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    GINA Vaginal Tablets (Estradiol) for Postmenopausal Symptoms

    LEADING POINTS:

    • Dryness and irritation relief
    • Significant improvement felt within just 4 weeks.
    • Easy application

    MORE INFORMATION:

    Click to access pil.13930.pdf

    ABOUT GINA

    WHAT IS GINA?

    Gina is a Hormone Replacement Therapy (HRT) medication containing the active ingredient Estradiol.

    Estradiol is an artificially made version of the naturally occurring female sex hormone oestrogen.

    Typically, during menopause, the levels of oestrogen drops significantly, so Gina helps to replace this lost oestrogen to restore normal function.

    HOW DOES GINA WORK?

    • It replaces the naturally occurring oestrogen produced by the vagina, causing relief.

    HOW LONG DOES GINA TAKE TO WORK?

    • Improvement should be felt within 4-8 weeks.
    • If not improved during this time, speak to your doctor for treatment review.

    WHO IS GINA SUITABLE FOR?

    Women 50+

    Have not had a period in at least a year

    Who should not take Gina:

    • Blocked blood vessels due to blood clot
    • Current or recent heart-related adverse event: eg angina, heart attack, stroke
    • History or increased proneness to blood clots, especially ones that have travelled and blocked blood vessels
    • Personal history of the cancers:
      • Breast cancer
      • Oestrogen-based cancers
    • Vaginal bleeding of unknown cause
    • Enlargement of the endometrium, not treated.
    • Current vaginal infection
    • Liver disease

    Take Gina within caution if:

    • Rare blood disease known as acute porphyria
    • Diabetes
    • Some risk factors for blood clots
    • Breast lumps – monitor closely (may be cancerous)
    • Fibrocystic disease – may be precancerous to breast cancer
    • Migraine
    • Antiphospholipid antibodies present in blood (positive test) – increased risk of blood clots
    • Familial history of breast cancer or other hormonal cancers.
    • May worsen endometriosis
    • May make fibroids larger
    • Risk of gall-bladder disease
    • Pituitary gland tumour
    • Prolonged immobility – increased risk of blood clot
    • High blood pressure
    • Epilepsy
    • Lupus
    • Asthma
    • Kidney problems
    • Issues with fluid retention

    OTHER WARNINGS AND PRECAUTIONS:

    • Risk of cancer
      • Prolonged use of oestrogen replacement, especially alone (without a progestogen to counteract it) can slightly increase the risk of hormonal-based cancers such as endometrial cancer, breast cancer and ovarian cancer.
      • The excess risk falls within a few years after stopping
      • It is best to avoid using for a long term basis (over 5-10 years) unless absolutely necessary
    • Treatment should be reviewed at least on a yearly basis to establish the need to continue
    • May interfere with breast cancer detection tests

    It should be noted that Gina has very low absorption into the blood as a vaginal tablet so side-effects are less likely than an oral tablet or other methods. However, caution should be taken anyway. The addition of a progestogen is not needed.

    Pregnancy

    • I don’t know how you would be pregnant after menopause but it should be avoided
    • Note that menopause is officially diagnosed with at least 1 year after the last period.

    Breastfeeding

    • Avoid.

    GINA WITH OTHER MEDICATIONS

    • Antiepileptic drugs
    • Antiviral drugs – particularly hep C drugs

    Note that inserted into vagina so low absorption but caution with drugs such as the ones above.

    GINA ALTERNATIVES

    • Estriol cream (Ovestin)
    • Oestrogel (oestrogen cream)
    • Evorel (oestrogen patches)

    HOW TO TAKE GINA:

    Please see the information leaflet below for full instructions on how to use (at the bottom):

    Click to access pil.13930.pdf

    Gina is a vaginal tablet and is only for vaginal use. It is not to be put into the mouth or any other areas.

    Mild vaginal discomfort may occur especially if improper technique is used or vaginal walls are thinning (Vaginal Atrophy).

    Each vaginal tablet comes with an applicator for single use only.

    SIDE EFFECTS

    Common:

    • Tiredness
    • Vaginal Bleeding
    • Stomach or pelvic pain

    Uncommon:

    • Sudden unexplained weight changes, particularly weight gain
    • Vaginal thrush

    Rare put potentially serious. Seek immediate medical attention:

    • Fluid retention
    • Liver damage
    • Blood clot
    • Tumour
    • Increased stroke risk
    • Enlargement of endometrium – must be checked out as potentially precancerous.

    LIFESTYLE CHANGES TO HELP WITH MENOPAUSE:

    • Smoking and excess alcohol can worsen menopausal symptoms. It is important to keep these under control.
    • There is an increased risk of osteoporosis as menopause involves a sharp drop in oestrogen. Oestrogen helps to maintain bone density. Vitamin D and Calcium supplementation and foods high in calcium such as milk, yoghurt and kale can help a lot.
    • Support groups – others going through same
    • Exercise regularly to keep muscles and bones strong.

    INGREDIENTS:

    Tablet core:

    Hypromellose

    Lactose monohydrate

    Maize starch

    Magnesium stearate

    Film-coating:

    Hypromellose

    Macrogol 6000

    SOURCES:

    [1] https://www.medicines.org.uk/emc/product/13930/smpc#gref

    [2] https://bnf.nice.org.uk/drugs/estradiol/#contra-indications

    [3] https://www.nhs.uk/conditions/menopause/