Vagifem is a type of hormone replacement therapy (HRT) used to treat symptoms of menopause that are local to the vaginal area, such as vaginal dryness, inflammation or itching, discomfort or pain during sex, vaginal tightness, spotting, irritation, and recurrent urinary tract infection (UTI).
Vagifem contains estradiol, a bioidentical form of estrogen produced naturally by the ovaries. As women approach menopause, the amount of oestrogen produced by the ovaries begins to decrease, leading to symptoms such as hot flushes and night sweats, mood swings, irregular periods and vaginal problems. The estradiol in Vagifem works locally, supplementing oestrogen levels in the vaginal region to reduce the impact of dryness, irritation, inflammation and tightness, discomfort or pain during sex, spotting, and recurrent UTI.
The active ingredient in Vagifem is estradiol hemihydrate (10 micrograms).
The inactive ingredients in Vagifem are hypromellose, lactose monohydrate, maize starch, magnesium stearate and macrogol 6000.
A doctor will prescribe the lowest dosage of Vagifem possible for your symptoms, and may chose to alter your dose at a later point. The usual dose is 1 tablet each day for the first 2 weeks, and then 1 tablet twice weekly.
Always use Vagifem as instructed by a doctor. Being using treatment on any day that is convenient for you. The tablet is inserted into the vagina where it sticks to the vaginal wall, and so can be inserted at any time of the day. Wash your hands thoroughly and tear off one of the blister packets from the pack, making sure it is not open or damaged. Carefully open the pack and remove the applicator. With one leg raised, or lying on your back with your legs apart, hold the applicator at the end topped with a button and slowly insert into the vagina, stopping when you feel some resistance (usually at about 8-10cm). Press the button gently until you feel a click, which signifies the tablet being released. Remove the applicator and dispose of it immediately.
If you forget to take your dose of Vagifem, take it as soon as you remember. Never take a double dose to make up for a missed one. Do not stop taking Vagifem without first consulting your doctor.
Like all medications, Vagifem can cause side effects in some patients, although not everybody gets them. Stop using Vagifem and contact your doctor immediately if you notice any of the following rare side effects:
Signs of a severe allergic reaction, including swelling, irritation or rash at the area of application, or anaphylactic shock
Jaundice (yellowing of the skin or whites of the eyes)
Severe headache, tiredness and dizziness, which may be signs of a sudden rise in blood pressure
Signs of a blood clot, including painful swelling in the legs, sudden chest pain or difficulty breathing
The following side effects may occur in between 1 and 10 in every 100 patients:
Vaginal bleeding, discharge or discomfort
A fungal infection of the genitals
The following rare side effects may occur in less than 1 in every 10,000 patients:
Chloasma (discolouration of the skin especially of the face or neck)
Erythema multiforme (rash with target-shaped reddening or sores)
Erythema nodosum (painful reddish skin nodules)
Do NOT take Vagifem if:
You are allergic to estradiol or any of the other ingredients of this medication
You have, have ever had or are suspected of having breast cancer
You have, have ever had or are suspected of having any cancer which is sensitive to oestrogens, such as endometrial cancer or ovarian cancer
You have any unexplained vaginal bleeding
You have endometrial hyperplasia (excessive thickening of the womb lining) that is not being treated
You have ever had thrombosis (a blood clot in the vein), such as in the legs or the lungs
You have a blood clotting disorder (such as protein C, protein S or antithrombin deficiency
You have or have recently had a heart attack, stroke or angina
You have or have every had a liver disease and your liver function tests have not returned to normal
You have porphyria (a rare and inheritable blood problem)
Inform your doctor and take particular care with Vagifem if you have or have ever had:
Problems caused by growth of the womb lining outside of the womb (fibroids or endometriosis)
Problems with your heart or circulation
A family history of blood clots
High blood pressure
Migraines or severe headaches
Liver or kidney problems
Systemic lupus erythematosus (SLE)
A hearing disorder known as otosclerosis
A family history of oestrogen-sensitive cancers
A high level of fat in your blood (triglycerides)
Fluid retention due to cardiac or kidney problems
Vagifem is unlikely to interact with other medications, as it contains a very low dose of estradiol. However, inform your doctor if you are taking or have recently taken any other medications, including those purchased over the counter without a prescription.
