be penalised by 2,000 penalty units 鈥� the equivalent of a $728,000 fine. This may make healthcare professionals reluctant to provide services for fear of being penalised, further limiting access to abortion care and widening the chasm in already under-served regions.

As this Bill applies to all Australian states and territories, overriding jurisdictional legislation, it risks reducing access to healthcare for all Australian women who require these services. A reduction in professionals who are willing to provide abortions will force women to travel further and face increased financial and logistical burdens to receive essential healthcare. This outcome will be particularly detrimental for those in regional, rural, and remote communities, as well as First Nations women and families, who already disproportionately suffer from a shortage of abortion providers.

This Bill risks doing considerable harm; it creates more red tape which will ultimately prevent women from accessing safe and timely abortion care.

The College urges the federal government to withdraw the proposed Bill. Should the Bill have a second reading, then the government should vote against it. If any Members of Parliament have concerns about clinical practice, they should be addressed through expert review and consultation, not politically driven legislation.

Fundamentally, not only is this Bill redundant in the face of robust professional guidelines around medical practice, but it is also a step backwards for access to equitable healthcare in Australia.

[1] Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Clinical Guideline for Abortion Care: An Evidence-Based Guideline on Abortion Care in Australia and Aotearoa New Zealand. Version 1.4. 欧美AV; 2026.
[2] Rosser S, Sekar R, Laporte J, et al. Late termination of pregnancy at a major Queensland tertiary hospital, 2010-2020. Med J Aust. 2022;217(8):410-414. doi:10.5694/mja2.51697.

Media enquiries

Bec McPhee
Head of Advocacy & Communications
bmcphee@ranzcog.edu.au
+61 413 258 166

Each year 欧美AV presents a selection of nominated individuals with honours and awards to recognise their outstanding service and dedication to advancing women鈥檚 health. Nominations are considered by the College Honours Committee and awarded by the 欧美AV Board.

The College would like to congratulate all recipients of the 2026 欧美AV Honours and Awards.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (欧美AV, the College) welcomes the announcement that Health New Zealand | Te Whatu Ora will adapt the 欧美AV Australian Living Evidence Guideline: Endometriosis for use in Aotearoa New Zealand. The College has been advocating for this following the release of the guideline last year.

The 欧美AV Australian Living Evidence Guideline: Endometriosis

Originally published in May 2025, the guideline was funded by the Australian Government and living evidence has been updated periodically to reflect the most recent scientific evidence for endometriosis and adenomyosis care in Australia.

This pivotal resource provides a broad range of recommendations, seeking to improve awareness, detection, and management of these conditions which impact so many women globally.

Key aspects of the guideline include:

• A focus on primary care, aimed at improving access for GPs to support early management of suspected endometriosis and/or adenomyosis through first-line hormonal treatment while diagnostic processes are underway.
• Emphasis on non-invasive diagnostic techniques where possible, such as transvaginal ultrasound and magnetic resonance imaging (MRI).
• Specific recommendations for adolescents.
• Highlighting the importance of multidisciplinary care, including physiotherapists, psychologists, pain specialists, and fertility specialists, and promoting shared decision-making.

Adapting and implementing the guideline to the Aotearoa New Zealand context

Approximately one in ten women and girls in Aotearoa New Zealand are affected by endometriosis.¹ Aotearoa New Zealand currently follows the New Zealand Government鈥檚 Diagnosis and Management of Endometriosis in New Zealand guideline, released in 2020. The implementation of 欧美AV鈥檚 guideline will ensure that the most recent and high-grade scientific evidence underpinning endometriosis and adenomyosis care is used, whilst additional Aotearoa New Zealand context will ensure it reflects the specific health systems and demographic needs of women and girls in Aotearoa.

Diagnosis of endometriosis in Aotearoa is currently taking a median of 10 years 鈥� likely a result of a range of factors including access to specialist care, surgery wait times, barriers to ultrasound and MRI access, and lack of awareness of the condition. Through these guidelines, GPs and primary care practitioners will be empowered to make clinical diagnoses and begin first-line treatment, with the goal to significantly improve the timeline from suspected diagnoses to symptom management. Health New Zealand has proposed that implementation of the guideline be supported by primary care education initiatives, including webinars and GP education resources.

