Vagifem

Vagifem is a hormone replacement therapy (HRT) medication that is used to treat menopause symptoms affecting the vagina, such as:

• vaginal dryness
• irritation
• pain during sex

Vagifem comes in the form of vaginal tablets, which are inserted directly into the vagina and is manufactured by Novo Nordisk.

Menopause symptoms, including those that affect the vagina, are typically caused by low oestrogen levels. Vagifem provides relief by raising oestrogen levels in the vagina using an artificial type of oestrogen called estradiol.

As the oestrogen (estradiol) in Vagifem is administered directly to the vagina, you’re less likely to experience side effects in other areas of the body than you might with other types of HRT, such as tablets you take by mouth.

How long does Vagifem last?

Vagifem's effects should last until you stop taking it. You’ll typically take Vagifem until you feel better, and clinical trials suggest it’s safe for most women to take for up to a year.

If you want to take Vagifem for longer than a year, it’s recommended to have a physical check-up with a doctor first.

How long does Vagifem take to work?

Vagifem starts to work as soon as you apply it. The vaginal tablet should dissolve slowly after you have inserted it. However, it can sometimes take between 8 to 12 weeks to feel the full effect.

How effective is Vagifem?

Vagifem is an effective treatment for vaginal menopause symptoms. Many women notice a significant improvement in their symptoms after taking Vagifem for 12 weeks, but some people see an improvement in as little as 2 weeks.

Vagifem comes as a vaginal tablet with an applicator. Insert 1 tablet into your vagina every night before bed for the first 2 weeks of treatment using the applicator.

After the first 2 weeks, you should insert 1 vaginal tablet twice a week, leaving 3 to 4 days between doses, unless instructed otherwise by your doctor.

To use Vagifem, you should:

1. Take an applicator, which looks like a long, thin plastic stick with a tablet on 1 end.
2. Unwrap the applicator at the end where the plunger is (not the tablet end).
3. Apply a little water-based lubricant to your vagina if it feels sore or dry to make sure this process is as comfortable as possible.
4. Get in a comfortable position and place the tablet end of the applicator into your vagina.
5. Push the applicator into your vagina and stop when you feel some resistance.
6. Push the plunger, which is at the other end of the applicator outside of your vagina, until you feel a click. This means the tablet is inserted into your vagina.
7. Gently take the applicator out of your vagina and throw it in the bin.
8. The tablet will stay inside if you lie down straight away, to give it time to stick to the wall of your vagina so you can absorb the medicine.

How long do you need to take Vagifem for?

You can take Vagifem for as long as it’s improving your symptoms unless a doctor advises you to stop.

You should expect your symptoms to improve within 3 months – if you do not notice an improvement, speak to your doctor as you may need to try an alternative treatment.

Vagifem has been tested in clinical trials for up to a year, so it’s typically safe to take the medication for this long. If you stop Vagifem and your symptoms come back, it may be possible to take it for longer if your doctor agrees. You’ll usually need a physical examination every year while you take Vagifem.

What if I miss a dose of Vagifem?

If you miss a dose of Vagifem, insert the medication as soon as you remember. You must not take a double dose to make up for one you’ve missed.

What if I take too much Vagifem?

If you take more Vagifem than recommended, it’s important to contact a doctor or pharmacist for advice. As it’s a low-dose vaginal medication, a high dose is usually needed for serious side effects to occur. If you do get side effects, this may include:

• dizziness
• drowsiness
• tenderness of the breasts
• vomiting

Vagifem can be bought from your local NHS pharmacy, selected high street pharmacies, or reputable and regulated online pharmacies like ZAVA.

Can I buy Vagifem online?

Yes, Vagifem can be purchased from trusted online doctor services like ZAVA. Our services are regulated and run by real doctors who can make sure you’re getting the right medication for you.

ZAVA offers:

• quick and easy consultation services
• professional doctor assessment and prescription
• discreet, to-your-door delivery service
• comprehensive follow-up care included

Fill out a short online assessment, and your ZAVA doctor will check if Vagifem is a suitable option for you.

Can I buy Vagifem over the counter?

No, Vagifem is a prescription-only medication, which means you will need a prescription from a doctor or prescribing healthcare professional to buy it.

Can I get Vagifem on the NHS?

Yes, if your GP thinks Vagifem would help with your symptoms, they may prescribe it.

You might find that they prescribe an alternative brand of vaginal oestrogen, though generic alternatives usually contain the same active ingredient as Vagifem, it may just have different non-active ingredients and a different name on the packaging.

Although many people take Vagifem without a problem, some people experience side effects.