Vagifem should not be used by women who are pregnant or breastfeeding, and is intended for use in postmenopausal women only. If you become pregnant, stop using Vagifem and contact your doctor immediately.
Suppositories such as Vagifem and topical treatments such as Ovestin, Estriol and Premarin Creams are a good choice for women who are starting HRT, but they are only effective in relieving symptoms that are local to the vaginal region. In general, these treatments carry less risk of side effects than oral forms of HRT because they bypass the digestive system. Topical creams, however, can have a weakening effect on latex condoms, so you will need to consult your doctor about other forms of contraception while using them.
Other oestrogen-only forms of HRT are only suitable for women who have had a hysterectomy, or who have an alternative supply of progesterone such as an intrauterine device (IUD), as progesterone is necessary to prevent oestrogen from causing a dangerous build up of the uterine lining. Premarin and Elleste Solo are tablets that are taken orally, while Elleste Solo MX80, Elleste Solo MX40 and Evorel are transdermal patches which need to be changed twice weekly. Patches are beneficial for those more prone to experiencing side effects, as they are absorbed straight into the bloodstream without being digested.
For women who have not had a hysterectomy, or who do not have an IUD fitted, a combined form of HRT containing both an oestrogen or progesterone supplement is necessary. These include Climesse, Elleste Duet Conti, and Prempak-C, as well as Kliovance and Elleste Duet, which allow for a withdrawal bleed in each 28 day cycle and are therefore more appropriate for women who have had a natural period within the last 12 months. A non-hormonal alternative is Tibolone (brand name Livial), a synthetic steroid which mimics the action of both oestrogen and progesterone in the body and is thought to carry less health risks.
HRT is widely accessible through the NHS, and online at Dr Felix, and is the most effective and popular choice for dealing with the symptoms of menopause. Some women may choose to try herbal supplements to help with mood swings and night sweats, although the effectiveness of such products is unknown. Before trying herbal supplements, speak to a doctor or pharmacist about their ingredients and effectiveness.
A few simple lifestyle changes can help to reduce the impact of menopause in your daily life. Cutting down on alcohol, coffee and spicy foods, and quitting smoking can all help to reduce hot flushes and night sweats, which exercising regularly and increasing your intake of vitamin D will help to keep your bones strong and healthy. Some women choose to try increasing their intake of plant-based foods containing phytoestrogens, such as sesame and flaxseeds, nuts dried fruits, and other fruits such as oranges, strawberries and apricots, although there is little evidence to suggest that an oestrogen-rich diet is sufficient for reducing the impact of menopause.
The three forms of oestrogen produced naturally by the body are estradiol, estrone and estriol. Each can be found in different types of HRT, as can conjugated oestrogens, which is a combination of the three.
Vagifem is considered to be a safe and effective treatment in most women, although it is important to check the contraindications and drug interactions listed in the patient information leaflet before use. While HRT has been linked to a small increase in the risk of developing oestrogen-sensitive cancers, blood clots, or stroke, this risk is so slight that is it outweighed by the benefits. Local HRTs such as Vagifem work locally at the vaginal region and are not digested, which means that they carry less risk of side effects and health complications.
Vagifem starts working to replenish oestrogen supplies as soon as you start taking it, although you may not notice the benefits for a few weeks. It usually takes between 8 and 12 weeks for the effects of Vagifem to become apparent.
Many women continue to use HRT for several years, and the effects will wear off when you stop treatment. You may choose to start with a local treatment such as Vagifem, before moving onto a form of HRT that addresses more on the general symptoms of menopause. You should discuss with your doctor if and when you decide it is time to come off of HRT.