Gina®

What is Gina?

Gina HRT tablets are a type of local vaginal hormone replacement therapy. This means you insert the tablets directly into your vagina using the included applicators to relieve symptoms of menopause in the vagina. For example, this might include irritation or dryness.

Gina vaginal tablets are a type of oestrogen-only HRT, as their only active ingredient is estradiol (a form of oestrogen). Typically, oestrogen-only HRT treatments are best suited to women who have had a hysterectomy, as the increased level of oestrogen can increase the risk of certain conditions (such as breast cancer or blood clots) in women who have an intact uterus.

But because Gina is applied locally to the vagina (instead of systemically like an oral tablet or skin patch), very little is absorbed into your bloodstream. So it’s thought that the risk of developing side effects with Gina is lower than with systemic HRT.^[1]

How does Gina work?

As women get older, the level of hormones their bodies produce begins to change. The menopausal transition is a period when two hormones made by the ovaries (oestrogen and progesterone) decrease naturally. In the years leading up to menopause, you may notice changes to your menstrual cycle, hot flushes, and other symptoms. This is known as perimenopause.

The menopause doesn’t actually occur until 12 months after your last period. After menopause, due to the reduced hormone levels in your body, you may get symptoms such as dryness and soreness in your vagina. Gina tablets provide oestrogen locally to replace the hormones your body is no longer producing. This helps to relieve vaginal discomfort.^[1]

Who is Gina for?

Gina estradiol tablets are only for postmenopausal women over the age of 50 who haven’t had a period in over a year.

Usually, HRT treatments that contain just oestrogen are recommended for women who have had a hysterectomy. Women with an intact uterus can use them, but only alongside a progesterone treatment. This is because increasing the level of oestrogen in the body without also raising the level of progesterone can heighten the risk of breast and endometrial cancer, among other conditions.

However, as Gina menopause tablets are applied locally, directly into the vagina, it’s considered to have a lower risk of these adverse effects. This means it’s suitable to be used by women who haven’t had a hysterectomy.

What doses does Gina come in?

This treatment only comes in one dose, the Gina 10 microgram vaginal tablet. Other vaginal estradiol tablets used to be available at a higher dose of 25mcg, such as Vagifem 25mcg. However, this dose has been discontinued after medical advice suggested women use the lowest effective dose of oestrogen;^[2] 10mcg tablets were shown to provide results that weren’t significantly different from the values of the 25mcg dose^[3]

How to take Gina

You should always take Gina as instructed by your clinician.

If you’re taking Gina for the first time, or you’ve taken a break from Gina and your menopause symptoms have returned, you should start by using one tablet every day for two weeks. This initial dose will increase the local level of oestrogen in your vagina. After two weeks, you’ll switch to a maintenance dose of one tablet two times a week, leaving three to four days between doses. This altered dose is to maintain the increased level of oestrogen.

Follow these steps to take your Gina vaginal tablets:

• Make sure you’ve washed your hands, and get into a comfortable position. You can take Gina either standing up or lying down;
• Open one of the blister packs, separate the plastic packaging, and take out the applicator that contains the tablet;
• Check that the tablet hasn’t fallen out of the applicator into the plastic wrapper. If it has, place it back into the end of the applicator carefully. Make sure your hands are clean and dry while touching the Gina tablet. If the tablet falls out of the applicator after removing it from the blister pack, throw both the applicator and tablet away and start again with a new one;
• Hold the applicator so that you can push down on the plunger at one end of the applicator;
• Carefully insert the applicator into your vagina. You can do this either standing up or lying down. You should try to insert half the applicator, but don’t push more than is comfortable;
• Push down on the applicator plunger gently until you feel a click. The click confirms the tablet has dispensed from the applicator. The tablet will then attach to the wall of your vagina and begin to dissolve. You won’t have to worry about it falling out if you stand up or walk around;
• Carefully remove the applicator and throw it away with the plastic packaging.

How long does it take for Gina to work?

Your symptoms should start to improve after a few months of taking Gina. If you find your symptoms are getting worse, you should contact your clinician. Likewise, if you’ve been taking Gina for three months and noticed no improvement in your symptoms, you should speak with your doctor or pharmacist.

What should I do if I make a mistake taking Gina?

Only take Gina as you’re told to by your clinician, and make sure to check your patient information leaflet if you need more details. The dosage of estradiol in Gina is very low, so even if you accidentally take more than you should, you’re unlikely to notice any side effects. Seek medical advice if you have any concerns.