Common side effects (affecting between 1 in 10 to 1 in 100 people) include:

• headaches
• stomach pain
• bleeding from the vagina
• vaginal discharge
• vaginal discomfort

Uncommon side effects (affecting between 1 in 100 and 1000 people) include:

• nausea (feeling sick)
• weight gain
• rashes
• hot flushes
• high blood pressure
• fungal infection of the vagina (usually thrush)

Other side effects have been recorded in people taking Vagifem, but they happen so rarely that it’s unclear whether they’re related to the medication or not. These include:

• insomnia
• fluid retention
• itchy rashes (including on the genitals)
• diarrhoea
• deep vein thrombosis (blood clots in the veins, typically in the legs)
• pain in the vagina or vulva
• overgrowth of the lining of the womb
• worsening of migraines
• breast and endometrial cancer
• application site injury or reaction
• allergic reactions (including anaphylaxis, where the face and airways swell and emergency medical attention is needed)

HRT is known to slightly increase the risk of ovarian cancer and blood clots (including strokes), but this risk is significantly reduced for Vagifem as it is applied directly to the vagina rather than taken by mouth.

Side effects tend to be worse to start with, but usually improve after taking Vagifem for a few months. If your side effects continue, are affecting your daily life, or you’re worried, contact your doctor.

More detailed information on side effects can be found in the medication patient information leaflet.

Vagifem may not be right for everyone, certain conditions may make Vagifem less effective or potentially unsafe. For this reason, it’s always important to tell your doctor any relevant medical history or family medical history when requesting treatment with Vagifem. Vagifem is not suitable for use during pregnancy.

If you have any of the following conditions, you should generally avoid taking Vagifem:

• current, past, or suspected breast cancer
• current, past, or suspected womb (endometrial) cancer or other cancers that are oestrogen-dependent
• undiagnosed vaginal bleeding
• untreated overgrowth of the womb lining (endometrial hyperplasia)
• current or previous deep vein thrombosis (blood clot in the veins of the leg) or pulmonary thrombosis (blood clot in the veins of the lungs)
• blood clotting disorders
• angina or a recent heart attack
• liver disease (current or past if liver function has not returned to normal)
• an allergy to any of the ingredients in Vagifem
• a rare disorder called porphyria

If you’re going to have surgery, speak to your surgeon beforehand and tell them you’re using Vagifem. You may have to stop using Vagifem for a few weeks before your surgery.

Some medical conditions may be worsened or triggered by Vagifem. If you have any of the following conditions, you may be able to take Vagifem with extra medical supervision:

• uterine fibroids (non-cancerous growths in the womb)
• endometriosis
• risk factors for blood clots
• risk factors for breast or endometrial cancers
• high blood pressure
• liver disorders
• diabetes
• migraines
• gallstones
• lupus
• epilepsy
• asthma
• fusion of the bones inside the ear

It’s unlikely that Vagifem will interact with other medications because it’s applied directly inside the vagina, but it might interact with other medications taken vaginally. If you’re worried about whether Vagifem will interact with medications you’re taking, it’s always best to discuss this with a doctor.

If you do not think Vagifem is right for you, there are various alternative HRT treatments you may be able to try.

Oestrogen creams

Oestrogen creams like estriol can also provide local relief for vaginal menopause symptoms.

HRT tablets

A variety of combined (oestrogen and progesterone) and oestrogen-only HRT tablets are available, including:

• Elleste Duet
• Kliovance
• Kliofem
• Femoston Conti
• tibolone

These tablets can also help with other menopause symptoms like hot flushes and night sweats, but may come with more side effects.

HRT patches

Patches like Evorel Sequi or Evorel Conti can be a good option for treating general menopause symptoms, and tend to come with fewer side effects than tablets.

➤ For advice on which HRT option is best for you, speak to your doctor. Alternatively, fill out a questionnaire with ZAVA, and one of our doctors can help you.

How long does it take for Vagifem to dissolve?

After inserting the medication into your vagina, Vagifem will dissolve slowly over several hours.

Can you use Vagifem once a week?

Vagifem should be taken every day for the first 2 weeks, then twice a week after that.

You should not take Vagifem in any other way unless you have been instructed to do so by a doctor.

Is Vagifem safe?

Vagifem has been tested on more than 673 women in clinical trials and is safe for most women to take for up to a year. It may be possible to take the medication for longer with regular medical check-ups.

Does Vagifem cause weight gain?

Weight gain is listed as an uncommon side effect of Vagifem, which means fewer than 1% of women will gain weight as a side effect of the medication.

Menopause is also linked to weight gain, so it’s advised to follow a healthy, balanced diet and exercise regularly. You can speak to your doctor for further advice on maintaining a healthy weight during and after menopause.