Vagifem vaginal tablets contain the active ingredient estradiol (previously spelt oestradiol in the UK), which is a natural form of the female sex hormone, oestrogen. It is manufactured by Novo Nordisk.

Vagifem is a treatment that can soothe tissues in and around the vagina. And it doesn't just mask symptoms temporarily. Unlike over-the-counter lubricants and moisturizers, Vagifem actually reverses changes in the vagina that occur with menopause and can help maintain this reversal with continued use.

Picture of Vagifem Vaginal Tablet With Applicator

Vagifem For Atrophic Vaginitis

What is atrophic vaginitis?

  • Atrophy is the partial or complete wasting away of body tissue.
  • Vaginitis is inflammation of the vagina.

What local genital symptoms might be associated with the menopause?

After the menopause, as a result of vaginal atrophy due to loss of estrogen, vaginal dryness and discomfort are more likely to become a problem for you. Local infection, atrophic vaginitis, becomes more common now that there is less protective lactic acid and this may result in inflammation causing soreness and discharge.

The vaginal dryness and inflammation may cause discomfort or even pain when you make love (dyspareunia). On occasion, the inflammation may cause bleeding. All postmenopausal bleeding must be investigated (17).

The peri menopause symptoms associated with atrophic vaginitis are:-

These atrophic vaginitis symptoms can occur as pre menopause symptoms although they are more common in post menopausal women.

How can atrophic vaginitis - dry vagina at menopause - painful sex - be treated?

Topical oestrogen (creams and pessaries) are commonly used in postmenopausal women to improve the quality of the vaginal epithelium in atrophic vaginitis.

Fifteen percent of premenopausal women, 10-40% of postmenopausal women, and 10-25% of women receiving systemic hormone therapy experience urogenital atrophy.

The most common symptoms are dryness, burning, pruritus, irritation, and dyspareunia (painful sexual intercourse). Topical Estrogen or hormone replacement therapy (ERT-HRT) is the treatment of choice in postmenopausal women.0101

If genital symptoms, such as vaginal dryness, pain during lovemaking or perhaps bladder symptoms are troubling you, these could be due to reduced oestrogen levels in the tissues around the genital area. These symptoms usually respond to HRT or to topical preparations (oestrogen creams or pessaries).

On occasion, local symptoms may fail to respond to HRT anyway and additional topical oestrogen may be required.

To begin with, the creams or pessaries are introduced each night for ten days to two weeks and then reduced to a maintenance regime varying from twice weekly to perhaps no more than once each month depending on symptoms, age and response. There are a variety of topical oestrogen preparations (Table 28.1).

Estring (Pharmacia and Upjohn), a synthetic soft rubber ring which slowly releases oestradiol can be introduced into the vagina and replaced at three monthly intervals. If the uterus is still present intermittent courses of progestogen should be considered to encourage endometrial shedding (HRT and progestogen). The ring is as effective as oestrogen creams and some women find the ring more acceptable.


Table 28.1 Topical creams and pessaries that are commonly used in menopause treatment.



Ortho-Gynest Pessaries Oestriol 500 g Janssen-Cilag
Ortho-Gynest Cream Oestriol  0.01% Janssen-Cilag
Ovestin Cream Oestriol 0.1% Organon
Ovestin Pessaries Oestradiol 1mg Organon
Premarin  Cream Conjugated oestrogens 625 mg Wyeth
Vagifem Pessaries Oestradiol 25 microg Novo Nordisk
Estring Ring Oestradiol (7.5 microg release/day) Pharmacia and Upjohn

Almost invariably, unless you are taking HRT, there will be some degree of vaginal atrophy after the menopause.

Quite frequently, patients are referred with vaginal discomfort and a physical examination reveals a prolapse (1). The only way to determine how much of the discomfort is due to the vaginal atrophy and how much to the prolapse is to treat the atrophy with topical (local cream or pessary) oestrogen and then reassess the symptoms.

Related Medical Abstracts - Click on the paper title:-

Restoration of vaginal ph - Rephresh

Please see Rephresh

Women's Health

Women's Health

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This is the personal website of David A Viniker MD FRCOG, retired Consultant Obstetrician and Gynaecologist - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.

Answers to FAQs on women's health, patient information and medical advice by David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist (Gynecologist - OBGYN), Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, London

Vagifem HRT

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