Menopause treatment sold over the counter is great… but women deserve more

IT’S been hailed as a life-changing move for menopausal women.

Vaginal oestrogen tablets are set to be made available over the counter for the first time, offering hope for up to 80 per cent of menopausal women plagued by vaginal dryness.

Currently, most suffer in silence with just eight per cent accessing treatment.
The effects can be devastating, as Joanne Gunn, 54, from Brighton, knows all too well.

“When I first started going through the menopause, the lack of oestrogen meant everything started drying up,” she says.

“I’ve got really thick curly hair and it went dry and brittle. So did my nails. My skin was literally falling off — it was unbelievable. And obviously down there as well, it was completely dry. It makes sex really painful.”

The stigma around such symptoms is slowly being demolished, with the help of celebrities like Davina McCall sharing their experiences.

In her documentary, Sex, Myths and The Menopause, she said: “I had severe dryness — so severe, that when I tried to wipe myself after going to the loo it felt sore, so I had to dab.”

Until now, women have only been able to get vaginal oestrogen tablets — which ease dryness — after seeing their GP or a specialist.

But the Medicines and Healthcare products Regulatory Agency (MHRA) has launched a public consultation on plans to make Gina vaginal tablets available to buy in pharmacies.

It signals a win for Fabulous’s Menopause Matters campaign, and Carolyn Harris, Labour MP and co-chair of the new UK Menopause Taskforce, says the move will be be “excellent” for many women.

Campaigners at the forefront of the global “menopause revolution” tell Fab Daily that making hormone therapies more widely available will undoubtedly transform lives.

But, they stress, it is not the same as hormone replacement therapy (HRT) — the gold-standard in menopause treatment.

Leading menopause specialist Dr Louise Newson agrees the consultation “is a move in the right direction” but says it’s “important women know it’s not HRT”.

The distinction is a subtle but important one.

While vaginal oestrogen can ease vaginal dryness and urinary symptoms, HRT is a systemic treatment, meaning it “replaces hormones throughout the body,” Dr Newson explains.

It’s the replacement of these hormones, which naturally start to fall in perimenopause and menopause, that can help ease the 34 official symptoms, including hot flushes, brain fog and a vanishing libido.

“Vaginal dryness occurs because the tissues in the vagina and bladder thin, so this topical over-the-counter treatment — if it becomes available next year — will help with one of the painful and difficult symptoms of menopause,” says Dr Newson.

Anyone who has suffered with vaginal dryness will know it’s an agonising reality that can have profound knock-on effects.

TV host Saira Khan told Fabulous it affected her marriage: “I suffered a loss of libido, because I felt dry and horrible down below. I’ve suffered from psoriasis since birth and the menopause sparked sore, nappy rash-like skin around my privates.”

While the vaginal dryness Trisha Goddard experienced “caused soreness and chafing when I ran long distances”, she told Fabulous, but was fortunate to discover “non-hormonal, moisturising pessaries, which were a revelation”.

The hope of greater access to vaginal oestrogen appeals to Helen, 46, who says it has “changed everything” in the last 12 months.

'LIFE IS BUSY'

“Vaginal dryness was one of the major symptoms of menopause for me. I divorced the father of my four children in 2018 and met a new partner last year.

When I became sexually active again, it suddenly became a huge issue. Not only that but it was sore and itchy a lot — not great when you’re in a meeting at work surrounded by men.

“I had a couple of UTIs too which I’ve never suffered from before and noticed I was starting to leak from my bladder at certain times of the day.”

Helen saw her GP who suggested trying vaginal oestrogen, and a year on, she says: “I can’t believe I put up with the symptoms for so long without getting help.

"I get it on prescription but it’d be brilliant if it was available to buy over the counter.

"Life is busy — I’ve got a full-time job and four children, I don’t always remember to get my request in for a repeat prescription, so the fact I might be able to buy it when I’m doing the weekly shop from the supermarket pharmacy would be a big bonus.”

Mum-of-three Joanne’s sex life took a real hit when she began experiencing vaginal dryness. She tried all sorts of treatments, including patches, but for a year her symptoms were “just getting worse and worse”.

“My partner and I would have to use lubrication to have sex,” she remembers.