Women in Aotearoa wait a median of a decade for endometriosis diagnosis 鈥� this is a statistic we cannot accept. The adaptation and implementation of these guidelines is an important step to improving awareness and access to evidence-based care for women and girls impacted by this often-debilitating condition.

鈥� Professor Cindy Farquhar, 欧美AV Dean of Research and Policy

Health New Zealand expect to publish the guidelines in mid-2027, following internal clinical assessment by their National Clinical Governance Group. 欧美AV looks forward to supporting Health New Zealand and Endometriosis New Zealand with the review and implementation of the guideline into the Aotearoa context, to continue to improve education, access, and care for women.

1. Endometriosis New Zealand. 2026.

Media enquiries

Catherine Cooper
欧美AV Executive Director, Aotearoa New Zealand
ccooper@ranzcog.org.nz
+64 21 137 0748

What reminds us clearly of why our听College听and our contributions听matter?

For me, the answer comes every time I attend one of 欧美AV’s elevation ceremonies. Throughout my years on the 欧美AV Board, and now as President, these occasions have听remained听one of the most rewarding parts of my role.

In June, I had the privilege of attending the Aotearoa elevation ceremony, held on the Sunday evening before the Annual Scientific Meeting. It was a wonderful opportunity to celebrate our newly elevated Fellows,听subspecialists听and award recipients, and to recognise the hard work, commitment and dedication that underpin these significant achievements.

What stays with me most is not the formality of the ceremony. It is the smiles on the faces of our colleagues, the pride of their families and friends, and the heartfelt applause that fills the room. It is also the privilege of watching our听newest听members go on to flourish in the areas of practice they are most passionate about. These moments remind me why we are all here: to support, encourage and inspire the next generation of leaders, just as those who came before us supported us on our own journeys.

In June, 欧美AV also welcomed听candidates听to听Djeembana,听College Place in Melbourne for the 2026 F欧美AV Selection interviews听鈥撎齛n important milestone that will help听determine听the careers of many aspiring obstetricians and gynaecologists. These interviews听represent听the culmination of听a significant听amount听of听preparation by听candidates听and a听considerable听collective effort from our听College听community.

I would like to thank the many听members, trainees and consumer representatives who generously gave their time to听participate听in the selection process. You听play a vital role in ensuring we continue to听identify听the right individuals to carry our profession forward,听as well as听supporting听and developing听our听future workforce.

It has also been a season of thoughtful discussion and collaboration across the College, with three roundtables held throughout June and July.

Reducing birth trauma听remains听a priority for 欧美AV and our members and trainees.听On 24 June, 欧美AV convened the first national roundtable on birth trauma, at听Djeembana, College Place. Supported by Birth Trauma Australia, the roundtable assembled clinicians,听midwives,听policymakers, sector leaders, and women with lived experience.

I commend the women who so generously shared their lived experiences of birth trauma, speaking with remarkable courage about the profound physical,听emotional听and social impacts they continue to face.

I also thank the听members听who reflected on the cumulative stress and vicarious trauma that can听accompany听our work. These discussions reinforced听an important听truth:听that providing compassionate, trauma-informed care听also听requires us as clinicians to prioritise the wellbeing of our workforce.

Following these powerful conversations, the College has developed its听Birth Trauma Roundtable Final Report,听containing听several recommendations which reflect听our听commitment to meaningful reform through collaboration and evidence-based practice.鈥疍elivering lasting change will require coordinated听action across governments, health services and the wider sector, and I encourage all members to read the report.

Workforce听remains听another听critical听focus听for the College. The Commonwealth Department of Health, Disability and Ageing recently released its听. Using workforce supply and demand modelling to 2048, the report projected an ongoing and increasing national shortage of O&G specialists in Australia, despite workforce growth.听Members of the Council also heard from relevant committee representatives about the workforce crises facing the O&G subspecialities during their most recent meeting.

