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module menu icon Differential diagnosis

Differential diagnosis

During a consultation, a woman may reveal symptoms that are not typical of VA. In these cases, local oestrogen therapy will not improve these conditions.

It is important for pharmacists to act accordingly in response to symptoms that warrant referral to a GP. The table below provides examples of a possible differential diagnosis depending on symptom presentation:

Presenting symptoms Possible differential diagnosis22
Vaginal or genital bleeding or spotting Endometrial cancer or endometrial hyperplasia23
  • These conditions are oestrogen-sensitive
Pain, bloating, or swelling in the lower abdomen or pelvis Ovarian cancer24
  • Ovarian cancer is oestrogen-dependent
Smelly or unusual vaginal discharge Vaginal infection25
  • Any vaginal infection must be treated before using vaginal oestrogen to ensure concomitant conditions are excluded
Changes to look/feel of vulval area e.g. thickening or a lump; raised and/or sore patches of red or dark skin; shrinking or scarring

Severe vaginal itching(interferes with sleep or daily living activities), itchy patches, vulval rash
Vulval dermatoses26,27
  • Vaginal oestrogen will not alleviate symptoms, but could delay medical assessment and treatment, and this itching may be confused with VA. Vulval dermatoses can be a precursor to vulval cancer

For a full list of symptoms and differential diagnoses, refer to the Pharmacy Guide for the Supply of Gina.