Related guidance:
Intravaginal oestrogen (NICE CKS updated October 2019)
| Therapeutic Area | Formulary Choices | Cost for 28 (unless otherwise stated) | Rationale for decision / comments |
|---|---|---|---|
| Vaginal and vulval fungal infections | |||
| Antifungal (Imidazole) |  Fluconazole - suitable for self-care | 150mg oral capsule: £0.72 (1) | Fluconazole is recommended as first line for vaginal candidiasis due to ease of use and cost effectiveness. 150mg single oral dose. Not licensed for under 16 years or over 60 years if bought over the counter. |
| Antifungal (Triazole) | Clotrimazole - suitable for self-care | 500mg pessary: £5.60 (1) | Clotrimazole pessaries are second line for the treatment of candidal vaginitis due to higher cost. One 500mg pessary should be inserted at night. Not licensed under 16 years or over 60 years if bought over the counter. |
| 2% topical cream / 500mg pessary combi-pack: £5.73 (1) | |||
| 1% topical cream: £1.24 (20g) | For the treatment of candidal vaginitis and treatment of the sexual partner's penis. The cream should be applied thinly 2-3 times daily and rubbed in gently. Treatment should be continued for at least two weeks for candidal infections. |
||
| Vaginal atrophy | |||
| Oestrogens | |||
| Estradiol | as Vagirux® | 10mcg vaginal tablet: £11.34 (24) | First line for treatment of vaginal atrophy due to oestrogen deficiency in postmenopausal women as per Traffic light guidance. Vagirux may be used in women with or without an intact uterus.The experience treating women older than 65 years is limited. (PAMM Oct 2020) One vaginal tablet daily for two weeks, then twice a week. Presented with multiple use applicator therefore reduced carbon foot print when compared to alternatives.  |
| as Vagifem® | 10mcg vaginal tablet: £16.72 (24) | Second line for treatment of vaginal atrophy due to oestrogen deficiency in postmenopausal women. One vaginal tablet daily for two weeks, then twice a week. |
|
| Estriol | as Ovestin® | 0.1% vaginal cream: £4.45 (15g) | For treatment of atrophic vaginitis, 1 application per day for the first weeks (maximally 4 weeks), followed by a gradual reduction, based on relief of symptoms, until a maintenance dosage (e.g. 1 application twice a week) is reached. A cream containing an oestrogen may be applied on a short-term basis to improve the vaginal epithelium in menopausal atrophic vaginitis. It is important to bear in mind that topical oestrogens should be used in the smallest effective amount to minimise systemic effects. The risk of endometrial hyperplasia and carcinoma is increased when systemic oestrogens are administered alone for prolonged periods. The endometrial safety of long-term or repeated use of topical vaginal oestrogens is uncertain; treatment should be reviewed at least annually, with special consideration given to symptoms of endometrial hyperplasia and carcinoma. |
| Selective oestrogen receptor modulators | |||
| Ospemifene | as Senshio® | 60mg tablet: £39.50 | For treating moderate to severe symptomatic vulvar and vaginal atrophy in postmenopausal women who are not candidates for local vaginal oestrogen therapy as per traffic light guidance when on the recommendation of specialist use (SPF Sept 22). One 60 mg tablet once daily with food taken at the same time each day. |