Related guidance: 

Local Estrogen for information local estrogen choices and information on urogenital symptoms

Menopause and Hormone Replacement Therapy for information on menopause symptom management and prescribing guidance.

Reproductive Health for information on reproductive health and information on sexual health

Medicines in pregnancy, children and lactation for information on prescribing in pregnancy and lactation, including breastfeeding and menopause

Somerset Infection Management – Management & treatment of common infections in primary care for information on recurrent UTIs and other infections including vaginal candidiasis

Chapter 6.8.1 – Female sex hormone responsive conditions for information on formulary HRT options

Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
Vaginal and vulval fungal infections, and localised conditions
Suitable for self-care

Green cross
For patients between 16 years and 60 years:
Suitable for self-care over the counter, including treatment of the partner. See the Self Care page for licenced indications and exclusions for OTC treatment

For patients under 16 years, or over 60 years of age or excluded from self-care:
See the: Antimicrobial page to access the latest Management & Treatment of Common Infections Guidance for Primary Care document.
Recurrent UTI post-menopauseLocal estrogen may be considered in line with Somerset infection guidance if clinically suitable, for Somerset detailed information on how to manage recurrent UTI see the: Antimicrobial page to access the latest Management & Treatment of Common Infections Guidance for Primary Care document.
Lichen SclerosusSee the Dermatology page for more information on Lichen Sclerosus
Vaginal atrophy
See the Local Estrogen page for detailed information on local estrogen choices and information on urogenital symptoms.

Some preparations may damage barrier contraception including condoms or diaphragms. People should be aware of this and supported on effective contraception and safer sex including the importance of using appropriate lubricants which can be purchased over the counter as self-care.

Manufacturers advise to use the lowest effective dose for the shortest period of time with frequent reviews to inform ongoing need, bear in mind symptom control and clinical need when reviewing, NICE NG23 recognises that local estrogen can be used for as long as it is needed to control symptoms.
Local Estrogen
See individual summary of product characteristics for full posology and method of administration
10mcg pessaries (as generic)10mcg vaginal tablet: £8.31 (24)Generic most cost-effective

Insert ONE vaginal tablet daily for two weeks, then twice a week.
as Vagirux®

10mcg vaginal tablet: £11.34 (24)Insert 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 generic1mg/g vaginal cream: £4.45 (15g)(Previously listed as Ovestin 0.1%, now discontinued, generic available)

Use ONE application per day up to a maximum of 4 weeks, followed by a gradual reduction, based on relief of symptoms, until a maintenance dosage is reached (e.g. ONE application twice a week).

0.5mg per dose
as Imvaggis®30mcg pessaries: £13.38 (24)During the first 3 weeks of treatment one pessary is administered daily. Thereafter a maintenance dose of 1 pessary twice a week is recommended.

No applicator.

0.03mg per dose
as Blissel®50mcg vaginal gel: £18.90 (30g)Initial treatment recommends ONE applicator-dose of vaginal gel per day for 3 weeks (use at bedtime), maintenance treatment recommended as ONE applicator-dose of vaginal gel twice a week at bedtime.

One applicator dose contains 1g of gel.

0.05mg per dose.
as generic estriol0.01% vaginal cream: £27.07 (80g)The recommended initial daily dose is one applicator full per day.

A maintenance dose of one applicator full twice a week may be used after restoration of the vaginal mucosa has been achieved.

The applicator holds 5ml of cream containing 0.5mg estriol.

0.5mg per dose.
as Estring®7.5mcg/ 24hours vaginal ring: £31.42 (1 vaginal delivery system)One ring to be inserted into the upper third of the vagina. Once inserted it is left in the vagina continuously for 90 days and replaced by a new ring as appropriate.

7.5 micrograms/ day for 90 days
Selective oestrogen receptor modulators
Ospemifene as Senshio®60mg tablet: £39.50For 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.