When it comes to managing menopause symptoms, most women reach out to their doctor for a prescription for hormone replacement therapy ( HRT). In fact, according to the NHS, there were 7.8 million items for HRT prescribed in 2021-22 in the UK. But what if you feel uneasy about talking to your doctor about uncomfortable symptoms like vaginal dryness? Or you just want the convenience of being able to pick up treatment from a pharmacy?
In the last year or so, a handful of new hrt treatments have been made available over the counter for menopausal women through pharmacies or privately run health organisations. In this article, we’ll take you through the two key players of over the counter hrt – what they are, what symptoms they treat, and how you can get your hands on them.
Firstly, what do we mean by HRT?
Hormone Replacement Therapy (HRT) is the most common treatment prescribed for woman's health to ease symptoms associated with menopause. As oestrogen levels decline associated symptoms develop including hot flashes, mood swings, anxiety, bloating and tiredness. But there are the less talked about other menopause symptoms.
Menopausal women and postmenopausal women will experience vaginal atrophy symptoms which include vaginal dryness, a decrease in vaginal health, an increase in urinary tract infections and thinner vaginal tissue with less natural lubrication which then leads to painful sex.
Hrt treatment is designed to replace the hormones that are lost during perimenopause and in menopause. HRT generally comes with few side effects, and as it’s available in a range of different forms, there’s something to suit almost every woman.
Why the sudden change in how women can access HRT?
You might remember seeing HRT make the headlines in 2022 when news broke that the Healthcare Products Regulatory Agency was going to offer hrt medication available to buy over the counter at boots stores?
The announcement was a little misleading, and was referring to gina hrt tablets for vaginal symptoms not all hrt products. As of July 2023, systemic HRT is still a prescription only medicine not a common pharmacy medicine.
In the UK, you still need a prescription from highly trained healthcare professionals like doctors and menopause specialists for the vast majority of hormone replacement therapies. That means you’ll usually need to have an appointment to discuss your sexual and reproductive healthcare and have tests done, such as blood tests, to check that you’re suitable.
There is in fact currently only one low cost type of HRT that’s available to buy without a prescription – Gina tablets.
Gina 10 microgram vaginal tablets
Gina 10 microgram vaginal tablets are a locally acting oestrogen hrt treatment that specifically targets the common menopause symptom of vaginal atrophy. This includes dryness, soreness, burning, itching, more sensitive vaginal tissues and painful intercourse. Vaginal atrophy happens because of declining oestrogen levels.
Gina tablets come in a tablet form and is inserted into the vagina with the help of an applicator, delivering a low dose of oestrogen directly to the vaginal wall. The initial dose is usually one tablet a day for two weeks. Then, a maintenance dose of two tablets a week, three or four days apart. You should start noticing an improvement in your symptoms eight to 12 weeks after you start treatment.
Benefits of getting Gina HRT over the counter
Vaginal dryness can be really uncomfortable and affect everyday life and relationships for postmenopausal women. The hormone estriol plays a role in keeping the vagina supple, flexible and moist, so by replacing this specific type of oestrogen that’s lost through menopause, you should notice things getting back to normal.
Is Gina HRT safe to buy without seeing a doctor?
Yes. It has been authorised by the Healthcare Products Regulatory Agency and the reclassification from a prescribed only medication to a pharmacy medicine was supported by pharmacy teams and prescribers such as boots pharmacists. It is a local oestrogen. It doesn't go through your system.
Are there risks of taking hrt over the counter that I should be aware of?
Gina isn’t suitable for all women. For starters, you’ll need to be over 50 and in menopause so no periods for at least a year. If you’ve had a period in the last 12 months, you’re classed as perimenopausal, so won’t be able to buy it just yet.
It’s also not available over-the-counter for women who have had womb, breast or ovarian cancer, or women who have previously taken oestrogen-only HRT and still have their womb. So, before you can get your hands on it, you’ll need to have a quick chat with a local pharmacist or pharmacy director in-store. If you do fall into any of the categories mentioned, the good news is that your doctor may still be able to give you a prescription for Gina – the drug is still available through the NHS.
AndroFeme is a treatment for testosterone deficiency. Its active ingredient is, unsurprisingly, testosterone – a hormone usually associated with men. In women, testosterone is produced in the ovaries and adrenal glands, and it plays a part in our overall cognitive functioning, mood, and metabolism, as well as our sexual, reproductive, and urinary health. As menopause approaches, testosterone levels fall, leading to symptoms like lower libido, depression, muscle loss, and cognitive problems. Women are also faced with an increased risk of developing osteoporosis.
This treatment comes in the form of a white cream that you massage into the skin, either on the abdomen or the outer thigh. The dosage and where you apply the cream differ from person to person, so you’ll need to follow your doctor’s instructions. Most people start with a 0.5ml daily dose, then gradually build up to 1.5ml each day.
Unlike Gina, Androfeme cannot be purchased over the counter because it’s unlicensed for this purpose in the UK. It is, however, recommended by the British Menopause Society, and you can obtain a private prescription for it through private menopause consultants and online clinics.
The bottom line
While most types of HRT require a prescription, you can still buy certain treatments for menopause symptoms over the counter or privately. Gina and Androfeme are two of the best options for women suffering from symptoms like vaginal atrophy and urinary problems. Not everyone will be able to take advantage of this, but for a lot of women, it’s a positive step in the right direction.
What is the best over the counter medicine for menopause?
The best menopause treatment varies from woman to woman, as it largely depends on what symptoms you’re suffering from and what stage of menopause you’re in. Symptoms of vaginal atrophy can be treated with vaginal oestrogen tablets like Gina, which are available over the counter.
Can you buy oestrogen over the counter?
Oestrogen and progesterone systemic hrt is usually only available on prescription. Currently, the only type of oestrogen available over the counter in the UK is Gina – a vaginal tablet used to treat the symptoms of vaginal atrophy, including dryness, soreness and itching.
Is there an over the counter substitute for Vagifem?
Gina is an alternative to Vagifem that you can buy over the counter from a pharmacy. It’s exactly the same drug – the only difference is that Gina is only intended for women aged 50 and over who have not had a period in at least 12 consecutive months.