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You may have heard of Vagifem in the context of treatment for symptoms of menopause. It is a vaginal tablet containing estradiol (a form of oestrogen) that can help to relieve vaginal irritation or dryness associated with menopause. The moisturising effect not only reduces vaginal discomfort but also helps to support vaginal health generally. The benefit to Vagifem being a vaginal tablet means it can target and act on the area directly, rather than systemically (on the whole body) like traditional hormone replacement therapy. If you are experiencing similar symptoms of vaginal dryness, vaginal irritation or vaginal atrophy then Vagifem may be suitable for you.
*Product images are for illustrative purposes only, and you may receive a different licensed alternative.
Price range: £35.95 through £75.95
Vagifem vaginal tablets are from the drug class known as Hormone Replacement Therapy (HRT). It is normally used to alleviate menopausal symptoms part of the genitourinary syndrome of menopause (GSM).
GSM tends to cause issues such as vaginal dryness, irritation inside the vagina and also around the external genital region also known as ‘vaginal atrophy’. It may also cause extreme burning and stinging. Women with GSM symptoms tend to also report higher incidences of urinary tract infections (UTI) which can also become chronic and cause a lot of discomfort and unease on a daily basis.
GSM normally occurs due to a drop in the endogenous oestrogen hormone which tends to occur with aging and is very common after menopause. Women undergoing perimenopause can also experience GSM. Oestrogen is normally produced in female ovaries.
Vagifem therefore works by replenishing the body with exogenous oestrogen in the form of estradiol 10 micrograms. As the medication is dispensed internally using an application, the hormone is released only where needed inside the vagina. This helps to relieve the symptoms caused by GSM.
Oestrogen is an endogenous hormone synthesied by the ovaries and is important because it helps to maintain the elasticity and thickness of the epithelium. It also helps to lubricate and improve blood flow in the local regions around the vagina. Most importantly, it helps to maintain the pH balance within the vaginal walls which improves the vaginal microbiome and prevents infections such as UTIs.
However, during and after menopause, oestrogen levels deplete which causes the vaginal layer to lose its elasticity and become thinner and fragile. This also causes the region to become more dry, prone to irritation which can be extremely painful and uncomfortable for the female and can also lead to chronic urinary tract infections (UTI).
Vagifem vaginal tablets work by increasing the levels of low oestrogen in the body. Therefore when the Vagifem applicator is inserted into the vagina, it dispenses a vaginal tablet consisting of estradiol 10 micrograms which is released within the walls of the vagina and acts directly on the vaginal and urethral tissues.
Studies show women who used Vagifem (estradiol) vaginal tablets over the course of weeks to months showed significant improvement in lubrication, had a lower vaginal pH and reported fewer GSM symptoms with improved outcomes occurring within just 2-8 weeks and most improving fully within 12 weeks.
Vagifem can be used by women experiencing menopausal symptoms such as the previously described genitourinary syndrome of menopause (GSM). GSM causes mild to severe forms of vaginal atrophy which can be painful and cause discomfort on a daily basis and hence Vagifem can be used to provide relief from these symptoms by providing moisture and vaginal lubrication alongside other benefits.
However, Vagifem is not recommended in women with unexplained vaginal bleeding, liver disease, a history of oestrogen sensitive cancers, breast cancer and others. We advise you to read the article further and familiarise yourself with the warnings and precautions related to Vagifem before starting treatment.
Vagifem is not a contraceptive medication therefore if you have had a period in less than 12 months, it is recommended to speak to your doctor and use an additional contraceptive method in order to prevent any unwanted pregnancies.
Vagifem 10 micrograms vaginal tablets contain estradiol hemihydrate which is equivalent to estradiol 10 micrograms. It also contains the following ingredients: hypromellose, lactose monohydrate, maize starch and magnesium stearate. The film coating on the tablet is made of hypromellose and macrogol 6000.
These are white, film coated tablets with a diameter of 6mm which are biconvex in shape and have a marking of NOVO 278 on one side. Each tablet comes with an applicator which is a single use applicator and should be discarded after use.
Vagifem comes in 2 pack sizes:
At the start of your treatment, your doctor will prescribe you the lowest dose of Vagifem to ensure treatment time is kept short. However, if the medication is not working for you because it is not strong enough or conversely the medication is too strong, then let your doctor know to reevaluate the treatment plan and start you on the correct dose to ensure treatment is effective.
