What Is Vaginal Dryness, and How Can You Treat It?
Vaginal dryness can happen at any age, but it's especially common after menopause. Learn about the causes, symptoms, and treatment options, with GoodRx.
Vagifem
Used for Atrophic Vaginitis
Used for Atrophic Vaginitis
Vagifem (estradiol vaginal insert) is used to treat vaginal dryness, irritation, and burning caused by menopause. It contains estradiol, a type of estrogen that helps to raise your hormone levels to ease these symptoms. You'll usually use one insert with an applicator twice a week (after using it daily for the first 2 weeks). Common side effects include back pain, diarrhea, and vaginal yeast infection.
What is Vagifem?
What is Vagifem used for?
- Vaginal dryness, burning, and irritation due to menopause
How Vagifem works
Vagifem is an estrogen replacement. It replaces the natural estrogen your body loses during menopause. The medication works by raising estrogen levels in the vagina to reduce vaginal dryness, burning, and irritation.
When does Vagifem start working?Time passed since treatment started:
Drug facts
| Common Brands | Vagifem |
|---|---|
| Drug Class | Estrogen replacement |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | Lower-cost generic available |
| Availability | Prescription only |
More on Vagifem essentials
Side effects of Vagifem
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Vaginal yeast infections (8%)
- Vaginal itching (8%)
- Back pain (7%)
- Diarrhea (5%)
Less Common Side Effects
- Weight gain
- Trouble sleeping
- Migraine
- Rash
- Hives
Vagifem serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Blood clot in arm or leg: swelling, pain, or tenderness in the arm or leg; skin that's warm to the touch
- Blood clot in the lung: trouble breathing, chest pain
- Heart attack: chest pain, arm pain, shortness of breath, cold sweat, lightheadedness
- Stroke: sudden weakness on one side of the body, drooping face, changes in your speech or vision, confusion, bad headache
- Unusual or heavy vaginal bleeding
When do Vagifem possible side effects begin and end?
Time passed since treatment started:
M
H
D
W
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Vaginal itching or irritation
The following Vagifem side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Blood clot—pain, swelling, or warmth in the leg, shortness of breath, chest pain
- Breast tissue changes, new lumps, redness, pain, or discharge from the nipple
- Gallbladder problems—severe stomach pain, nausea, vomiting, fever
- Increase in blood pressure
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
- Unusual vaginal discharge, itching, or odor
- Vaginal bleeding after menopause, pelvic pain
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
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Pros and cons of Vagifem
Pros
- After the first 2 weeks, only need to use twice a week
- Works directly at the site of application to relieve vaginal symptoms
- Comes preloaded in an easy-to-use applicator
Cons
- Can cause vaginal yeast infections
- Doesn't treat other menopause symptoms like hot flashes or night sweats
- Must take a progestin if you have a uterus to lower your risk of uterine cancer
Pharmacist tips for Vagifem
- You'll typically use Vagifem every day for 2 weeks, then twice a week after that. Pick two days each week and mark them on your calendar so you don’t forget your doses.
- You can insert Vagifem at any time of day, but try to use it around the same time each day. This helps keep your routine consistent.
- Each applicator contains one tablet that will be placed in the vagina. Never take Vagifem by mouth.
- Vagifem has some serious risks like heart attacks and strokes. Because of this, use it for the shortest time needed and check in with your prescriber regularly to see if you still need it.
- Tell your prescriber right away if you notice unusual vaginal bleeding, breast lumps, vision changes, or severe headaches after starting Vagifem. These aren’t typical side effects and could be signs of a more serious problem.
How to use Vagifem
- Wash your hands with warm water and soap before and after using Vagifem.
- While lying back or standing, gently place the applicator as far into your vagina as is comfortable, then press the plunger to release the tablet.
- If the tablet falls out of the applicator before you insert it, throw both the tablet and applicator away and use a new one.
Risks and warnings for Vagifem
Vagifem can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk for blood clots and related complications
- Risk factors: Personal or family history of blood clots | High blood pressure | Diabetes | High cholesterol | Smoking | People who identify as obese | Systemic lupus erythematosus (SLE)
Estrogen therapy, like Vagifem, can raise your risk of blood clots. Sometimes, these blood clots can be very dangerous and lead to a heart attack, stroke, or a blood clot in your lungs (called a pulmonary embolism). Because of this risk, Vagifem shouldn't be used to prevent heart disease.
Tell your prescriber about your full medical history, especially if you've ever had a blood clot. Also let them know if you have a planned surgery or expect to be on bedrest for a long time. Your prescriber will let you know when to stop Vagifem before your procedure and when to restart it after you're moving around again to lower your risk of blood clots. In general, you should use the lowest dose for the shortest amount of time to stay safe.
Know the signs of a blood clot or related problem:
- Blood clot in arm or leg: swelling or pain in the arm or leg
- Blood clot in the lung: chest pain, trouble breathing
- Blood clot in the eye: sudden partial or complete vision loss, bulging eyes, double vision
- Heart attack: chest pain, arm pain, shortness of breath, a cold sweat, lightheadedness
- Stroke: sudden weakness on one side of the body, drooping face, trouble breathing, bad headache, changes in speech or vision
Remove Vagifem and get medical help right away if you have any signs or symptoms of a blood clot.
Risk for uterine cancer (also called endometrial cancer)
- Risk factors: Taking Vagifem by itself without additional progestin if you have a uterus | Taking estrogen therapy for more than one year | High estrogen dose
Estrogens like estradiol, found in Vagifem, can thicken and change the lining of your uterus (called the endometrium). This can lead to uncontrolled growth of the uterine lining and put people who have a uterus at risk for uterine cancer (or endometrial cancer). Watch for warning signs like vaginal bleeding after menopause or pelvic pain, and let your prescriber know if you notice anything unusual.
