What is the dose for Vagifem (estradiol)?

Vagifem (Estradiol) Dosing Guidelines

The recommended dose for Vagifem (estradiol vaginal tablets) is 10 micrograms administered vaginally once daily for the first 2 weeks, followed by twice weekly maintenance dosing. 1

Dosing Protocol

• Initial treatment: Insert one 10 μg vaginal tablet daily for the first 2 weeks 1, 2
• Maintenance therapy: Insert one 10 μg vaginal tablet twice weekly 1, 3
• Administration should be consistent with the lowest effective dose for the shortest duration needed to control symptoms 4
• Patients should be reevaluated periodically (every 3-6 months) to determine if continued treatment is necessary 4

Clinical Efficacy

• Vagifem 10 μg is effective for treating symptoms of vulvovaginal atrophy including vaginal dryness, irritation, and pain with intercourse 2
• Studies show comparable efficacy between Vagifem tablets and vaginal estrogen creams for treating atrophic vaginitis 2
• Vagifem has been shown to improve maturation of vaginal epithelium from atrophic to proliferative state within 48 weeks of treatment 3

Patient Preference Considerations

• Vagifem tablets are reported as more user-friendly compared to vaginal estrogen creams (90% vs 55% preference) 2
• Vagifem causes significantly fewer hygienic problems compared to vaginal creams (0% vs 23%) 2
• The tablet form may improve treatment adherence due to ease of use 1

Safety Considerations

• For women with an intact uterus, progestin therapy should be considered to reduce the risk of endometrial cancer 4
• Serum estradiol levels with Vagifem 10 μg typically remain within the normal postmenopausal range 3
• Studies show no significant increase in endometrial thickness after 48 weeks of treatment 3
• Patients with undiagnosed persistent or recurring abnormal vaginal bleeding should undergo appropriate diagnostic measures to rule out malignancy 4

Special Populations

• In post-pubertal women with premature ovarian insufficiency, vaginal estradiol can be administered at doses ranging from 0.5 to 1 mg daily 5
• For postmenopausal women after TVT-O anti-incontinence surgery, Vagifem 25 μg daily for 2 weeks followed by twice weekly for 6 months has shown benefits for urgency and frequency symptoms 6

Monitoring

• Patients with an intact uterus should be monitored for signs of endometrial cancer 4
• Appropriate diagnostic measures should be taken in cases of persistent or recurring abnormal vaginal bleeding 4
• Regular follow-up every 3-6 months is recommended to assess continued need for therapy 4