How many tablets should I use for the treatment?
What if I use more vagifem than I should have?
What if I forget to take my medication?
What if I stop using Vagifem?
What If I have an upcoming surgery soon?
Only use this medication under the supervision of a qualified health care professional. Treatment with Vagifem can be started as advised by your doctor or on whatever day suits you best.
The following instructions outline how to use Vagifem tablets:
The following table outlines the side effects which may occur when taking Vagifem and these range from common to potentially rare but serious side effects:
How common? | What are the side effects? | What are the next steps? |
Common |
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Uncommon |
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Not known |
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Rare |
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The following table lists a series of safety information which includes warnings and precautions about using Vagifem:
Do not use Vagifem if the following applies to you. | Warnings and precautions if you suffer from any of the following conditions
| Stop using Vagifem immediately and refer to a doctor if the following apply to you. |
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The following table outlines certain conditions which are at an increased risk of developing during HRT treatment and should be considered before starting HRT treatment or during HRT treatment:
Condition | Description |
Breast cancer |
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Ovarian Cancer |
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Endometrial hyperplasia (excessive thickening of the womb lining)/endometrial cancer |
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Blood clots in veins (thrombosis) |
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Heart disease |
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Stroke |
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Other conditions |
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NHS prescriptions are currently free of charge in Scotland, Wales and Northern Ireland. In the UK, Vagifem is currently prescribed as a prescription only medication (POM). You can order Vagifem online using an NHS prescription which is charged using the standard prescription charge rate of £9.90 per item. However, if any of the NHS exemptions apply to you then you do not have to pay the NHS charge.
If however, you are not exempt from paying the NHS charge, you can purchase a Prescription Prepayment Certificate (PPC) which allows you to purchase a 3 month (£32.05) or a 12 month (£114.50) certificate at a set price which works out cheaper if you need to purchase prescription-only medications often.
You can also buy Vagifem online UK using a private prescription although the prices are determined by each individual pharmacy and do not follow the normal NHS charge guidelines.
In the event of a shortage of Vagifem, some pharmacies may supply generic estradiol 10 micrograms vaginal tablets instead of the branded version; however, they are both the same medication. The NHS charge for estradiol vaginal tablets both generic and the branded version is the same.
Vagifem can be purchased online, however, the pharmacy online has to be a registered UK online pharmacy who are only able to dispense this medication after a clinical assessment. Therefore, online pharmacies such as Superdrug, and others can prescribe and dispense Vagifem after a thorough clinical assessment.
Vagifem vaginal tablets are a prescription only medication (POM) therefore can only be prescribed by a doctor, and dispensed by a UK registered pharmacist. It can also be purchased via a private prescription although private prescription charges are determined by each individual pharmacy and do not follow the NHS charge guidelines.
Vagifem is a medication often prescribed to manage vaginal symptoms of menopause such as dryness and irritation. Estradiol pessaries like Vagifem come in tablet form and are designed to be placed in the vagina to exert its relieving effects directly to the area affected. If you are familiar with hormone replacement therapy (HRT), Vagifem works similarly as it also uses hormones. Vagifem contains Estradiol Hemihydrate (containing the active ingredient estradiol) which means oestrogen is delivered directly to the vaginal area unlike traditional HRT which works systemically (through being absorbed in the bloodstream). Thus, if you need more targeted relief, medication like Vagifem that works locally may be more suitable for you.
While there are some ‘classic’ symptoms of menopause, it is important to be aware that many people can experience it differently. Also, some people notice symptoms months or even years before periods stop completely so if any of these symptoms start to affect your daily life, it is advised that you seek medical advice. Here is a general overview of some common symptoms of menopause.
Symptom | Description
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Irregular periods | You may notice your periods becoming irregular before they completely stop. This could be in the amount of flow or the length of the menstrual cycle. |
Night sweats | This refers to intense sweating when you sleep. It often disturbs sleep quality, falling asleep, or staying asleep which can have other uncomfortable effects. |
Hot flushes | People going through menopause often report suddenly feeling uncomfortably hot. This is often in the chest, the face, or the neck. |
Mood swings, brain fog, and libido changes | For example, this is when you might suddenly go from feeling very anxious to very low in mood. Some people also note problems with remembering things or finding concentration more difficult. You may also notice a reduced sex drive. |
Palpitations | You might notice changes to your heartbeat like a racing or irregular heartbeat. |
Muscle, skin, and body changes | Some other commonly reported symptoms are aches or stiffness in the muscles and joints. Itchy or dry skin may also occur. You may also notice some changes in body shape or weight gain. |
If you relate to these symptoms, although they are associated with menopause, it is still best to consult a medical professional about them as many of the symptoms listed can also overlap with other conditions.
