Gina HRT tablets

Gina is a low-dose vaginal oestrogen tablet that belongs to a group of medications called hormone replacement therapy (HRT), which help deal with symptoms of menopause. It contains the active ingredient estradiol hemihydrate, an artificial version of the hormone oestrogen, to replace the naturally falling levels that occur during menopause.

Gina is suitable for women who are older than 50 and have not had a period in at least 1 year. It’s a local vaginal HRT, which means it treats the area it has been applied to rather than circulating in your blood

Gina tablets arrive pre-loaded into an applicator, which you insert into your vagina to release the tablet. Once inserted, the tablet dissolves, releasing oestrogen directly into your vaginal tissue. This works to replace the hormones that have been reduced by menopause.

What is Gina used for?

Gina is used to treat vaginal atrophy or urogenital atrophy, which is one of the most common symptoms of menopause. Vaginal atrophy is the clinical term used to describe when you get vaginal symptoms such as:

• dryness
• soreness
• itching
• burning
• pain during sex
• spotting or bleeding, especially during/after sex

Vaginal atrophy tends to happen because of low oestrogen levels, which decline naturally during menopause, causing thinning of the tissue surrounding your vagina. Gina replaces the oestrogen you’ve lost, helping to improve or get rid of your symptoms.

Please note that use in women under 50 or who are not postmenopausal is an ‘off-label’ use for Gina. All medications we offer are fully licensed within the UK. Some medications, such as this one, are prescribed for conditions or circumstances that are outside the license, also known as ‘off-label’. Prescribing ‘off-label’ is a common practice by healthcare professionals to ensure a medication can safely benefit as many patients as possible. This is always based on updated information and evidence since the product first became available.

Gina is a form of HRT, which means it works by replacing the hormones you naturally lose as you go through menopause. It does this by releasing additional oestrogen into your vaginal tissue, which stops you from developing uncomfortable symptoms caused by a decline in your natural oestrogen levels.

How long does Gina last?

Once inserted into your vagina, Gina tablets take around 8 hours to dissolve, but the effects of Gina continue after they have dissolved. You should continue to feel the positive impact of using Gina for as long as you continue to use it.

How long does Gina take to work?

Gina starts working immediately, but you may not feel its full effects until you have been taking it for at least 4 to 8 weeks. It’s important to remember that how long it takes Gina to work can vary from person to person. Still, if you do not notice any benefits after 3 months of continued use, you should speak to your doctor, who may recommend a more suitable alternative treatment.

How effective is Gina?

Gina tablets have been proven to effectively treat symptoms of menopause like vaginal dryness, itching, and soreness. After 12 weeks of treatments with a 10mcg vaginal estradiol tablet, there was a 13% increase in healthy, mature cells lining the vaginal wall compared to 4% in people given a placebo.

National guidelines recommend Gina as a low-dose vaginal oestrogen tablet if you are going through menopause and need help managing your symptoms.

You take Gina by inserting the pre-loaded applicator into your vagina to release a tablet.

Initially, you will take 1 tablet a day for 2 weeks. After this, you will lower your dose to 1 tablet twice weekly. It’s fine to take Gina at any time that works for you, but you must try to take it at the same time each day.

Full instructions on how to take Gina are available in the patient information leaflet that comes with your medication, but if you’re still not sure how to take Gina, you should speak to your doctor.

Here’s a step-by-step guide on taking Gina:

1. Wash your hands thoroughly and dry them thoroughly.
2. Tear off 1 of the blister packs and open it at the end. Carefully take out 1 applicator.
3. Position the applicator so that you can press the ‘applicator plunger’ with 1 finger.
4. Prepare to insert the applicator by getting into a comfortable position, either lying down or standing up.
5. Slowly insert the applicator into your vagina. You should aim to insert half the applicator, but only as far as it feels comfortable.
6. Gently press the ‘applicator plunger’ all the way in to release the tablet.
7. Remove the applicator from your vagina and throw it away.

How long do you need to take Gina tablets for?

Most people will take HRT for 2 to 5 years to relieve their symptoms, but you may need to take it for longer. Gina can be used for as long as you need it if you have not experienced any uncomfortable, harmful side effects while taking it.

You should speak to your doctor at least once per year to check that vaginal HRT is still suitable for you.

What if I miss a Gina tablet?

If you forget a Gina dose, take it as soon as you remember, but you must not take a double dose to make up for a forgotten one.

What if I take too many Gina tablets?

Taking more Gina than you should is unlikely to be harmful in the short term, but if you feel that your dose is too strong or weak for you, speak to your doctor or pharmacist. You should not increase your dose of Gina.

Gina can cause side effects, and if you do get them, you should speak to your doctor.