In response听欧美AV听convened the Women鈥檚 Health Roundtable, bringing together听O&G trainees, Fellows听and members, jurisdictional and national government representatives听鈥撎齣ncluding the Health Minister for Victoria and the National Rural Health Commissioner听鈥撎齛s well as midwifery and other sector leaders. The session听facilitated听constructive discussion and knowledge sharing between clinicians and policymakers. It provided a platform to听share perspectives,听collectively听discuss听and听identify听current and future workforce challenges,听showcase听state-led examples of good practice, and explore practical opportunities for national collaboration.

The College听looks forward to听publishing听its听final report听from the roundtable and听progressing the recommendations alongside all professions involved in delivering multidisciplinary women’s healthcare.

Of course, effective sector collaboration is听also听essential in听solving these problems and听progressing our collective mission.听As a community of professionals, we are all committed to听equitable, accessible,听inclusive听and evidence-based healthcare for women and families.听In July, 欧美AV convened the first partnership roundtable,听bringing together representatives of societies and associations from across the听full-spectrum听of O&G to explore how we can better work together to maximise our collective impact.

It is in听all听of听our interests to work collaboratively to make the noise听required听to achieve听our aims. This roundtable was all about building bridges,听creating meaningful relationships between our听organisations听and finding new ways to advocate and support O&Gs with a more united voice.听I very much look forward to ongoing conversations with our partners.

As I reflect on the past two months, I am struck by a common thread running through each of these activities. Whether celebrating the achievements of our newest听members and awards winners,听selecting the next generation of specialists, or bringing together diverse voices to tackle some of the most pressing challenges听facing our specialty, our听College听and its impact听is at its best when we come together with a shared sense of purpose.

Thank you to everyone who has contributed their time to these important initiatives. Your commitment continues to strengthen our profession, our听College听and, most importantly, the care we provide to women and their families across Australia and Aotearoa New Zealand.

I look forward to sharing further updates with you in the months ahead.

Dr Nisha Khot
欧美AV President

The Warrnambool Obstetrics and Gynaecology Education and 欧美AV (OGET) hub recently hosted an obstetric anal sphincter injury (OASI) training workshop benefiting from the use of simulation equipment in Camperdown, Victoria. The session highlighted important, targeted skills training for improving outcomes for mothers in rural and regional areas.

OASI injuries are complex tears that can occur during childbirth. When recognised early and repaired correctly, long-term complications such as chronic pain, incontinence and psychological distress can often be prevented. For women giving birth in rural settings where immediate access to specialist obstetric services may be limited. This makes structured training essential for obstetricians, midwives, rural general practitioners and trainees alike.

The training combined evidence-based education with hands-on simulation using realistic perineal and sphincter repair models. These simulators allowed practitioners to practise identifying injuries and performing repairs in a safe, controlled environment.

Under the guidance of experienced facilitators, participants worked through step-by-step repair strategies, received real-time feedback and refined skills. Beyond the technical work, the training emphasised team communication and patient safety, helping translate simulated practice into better care in real clinical environments. For practitioners working in rural or regional settings, exposure to severe perineal trauma may be infrequent, simulation-based education is especially beneficial in bridging experience gaps and maintaining competence.

By refining technical skills and reinforcing best-practice approaches, the workshop directly supports better outcomes for rural mothers. Improved clinician confidence and competence reduce the need for transfers to tertiary centres, allowing women to receive high-quality care closer to home, surrounded by their families and support networks.

Importantly, the training also emphasised communication, consent and post-birth follow-up so patients feel informed, supported and safe during what can be a physically and emotionally challenging experience.

Overall, the OGET OASI simulation training in Camperdown represents a meaningful investment in rural maternity care. By equipping clinicians with advanced skills and confidence, this education supports women in rural communities to receive safer births, timely treatment, and better long-term health outcomes closer to home.

Dear Fellows,

The 欧美AV Board welcomes feedback from all Fellows on the proposed Constitution changes. We value your input to ensure we strive for continual improvement and refinement of our Constitution.

