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Scenario

Mrs W is 55 and went through the menopause at least 4 years ago. She has come into your pharmacy today as she has heard that vaginal oestrogen can be purchased from pharmacy for symptoms of vaginal atrophy (VA).

When you ask her about her existing symptoms, she advises that she experiences vaginal dryness, soreness and mild itching. Mrs W wants to know if these symptoms are indicative of VA.

What advice would you give and why?

A.Explain to Mrs W that the symptoms she is experiencing could be due to VA and she may benefit from using a local oestrogen therapy such as Gina

CorrectThese symptoms are examples of VA symptoms. Other VA symptoms include burning and discomfort during sex

B.Explain to Mrs W that the symptoms she has described could indicate a differential diagnosis

IncorrectThese symptoms are suggestive of VA. Examples of symptoms that would indicate a differential diagnosis include severe vaginal itching and undiagnosed vaginal bleeding

Now complete the next module in the training programme

What is Gina?

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Pharmacy Team
Training Guide

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Pharmacy Guide for
the Supply of Gina

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Pharmacy
Checklist

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Click continue to assessment to answer some further questions to test your understanding and record this learning in your learning log.

Pharmacists and pharmacy technicians can use this training module to help support their GPhC revalidation.

 


References

1. Nappi RE, Palacios S, Particco M, et al. The REVIVE (Real Women’s Views of Treatment Options for Menopausal Vaginal Changes) survey in Europe: Country-specific comparisons of postmenopausal women’s perceptions, experiences and needs. Maturitas 2016;91:81–90.

2. Palacios S, Nappi RE, Bruyniks N, et al. The European Vulvovaginal Epidemiological Survey (EVES): prevalence, symptoms and impact of vulvovaginal atrophy of menopause. Climacteric 2018;21(3):286–291.

3. Kingsberg SA, Larkin L, Krychman M, Parish SJ, Bernick B, Mirkin S. WISDOM survey: attitudes and behaviors of physicians toward vulvar and vaginal atrophy (VVA) treatment in women including those with breast cancer history. Menopause 2019;26:124–131.

4. Panay N, Maamari R. Treatment of postmenopausal vaginal atrophy with 10-μg estradiol vaginal tablets. Menopause Int 2012;18(1):15–19. 10. Nilsson K, Heimer G. Low-dose oestradiol in the treatment of urogenital oestrogen deficiency-a pharmacokinectic and pharmacodynamics study. Maturitas. 1992;15(2):121–127.

5. Archer DF, Kimble TD, Lin Y, et al. A randomized, multicenter, double-blind, study to evaluate the safety and efficacy of estradiol vaginal cream 0.003% in postmenopausal women with vaginal dryness as the most bothersome symptom. J Women’s Health 2018;27(3):231–237.

6. Wysocki S, Kingsberg S, Krychman M. Management of vaginal atrophy: implications from the REVIVE survey. Clin Med Insights: Reproductive Health 2014;8:23–30.

7. Portman DJ, Gass ML. Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Menopause. Oct 2014;21(10):1063–1068.

8. Castelo-Branco C, Cancelo MJ, Villero J, et al. Management of postmenopausal vaginal atrophy and atrophic vaginitis. Maturitas 2005;52 Suppl1:S46–52.

9. Cagnacci A, Xholli A, Sclauzero M, Venier M, Palma F, Gambacciani M, et al. Vaginal atrophy across the menopausal age: results from the ANGEL study. Climacteric 2019;22(1):85–89.

10. Kingsberg SA, Wysocki S, Magnus L, et al. Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE (Real Women’s Views of Treatment Options for Menopausal Vaginal Changes) Survey. J Sex Med 2013;10:1790–1799.

11. Simon JA, Kokot-Kierepa M, Goldstein J, Nappi RE. Vaginal health in the United States: results from the Vaginal Health: Insights, Views & Attitudes survey. Menopause 2013;20(10):1043–1048.

12. Nappi RE, Kokot-Kierepa M. Vaginal Health: Insights, Views & Attitudes (VIVA) - results from an international survey. Climacteric 2012; 15(1):36–44.

13. Nappi RE, Kokot-Kierepa M. Women’s voices in the menopause: results from an international survey on vaginal atrophy. Maturitas 2010; 67(3):233–238.

14. Nappi RE, Palacios S. Impact of vulvovaginal atrophy on sexual health and quality of life at postmenopause. Climacteric 2014;17(1):3–9.

15. Parish SJ, Nappi RE, Krychman ML, et al. Impact of vulvovaginal health on postmenopausal women: a review of surveys on symptoms of vulvovaginal atrophy. Int J Womens Health. 2013 Jul 29;5:437–447

16. Hamoda H et al. (2022) BMS Menopause Practice Standards. Available on: https://thebms.org.uk/wp-content/uploads/2022/12/BMS-Menopause-Practice-Standards-DEC2022-A.pdf (Accessed May 2024).

17. NICE (2019). Menopause: diagnosis and management. NG23 . Available from: nice.org.uk/guidance/ng23 [Accessed June 2022]

18. Briggs P. Consensus statement – Urogenital atrophy. Post Reproductive Health. 2022;28(1):47-50. doi:10.1177/20533691211065808

19. D. W. Sturdee and N. Panay, on behalf of the International Menopause Society Writing Group. Recommendations for the management of postmenopausal vaginal atrophy. Climacteric 2010;1–14. Available from: https://www.imsociety.org/wp-content/uploads/2020/08/ims-recommendations-2010-10-english.pdf [Accessed June 2022]

20. Donders GGG, Ruban K, B ellen G, et al. Pharmacotherapy for the treatment of vaginal atrophy. Expert Opin Pharmacother 2019;20(7): 821– 835.

21. Naumova I and Castelo-Branco C. Current treatment options for postmenopausal vaginal atrophy. In J Womens Health 2018;10:387–395.

22. Novo Nordisk. Pharmacy Guide for the Supply of Gina [2022]. https://www.medicines.org.uk/emc/rmm/2509/Document

23. National Health Service (NHS). Womb (uterus) cancer. Symptoms. June 2018. Available from: https://www.nhs.uk/conditions/womb-cancer/ [Accessed August 2022]

24. National Health Service (NHS). Ovarian cancer. Symptoms. Feb 2020. Available from: https://www.nhs.uk/conditions/ovarian-cancer/symptoms/ [Accessed August 2022]

25. Institute for Quality and Efficiency in Health Care. Vaginal yeast infection (thrush): Overview. June 2019. Available from: https://www.ncbi.nlm.nih.gov/books/NBK543220
[Accessed August 2022]

26. Ringel NE, Iglesia C. Common benign chronic vulvar disorders. Am Fam Physician 2020;102(9):550–557.

27. Marnach ML, Torgerson RR. Vulvovaginal issues in mature women. Mayo Clin Proc 2017;92(3):449–454.

All references last accessed June 2024

Further information about this product, including essential supply information, adverse reactions, precautions, contraindications, and method of use can be found at: https://www.medicines.org.uk/emc/product/13930

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