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

cream as Ovestin®

pessaries as Vagirux® (1st line)

pessaries as Vagifem® (2nd line)

0.1% cream £4.45 (15g)


10mcg pessaries £11.34 (24)


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.

Vagirux is a cost effective alternative to Vagifem - Approved at October 2020 PAMM

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 guide
Second line:Green crossClotrimazole (intra vaginal and/or topical)500mg pessary: £5.16 (1)
2% cream / 500mg pessary combi-pack: £5.21 (1)
1% Cream: £1.15 (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 guide