7.2. Treatment of vaginal and vulval conditions
7.2.1. Preparations for vaginal and vulval changes
Prescribing Notes:
The estriol concentration of estriol intravaginal cream is 0.01%. This preparation contains arachis (peanut) oil and is not suitable for patient with peanut allergy. This preparation also damages latex condoms.
Restrictions:
Treatment of moderate to severe symptomatic vulvar and vaginal atrophy (VVA) in post-menopausal women who are not candidates for local vaginal oestrogen therapy is restricted to initiation by, or on advice of, a specialist.
7.2.2. Vaginal and vulval infections
Restrictions:
The treatment of bacterial vaginosis is restricted to use in patients for whom the initial treatment is not effective or well tolerated.
Restrictions:
Metronidazole gel is restricted to patients unable to tolerate or comply with oral metronidazole therapy.
Prescribing Notes:
Strength: 0.75%
7.2.3. Preparations for uterine fibroids and endometriosis
Restrictions:
Restricted to specialist initiation for the treatment of moderate to severe symptoms of uterine fibroids in adult women of reproductive age when conventional first-line treatments (such as tranexamic acid, hormonal contraceptives and intrauterine devices) have failed or are considered unsuitable.
Prescribing Notes:
A DEXA scan is required prior to initiating in patients considered at risk of osteoporosis and in all patients after 1 year of use. Scan will be organised and results reviewed by the specialists.
Restrictions:
Restricted to specialist initiation according to GGC protocols:
- for treatment of moderate to severe symptoms of uterine fibroids in adult women of reproductive age who have failed or are unsuitable for conventional therapies (first line treatments), such as tranexamic acid, hormonal contraceptives and intrauterine delivery systems.
- for symptomatic treatment of endometriosis in adult women of reproductive age with a history of previous medical or surgical treatment for their endometriosis.
Restrictions:
The treatment of moderate to severe symptoms of uterine fibroids in adult women is restricted to the following MHRA advice:
- intermittent treatment of moderate to severe symptoms of uterine fibroids in women of reproductive age who are not eligible for surgery or where surgery has failed
- treatment is to be initiated and supervised by a physician experienced in the diagnosis and treatment of uterine fibroids
Please refer to MHRA information prior to initiation.