Frequently Used Medications Guide

1. Wash your hands before use.
2. Remove one pessary from its protective packaging.

1. Choose a comfortable position, such as lying down with knees bent, squatting, or standing with legs apart.
2. Insert the pessary gently using an index finger.
3. For vaginal use, place the pessary between the lips of the vagina and push it upwards and backwards into the vaginal passage as far as comfortable.
4. For rectal use, gently push the pessary into the rectum by about 2 to 3 cm.
5. If using rectally, squeeze your buttocks together for a few seconds to help hold it in place.
6. Wash your hands after application.

Dispose of empty packaging in household waste.

• Lying down for 15 to 30 minutes can help absorption and reduce leakage, especially if using vaginally during the day.
• Using the pessary at bedtime may reduce disruption.
• Minor discharge can occur as the pessary dissolves.

1. Remove the cap and use the pointed tip on the cap to pierce the tube seal.
2. If using internally, screw the open end of the reusable plastic applicator onto the tube.
3. Squeeze the tube from the bottom with both hands to fill the applicator barrel up to the red ring mark.
4. The plunger stops automatically at the correct dose (standard dose is 0.5 g of cream, containing 0.5 mg estriol).
5. Unscrew the filled applicator from the tube and replace the cap on the tube.

1. Lie on your back with knees bent and apart, or stand in a comfortable position.
2. Insert the open end of the applicator into the vagina as far as comfortable.
3. Push the plunger slowly and steadily all the way in to empty the cream.
4. Keep the plunger pressed down as you gently remove the applicator.
5. After use, pull the plunger fully out of the barrel and wash both parts in warm, soapy water.
6. Rinse well with clean water and allow to dry.
7. Do not use detergents or boiling water.
8. If advised, the cream can also be applied to the vulva using fingertips.

Dispose of empty tubes and applicators in household waste.

• There are two different strengths of estriol cream in use: 0.1 percent (standard) and 0.01 percent (low dose). Check your prescription and clinic letter.

1. Ensure the skin is clean, dry and free from oils, lotions, creams or powders.
2. Tear open the sachet along the notched edge when you are ready to apply the patch.

1. Bend the patch and peel off half of the protective liner, avoiding touching the sticky side where possible.
2. Place the adhesive side onto a skin area below the waist.
3. Remove the remaining liner.
4. Press firmly with the palm of your hand for around 10 seconds, making sure the edges stick well.
5. Wash your hands after applying.

Fold the used patch in half so the sticky sides stick together, then dispose of it and the packaging in household waste. Do not flush patches down the toilet.

• Evorel Conti patches are usually changed twice weekly on the same days each week.
• If a patch falls off, apply a new patch and then return to your usual schedule.

1. Prime a new container before first use. This only needs to be done once per container.
2. Keep the cover on and hold the container upright.
3. Press the button down fully three times.
4. Mark the three priming sprays on the dose tracker on the carton if helpful.

1. Apply to clean, dry, unbroken skin on the inner thigh or forearm.
2. Avoid the face, breasts and genital area.
3. Remove the plastic cover and hold the container upright.
4. Rest the plastic cone flat against the skin so there are no gaps.
5. Press the button down fully once for a single dose.
6. If prescribed more than one spray, move to an adjacent, non overlapping area for each spray.
7. Allow to dry for at least 2 minutes before dressing. Do not rub or massage it in.
8. Wait at least 60 minutes before bathing, swimming or washing the area.
9. Avoid skin contact with others until the area is dry. Take care to prevent children and pets from touching the application site.

Return finished devices to a pharmacy, as they may contain a small amount of hormone.

• The spray contains alcohol and is flammable until dry. Keep away from open flames, lit cigarettes and hot devices until it has fully dried.
• Lenzetto delivers 56 sprays after priming. Marking the dose tracker can help you keep count.

1. Wash your hands before use.
2. Remove the capsule from the packaging.

1. Take the capsule at bedtime with a glass of water.
2. Take on an empty stomach, ideally 2 hours after eating.
3. Your prescription may be for one capsule every night, or two capsules for 12 to 14 days of your cycle. Follow the instructions on your prescription and clinic letter.
4. If you forget a dose, take it as soon as you remember unless it is nearly time for the next dose. Do not take a double dose.

Dispose of empty packaging and blister packs in household waste. Return unused medication to a pharmacy.

• Some brands contain soybean lecithin. If you have a soya or peanut allergy, check with your pharmacist before taking.
• Progesterone can cause drowsiness. Taking it at night may reduce daytime sleepiness.

1. Tablets are ready to swallow.

1. Take one tablet daily at the same time each day.
2. Follow the arrows on the pack: 24 white active tablets followed by 4 green placebo tablets.
3. Follow your clinic letter if you have been advised to omit the placebo tablets.

Dispose of empty blister packs in household waste. Return unused tablets to a pharmacy.

• Sometimes placebo tablets are included, and sometimes they are omitted. Check your clinic letter for your plan.

1. Wash your hands before use.
2. Remove the capsule from the packaging.

1. Take with a glass of water at bedtime.
2. Take on an empty stomach, ideally 2 hours after food.
3. Your prescription may be one capsule nightly or two capsules for 12 to 14 days of your cycle. Follow your prescription and clinic letter.
4. If you forget a dose, take it as soon as you remember unless it is nearly time for the next dose. Do not take a double dose.
5. Occasionally, your specialist may recommend using the capsule vaginally (off licence). If advised, insert the capsule well into the vagina using your finger. This is often easiest squatting or lying on your back or side.

Dispose of empty packaging and blister packs in household waste. Return unused medication to a pharmacy.

• Utrogestan contains soya. If you have a soya or peanut allergy, check with your pharmacist before use.
• The dose and route may vary. Follow your clinician instructions and ask if you are unsure.
• May cause drowsiness. Night time use may help reduce daytime sleepiness.

1. Wash your hands before use.
2. Remove the applicator device from its sealing foil, opening the plunger end first.
3. Vagifem pessaries come ready loaded in the applicator.
4. For Vagirux, insert the pessary into the applicator:
   1. Gently pull the plunger out until you hear one click, then keep pulling until it stops. Do not pull past a second click.
   2. Take a vaginal tablet from the blister pack and place it firmly into the holder at the wide end of the applicator until it is secure.

1. Choose a comfortable position. You can stand with one leg raised, or lie on your back with knees bent.
2. Insert the applicator gently into the vagina as far as comfortable (around 8 to 10 cm), without force.
3. Press the plunger with your index finger until it stops and you hear or feel a click.
4. Remove the applicator. The tablet sticks to the vaginal wall and should not fall out.
5. If using Vagirux, clean the reusable applicator after use:
   1. Pull the applicator apart into the tube and plunger.
   2. Wash with mild soap and rinse with warm tap water for around 5 seconds.
   3. Shake off excess water and allow both parts to air dry on a clean surface.
   4. Reinsert the plunger into the tube for the next use.

1. Vagifem applicators are single use. Dispose of them in household waste. Do not flush down the toilet.
2. Vagirux applicators can be reused up to 24 times, then should be discarded in household waste or recycled if your local guidance allows. Use a new applicator with each new pack.

• It can take 8 to 12 weeks to feel the full benefit. Continue using as prescribed even if symptoms improve.
• If you miss a dose, use it as soon as you remember. Do not use a double dose to make up for a missed one.