Estradiol 10mcg vaginal tablets were reclassified as a pharmacy (P) medicine, brand name Gina, and are the same strength as prescription only medicine (POM) Vagifem tablets. Community pharmacists now have the opportunity to recommend treatment of vaginal atrophy due to oestrogen deficiency in postmenopausal women aged 50 years and above, who have not had a period for at least 12 months. 

The initial dose is one tablet used daily for a fortnight and the maintenance dose is one vaginal tablet twice a week, leaving three or four days between each dose. New users are asked to return to the pharmacy at seven weeks to check that their symptoms have not worsened and that there are no new symptoms before another pack of tablets is supplied.

A pharmacy checklist has been produced which sets out suggested questions for the three potential scenarios in which a woman might be having a consultation with the pharmacist:

• Women who have never previously used Gina (first visit to the pharmacy)
• Women who are returning to the pharmacy for their second visit (seven weeks) or first three-monthly visit
• Women who are returning for their ongoing three-monthly visits.

A Pharmacy Guide providing practical information, including guidance on switching from another local vaginal oestrogen preparation, and a checklist can be found here. 

The updated National Institute for Health and Care Excellence (NICE) guideline for depression states that, although there is evidence that St John’s Wort may be of benefit in less severe depression, healthcare professionals should not prescribe or advise its use by people with depression because of: 

• Uncertainty about appropriate doses
• Persistence of effect
• Variation in the nature of preparations
• Potential serious interactions with other drugs (including hormonal contraceptives, anticoagulants and anticonvulsants).