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.
Vagifem contains estradiol, a bioidentical form of oestrogen 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 choose to alter your dose at a later point. The usual dose is 1 vaginal tablet each day for the first 2 weeks, and then one vaginal tablet twice weekly.
Always use Vagifem as instructed by a doctor. You can begin the 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.
The following side effects may occur in between 1 and 10 in every 100 patients:
The following side effects may occur in between 1 in 100 and 1 in 1000 women:
The following other side effects have been reported, which are very rare (<1 in 10,000 patients):
Do NOT take Vagifem if you:
Inform your doctor and take particular care with Vagifem if you have or have ever had:
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 and estriol 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 a Mirena intrauterine system (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 that 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 a Mirena coil fitted, a combined form of HRT containing both an oestrogen or progesterone supplement is necessary. These include Elleste Duet Conti and Elleste Duet. Which one is most suitable for you will depend if you have had a menstrual period in the past year or not.
A non-hormonal alternative is Tibolone (brand name Livial), a synthetic steroid that mimics the action of both oestrogen and progesterone in the body and is thought to carry fewer health risks.
A range of HRT is available 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. Vagifem contains estradiol, whereas Ovestin contains estriol. Conjugated oestrogens are obtained from synthetic manufacture, or from equine urine and are found in some oral HRT preparations.
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.
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