Common side effects include:

• headache
• stomach pain
• vaginal bleeding, discharge, or discomfort

Uncommon side effects include:

• fungal infections
• rashes
• nausea (feeling sick)
• weight gain
• high blood pressure
• hot flushes

Rare side effects include:

• diarrhoea
• worsened migraines
• water retention
• generalised hypersensitivity

Stop using Gina and seek medical advice if you:

• get new vaginal bleeding, spotting, or itching
• have endometriosis, and your symptoms come back
• develop a vaginal infection
• get yellowing skin or whites of your eyes (jaundice)
• notice your blood pressure increasing (may cause headaches, tiredness, and dizziness)
• get migraine-like headaches for the first time
• become pregnant

If you get side effects that could be signs of an allergic reaction to Gina, call 999 straight away. Symptoms include:

• suddenly feeling unwell with sweating
• being sick (vomiting)
• breathing difficulties
• swelling of the face and throat
• rapid heartbeat or feeling dizzy

Do not use Gina if you have:

• an allergy to any of the ingredients
• had any vaginal bleeding since your periods stopped
• or have ever had womb or ovarian cancer
• any vaginal or lower abdominal symptoms which have not been diagnosed properly yet
• or have ever had a blood clot or a clotting disorder
• or have ever had breast cancer
• cardiovascular disease, or have recently had a cardiovascular event (such as a heart attack or stroke)
• or have ever had liver disease, and your liver function tests have not normalised
• a blood problem called ‘porphyria’

Before starting Gina, speak to your doctor if you:

• have a history of endometriosis
• have a history of endometrial hyperplasia
• are receiving a type of HRT (including tablets or patches) that circulates in the blood
• are switching from another vaginal oestrogen HRT
• have uterine fibroids (leiomyoma)
• have an increased risk of blood clots
• have an increased risk of womb, ovarian, or breast cancer
• have high blood pressure
• have a liver disorder
• have diabetes
• have gallstones
• get migraines
• have systemic lupus erythematosus (SLE)
• have epilepsy
• have asthma
• have a disease that affects your eardrum and hearing (otosclerosis)
• have a very high level of fat in your blood
• have fluid retention from cardiac or kidney problems
• have hereditary or acquired angioedema

Gina is not the right treatment for everyone, which is why it’s important to make sure it’s safe for you first. We recommend Gina for people who are over 50 and have not had a period for over 1 year.

You can read about Gina in the patient information leaflet.

HRT is available in several forms, including oral tablets, patches, and vaginal creams. At ZAVA, we can prescribe a range of alternative HRT treatments to meet your needs.

Vaginal HRT creams and tablets

If you are getting local vaginal symptoms, such as dryness, itching, and irritation, there are several alternative creams and tablets available. At ZAVA, we can provide:

Estriol cream

Estriol cream, also available under the brand name Ovestin, is a prescription-only medication that is applied directly inside the vagina and contains the active ingredient estriol, a synthetic type of oestrogen.

It works similarly to Gina because it replaces the falling hormone levels you experience during menopause. Estriol cream can be used on its own or alongside other forms of HRT, like patches and tablets, to treat wider menopause symptoms.

Vagifem

Vagifem, like Gina, is a vaginal oestrogen tablet which contains estradiol and works to treat vaginal dryness and irritation. However, Vagifem is only available by prescription and may contain different non-active ingredients.

HRT oral tablets

Oral HRT tablets are one of the most common forms of HRT available. They’re usually taken once a day and are available as oestrogen-only and combined pills (also containing an artificial progesterone).

At ZAVA, we can prescribe the following HRT tablets:

Elleste Duet Conti

Elleste Duet Conti is a continuous form of HRT that contains synthetic versions of oestrogen and progesterone. It’s taken without a break and can relieve symptoms, such as hot flushes, night sweats, and mood shifts.

Femoston Conti

Femoston Conti is another continuous method of HRT that contains 1mg of estradiol (oestrogen) and 5mg of dydrogesterone (progesterone). It’s also available in a lower 0.5mg/2mg dose, which may be more suitable for you if the higher strength is difficult to tolerate.

Kliofem

A combination of oestrogen and progesterone that is taken daily without a break. It’s also available in a lower dose under the brand name Kliovance.

Premique

A combined HRT that contains a low dose of artificial oestrogen and synthetic progesterone. It can relieve menopause symptoms in postmenopausal people.

Tibolone

Also available under the brand name Livial, the active ingredient, tibolone, is an artificial hormone that is broken down by the body to produce substances that mimic the hormones oestrogen, progesterone, and testosterone.

HRT patches

Skin patches are another form of HRT that delivers artificial hormones locally through the skin to relieve menopause symptoms. They are a convenient alternative to oral tablets, especially for anyone who has difficulty swallowing pills or who has experienced side effects from oral medication.

At ZAVA, we offer the following HRT patches:

Evorel Sequi

A sequential or cyclical type of HRT, which contains 2 different types of patches that you switch between to deliver a controlled level of hormones through your skin.

Evorel Conti

Evorel Conti is a combined HRT that delivers estradiol (oestrogen) and norethisterone (progesterone) through the skin and is changed twice a week. Evorel Conti patches are worn continuously without a break.

We also provide Estradot patches, which only contain synthetic oestrogen and a separate progesterone-only HRT pill called Utrogestan. Some people prefer to take HRT in this way. Estradot patches are also smaller than Evorel, making them a preferable choice for anyone who may be conscious about wearing a patch.

Examples that we offer include:

• Estradot and Utrogestan sequential
• Estradot and Utrogestan continuous

Finding the right HRT is not always easy, but we’re here to help. During your consultation, your doctor will note down your preferred treatment but may recommend an alternative that’s more suitable for your health and needs.

Can I buy Gina over the counter?

Yes. Gina is available to purchase without a prescription because vaginal atrophy, which Gina treats, can be diagnosed based on your symptoms without needing a doctor to examine you. Also, as Gina is a low-dose medication, your chances of getting harmful side effects are very low. This means you can buy it over the counter, but you will have to answer a few questions so the pharmacist can make sure it’s safe and suitable for you.

Can I get Gina on the NHS?

Yes. You can get Gina on the NHS, but you may need a consultation with your GP and a prescription. Your doctor may decide a different HRT is more suitable for you.