Vagifem

Vagifem is a vaginal insert used to relieve the symptoms of the menopause that can occur in the vagina. It comes in the form of a tablet that contains the synthetic form of the hormone oestrogen (oestrodiol). The menopause is a natural part of aging but can cause several unpleasant vaginal problems for a woman. Vagifem can help reduce the symptoms associated with this time in a woman’s life.

What is Vagifem?

Vagifem is a tablet medication for hormone replacement therapy (HRT) that is used to relieve the symptoms of the menopause that can occur in the vaginal area. It is inserted directly into the vagina, not taken orally. It is a synthetic form of the female sex hormone oestrogen (also known as estradiol).

Before (known as the perimenopause, which can begin several years before the last period), during and after the menopause (known as post-menopause), the body’s production of oestrogen declines. This occurs in most women between the ages of 40 and 55 and is often referred to as “the change”. It will also take place if a woman has a hysterectomy (complete removal of the womb) for medical reasons. As the ovaries produce less oestrogen, the walls of the vagina get thinner and the following symptoms can occur in the vaginal area, which is medically referred to as vaginal atrophy:

• Dryness;
• Itching;
• Irritation;
• Pain when urinating;
• Burning sensation;
• Soreness;
• Pain and bleeding during sexual intercourse.

When is Vagifem used?

Vagifem is used when a woman suffers from uncomfortable problems in the vaginal area due to the menopause. This can be vaginal dryness, soreness, irritation or pain during sexual intercourse. Vagifem tablets can relieve these symptoms by replacing the lost oestrogen with an artificial form of this female hormone.

This product is a convenient and easy way to take a low dose of HRT. It is applied directly into the vagina with an applicator. There are two kinds of oestrogen treatment for menopause:

• Local estrogren treatment, which is applying oestrogen directly into the vagina (Vagifem);
• Systemic treatment, i.e. taking oestrogen as an oral medicine, patch, injection, gel, cream or spray.

Vagifem has fewer side effects than other HRT treatments because it is applied locally, so only a small amount is absorbed directly into the bloodstream and very little travels to the rest of the body. It also works more rapidly and directly than systemic HRT treatment.

Sometimes a doctor will recommend that a woman takes a progestin (another hormone) in combination with Vagifem if she still has her uterus. This is to reduce the chances of getting cancer of the womb. If you experience unusual vaginal bleeding when taking this product or after the menopause, it is important to see a doctor as soon as possible.

When you start using Vagifem, you are not likely to see an improvement in your symptoms immediately. This does not mean the product is not working and you should start to see changes after 8-12 weeks of regularly taking this medication. Vagifem should not be used long term and its use should be reviewed annually by a doctor. If your symptoms improve, they may advise you to stop taking this product. However, if the symptoms return and you wish to start taking Vagifem again, you should talk to your doctor before recommencing this product.

How do you use Vagifem?

Vagifem is a tablet that is inserted directly into the vagina with a plastic applicator that is similar to a tampon. It is convenient, quick and easy to use. There is no need to touch the tablet as it is inside the applicator. If the Vagifem tablet has fallen out of the applicator, discard it and use a new one. Do not attempt to replace the Vagifem tablet into the applicator or into the vagina without using the applicator.

Carefully slide the applicator into the vagina and insert the Vagifem tablet while in a comfortable position (standing or lying down). The position used for inserting a tampon works for many women. The applicator should not be forced in. Then gently press the plunger on the applicator which will release the Vagifem tablet. Remove the plunger and throw it away. For hygiene and safety reasons, never reuse the applicator. The Vagifem tablet will not fall out but will dissolve slowly and you will not be able to feel it. To ensure Vagifem works correctly, the tablet should be inserted at approximately the same time each day.

What dosages are there?

Vagifem comes in doses of 10 mcg and 25 mcg. Your doctor will advise which is the best dose for you depending on the extent of your symptoms. The lowest dose for the shortest period of time should be taken due to the associated risks of taking HRT (see ‘Side effects’ below). The usual dose is one Vagifem tablet once a day for two weeks, then one Vagifem tablet twice a week for the duration you use Vagifem (which will be decided by you and your doctor). You can choose the days that are most convenient for you, but they should be spread out evenly over the week to ensure the product delivers the maximum effect.

If you forget to take a dose of Vagifem, you should consult a doctor about when to take the next dose due to the differences in the dosage pattern. Do not insert another Vagifem tablet as soon as you remember as this could be harmful and affect the treatment procedure.