Proposed changes

The key proposed changes to the Constitution are:

Retired Fellow eligibility requirements

Retired fellows will only need to be retired in the practice of Obstetrics and Gynaecology (O&G) but can still practice in other fields. Currently, a retired fellow must be retired from all areas of medical practice.

New Subspecialist membership class

The introduction of a Subspecialist, together with a Retired Subspecialist, class of membership that holds the same rights and privileges as Fellows. A practitioner would choose to practice as either a Fellow or Subspecialist.

Director eligibility

This would enable the removal of a director or Councillor upon being charged with an indictable offence and would ensure alignment with current policies, safeguard the reputation and proactive risk management of the College.

Gender neutral language

To align the Constitution with the AMC standards, through more inclusive gender-neutral language.

Frequently asked questions

Have your say

We encourage you to by 5.00pm AEST on Friday 28 August 2026.

For further information on the proposed changes, please refer to the below documents in Integrate Resources:

Next steps

The proposed Constitution changes were approved in principle by the 欧美AV Board and Council at the July 2026 Board and Council meetings. The Board and Council will consider feedback provided by Fellows at their September meetings before formal approval at the Annual General Meeting in October.

More information

For more information, contact May Raguine, Head of Governance and Legal.
Email: governance@ranzcog.edu.au

One in three Australian women experience childbirth as traumatic. This Birth Trauma Awareness Week, the national peak body for obstetricians and gynaecologists warns that action on birth-related trauma cannot wait any longer.

Birth trauma is an escalating public health issue in Australia, yet national policy has not kept pace. This under-acknowledged crisis impacts a strained maternity care system, carries societal and productivity costs, and leaves women and families to grapple with devastating psychological, physical, and social consequences.

In search of solutions, The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (欧美AV, the College), supported by Birth Trauma Australia, has convened the first national roundtable on birth trauma. Clinicians, policymakers, sector leaders, and women with lived experience assembled to confront a difficult truth: that birth trauma is not a series of isolated incidents, and rather stems from broader, system-level failure.

The roundtable follows the 2023 New South Wales Select Committee on Birth Trauma, which saw over four thousand submissions 鈥� one of the largest volumes of consumer input in the state鈥檚 history 鈥� evidencing the widespread impacts of birth-related trauma and significant gaps in the system.

Consumer lived experience grounded the roundtable discussion, illustrating the realities of birth-related trauma and its consequences that extend well beyond the immediate postnatal period. Women described physical injury, chronic pain, incontinence, prolapse, and sexual dysfunction. These outcomes were further complicated by delayed diagnosis, inconsistent advice, and a lack of coordinated postnatal care.

Pelvic floor dysfunction was identified as one of the most common and least recognised consequences of giving birth. Often emerging months or years after childbirth, pelvic floor disorders remain largely invisible within national data and funding structures.

Things people take for granted, like teaching their kid to ride a bike […] I couldn’t run beside them to steady them. It’s something I’ll forever remember. Something this injury has taken away from me.
鈥� Consumer

Roundtable participants described a wide spectrum of psychological harm. Women spoke of severe distress and isolation, compounded by the toll of managing severe injury and chronic pain while navigating a version of parenthood they had never imagined. Often, the impact extended even further 鈥� with relationship strain or breakdown, cutting back on paid work, or leaving their chosen career path altogether as symptoms persisted.

Clinicians described the emotional, psychological, and professional toll of working within a system where women can feel unheard or unsupported. Many spoke of cumulative stress and vicarious trauma 鈥� particularly when system pressures prevented them from providing the level of care they wanted to. Underpinning much of this is a maternity system under strain: with staffing shortages, service closures, high turnover, and escalating workloads, all of which put both healthcare workers and patients at risk.

We have developed a structure where clinicians can put on a brave face, go home, lie awake all night, sleep for an hour, and get up and do it all again.
鈥� Clinician

欧美AV President Dr Nisha Khot emphasised the need for strategic, collaborative efforts to address this systemic issue.