Fortunately she was prescribed Oestrogel HRT by her doctor — a gel that Joanne applies to her thighs.

“It was like a miracle!” she says. “You had to give it a month or so to kick in and get into your system, but down there was back to normal again.

“Before I was on it, the pain was horrible. You just couldn’t enjoy yourself. I kept thinking before sex, ‘Oh, I don’t want to do it!’ It’s like when you’ve got a tight pair of jeans on and you think, ‘Arghh’. It’s not comfortable at all.”

Dr Philippa Kaye, a GP and author of The M Word: Everything You Need To Know About The Menopause, says the move could be a game changer for lots of women.

“And by game changer, I mean life changer,” she says. “It is not easy for some people to go to the doctor. It can be difficult to explain what’s going on, and it might be easier, for some to get these things from a pharmacist.”

Dr Kaye’s patients report vulval and vaginal irritation, soreness, itching and painful sex. “I have some patients who say that even sitting down is uncomfortable, they’re constantly jiggling, and it can lead to recurrent urinary tract infections, which makes you feel not well.”

'REBALANCING TOOLS'

Undoubtedly vaginal oestrogen can help with many of those problems.

“That means women potentially get their sex lives back, it means they’re not incapacitated by having recurrent UTIs, and that can make a very big difference to women,” says Dr Kaye,

“But I tell patients that, technically vaginal oestrogen is a form of hormone replacement, but don’t lump it in together with all the other kinds of HRT, because it’s only acting locally.”

GP Dr Rachel Ward says the proposed plans could “make a huge difference”, but agrees we “need to keep it in perspective” and not forget that vaginal oestrogen “is not the same as HRT in the form of tablets and gel patches that are absorbed into the body and treat lots of other symptoms — mood disorder, hot flushes, tiredness.

This is not what that is for, so although this is an important part of menopause treatment, it’s not going to treat all symptoms. We wouldn’t want it to put women off seeking medical advice about other symptoms.”

Dr Newson says there are other factors to take into account too.

“It’s great to have the ease of popping to the chemist to buy vaginal oestrogen, but the restrictions attached to buying it don’t all make clinical sense.

"For example, it is women over 50 who haven’t had a period for a year who will be able to buy it if it becomes available, but two of the caveats are they can’t have had changes to the feel of the vulva (a common symptom of vaginal dryness) or had blood clots in the past.

"But there’s no clinical sense in this, so one of my concerns is that it won’t be meted out accurately by the chemists and pharmacies who are being given the task. The price point, if it stays the same, will make it easier on a lot of women though.

“At the moment, it’s suggested it’ll cost £2.50 a week, after an initial outlay of £29.99, which may make it cheaper than current prescriptions. But accessibility is the most positive part.”

'ACCESS IS DIFFICULT'

One thing the experts agree on is the fact that it is vital women still have appointments with their GP to discuss HRT.

After all, Dr Ward says there is still “a significant amount of counselling that needs to be done, about risk and benefits”, as well as patient monitoring, which depends on symptoms and medical history.

What’s more, Carolyn Harris, MP for Swansea East, adds that she will fight “tooth and nail” to stop HRT becoming an over-the-counter product, warning that it would “stop some women from accessing it”.

It then becomes something only those who can afford it will be able to buy,” she tells Fab Daily. We need it to be as cheap as possible for every woman so that no woman is unable to access the rebalancing tools they need to be able to get on with their life as normally as possible.”

On the subject of the consultation, she adds: “I wouldn’t want people to be under any illusion that this was the cure-all for the menopause, because this is one type of HRT.”

Dr Newson says that over-the-counter vaginal oestrogen is really part of a much bigger conversation about improving menopause care and treatment.

“Currently, many women are denied hormones they vitally need in menopause, often because access is difficult.

“Men can go into a chemist and buy Viagra for erectile dysfunction without knowing whether they have diabetes or high blood pressure — two conditions that can be affected by taking Viagra. Yet women have to jump through too many hoops in order to access hormones and HRT.

“We need to make it easier for women.

“The topical vaginal hormone treatment in consultation right now is a welcome step but it’s most definitely not HRT.

“More needs to be done for women in menopause - and it needs to be done now.”