Gina is a new low dose vaginal hormone replacement therapy (HRT). It is used to treat the common menopause symptom of vaginal atrophy. This can lead to the area feeling dry, sore, and itchy, and can cause painful sex due to a decrease in mucus production that otherwise lubricates the area.

Menopause is when your periods stop due to lower hormone levels. However, it comes in several stages and is officially diagnosed once you have gone 12 months without having a period. The three main stages include:

Perimenopause: the time leading up to menopause when hormones start to decline and menstrual cycles become erratic and irregular. You may start to experience physical side effects such as hot flashes and vaginal dryness, as well as mental changes including mood swings.
You can read more about perimenopause in our Signs of Perimenopause guide.

Menopause: Menopause affects the majority of women between the ages of 45 and 55, and the transition from perimenopause to menopause can take anywhere from 1 to 3 years. Your periods will stop during this time, and you may continue to experience symptoms similar to those experienced during the perimenopause stage.
Read more about common menopause symptoms in our 34 Symptoms of Menopause Guide.

Postmenopause: After one year of not having a period, you have reached the final stage of postmenopause. Your hormone levels will stay low, and you won't have a monthly period. You are unable to become pregnant because your ovaries have stopped producing eggs.

Gina is used to treat vaginal atrophy symptoms in postmenopausal women over the age of 50, who have not had a period in at least a year. Before you begin using Gina, your pharmacist will ask about your personal and family medical history. They may also inquire about your menopause and the symptoms you have experienced. This is to ensure that Gina is appropriate for you and that you do not need to consult with your doctor before using Gina or any other treatments that may be more appropriate.

Atrophic vaginitis (thinning, vaginal dryness, and inflammation of the vaginal walls) can occur when your body produces less oestrogen — a hormone that improves vaginal elasticity and natural moisture. Vaginal atrophy most commonly occurs after menopause. It not only makes intercourse painful for many women, but it also causes distressing urinary symptoms.

Almost half of all post-menopausal women experience vaginal atrophy due to low oestrogen levels. Some of the common symptoms of vaginal atrophy include:

• Dryness of the vagina
• Burning and/or itching of the vagina
• Pain during sex
• Spotting or bleeding
• Going to the bathroom more frequently
• Painful urination
• Burning during urination

It’s important to seek professional medical advice if you experience any of the above symptoms, as they may relate to another condition. However, if you are diagnosed with vaginal atrophy, treatments such as Gina hormone replacement therapy (HRT) tablets can provide vaginal relief and make sex more comfortable.

Gina is a local form of low-dose HRT. They are vaginal dryness pessaries which are administered into the vagina, where the oestrogen is gradually released into the vaginal tissue. An increase in oestrogen will help ease post-menopausal vaginal symptoms so you can better manage discomfort, irritation and pain.

Continuous combined HRT treatment can also be a great option if you cannot use Gina tablets or prefer an alternative treatment. This involves taking oestrogen and progestogen on a daily basis with no breaks.

Women on long-term HRT should consider using topical treatments, such as gels or patches, because the risk of using these treatments long-term has been shown to be very low.

Alternative treatment options include:

Elleste Solo Tablets
Elleste Duet Tablets
Elleste Duet Conti Tablets
Evorel Patches
Femoston
Kliofem
Kliovance
Livial Tablets
Novofem
Premarin Tablets
Premique Low Dose Tablets
Natural alternatives for managing vaginal atrophy include:

Water-based lubricants to add moisture to the vaginal lining
Vaginal moisturisers made specifically for addressing dryness
You can discuss your symptoms with your GP or pharmacist for further recommendations.

Gina should be used once daily for the first 2 weeks as an initial dose. After this, the dose is reduced to just twice a week as maintenance. Follow the below instructions for application:

1. Wash your hands and get into a relaxed, comfortable position, which could be standing or lying down.
2. Open one of the blister packs, remove the applicator, and separate the plastic wrapper. If, after opening the plastic wrapper, you notice that the tablet has come out of the applicator but has not yet fallen out of the plastic wrapper, carefully place it back into the applicator's end, ready for insertion. When handling the tablet, keep your hands clean and dry.
3. Hold the applicator so that the applicator plunger can be pressed with the finger of one hand. If the tablet falls out of the end of the applicator before insertion, discard the tablet and applicator and begin again.
4. Carefully insert the applicator into your vagina (either lying down or standing up). Insert about half of the applicator, but only as far as you feel comfortable - don't force it.
5. Gently press the plunger of the applicator until you hear a click, which indicates that the tablet has been released. The pessary will stick to the vaginal wall. Don't worry; it will not fall out if you stand or walk.
6. Remove the applicator gently and dispose of it as well as the plastic wrapper.

Systemic HRT (treatments that circulate in the blood) increases the risk of some conditions occurring, especially when used for a long time. However, Gina is classed as a local vaginal HRT and not a systemic HRT. It contains a low dose of oestrogen which works locally in the vagina. It is considered that the risks associated with local HRT treatments are much lower when compared to systemic HRT.

Nevertheless, like all medications, there is a risk of possible side effects for some users. Stop using the treatment and seek medical assistance if you experience any of the following:

• Headaches
• Stomach pain
• Vaginal bleeding, discharge or discomfort
• Returning symptoms of endometriosis (for those that already suffer with the condition)

Although extremely rare, serious side effects of Gina HRT can include:

• Difficulty breathing or swallowing
• Swelling of the face, lips, tongue, or throat
• Palpitations
• Diarrhoea
• Water retention
• Worsened migraines
• Generalised hypersensitivity (e.g. anaphylactic reaction/shock)

If you experience any of the above side effects (or any other effects not listed here) you should seek emergency medical assistance.

Estradiol is the active ingredient in Gina tablets. Other ingredients include: hypromellose, lactose monohydrate, maize starch, and magnesium stearate. Each vaginal tablet's film coating contains hypromellose and macrogol 6000.

It’s important to use medications that are safe and suitable for your needs. If you are unsure, consult your doctor before use. Gina tablets are not suitable if the following applies:

• You are allergic (hypersensitive) to estradiol or any of Gina's other ingredients (as listed in the product label).

• You have or have ever had womb or ovarian cancer, or you are experiencing symptoms such as vaginal bleeding.

• You have not told us about any bleeding, pain, bloating, or swelling in your lower abdomen or pelvis.

• You have experienced any vaginal or genital bleeding since your periods stopped as a result of menopause.

• You have recent or suspected endometrial hyperplasia or have been referred for an ultrasound and are awaiting the results.

If any of the above statements apply to you, alternative treatment should be used to help with your vaginal symptoms.

Sources

https://www.medicines.org.uk/emc/files/pil.13930.pdf