VAGIFEM (Estradiol)

VAGIFEM (Estradiol)

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What is this medication?

Estradiol, Vagifem/Estring(US/CDN)/Yuvafem(US)
Estrogen Derivative

“Alert: US Warning

Endometrial Cancer
There is an increased risk of endometrial cancer in a woman with a uterus who uses unopposed estrogens. Adding a progestin to estrogen therapy has been shown to reduce the risk of endometrial hyperplasia, which may be a precursor to endometrial cancer. 

Cardiovascular Disease
Estrogen-alone therapy should not be used for the prevention of cardiovascular disease. Estrogen plus progestin therapy should not be used for the prevention of cardiovascular disease.

Breast Cancer
The WHI estrogen-plus-progestin study demonstrated an increased risk of invasive breast cancer.

Estrogen-alone therapy should not be used for the prevention of dementia. Estrogen plus progestin therapy should not be used for the prevention of dementia.”

How does this medication work? 

Estradiol, Vagifem/Estring/Yuvafem are vaginal estradiol which is the primary intracellular form of estrogen secreted prior to menopause and is largely responsible for the development and maintenance of the female reproductive system and secondary sexual characteristics.

How should I take this medication? 

Usual (Vaginal): 
Estrace: Insert 2g to 4g intravaginally for 2 weeks, followed by a maintenance dose of 1g inserted 2 to 3 times weekly. 

Estring: Insert 2mg ring intravaginally and keep in place for 90 days. 

Vagifem: Insert 1 tablet once daily for 2 weeks, followed by a maintenance dose of 1 tablet inserted 2 to 3 times weekly. 

Estrace: 0.5mg to 2mg once daily.

Vaginal Cream: Insert the applicator intravaginally.  Cleanse the applicator after each use with water and soap.  

Vaginal Insert: Insert with vaginal insert approximately 2 inches into the vaginal canal.

Vaginal Tablet: insert the tablet using an applicator intravaginally.  Once inserted, press plunger until fully depressed, then remove applicator and discard. If tablet comes out of applicator prior to insertion, do not replace; use a new tablet filled applicator instead (if the tablet has fallen out of applicator but still remains in the package, it can be reinserted in the applicator for use).

Vaginal Ring: Insert the ring intravaginally as deeply as possible.  You should not experience any discomfort.  If ring is expelled prior to 90 days, it may be rinsed in lukewarm water and reinserted. If vaginal infection, ulceration, erosion, or adherence to vaginal wall develops, remove ring and reinsert only after healing is complete.

What should I watch for while using this medication? 

Before starting Estradiol, Vagifem/Estring/Yuvafem make sure your physician is aware of any allergies or medications you currently take, and activities you perform.  Estradiol, Vagifem/Estring/Yuvafem when used with progestin can increase the risk of invasive breast cancer in post menopausal women.  Unopposed Vagifem/Estring/Yuvafem usage in women with an intact uterus can increase the risk of endometrial cancer. Estradiol, Vagifem/Estring/Yuvafem can exacerbate endometriosis and may cause retinal vascular thrombosis. Estradiol, Vagifem/Estring/Yuvafem should be used with caution in patients with familial defects in lipoprotein metabolism, asthma, diabetes, cardiac and renal dysfunction, epilepsy, cholestatic jaundice, hypoparathyroidism, migraine, porphyria, systemic lupus erythematosus, and hepatic hemangiomas. Estradiol, Vagifem/Estring/Yuvafem are contraindicated in women with active DVT, PE, arterial thromboembolic disease (stroke and MI), or a history of these conditions.

What if I miss a dose?

If you miss a dose of medication, try to take it as soon as possible. However, if it is almost time for your next dose, take only that scheduled dose. Do not take double or extra doses.

How should I store this medication?

Keep out of the reach of children at all times. Store at room temperature, 59 to 86° F (15 to 30° C). Protect from light. Keep the container tightly closed. Properly dispose of any unused medication after the expiration date.

What are the possible side effects of using this medication?
Headache, vulvovaginal pruritus, genital candidiasis, leukorrhea, vaginitis, vaginal discomfort, vaginal pain, diarrhea, abdominal pain, nausea, bacterial vaginosis, vaginal hemorrhage, urinary tract infection, back pain, arthritis, arthralgia, skeletal pain, upper respiratory tract infection, sinusitis, flu-like symptoms

Note this is not a complete list of side effects, only the most common.