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estradiol vaginal (Vagifem)

Indications: - atrophic vaginitis Contraindiactions: - a remote history of gyncecologic cancer (breast cancer, uterine cancer, ovarian cancer) is not a contraindication [1,5] - vaginal estradiol does not alleviate systemic symptoms of menopause (hot flashes) [2] - vaginal estradiol may be safe in women taking tamoxifen for hormone-receptor positive breast cancer [5] Dosage: - 10 ug intravaginal tablet (suppository) QD for 2 weeks, then twice weekly (Vagifem) provides lowest controlled dose [1] - estradiol* vaginal cream - 2-4 g/day for 2 weeks - reduce to 1-2 g for 2 weeks - maintenance 1 g 2-3x/week [1] - use of high-strength creams containing estradiol 100 ug/g (0.01%) should be restricted to <= 4 weeks [4] - patients seem to prefer tablets or the vaginal ring over cream * no need for progestin to prevent endometrial hyperplasia [2] Adverse effects: - little to no systemic effects [3] - no endometrial hyperplasia [2] - 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 [4] - in women treated for breast cancer, vaginal estrogen therapy is not associated with increased risk for either breast cancer recurrence or mortality [5] Mechanism of action: - binds to estrogen receptors in vaginal epithelium

Interactions

drug adverse effects of estrogens

Related

Femring

General

17-beta estradiol (E2, Estrace, Estinyl, Delestrogen, Elestrin, Evamist, Imvexxy) vaginal agent

References

  1. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
  2. Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018.
  3. Bhupathiraju SN, Grodstein F, Stampfer MJ et al. Vaginal estrogen use and chronic disease risk in the Nurses' Health Study. Menopause 2018 Dec 17 PMID: 30562320
  4. Brown T EU Panel: Don't Use Estradiol Creams for Longer Than 4 Weeks Medscape - Oct 07, 2019. https://www.medscape.com/viewarticle/919501
  5. Cold S et al. Systemic or vaginal hormone therapy after early breast cancer: A Danish observational cohort study. J Natl Cancer Inst 2022 Jul 20; [e-pub]. PMID: 35854422 https://academic.oup.com/jnci/article/114/10/1347/6645744 - Cathcart-Rake EJ, Ruddy KJ. Vaginal estrogen therapy for the genitourinary symptoms of menopause: Caution or reassurance? J Natl Cancer Inst 2022 Jul 20; [e-pub] PMID: 35854417 https://academic.oup.com/jnci/article/114/10/1315/6645745
  6. Vigigem: estradiol vaginal tablets http://www.vagifem10.com/