The news that the first HRT product will be manufactured available over the counter It comes as the government prepares to launch its Women’s Health Strategy this spring.
The women’s health overhaul has been a long time coming: It follows a series of women’s health care scandals over several decades, including vaginal mesh and epilepsy drugs that harmed unborn babies, and the bare find in Sir Michael Marmot’s 2020 review, life expectancy for women in the poorest parts of the UK has fallen for the first time in 100 years. Some wondered if the latest exercise was a symbolic gesture.
The decision is a promising indication that it will be more than that. Making vaginal estrogen tablets, a product called Gina, available without a prescription is non-controversial and a good place to start.
The drug is used to treat vaginal dryness, a symptom estimated to affect up to 80% of menopausal women and which can cause irritation and pain during intercourse. The drug can also reduce the risk of urinary tract infections, which affect some women more often during menopause and often require antibiotic treatment. And because it only has a small dose of locally acting hormones, it carries none of the risks of globally acting HRT, such as breast cancer and blood clots, so it’s safe to take indefinitely.
“Nobody talks about vaginal dryness,” said Paula Briggs, a sexual and reproductive health consultant at Liverpool Women’s Hospital, who welcomed the possibility of the HRT product being distributed without a prescription. “Women accept it as part of aging and it doesn’t have to be that way. This is an area where we could greatly improve the quality of life.”
A public consultation, prior to the launch of a Women’s Health Strategy, found that for women aged 40-59, menopause was the most common health priority. There are suggestions the government is prepared to take action in other areas, with an announcement this week that it plans ban virginity tests and hymen repair surgery, which is offered at some private clinics.
There are other relatively simple steps that could be taken, such as doing provision of abortion pills at home – an emergency measure introduced during the pandemic – a permanent fix. The modified rules will expire on March 30.
However, deeper changes in health provision will also be required to more fully address the wide range of health inequalities women face.
The 2020 Cumberlege investigation identified a culture among medical professionals in which serious medical concerns have been dismissed as “women’s problems” as the basis for some of the failures in women’s health provision.
Others have highlighted systemic problems that mean opportunities to improve women’s health are routinely missed. For example, women who experience preeclampsia during pregnancy are at much higher risk of future heart disease, but are not always offered interventions aimed at improving long-term cardiovascular health.
There is also the fractured commissioning, meaning, for example, that a woman who needs a hormonal coil to treat menopausal symptoms cannot be treated in a sexual health clinic. Some areas of women’s health, such as endometriosis treatment, have been severely affected by delays created during the pandemic. And there are significant disparities in experiences and outcomes among women, depending on where they live, ethnicity, education, and wealth.
Tackling these problems is a much more ambitious task, but, according to experts, it is the motivation to have an overarching strategy rather than making a handful of one-off policy changes. Dr Edward Morris, president of the Royal College of Obstetricians and Gynaecologists, said: “It’s not about getting it right for those who know where it is, it’s about getting it right for everyone.”
