estradiol vaginal (Vagifem)

Indications

• atrophic vaginitis Contraindiactions:
• a remote history of gyncecologic cancer (breast cancer, uterine cancer, ovarian cancer) is not a contraindication
• vaginal estradiol does not alleviate systemic symptoms of menopause (hot flashes)
• vaginal estradiol may be safe in women taking tamoxifen for hormone-receptor positive breast cancer

Dosage

• 10 ug intravaginal tablet (suppository) QD for 2 weeks, then twice weekly (Vagifem) provides lowest controlled dose
• estradiol* vaginal cream
  • 2-4 g/day for 2 weeks
  • reduce to 1-2 g for 2 weeks
  • maintenance 1 g 2-3x/week
  • use of high-strength creams containing estradiol 100 ug/g (0.01%) should be restricted to <= 4 weeks
• patients seem to prefer tablets or the vaginal ring over cream

* no need for progestin to prevent endometrial hyperplasia

Adverse effects

• little to no systemic effects
  • no endometrial hyperplasia
• risk for thromboembolism, strokes, & cancers can result from absorption of estradiol into the bloodstream from high potency intravaginal creams (0.01%) used to treat vaginal atrophy
• in women treated for breast cancer, vaginal estrogen therapy is not associated with increased risk for either breast cancer recurrence or mortality

• drug adverse effects of estrogens

Mechanism of action

• binds to estrogen receptors in vaginal epithelium

More general terms

• estradiol
• vaginal agent

Additional terms

• Femring