So the ovaries start to produce less and less oestrogen during menopause. Oestrogen is a key hormone supporting good blood flow, moisture, and elasticity of tissues in the vagina. Thus with the decreased levels of oestrogen in menopause, the vagina becomes drier, thinner, and more fragile which results in the commonly reported symptoms of irritation and vaginal discomfort. The key ingredient in Vagifem that helps relieve vaginal symptoms of menopause is estradiol (form of oestrogen).
By increasing the levels of oestrogen, this improves moisture to the tissues of the vagina and relieves symptoms. The fact that Vagifem is an Estradiol pessary means it is administered as a tablet directly to the vagina to target the affected area, and there is a lower risk of systemic side effects.
The medication may take almost 3 months for full symptom relief. If you have been using Vagifem and feel like it has not been effective or you have concerns about the medication, please seek medical advice.
Typically, when using Vagifem 10 micrograms you may need to wait up to 3 months for symptoms of vaginal irritation or dryness to fully be relieved. This is a similar timeframe to other oestrogen treatments for the vagina. If you have not noticed any benefits after 3 months, you should inform your doctor who can reassess the situation and explore other treatment options such as vaginal moisturisers or prasterone pessaries.
Vagifem may be a bit strange to use at first if you are not used to using an applicator, however, once you get used to it, it is much easier. Typically the dosage is initially one Vagifem tablet every day for two weeks and then after that one tablet two times a week. Here is a step-by-step guide of how to use Vagifem:
The exact timeframe it takes for Vagifem tablets to dissolve after being inserted into the vagina is varied but usually it is around several hours or up to one day. This is because the medication is designed to release estradiol slowly over time to stick to the walls of the vagina and help relieve symptoms of irritation and dryness.
If you are considering using Vagifem UK it is important that you are well informed about the benefits but also the potential risks associated with taking this medication. Here is a table comparing some pros and cons of Vagifem to help guide you to an informed decision:
Pros | Cons
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– Effective: It is effective at treating vaginal dryness and irritation – Targeted: Vagifem is a localised treatment as it is delivered directly to the vagina. – Less systemic risks: as mentioned in the previous point, Vagifem is a local treatment which unlike traditional HRT is less likely to get taken up in the blood. Thus there is a lower risk of breast cancer or blood clots. | – Side effects: Some people experience abdominal pain, headaches, or vaginal bleeding when using Vagifem. – Does not treat all symptoms: The targeted effect may also be a con as Vagifem does not help with other common symptoms of menopause such as mood swings or hot flushes. – Long-term use: Symptoms may come back if you stop using Vagifem so long-term use may be needed. Long-term use of oestrogen therapy is still associated with a risk of blood clots and breast cancer (although the chances are lower than traditional HRT). |
Like all medication, there are some common and serious side effects associated with Vagifem use. If you have any concerns about the medication, please consult a medical professional for further assessment.
If you notice any of these serious symptoms, make sure you seek medical attention urgently.
Patients can start to feel the effects from this treatment within 2-4 weeks with full effect occurring by 12 weeks in order to improve vaginal dryness. If you feel no difference in your symptoms, speak to your doctor as soon as possible who will discuss an alternative treatment.
Yes, Vagifem can be used alongside systemic HRT tablets when the treatment is not enough on its own to relieve symptoms and hence provide relief from GSM related symptoms.
Vagifem uses an applicator form which dispenses a 10microgram estradiol tablet into the vagina where estriol (Ovestin) is an internal cream. Both work to provide symptoms from GSM but work using different medications in different strengths.
Vagifem works to relieve symptoms of dryness and irritation and promotes lubrication which in turn can help increase libido and intimacy due to relief of symptoms.
Yes it is normal to experience mild irritation such as vaginal irritation however, if symptoms persist, speak to your doctor for more advice.
It is best advised to speak with your doctor before starting treatment with Vagifem after any such procedures as the area may still need to heal and the treatment may be too invasive.
It is advised to use the treatment as directed by your doctor or relevant healthcare advisor.