鈥淏y uniting policy professionals, researchers, women with lived experience, and clinicians, we can build a national understanding of the true impact and cost of birth-related trauma. This is the vital first step in enacting urgently needed, meaningful system change.鈥�
鈥� Dr Nisha Khot, 欧美AV President

The College has compiled a report from its Birth Trauma Roundtable, providing an overview of the discussion and a clear set of recommendations:

Recommendation 1 | Modernise postnatal care settings to support early identification and continuity

• Strengthen postnatal care settings to enable comprehensive assessment, timely follow-up, and coordinated care across the first year postpartum.
• Modernise MBS arrangements to support longer consultations and multidisciplinary pathways.
• Strengthen GP-led pathways for early identification and structured follow-up.
• Introduce dedicated MBS and public hospital funding for pelvic floor assessment for all women post-birth.
• Strengthen public hospital funding to support equivalent postnatal follow-up across the first year.

Recommendation 2 | Improve public awareness and trauma-informed care across maternity services

• Deliver accessible, culturally safe public information on birth-related trauma and recovery.
• Embed trauma-informed care across antenatal, intrapartum, and postnatal services.
• Strengthen training and communication that supports safe, respectful care.

Recommendation 3 | Strengthen multidisciplinary postnatal and recovery pathways

• Progress national standards for post-birth assessment, referral, and follow-up.
• Expand access to pelvic health physiotherapy, psychological care, and telehealth-enabled pathways.
• Progress research to strengthen evidence on recovery and early intervention.
• Develop a Clinical Guideline for pelvic floor dysfunction and birth-related trauma, consistent with NHMRC methodology.

Recommendation 4 | Improve affordability and access to prevention and early intervention

• Expand access to antenatal education and early intervention services across public and private settings.
• Reduce cost barriers through subsidies and aligned funding.
• Strengthen rural and regional access through telehealth, outreach, and integrated service models.

Recommendation 5 | Strengthen national data, visibility, and disability recognition for long-term maternal morbidity

• Enhance national datasets, indicators, and reporting to reflect long-term maternal morbidity.
• Develop data standards that capture outcomes across the first year postpartum and beyond.
• Strengthen recognition of chronic functional impacts of pelvic floor morbidity within disability assessment pathways.

The roundtable, and its findings, is the first step in a much longer process of reform. Enacting these system-level solutions will require coordinated action across governments, insurers, health services, professional bodies and sector leaders. 欧美AV will use the report鈥檚 findings to press for urgent action 鈥� including improved postnatal care, reduction of cost barriers and recognition of long-term maternal impacts such as pelvic floor dysfunction.

Every part of the system must act on birth-related trauma as the structural issue the roundtable has confirmed it to be. Bringing these solutions from discussion to implementation is a key step in ensuring women in Australia receive the care, support and acknowledgement they deserve.

Media enquiries

Bec McPhee
Head of Advocacy & Communications
bmcphee@ranzcog.edu.au
+61 413 258 166

Introduction

GLP-1 receptor agonists (GLP-1 RAs) activate the GLP-1 receptor to increase glucose dependent insulin secretion, suppress glucagon secretion and slow gastric emptying. These medications are indicated for type 2 diabetes mellitus and chronic weight management. Common types include semaglutide, exenatide, liraglutide and tirzepatide (which additionally enhances insulin sensitivity).

The Therapeutic Goods Administration (TGA) recommend against the use of GLP1 鈥� RAs during pregnancy (TGA, 2025). Despite this, recent Australian retrospective cohort data suggests a rising use of GLP1- RAs in women of reproductive age, with low rates of contraception use at treatment initiation (Thapaliya et al).

Pregnancy

GLP-1 RAs are classed as a Category D medicine by the TGA. They are not approved for use during pregnancy and should be ceased prior to conception. If pregnancy occurs, GLP1-RAs should be immediately ceased due to limited human safety data (Drummond, 2025) and potential risks suggested in animal studies (TGA, 2025). Due to lack of conclusive evidence abortion is not recommended based solely on exposure to GLP-1 RAs.

Animal reproductive toxicology studies have demonstrated adverse fetal effects (decreased fetal growth, skeletal, visceral anomalies and embryonic death) at high doses supporting continued caution (Ozempic TGA, 2024). Human data is derived primarily from observational cohorts is not powered for definitive safety conclusions (Kettner 2025) but has not demonstrated a clear pattern of congenital anomalies after periconceptional inadvertent exposure (Dao 2024, Parker 2025).

