What is Vagifem Used For
Vagifem (estradiol vaginal tablet) is used to treat moderate to severe symptoms of vulvar and vaginal atrophy associated with menopause, including vaginal dryness, itching, burning, and painful intercourse (dyspareunia). 1
Primary Indication
Vagifem is a low-dose vaginal estrogen formulation specifically designed to treat postmenopausal vaginal atrophy symptoms locally with minimal systemic absorption. 2, 3 The FDA-approved ultra-low-dose formulation (10 mcg) provides effective symptom relief while minimizing systemic estrogen exposure. 3
Specific Symptoms Treated
- Vaginal dryness - the most common symptom of vaginal atrophy affecting approximately one-third of postmenopausal women 2
- Dyspareunia (painful intercourse) - significantly improved with vaginal estrogen therapy 2, 4
- Vaginal itching and burning - effectively relieved by local estrogen application 2, 4
- Vaginal inflammation and thinning - reversed through restoration of vaginal epithelium 2
How It Works
Vagifem delivers estradiol directly to vaginal tissues, restoring the vaginal epithelium that has thinned due to decreased estrogen levels during menopause. 2 This local treatment results in relief of symptoms in 80-90% of patients who complete therapy. 2
Dosing Approach
- Initial phase: One tablet daily for the first 2 weeks 1, 4
- Maintenance phase: One tablet twice weekly thereafter 1, 4
- The lowest effective dose should be used for the shortest duration consistent with treatment goals 1
Comparison to Other Formulations
Vagifem tablets are as effective as vaginal estrogen creams but offer superior user-friendliness and fewer hygienic problems (0% versus 23% with creams). 4 Ninety percent of patients reported Vagifem as easier to use compared to 55% with estrogen cream. 4
When Topical Vaginal Products Are Preferred
When prescribing solely for the treatment of symptoms of vulvar and vaginal atrophy, topical vaginal products like Vagifem should be considered over systemic estrogen therapy. 1 This is because vaginal estrogen provides targeted relief with minimal systemic absorption and avoids the risks associated with systemic hormone therapy. 2, 3
Important Contraindications
- History of hormone-dependent cancers (requires special consideration) 2
- Undiagnosed abnormal vaginal bleeding 2
- Active or recent pregnancy 2
- Active liver disease 2
Special Caution for Breast Cancer Patients on Aromatase Inhibitors
Vagifem is contraindicated in women taking aromatase inhibitors for breast cancer. 5 Vaginal estradiol tablets significantly raise systemic estradiol levels within 2 weeks (from ≤5 pmol/L to mean 72 pmol/L), which reverses the estradiol suppression achieved by aromatase inhibitors and may reduce their efficacy. 5 For these patients, non-hormonal options (moisturizers, lubricants) or vaginal DHEA should be tried first. 2, 6
Treatment Algorithm Position
Vagifem is positioned as second-line therapy after non-hormonal options (vaginal moisturizers and water-based lubricants) have been tried for 4-6 weeks without adequate symptom relief. 2, 6 However, for severe symptoms at presentation, escalation to vaginal estrogen like Vagifem can be considered earlier. 2