Vagifem Tablets vs Estrace Cream: Which Estrogen Is Best?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Local estrogens work for the treatment of vaginal dryness, painful intercourse and preventing urinary tract infections. Forty-five percent of postmenopausal women experience those symptoms but only a minority use vaginal estrogens. A recent study revealed the solution may lie in prescribing vaginal tablets over the creams—more women seem to prefer the tablets.

Why are vaginal estrogens a good thing? They don’t carry the same risks as oral estrogens do because there is much less systemic absorption. Low dose vaginal estrogens also don’t cause problems with the uterine lining (the endometrium) so you don’t need to add the progesterone that’s required when you are using an estrogen pill or patch.  
Here are 10 tips to help you compare vaginal estrogens and ease symptoms after menopause.

  1. Hormone-free: If you don’t want to use estrogens, start with a moisturizer called Replens which is available over the counter. Replens has been shown to increase vaginal moisture, fluid volume and elasticity.
  2. Dryness and intercourse: Lubricants such as K-Y or Astroglide are intended for use during sexual activity and will help for painful intercourse from vaginal dryness.
  3. Vaginal estrogen options: Four vaginal estrogens exist: two creams (Estrace and Premarin), one ring (Estring) and one tablet (Vagifem). All are brand-name drugs which tend to be pricey.
  4. Which is the best? Well, women seem to prefer Vagifem. Vagifem is a 10 mcg estrogen tablet inserted into the vagina once daily for two weeks, then twice weekly.
  5. Does the Vagifem tablet stay inside of me? No. Vagifem is a dry tablet but as moisture permeates, the tablet is eroded and releases estradiol into the vagina.
  6. Vaginal tablet over cream: A recent study of 21,000 women in Israel found that while more women were using vaginal creams (79%), those using the vaginal tablets, Vagifem, were more likely to stick with it.  
  7. What about the ring? Estring is a ring inserted into the vagina that is changed every 90 days. Of note, Estring was not compared in the above mentioned study where tablet vs cream was compared.
  8. Do I need to take progesterone if I use a vaginal estrogen? No. Progesterone is not indicated with low dose vaginal estrogen
  9. Will this help prevent urinary tract infections? Yes. After menopause, the pH of the vagina rises and lactobacilli survival is hindered. This predisposes you to vaginal infections and UTI. So vaginal estrogens help for this.
  10. Is Vagifem expensive? Yes. The full cash price for a one-month supply (8 tablets) is typically around $150 – $200. Find out which vaginal estrogen is preferred by your insurance plan and search around for coupons—you could lower your price up to $50 with a GoodRx coupon, for example. The manufacturer, Novo Nordisk, has a savings program too.

Dr O.

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