New over the counter estradiol (oestrogen) available NOW

New over the counter estradiol medication became available in the UK. Gina 10 microgram vaginal tablets became the first hormone replacement therapy (HRT) medication available without a prescription.

Where can you buy over the counter estradiol?

Gina vaginal tablets are classified as pharmacy-only medication (P). P medicines can only be sold from pharmacies, including online chemists. Additionally, pharmacy-only medicines are kept behind the pharmacy counter, away from public view.

What is over the counter estradiol used for?

Over the counter estradiol (Gina vaginal tablets) are used for the treatment of vaginal atrophy. Vaginal atrophy is a common condition affection postmenopausal women with the main symptoms that include (Lethabyet al, 2016):

• vaginal dryness,
• itching,
• discomfort and
• painful intercourse.

What is the recommended treatment for vaginal atrophy?

NICE guide in the management of menopause recommends using vaginal oestrogen for women with symptoms of vaginal atrophy, including women who use systemic HRT medicines like patches or tablets. Additionally, women with vaginal dryness can use moisturisers and lubricants alone or alongside vaginal oestrogen (NICE, 2019).

Who can buy Gina tablets over the counter?

Gina tablets are licensed for postmenopausal women aged 50 years and above, who have not had a period for at least 1 year and have symptoms of vaginal atrophy due to oestrogen deficiency.

Pharmacy assessment before the supply of Gina tablets

Women who seek to purchase over the counter oestrogen will need to answer a few questions provided by the pharmacist to assess the suitability of Gina tablets.

Screening questionnaires differ depending on whether the patient used oestrogen before or not.

Women who have not used vaginal oestrogen before may be asked questions regarding the following (Novo Nordisk, 2022):

• vaginal symptoms
• age
• an episode of the last period
• any additional vaginal symptoms like undiagnosed vaginal bleeding or unusual vaginal discharge.
• Any other health conditions
• Any medication taken (including other local oestrogen drugs)
• Allergies

Women who return to the pharmacy for their second visit, after completing their first or second pack will be asked the following (ibid):

• Whether the first or second pack was completed and if the symptoms improved, stayed the same or got worse.
• Presence of vaginal symptoms, for example, undiagnosed bleeding, unusual vaginal discharge and other symptoms.
• Changes to their or first-degree relatives (sibling or parent) health, for example, any new health conditions since starting oestrogen over the counter.
• Any other problems whilst using Gina. 

How is Gina oestrogen (estradiol) taken?

Women who never had vaginal oestrogen therapy:

• Initial dose: 1 vaginal tablet daily for the initial 2 weeks.

The maintenance dose (continuation of the treatment):

• 1 vaginal tablet twice a week, leaving 3 or 4 days between each dose.

Women who purchased Gina over the counter will be asked to return to the pharmacy 7 weeks after finishing of the first pack.

How much do Gina vaginal tablets cost?

Gina tablets are priced between £25 to £30 per box containing 24 vaginal oestrogen tablets.

What are alternatives to over the counter oestrogen?

Gina 10 micrograms vaginal tablets are the first HRT product available over the counter without a prescription. Other alternative HRT drugs which are currently used for the treatment of vaginal atrophy include prescription-only medicines containing oestrogen (estradiol):

• Vagifem and Vagifem alternative pessaries. Vagifem contains the same amount of estradiol found in Gina vaginal tablets.
• IMVAGGIS 0.03 mg pessary (contains 0.03 mg estriol)
• Estriol 0.01% cream
• Ovestin 1mg cream
• Blissel 50micrograms/g vaginal gel

References:

Lethaby A, Ayeleke RO, Roberts H (2016). Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2016 Aug 31;2016(8):CD001500. doi: 10.1002/14651858.CD001500.pub3. PMID: 27577677; PMCID: PMC7076628. Available at: https://doi.org/10.1002/14651858.cd001500.pub3 Accessed on 10/11/2022

NICE (2019). Menopause: diagnosis and management. Available at: https://www.nice.org.uk/guidance/ng23/chapter/recommendations#managing-short-term-menopausal-symptoms Accessed on 11/11/2022

Novo Nordisk (2022). Gina 10 micrograms vaginal tablets: Pharmacy Checklist.