Because of this cancer risk, if you haven't had your uterus removed (through a hysterectomy), your prescriber will usually have you take a progestin along with Vagifem. Progestins help balance estrogen's effect and protect the uterus. Speak with your prescriber if you have questions about uterine cancer risk and how to lower it.
Risk for breast cancer
- Risk factors: Personal or family history of breast cancer | Taking estrogen and progestin together | Taking estrogen for many years
Studies suggest that taking estrogens like Vagifem for several years might raise the risk for breast cancer. This risk is even higher if you take estrogen with a progestin. Don't take Vagifem if you currently have or have ever had breast cancer.
To lower your risk for breast cancer, take the lowest dose of Vagifem for the shortest time needed. Regularly check your breasts for any changes and get recommended breast scans (mammograms). Let your prescriber know if you notice any lumps, pain, or swelling in your breasts.
Risk for ovarian cancer
- Risk factors: Taking estrogen and progestin together
Some studies suggest that people who take estrogens like Vagifem for menopause symptoms might have a higher risk for ovarian cancer. Speak with your prescriber if you're concerned about this risk. Let your care team know if you have any unusual bloating, pelvic pain, trouble eating, or feeling full quickly. These can be signs of ovarian cancer.
Risk for dementia
- Risk factors: Older adults
People ages 65 and older who take estrogen medications like Vagifem might have a higher risk of developing dementia. Because of this, estrogen therapy shouldn’t be used to prevent dementia.
Be aware of the early signs of dementia, such confusion, memory loss, getting lost, or struggling to do everyday tasks. If you’re worried about the risk for dementia, talk to your prescriber.
Gallbladder or liver problems in certain people
- Risk factors: History of liver disease or jaundice
The risk for gallbladder problems is higher for people who have gone through menopause and are taking estrogen therapy, like Vagifem. In some cases, these problems have required surgery. Let your prescriber know if you've ever had jaundice (yellowing of your skin or whites of your eyes). Also tell your care team right away if you notice jaundice, stomach pain that doesn't go away, nausea, or vomiting while you're taking this medication — these could be signs of liver damage or gallbladder problems.
High triglyceride (fat) levels
- Risk factors: History of high triglyceride levels in the blood
Let your prescriber know if you've ever had high triglyceride levels. Estrogens like estradiol (found in Vagifem) can sometimes raise the amount of triglycerides (fat) in your blood. Having too much can lead to swelling of the pancreas (pancreatitis). Tell your care team right away if you have symptoms like sudden stomach or back pain, nausea, vomiting, fever, or weakness.
Changes in calcium levels in certain people
Estrogen therapy like Vagifem can affect the calcium levels in your blood. People with breast cancer or cancer that's spread to the bones are at higher risk of dangerously high calcium levels while they're taking estrogens. Tell your care team if you have any symptoms of high calcium levels like tiredness, muscle weakness, bone pain, nausea, constipation, and thirst.
On the other hand, if you have low parathyroid hormone levels, estrogen can cause your calcium to drop too low. Call your care team if you have signs of low calcium, like muscle cramps, brittle nails, or tingling in your fingers, toes, or lips.
Low thyroid hormone levels
- Risk factors: Conditions that cause low thyroid hormone levels
Estrogen therapy like Vagifem can change thyroid hormone levels. If you have low thyroid hormone levels (hypothyroidism), it might be harder for your body to adjust. If you're taking thyroid replacement medication, you might need a higher dose while using estrogen therapy. Talk to your prescriber so they can help adjust your medication if needed.
Buildup of fluids in your body (fluid retention)
- Risk factors: Certain heart conditions | Kidney damage
Estrogen therapy like Vagifem can make your body hold onto extra fluids. This can sometimes cause swelling of your hands and feet. Fluid retention can worsen symptoms of certain heart conditions like heart failure, or kidney damage. If you have heart or kidney problems, tell your healthcare team right away if you notice swelling, sudden weight gain, or other signs of fluid retention while taking Vagifem.
Worsening of certain other health conditions
Before you start Vagifem, talk to your care team about your medical history. Estrogen-containing medications can make certain health conditions worse, and you might need closer monitoring. These conditions include diabetes, asthma, migraine, lupus, seizures, and hereditary angioedema.
Vaginal irritation with applicator use
- Risk factors: Severe menopause symptoms
Some people find that the Vagifem applicators cause vaginal irritation right after they insert the medication. This is more likely to happen if your menopause symptoms are more severe. If the irritation you experience gets worse or is very bothersome, speak with your prescriber.
Vagifem dosage
The average cost for 24 inserts of 10mcg of Vagifem is $90.88 with a free GoodRx coupon. This is 59.49% off the average retail price of $224.33. 
Insert
Insert| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 10mcg | 24 inserts | $90.88 | $3.79 |
Typical dosage for Vagifem
Each Vagifem insert contains 10 mcg of estradiol.
Place 1 insert into the vagina once a day for the first 2 weeks. After that, place 1 insert into the vagina twice a week (for example, on Tuesday and Friday).
More on Vagifem dosage
How much does Vagifem cost?
To access savings, use a GoodRx coupon and pay just a fraction of the retail price.
Vagifem contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Vagifem will not be safe for you to take.
- Abnormal vaginal bleeding
- History of breast cancer
- Tumor that depends on estrogen for growth
- History of blood clot or blood clotting conditions
- History of heart attack or stroke
- Liver problems
What are alternatives to Vagifem?
There are a number of medications that your doctor can prescribe in place of Vagifem. Compare a few possible alternatives below.
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Vagifem images