Vagifem should not be used as a long-term treatment for menopausal symptoms and its use should be reviewed annually with a doctor, as HRT can increase the risk of developing some cancers, strokes and other serious conditions. Whilst Vagifem only contains a small amount of oestrogen, it is important to understand the risks of taking it as an HRT. If you have any doubts at all about using Vagifem, please discuss them with your doctor or gynaecologist (specialist in the female reproductive system).

What are the side effects of Vagifem?

As with all medicines, Vagifem can sometimes cause side effects, but of course not everyone using this product will experience them. As it is placed directly inside the vagina, this medication usually has fewer side effects, if any, than other forms of HRT. The most common possible side effects are:

• Headaches;
• Diarrhoea;
• Bloating (fluid retention);
• Vomiting or nausea;
• Vaginal fungal or yeast infection;
• Irregular vaginal bleeding;
• Breast tenderness;
• Weight change;
• Hair loss;
• Abdominal cramps or stomach pain.

If you experience any of these side effects whilst taking Vagifem tablets, you should see your doctor to make sure the product is right for you. In particular, it is important to investigate irregular vaginal bleeding after menopause as this can be a sign of cancer of the womb. However, it is important to be aware of the possible serious side effects of taking oestrogen-only medication (such as Vagifem) over a long period of time. This can increase the risk of:

• Cancer of the lining of the womb (the endometrium);
• Cancer of the uterus (womb);
• Breast cancer;
• Stroke;
• Deep vein thrombosis (DVT);
• Pulmonary embolism (blood clot on the lungs);
• Dementia.

It is therefore important to talk to your doctor before taking Vagifem tablets and consider the risks.

When should you not use Vagifem?

You should not use Vagifem if you have or have had:

• Breast cancer;
• Endometrial cancer or another cancer prompted by oestrogen;
• A stroke;
• A heart attack;
• Liver cancer or hepatitis;
• Unusual vaginal bleeding;
• Blood clots.

You should not use Vagifem if you are allergic to any of the ingredients listed on the package information leaflet, or if you think you may be pregnant, which is possible even if you are going through the menopause. If you are under 50 years of age and experience the menopause, you are still considered to be fertile for two years after your last menstrual period. If you are over 50 years of age, then you may still be fertile for one year. If you may still be fertile and wish to take Vagifem tablets, you should use a condom as a form of contraception, not the hormonal contraceptive pill.

Oestrogen from Vagifem can pass into breast milk, so it is not advisable to use this product if you are breastfeeding. Similarly, Vagifem is not recommended if you smoke, as smoking combined with oestrogen can increase the risk of heart attack, strokes, high blood pressure and blood clots.

Does Vagifem interact with other medication?

Vagifem tablets may interact with other medication, so it is essential you tell your doctor about any medicines you are taking before using this product. This includes any herbal medicines you are taking (including St. John’s Wort). Vagifem tablets can interact with other medication containing oestrogen, including the contraceptive pill. Among others, it can also interact with medication for:

• Epilepsy;
• Tuberculosis;
• Thyroid problems;
• Regulating plasma or cortisol levels;
• HIV.

Where can you buy Vagifem?

You cannot buy Vagifem tablets over the counter, as you require a prescription from a doctor. Your blood pressure and cardiovascular risk will have to be assessed.

Can I get Vagifem without a prescription?

No, you must have a prescription from a doctor to buy Vagifem tablets.

Sources:

Ghelani, R. (12 November 2019). Vagifem (estradiol). Retrieved 19 November 2019 from https://www.netdoctor.co.uk/medicines/a7713/vagifem-estradiol/

Menopause. (N.D.) Retrieved 19 November 2019 from https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397

Package leaflet. Vagifem estradiol vaginal tablets. 25 November 2009. Retrieved 22 November 2019 from https://s3-eu- west-1.amazonaws.com/docomimg2.s3.amazonaws.com/leaflets/en/patient_information_leaflet-395-acid-a-vit-uk.pdf- 1510756506.pdf

Vagifem® (estradiol vaginal inserts) 10 mcg. (N.D). Retrieved 19 November 2019 from https://www.vagifem.com/

Vagifem tablet. (N.D.) Retrieved 19 November 2019 from https://www.webmd.com/drugs/2/drug-18858/vagifem-vaginal/details