Menopausal women are finally able to buy a form of hormone replacement therapy (HRT) over the counter for the first time, with the development being described as a “landmark” moment for women’s health.
From today, Gina, a pessary that treats menopausal vaginal dryness with the hormone estradiol, is available in selected branches of Boots. It will be rolled out to other chemists later this month.
Although groundbreaking, this move is not quite the game-changer that many hoped it would be, as it will not alleviate the HRT shortage that has caused so much suffering among menopausal women.
“This product is not HRT in the conventional sense,” Labor MP and menopause campaigner Caroline Harris said on BBC Radio 4’s Today programme. “It’s not going to replace the hormones that women lose through peri-menopause in their lives. It’s a low level of estrogen that isn’t absorbed into the body. There are similar products you could get anyway, so this is not a news flash. “
Here are its uses – and limitations:
What is estradiol and is it really HRT?
Estradiol is a form of topical HRT for postmenopausal women over 50 who have not had a period for a year. The general practitioner Dr. Clare Spencer, menopause specialist and co-founder of mymenopausecentre.com, explains: “It’s a vaginal estrogen that treats the symptoms of vulvovaginal atrophy (or menopausal genitourinary syndrome). It’s a local form of hormone replacement, but it’s not full- on HRT as people understand it.”
What is the difference between Gina and prescription HRT?
There is no difference between Gina and the two prescription estradiol brands Vagifem and Vagirux: all three deliver 10 micrograms of the hormone via a pessary and treat vaginal atrophy. “It replaces some of the estrogen that would have been available to the vagina and bladder before menopause,” says Dr. Spencer. “The amount you absorb into your bloodstream is minimal.”
However, it is different from systemic HRT, which provides estrogen and progestin and is absorbed into the bloodstream. “This does not replace the tablets, gels, patches, sprays or Mirena IUD,” says Dr. Spencer. “It’s dealing with one aspect of menopause, and it’s effective, but it doesn’t have the long-term health benefits of taking systemic HRT, such as reducing the risk of osteoporosis and heart disease. It won’t deal with hot flashes or psychological or cognitive symptoms of menopause .”
Why should you take it without a prescription?
Vaginal atrophy can be diagnosed based on discussion of symptoms alone and without the need for a physical examination. Going to the pharmacy, where women can complete a checklist or consult with a pharmacist in confidence, can make it easier for women who find it difficult to get a doctor’s appointment.
“It’s incredibly common,” says Dr. Spencer. “Over 50 percent of menopausal women may experience symptoms, and they often don’t volunteer because they’re too embarrassed. It’s heartbreaking to hear someone say they’ve had discomfort for five years and have stopped having sex, with all the knock-on effects it has. This will undoubtedly help more women come forward: it highlights the condition and the fact that there is a product available.”
What are the symptoms?
The symptoms of vulvovaginal atrophy are, according to Dr. Spencer: “Vaginal irritation, itching, lack of lubrication and dryness, painful intercourse and shortening of the vagina. Some women have loss of elasticity, which makes sex almost impossible. You can also have bladder symptoms, so you can feel that you have a water infection without signs that there is one. This is because estrogen is important for maintaining elastic, well-moisturized tissue and for maintaining a healthy balance of bacteria in the vagina.”
What is the dose and why is it only available to women over 50 who have not had a period for a year?
The starting dose will be one vaginal tablet daily for two weeks, followed by a maintenance dose of one tablet twice a week, which can be taken until symptoms improve. Currently, Gina is only approved for use in women over 50. Dr. However, Spencer stresses that a GP may be able to provide a prescription version of estradiol if you are under 50, in menopause and have symptoms.
What are the side effects?
The Gov.uk website reports that the most common side effects of using Gina are “abdominal pain, vaginal discharge, vaginal discomfort and vaginal bleeding”. Women who have a history of conditions such as breast or ovarian cancer will not be able to access Gina over the counter and will need to see their doctor for a prescription. Pharmacists will also be aware of symptoms such as vaginal bleeding that may be the result of other conditions.
Is it really the answer to the shortage?
The short answer is absolutely no. As Caroline Harris says, it is the solution to one of the symptoms of menopause, but it is not an answer to HRT shortages or the issue of repeat prescription charges. “The government making a fuss about this is nonsense,” she says.
Dr. Spencer adds: “It’s part of the way, but not all the way: a positive step, but only a small step. However, in my experience, the offering has improved significantly, although there are still some special brands and patches [of systemic HRT] which are hard to come by.”
For more information about menopause see mymenopausecentre.com