From the Guidelines
The recommended dosing for Vagifem (estradiol) for treating dyspareunia due to menopause is 10 mcg inserted vaginally once daily for two weeks, followed by a maintenance dose of 10 mcg twice weekly. This dosing regimen is based on the most recent and highest quality evidence available, which prioritizes minimizing systemic absorption while effectively targeting vaginal tissues to restore vaginal tissue thickness, elasticity, and lubrication that diminish during menopause due to decreased estrogen levels 1. Key points to consider in the treatment of dyspareunia with Vagifem include:
- Initiating treatment at the lowest effective dose and for the shortest duration consistent with treatment goals
- Using a vaginal tablet with an applicator for insertion to minimize systemic absorption
- Expecting symptom relief within 2-3 weeks, with full benefits potentially taking 4-6 weeks
- Reevaluating patients periodically, typically at 3-6 month intervals, to determine if treatment is still necessary
- Considering alternative treatments or dosage adjustments if dyspareunia persists despite treatment, as suggested by recent guidelines 1. It's also important to note that while Vagifem is effective for treating vaginal dryness and dyspareunia, other options such as ospemifene, an FDA-approved selective estrogen receptor modulator (SERM), may also be considered for survivors without a history of estrogen-dependent cancers 1.
From the Research
Vagifem Dosing for Dyspareunia due to Menopause
- The recommended dosing for Vagifem (estradiol) for treating dyspareunia due to menopause is 10 μg inserted vaginally once daily for 2 weeks, followed by 1 insertion twice weekly [(2,3,4)].
- Studies have shown that Vagifem is effective in improving dyspareunia, vaginal cytology, and vaginal pH, with minimal systemic absorption of estradiol [(2,3,4)].
- A lower dose of 4 μg has also been shown to be effective in treating moderate to severe dyspareunia due to menopausal vulvar and vaginal atrophy (VVA) 2.
- Another study found that a lower-dose estradiol vaginal cream (0.003%) was effective in treating VVA-related dyspareunia, with dosing of 15 μg estradiol (0.5 g cream) applied daily for 2 weeks, followed by three applications/week for 10 weeks 5.
Efficacy and Safety
- Vagifem has been shown to be well-tolerated, with no clinically significant differences in treatment-emergent or serious adverse events compared to placebo 2.
- The use of low-dose vaginal estrogens, such as Vagifem, has been shown to be effective in treating symptoms of vaginal atrophy without causing significant proliferation of the endometrial lining 6.
- Vulvovaginal mycotic infections were more frequent with estradiol vaginal cream (0.003%) compared to placebo 5.