Expert answers women’s questions about vaginal HRT changes

By Amanda Savage, Pelvic Health Physiotherapist and trusted advisor to Kegel8 

The UK medicines regulator, the MHRA, is currently asking GPs, pharmacists and the public for their views on re-classifying vaginal hormone replacement therapy (HRT) tablets to sell them over the counter.

The proposal is part of a consultation open until 23 February 2022 and applies to a specific type of HRT – vaginal tablets - for the treatment of vaginal atrophy (dryness) caused by oestrogen deficiency.

But what would these changes mean for women going through menopause? Amanda Savage, Pelvic Health Physiotherapist and trusted advisor to Kegel8 explains all…

What is HRT?

HRT is typically used to replace the hormones (oestrogen and progestogen) that a woman’s body no longer produces naturally during and after the menopause.

Vaginal HRT tablets are what the regulator is considering re-classifying so women can buy these over the counter instead of needing a prescription.

This local oestrogen therapy is inserted into the vagina using an applicator and gradually releases hormones into the vaginal tissue. This helps to treat vaginal atrophy by restoring the integrity of the vaginal wall, relieving symptoms of dryness, soreness, itching, burning and painful intercourse.

Are there other forms of HRT?

There are several HRT treatments, each with its own pros and cons. It is best to discuss with your GP which is the best option for you.

Tablets are the most common type of HRT, typically taken once a day. This treatment consists of two tablets – one with oestrogen and another with progestogen. This is often the simplest treatment but there is a small risk of blood clots.

Hormones can also be absorbed by the body via skin patches, implants inserted under the skin, and a topical gel.

Will I be eligible?

If proposed changes are given the green light, Vaginal HRT tablets will be available to purchase over the counter. However, this specifically refers to the drug Gina 10 which contains topical oestrogen.

To be eligible, postmenopausal women must be experiencing vaginal atrophy symptoms caused by an oestrogen deficiency. They must be aged 50 years and above and haven’t had a period for at least 1 year.

How much will it cost?

Manufacturers of Gina 10 said that the first pack would cost £29.99 (which consists of 14 tablets to be taken daily), followed by a weekly cost (one tablet taken weekly) costing about £2.50.

Should you speak to your doctor first?

Most women start the menopause between the ages of 45 and 55 and it is recommended that you discuss any symptoms you may be experiencing with a health professional.

Before beginning HRT, you should be checked for any other issues such as thyroid problems before you’re prescribed any treatment. For women with a history of breast, ovarian or womb cancer, blood clots, or high blood pressure there may be other safer options.

The manufacturer of Gina10 has produced training material for pharmacists as well as a checklist for women to complete, to ensure risks are minimised. It is not essential to consult your doctor prior to purchasing the over-the-counter treatment, however, it is recommended to make sure it’s the best option for you.

How else can I look after my intimate health through the menopause?

Going through the menopause doesn’t mean you have to put up with intimate health concerns, including dryness, pelvic floor weakness, loss of sensation and low libido.

For vaginal dryness and discomfort, vaginal moisturisers and lubricants can help ease these symptoms. Vitamin D has also been found to be effective in combatting vaginal dryness during the menopause.

Keeping your pelvic floor muscles strong during the menopause is also important, helping to increase the blood flow to your vagina, and improve natural lubrication and sensitivity. Pelvic floor exercises should be an important part of your daily exercise regime and an electronic pelvic floor toner can help you locate and strengthen this often-neglected muscle group easily.

2 March 2022
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