Vaginal Estradiol Dosages: Your GoodRx Guide
Key takeaways:
Vaginal estradiol (Estrace, Estring, Vagifem) is approved to treat menopause symptoms that affect the vagina. It’s available in a cream, vaginal rings, and vaginal suppositories. One form of vaginal estradiol, Femring, is also approved to treat bodywide menopausal symptoms, such as hot flashes.
Vaginal estradiol rings are inserted once every 90 days. Vaginal estradiol cream is inserted daily for 2 to 4 weeks, then just one to three times a week thereafter. Vaginal estradiol suppositories are inserted daily for 2 weeks, then twice a week thereafter.
There are many ways to save on vaginal estradiol medications. There are lower-cost generics available for some of these medications, as well as copay savings opportunities. GoodRx can help make your prescription more affordable.
Table of contents
Menopause causes many bothersome changes to the body. Vaginal changes caused by menopause are often treated with vaginal estradiol (Estrace, Estring, Vagifem) medications. These medications contain a lab-made form of estrogen that’s inserted into the vagina to lessen symptoms such as dryness and irritation.
This guide will cover typical vaginal estradiol dosages. Keep in mind that these are general dosing recommendations. Your prescriber may have you use vaginal estradiol differently than discussed below.
What dosage forms does estradiol come in?
Vaginal estradiol comes in many different dosage forms, including a cream, rings, and suppositories (inserts). Estradiol also comes in oral tablets and in topical patches, gels, and spray, which are applied to the skin. Oral and topical forms of estradiol are covered in separate dosage guides.
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The various vaginal forms of estradiol and their available doses are shown in the chart below:
Brand Names | Dosage form | Available strengths |
Cream | • 0.1 mg per gram of cream | |
Ring | • 7.5 mcg/day | |
Ring | • 0.05 mg/day • 0.1 mg/day | |
Suppository (tablet) | • 10 mcg | |
Suppository (capsule/insert) | • 4 mcg • 10 mcg |
Vaginal estradiol cream is typically measured and inserted into the vagina using an applicator that comes with the medication. The applicator has 1 g, 2 g, 3 g, and 4 g markings to help you measure the right dose. You’ll insert the applicator into your vagina and press down on the plunger to administer the dose.
You may have some leakage after using vaginal estradiol cream. This is normal and shouldn’t interfere with how the medication works. It may be helpful to lie down for a few minutes after insertion to increase absorption. A sanitary pad or pantyliner can also help protect your clothing if leakage happens.
If you’re using a vaginal estradiol ring, it should be inserted with clean, dry hands. The ring should be placed in the upper one-third of the vagina, close to the cervix. When the ring is placed properly, you shouldn’t be able to feel it at all.
Some vaginal estradiol suppositories come with an applicator to help you insert them. You’ll place the applicator inside the vagina and press the plunger, like you would when using a tampon. Others are inserted manually with clean, dry hands.
What are the typical vaginal estradiol dosages for adults?
Most vaginal estradiol medications are only approved to treat vaginal symptoms of menopause. These include vaginal thinning, dryness, and irritation. Painful sex can also be an issue. The approved vaginal estradiol dosages differ based on the brand and form of the medication you’re using.
Once you start using vaginal estradiol, your prescriber will likely check in every 3 to 6 months to determine when treatment should be stopped. It’s best to use vaginal estradiol for the shortest time possible, based on your symptoms.
Estradiol vaginal cream
The recommended dosage of Estrace (estradiol) vaginal cream is 2 g to 4 g inserted vaginally, using an applicator, once a day for 1 to 2 weeks. You’ll then reduce the dose by half and continue inserting the cream daily for another 1 to 2 weeks. Once the vaginal symptoms improve, a maintenance dosage of 1 g inserted vaginally one to three times a week is recommended.
Estradiol vaginal ring
There are two approved vaginal estradiol rings: Femring (estradiol acetate) and Estring (estradiol).
Femring is the only form of vaginal estradiol that’s approved for both vaginal symptoms of menopause and vasomotor symptoms, such as hot flashes and night sweats. The recommended starting Femring dosage is 0.05 mg/day, which is equal to one ring inserted vaginally every 90 days. If symptoms don’t respond to 0.05 mg/day, a higher-dose ring is available. It delivers 0.1 mg/day of estradiol in the same manner.
The recommended vaginal Estring dosage is 7.5 mcg/day, which is equal to one ring inserted vaginally every 90 days. Estring is preferred over Femring for menopause symptoms limited to the vagina. It carries a lower risk of serious side effects.
Estradiol vaginal suppositories
There are two approved vaginal estradiol suppositories: Vagifem tablets (Yuvafem, estradiol) and Imvexxy capsules.
