Considerations for long-term or repeated use of Gina
Considerations for long-term
or repeated use of Gina
For initiation and continuation of treatment of postmenopausal symptoms, the lowest effective dose for the shortest duration should be used. Continued suitability of treatment with Gina should be verified at each supply.
Some risks associated with systemic HRT are likely to be lower for local vaginal oestrogens, such as Gina - this is because comparably, there is only a minor degree of systemic absorption. However, these risks should be considered where there is long-term or repeated use of Gina.1
Women with any of the conditions below can be supplied Gina, but should also be advised to let their GP know that they are using it, and to seek advice if their condition is aggravated or recurs while using Gina.1
- Hereditary and acquired angioedema
- Uterine fibroids (leiomyoma)
- Hypertension
- Liver disorders (e.g. liver adenoma)
- Diabetes
- Gallstones
- Migraine or (severe) headache
- Systemic lupus erythematosus (lupus)
- Epilepsy
- Asthma
- Otosclerosis (a disease affecting the eardrum and hearing)
Women who are at increased risk of developing blood clots (e.g. older age, major surgery, prolonged immobilisation, obesity with BMI greater than 30kg/m2, and cancer) and those at increased risk of developing endometrial, ovarian or breast cancer (e.g. having a first degree relative who has had any of these cancers) should let their GP know that they are using Gina.
Medical and family history
Before starting or reinstating Gina, a medical history should be taken to check suitability. The health of immediate family members should be checked before treatment initiation and at resupply of Gina – i.e. no new cases of breast or ovarian cancer, deep vein thrombosis (DVT) or pulmonary embolism in a close relative (parent, sibling or child). Women with an immediate relative diagnosed with an oestrogen-dependent malignant tumour (e.g. breast cancer, ovarian cancer) or venous thromboembolism have an increased risk of developing these conditions. As HRT may add to this risk, they should be referred to their GP.1