What is Gina?

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What is Gina?

11 / Sep

Gina is indicated for the treatment of vaginal atrophy (VA) due to oestrogen deficiency in postmenopausal women aged 50 and above who have not had a period for at least one year.

Gina is the only product available without a prescription that effectively treats the cause of postmenopausal vaginal dryness. It acts to relieve symptoms of VA including:

Vaginal dryness | Itching | Burning | Soreness | Discomfort during sex

 

How Does Gina Work?

Before menopause, women have higher levels of a hormone called oestrogen, which helps keep the vagina healthy.

The vaginal lining has three layers of cells: superficial, intermediate, and parabasal cells. Oestrogen helps keep these layers thick and moist, and it also keeps the vaginal pH level healthy and acidic. After menopause, oestrogen levels drop, the superficial cells decrease, and the parabasal cells increase, causing the pH to rise. This can lead to a condition called vaginal atrophy, with symptoms like dryness, itching, burning, soreness, and discomfort during sex.

Gina works by replacing the lost oestrogen in the vagina to help treat the root cause of dryness.

After two weeks of using Gina, the vaginal lining starts to thicken, and the pH level begins to lower. As the lining becomes thicker and more lubricated, symptoms are noticeably reduced by week eight. The pH level returns to its pre-menopause state after about 12 weeks of regular use. Gina helps maintain vaginal health and significantly reduces the symptoms of vaginal atrophy.

You can use Gina as long as you and your pharmacist agree it’s needed. It’s important to talk about your progress each time you get a new supply of Gina

How Often to Use Gina 

Gina is a vaginal tablet that comes with a single-use applicator, already loaded and ready to use. Each pack of Gina contains 24 of these preloaded applicators. You can start your treatment on any day that works best for you.

INITIAL DOSE: 1 vaginal tablet daily for 2 weeks, then follow maintenance dose.

MAINTENANCE DOSE: 1 vaginal tablet twice a week, leaving 3 or 4 days between each dose.

 

What happens if I miss a dose?

If you miss a dose, you can take it as soon as it’s convenient, but don’t use more than one tablet in a day. After that, just continue with your next tablet as planned.

Your treatment should always be at the lowest dose for the shortest time possible, so talk to your pharmacist about this when you get Gina.

Keep in mind, vaginal atrophy is a long-term condition, and symptoms can come back if you stop using Gina. You can continue using Gina for as long as it works for you, which might be years. Your pharmacist will check if it’s still right for you every 3 months when you come back for more.

What happens if I want to re-start using Gina after a break?

If you’ve taken a break from using Gina or another local oestrogen treatment, the amount you should use will depend on how bad your symptoms are. If your symptoms have come back and are bothering you, it’s best to start with the initial dose. If not, you can continue with the maintenance dose. Speak to your pharmacist for more information.

The Applicator

Gina comes in a hygienic, pre-loaded applicator designed to deliver the correct dose every time.

Some women may find it difficult to use the applicator for the first time, and it could cause some pain or bleeding, though this is uncommon. If you’re using it correctly and still have trouble, see your GP. They might prescribe a different oestrogen treatment, like a cream, to help with your symptoms before trying Gina again.

Remember, you can’t use oestrogen creams and Gina at the same time.

What side effects are there?

Commonly reported side effects include:

• Headache

• Abdominal pain

• Vaginal bleeding, discharge or discomfort

If you have a serious allergic reaction or signs of a blood clot (like painful swelling or redness in your legs, sudden chest pain, or trouble breathing), stop using Gina and get medical help right away.

Also, stop using Gina and talk to your GP if you:

• Develop a reason why you shouldn’t use Gina

• Have any new vaginal bleeding or spotting

• Start experiencing new vaginal itching

• Get vaginal infections that don’t improve with over-the-counter products

• Notice symptoms of endometriosis returning

Seek prompt medical advice from your GP if you experience:

• Yellowing of your skin or the whites of your eyes

• A significant increase in blood pressure

• New migraine-type headaches

• Pregnancy (as Gina should not be used during pregnancy

 

Please refer to the patient information leaflet for more information

View Menopause Treatments

Sources

  1. Novo Nordisk. Gina Summary of Product Characteristics (SmPC). Available at: Medicines.org.uk
  2. Nilsson K, Heimer G. Low-dose oestradiol in the treatment of urogenital oestrogen deficiency – a pharmacokinetic and pharmacodynamics study. Maturitas. 1992;15(2):121–127.
  3. Mylan. Elleste Solo 1mg SmPC. Available at: Medicines.org.uk
  4. Simon J, Nachtigall L, Gut R, et al. Effective treatment of vaginal atrophy with an ultra-low-dose estradiol vaginal tablet. Obstet Gynecol. 2008; 112(5):1053–1060.
  5. Novo Nordisk. Pharmacy Guide for the Supply of Gina [2022]. Available at: Medicines.org.uk
  6. Gina Patient Information Leaflet.
  7. Ayres J et al. British Menopause Society – HRT Guide. July 2020. Available at: British Menopause Society
  8. Kongnyuy WJ, Norman RJ, Flight IH, Rees MC. Oestrogen and progestogen hormone replacement therapy for peri-menopausal and post-menopausal women: weight and body fat distribution. Cochrane Database Syst Rev. 2000;(2)

 

Frequently Asked Questions 

If you’re switching from another local oestrogen therapy, make sure:
  1. You’ve been using your current therapy for more than 3 months.
  2. Your symptoms have been well-controlled with that therapy.
  3. There haven’t been any changes in your health since your last prescription.
Speak to your pharmacist for more information.
The vaginal tablet should not fall out. Once you insert it, it sticks to the vaginal wall and dissolves. If you’re concerned about it, try using Gina in the evening before you go to bed.
Most women who haven’t used local oestrogen therapy before might not see significant improvement in their symptoms until after 3 months of treatment. However, some women may notice improvements sooner.

If you’re scheduled for surgery and need to stay immobile during recovery, it’s best to stop using Gina 4-6 weeks before your surgery. You should not use Gina while you are immobile after surgery. Once you’re fully mobile again, you can resume using Gina.

Speak to your pharmacist for more information

Gina is not linked to weight gain. There’s no evidence that hormone replacement therapy like Gina affects body weight.

However, it's normal to experience weight gain around menopause, so if you’re concerned, this could be a factor.