Registries and larger prospective studies are needed to clarify the true pregnancy safety profile of this increasingly used class of medications, particularly in preconception and pregnancy (Varughese, 2025).

Preconception

Human evidence on GLP-1 RA use specifically in the preconception period is extremely limited and primarily derived from small clinical trials and case reports. Given the lack of high-quality evidence, discontinuation of GLP1-RAs is advised two months prior to attempting conception Endocrine Society, 2025) to account for washout periods. However it must be noted that each GLP-1 RA has a different timeline of washout and some data suggests tirzepatide could be closer to 4 weeks and exenatide up to 12 weeks. 听

Acknowledging the adverse effects of obesity, insulin resistance, and metabolic syndrome on fertility and pregnancy outcomes, alternative strategies for metabolic optimization, such as lifestyle modification and metformin therapy, should be considered during the preconception period (Thakore et al., 2025; Kettner et al., 2025; American Diabetes Association, 2026). Preconception counselling should include discussion of contraception during therapy, timing of discontinuation and risks of inadvertent early pregnancy exposure (TGA 2025).

Contraception

Due to limited safety data and potential fetal risk, effective contraception is advised for all women of childbearing age whilst on GLP-1 RAs. Pharmokinetic evidence suggests tirzepatide is the only widely used GLP1-RA that significantly reduces bioavailability of oral contraceptives (Skelley, 2024; Kettner 2025), hence potential for reduced effectiveness (CoSRH, 2025). TGA recommends switching to non-oral or additional barrier methods for 4 weeks after tirzepatide initiation or dose escalation (TGA, 2025).

There is no pharmacokinetic data regarding the impact of GLP-1 receptor agonists on emergency hormonal contraception; however, given delayed gastric emptying and potential reduced absorption of oral agents, guidelines suggest considering non-oral emergency contraception, particularly copper intrauterine device insertion noting the reduced efficacy of levonorgestrel emergency contraception in women with a BMI >26 (欧美AV).

Menopause

Current evidence regarding the interaction between GLP-1 RAs and menopausal hormone therapy is limited. Available reviews suggest no clear pharmacologic interaction, and observational data indicate potential additive benefits on weight and cardiometabolic outcomes in postmenopausal women receiving both therapies (Graczyk, 2026; Mikdachi, 2025). However, this evidence requires robust randomized controlled trials for confirmation of effect.

Current regulatory product information and Australian guidance from the TGA do not provide specific recommendations regarding co-administration. However, it should be noted that bodies such as the British Menopause Society (BMS) recommend consideration of up-titration of oral progesterone in the setting of GLP1-RA use due to risk of altered absorption (BMS, 2025). In the absence of robust evidence, individualised assessment of cardiometabolic risk and routine clinical monitoring are recommended; in consultation with a primary care physician or treating specialist.

Fasting for surgery

Current Australian multidisciplinary guidance recommends continuing GLP-1 RAs peri-operatively, with a 24 hour clear fluid diet followed by standard 6 hour fasting to mitigate aspiration risk due to delayed gastric emptying. Where the 24 hour clear fluid strategy is not followed, clinicians should manage the patient as unfasted to mitigate aspiration risk (Hocking, 2025).

Conclusion

GLP-1 RAs require caution across reproductive, menopausal, and perioperative contexts. They should be combined with effective contraceptive in women of childbearing age and stopped in preconception. Use should be monitored in menopause with further studies required to clarify safety and optimal use with MHT. Recent updates recommend continued use in the peri-operative period with altered fasting protocols.

