How to Use Vagifem (Estradiol Vaginal Tablets)
Vagifem (estradiol vaginal tablets) should be inserted high into the vagina using the provided applicator, with an initial dose of one tablet daily for two weeks, followed by a maintenance dose of one tablet twice weekly. 1
Proper Administration Technique
- Insert one vaginal tablet high into the vagina using the provided applicator, preferably at the same time each day during initial therapy 1
- For initial treatment of vaginal atrophy symptoms, use one tablet daily for the first 2 weeks 1, 2
- After the initial treatment period, reduce to a maintenance dosage of one tablet twice weekly (for example, Tuesday and Friday) 2
- The tablet dissolves in the vagina, so no removal is necessary 3
Efficacy and Benefits
- Vagifem effectively relieves symptoms of vaginal atrophy including dryness, soreness, irritation, and dyspareunia 1
- The 10 mcg formulation provides effective symptom relief while minimizing systemic absorption 4, 2
- Vagifem demonstrates a localized effect without appreciable systemic estradiol increases, making it preferable to vaginal creams which may cause more systemic absorption 1
- Patient satisfaction and compliance rates are higher with vaginal tablets compared to vaginal creams 1, 3
Special Considerations
- For women with an intact uterus, progestin therapy is generally recommended with systemic estrogen therapy, but may not be necessary with low-dose vaginal estradiol due to minimal systemic absorption 5, 2
- Endometrial safety studies of the 10 mcg formulation showed no cases of endometrial hyperplasia or cancer after 12 months of use 2
- Women using aromatase inhibitors for breast cancer treatment should exercise caution as vaginal estradiol may increase circulating estradiol levels within 2 weeks of use 6
- For breast cancer survivors, consider non-hormonal vaginal lubricants like Replens or Sylk first before using vaginal estrogen products 6
Monitoring and Follow-up
- Patients should be reevaluated periodically (every 3-6 months) to determine if treatment is still necessary 5
- Monitor for signs of endometrial stimulation in women with an intact uterus, though risk is minimal with low-dose vaginal formulations 5, 2
- Discontinue use and contact healthcare provider if experiencing unusual vaginal bleeding 5
- The lowest effective dose should be used for the shortest duration consistent with treatment goals 5
Potential Side Effects
- Side effects are generally minimal due to the low dose and localized application 4, 2
- Unlike vaginal creams, Vagifem tablets cause minimal leakage (reported by only 6% of users) and typically don't require sanitary protection 3
- Endometrial thickness typically does not increase significantly with the 10 mcg formulation 2
- The risk of systemic effects is lower compared to vaginal creams or systemic estrogen therapy 1