Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
BNF Chapter 7: Obstetrics, gynaecology, and urinary-tract disorders
7.2 Treatment of vaginal and vulval conditions
Preparations for vaginal atrophyEstradiol

as Ovestin®

as Vagifem®


0.1% cream £4.45 (15g)

10mcg pessaries £16.72 (24)
Topical oestrogens should be used in the lowest effective amount to minimize systemic absorption. Patients should be reviewed at least annually to re-assess the need for continued treatment and to monitor for symptoms of endometrial hyperplasia or carcinoma in women with a uterus.
Patients should have the opportunity to choose a product suited to them although there is no evidence of difference in effect.
Long term treatment may be required as symptoms can recur on cessation of therapy
Vagifem 25mcg pessaries were discontinued February 2013
Vaginal and vulval infections
Fungal infections:
First line:Green crossFluconazole (oral)150mg capsule: £0.83 (1)Fluconazole is recommended as first line due to ease of use and cost-effectiveness. Recommend as self care as available to buy inexpensively from pharmacies.Not licensed under 16 years or if bought OTC over 60 years.
Self care leaflet
Second line:Green crossClotrimazole (intra vaginal and/or topical)500mg pessary: £2.93 (1)
2% cream / 500mg pessary combi-pack: £5.21 (1)
1% Cream: £1.06 (20g)
Clotrimazole pessaries are second line due to higher cost.
NB: Recommend for self care as available OTC, often at cost lower than the NHS prescription charge.Not licensed under 16 years or if bought OTC over 60 years.
Self care leaflet