1. Therapeutic Goods Administration. TGA Medicines Safety Update. 2025 Dec 1.
2. Thapaliya K, Sweeting A, Black KI, et al. Incidence of GLP-1 receptor agonist use by women of reproductive age attending general practices in Australia. Med J Aust. 2025.
3. Skelley JW, Swearengin K, York AL, Glover LH. The impact of tirzepatide and glucagon-like peptide-1 receptor agonists on oral hormonal contraception. J Am Pharm Assoc. 2024;64(1):204-211.e4.
4. Kettner J, Donnelly E, Maes ML. Glucagon-like peptide-1 receptor agonists and reproductive health: current evidence and clinical implications. J Pharm Pract. 2025 Sep 4:8971900251376795. doi:10.1177/08971900251376795
5. College of Sexual and Reproductive Healthcare (CoSRH). Glucagon-like peptide-1 (GLP-1) agonists and oral contraception. London: CoSRH; 2025 Feb.
6. Thakore S, et al. GLP-1 receptor agonists in preconception and fertility management: a narrative review. J Endocrinol Metab. 2025;11(3):115-126.
7. American Diabetes Association. Standards of care in diabetes鈥�2026. Diabetes Care. 2026;49(Suppl 1):S1-S273.
8. American Diabetes Association, Endocrine Society, European Society of Endocrinology. Management of preexisting diabetes and pregnancy: joint clinical practice guideline. 2025.
9. Royal Australian and New Zealand College of Obstetricians and Gynaecologists (欧美AV). Contraception Clinical Guideline (C鈥慓yn听3), July听2024.
10. British Menopause Society. Use of incretin-based therapies in women using hormone replacement therapy (HRT): Tool for Clinicians. London: British Menopause Society; April 2025.
11. Varughese MS, O鈥橫ahony F, Varadhan L. GLP-1 receptor agonist therapy and pregnancy: evolving and emerging evidence. Clin Med (Lond). 2025;25(2):100298. doi:10.1016/j.clinme.2025.100298
12. Drummond RF, Seif KE, Reece EA. Glucagon-like peptide-1 receptor agonist use in pregnancy: a review. Am J Obstet Gynecol. 2025;232(1):17-25. doi:10.1016/j.ajog.2024.08.024
13. Novo Nordisk Pty Ltd. Ozempic (semaglutide) product information. Therapeutic Goods Administration; 2024.
14. Dao K, Shechtman S, Weber-Schoendorfer C, Diav-Citrin O, Murad RH, Berlin M, et al. Use of GLP-1 receptor agonists in early pregnancy and reproductive safety: a multicentre, observational, prospective cohort study based on the databases of six Teratology Information Services. BMJ Open. 2024;14(4):e083550. doi:10.1136/bmjopen-2023-083550
15. Parker听CH, Slattery听C, Brennan听DJ, leRoux听CW. Glucagon-like peptide 1 (GLP-1) receptor agonists’ use during pregnancy: Safety data from regulatory clinical trials. Diabetes Obes Metab. 2025;27(8):4102-4108. doi:10.1111/dom.16437
16. Graczyk NA, Bisschops J. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) for obesity and symptoms in menopause: a review. Cureus. 2026;18(1):e101693. doi:10.7759/cureus.101693
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Media enquiries

Bec McPhee
Head of Advocacy & Communications
bmcphee@ranzcog.edu.au
+61 413 258 166

The Board of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (欧美AV) acknowledges the open letter published by the National Association of Specialist Obstetricians and Gynaecologists (NASOG) regarding the College鈥檚 President Dr Nisha Khot’s planned participation in an event about intersectional leadership.

欧美AV is committed to the highest standards of governance, integrity, and accountability. The Board recognises that College members, trainees and the broader community expect the College and its office bearers to act in a manner that maintains confidence in the College’s independence and governance.

The Board has been advised that the President withdrew from the event as soon as she became aware that it included a political fundraising component.

Consistent with the College’s established governance processes, the matters raised in the open letter have been referred to the Independent External Reviewer. The Independent External Reviewer will consider the matters in accordance with the College’s governance framework and applicable legal obligations, including ensuring procedural fairness for all parties. Dr Khot has advised that she intends to cooperate fully with that process.

The Board has confidence in the College’s governance processes and believes it is important that the independent review be allowed to proceed without prejudice or external influence.

Accordingly, while this process is underway, it would not be appropriate for the Board to comment further on the matters raised or to anticipate the findings of the Independent External Reviewer.

欧美AV Board