A vaginal estradiol suppository dosage of 10 mcg is recommended for most vaginal symptoms of menopause. Imvexxy is also available in a 4 mcg dose, which treats painful sex caused by menopause.
The recommended vaginal estradiol dosage is one suppository (4 mcg or 10 mcg) inserted vaginally every day for 2 weeks. After that, you’ll insert one suppository vaginally twice a week, roughly 3 to 4 days apart.
Good to know: Vaginal estradiol suppositories come in two different package sizes: 18 doses and 8 doses. The 18-dose package is meant for the first month of treatment (when you’ll insert a suppository daily for 14 days, then twice a week). The 8-dose package is meant for the following months of treatment (when the suppositories are inserted twice a week). You may need a separate prescription for each package size. Your pharmacist can help you with this if needed.
What happens if you miss a dose of vaginal estradiol?
If you miss a dose of estradiol when you’re using it daily, insert the dose as soon as you remember. But if it’s almost time for your next dose, skip the missed dose. It’s best not to double up on your doses, unless your prescriber tells you to do so.
For estradiol that you don't take every day, it’s best to reach out to your prescriber or pharmacist about what to do if you miss a dose. They’ll be able to help you get back on schedule.
If your vaginal estradiol ring comes out during the 90-day treatment window, just rinse it with lukewarm water and reinsert it. If you leave the ring in for longer than 90 days by mistake, remove it right away and contact your prescriber.
If keeping track of your vaginal estradiol doses becomes challenging for you, consider setting a calendar alert or using a reminder app on your phone to help. You can also talk with your prescriber about other forms of estradiol that may be easier to use.
What should you do if you take too much estradiol?
If you accidentally use an extra dose of vaginal estradiol, it’s unlikely to cause you serious harm. Most of these medications don’t reach your bloodstream in large amounts, so it’s not likely to be an issue. Still, it’s possible that large doses of estradiol can lead to uncomfortable symptoms such as:
Abdominal pain
Drowsiness
Fatigue
Nausea
Vomiting
Vaginal bleeding
If you or a loved one uses too much vaginal estradiol, contact a healthcare professional or call Poison Control at 1-800-222-1222. They’ll let you know what the best course of action is.
How to save on estradiol
There are several ways to save on your vaginal estradiol medication. GoodRx can help you explore your options, which will vary based on the type and brand of vaginal estradiol you use.
Estrace vaginal cream is available as both a brand name medication and a lower-cost generic. Generic estradiol cream’s price at certain pharmacies is as low as $31.63 with a free GoodRx discount.
Vagifem vaginal tablets are also available as a brand name medication and as two different lower-cost generics. GoodRx can help you save over 75% off the average retail price of the generic versions.
Imvexxy vaginal inserts are only available as a brand-name medication. Anyone with a valid prescription, regardless of insurance status, can use GoodRx to purchase 8 inserts of Imvexxy at an exclusive cash price of $85. If you have commercial insurance, you may be eligible to pay as little as $35 using a savings card from the manufacturer.
Estradiol vaginal rings are only available as brand-name medications. But you can pay as little as $25 for a 90-day supply of Femring and $45 for a 90-day supply of Estring using savings cards from the manufacturer, if you have commercial insurance. Anyone with a valid prescription, regardless of insurance status, can use GoodRx to purchase a 3-month supply (1 ring) of Estring at an exclusive cash price of $249. And if you’re uninsured or underinsured, you may be eligible for the Estring patient assistance program, which offers the medication free of cost.
The bottom line
Vaginal estradiol medications are used to manage menopausal symptoms affecting the vagina. One of these medications, Femring, is also approved for bodywide menopause symptoms, such as hot flashes. Vaginal estradiol is available in a cream, rings, or suppositories. The recommended vaginal estradiol dosage depends on the form you’re using.
Estradiol vaginal rings are inserted once every 90 days. For suppositories, you’ll insert one every day for 2 weeks, then twice a week thereafter. Estradiol vaginal cream is used daily for 2 to 4 weeks. You’ll then use it one to three times a week thereafter.
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References
Allergan, Inc. (2022). ESTRACE- estradiol cream [package insert].
AvKARE. (2022). YUVAFEM- estradiol tablet [package insert].
Millicent US, Inc. (2023). FEMRING- estradiol acetate ring [package insert].
Novo Nordisk. (2022). VAGIFEM- estradiol insert [package insert].
Pfizer Laboratories Div Pfizer Inc. (2024). ESTRING- estradiol ring [package insert].
TherapeuticsMD, Inc. (2022). IMVEXXY- estradiol insert [package insert].
Thurston, R. C., et al. (2012). Vasomotor symptoms and menopause: Findings from the study of women’s health across the nation. Obstetrics and Gynecology Clinics of North America.
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