Menopause is individual to every woman, and treatment should be tailored to her individual symptoms and concerns as she goes through the change in hormones from her late-40s onwards. Every woman goes through it, but everyone experiences different symptoms, and to varying degrees of severity. Previously women would book an appointment with their doctor to discuss symptoms and treatment options, but some women have done their research and already think that Hormone Replacement Therapy (HRT) is right for them. To make access easier, there’s a proposal underway to make HRT available without a prescription, so you no longer need an appointment with your GP. It’s not quite that black-and-white, so let’s talk you through the proposed change to getting hold of HRT.
The menopause is defined as periods stopping completely for a year if you are over 50, or for 2 years if you are under 50. In broad terms, it’s when oestrogen levels decline, and causing symptoms such as hot flushes. At the same time another female hormone, follicule stimulating hormone (FSH), fluctuates up and down, until it eventually declines, too. So HRT is used to replace oestrogen and thereby reduce certain symptoms. This can be on a body-wide basis – by patches, a spray or gel applied to the skin and absorbed, or by tablets by mouth. Alternatively it’s applied to areas that rely on rich levels of oestrogen, such as around the vagina, to ease symptoms. Some HRT products may also be used to prevent osteoporosis (fragile bones), if this is a particular concern.
Lack of oestrogen around the vagina can cause dryness, making women vulnerable to thrush, urinary tract infections and soreness during sex, and also causing discomfort, fragile skin and itching. Vaginal oestrogen is inserted via pessaries, cream, vaginal tablets or a vaginal ring. It helps to restore moisture levels and plumpness to the tissues, thereby relieving symptoms. It’s a good idea to also use a moisturiser in the area and lubrication during sex to ensure optimum comfort. This is the HRT that the UK government is proposing to make available from pharmacies, in a product called Gina, containing 10 mcg estradiol. These are oestrogen tablets inserted via an applicator into the vagina. Vagifem is a similar product, with the same dose of estradiol, that is only available by prescription from your doctor.
This medication is not an off-the-shelf product, it requires a discussion with a pharmacist who will check that you meet the criteria via a set of questions, so they are selling the product safely and responsibly. This proposal is still in the consultation stage, so it hasn’t been fully approved, and even if approved, it’s unlikely to be available until at least the end of the year. Once approved, pharmacists will need to go through training to be able to sell this product, so it’s possible that it won’t be available in every pharmacy immediately – check with yours before making the journey, or look for an online provider.
Other modes of HRT that are designed for systemic absorption (replacing oestrogen throughout the body) will still require a prescription from your doctor. They will ask questions about your symptoms to ensure they are prescribing the right treatment. They may suggest other medications or investigations, depending on your health conditions and risk factors, and they will review you regularly. The aim is for HRT to bridge the months or years when symptoms are troublesome, until the fluctuations in hormone levels settle.