Sexuality and Vaginal Dryness My gynecologist recommended Vagifem vaginal tablets for vaginal atrophy and dryness. Are they safe to use long-term? Vagifem is a tablet that sticks to the vaginal wall. It works by releasing a low dose of estradiol into the vagina. Most of this estrogen goes into the vaginal wall, but a small amount does also get into the blood stream. However, the amount that enters into the blood stream is far less than what would be present in a woman taking oral estrogen tablets. And because it is such a low dose, women who use Vagifem do not need to take a progestin or use progesterone cream. In contrast, women who take oral estrogens must also take a progestin, unless they have had a hysterectomy.
No one has conducted a long-term study of Vagifem. All of the studies that have been evaluated this drug's benefits and risks have followed women for 12 months, or less. However, most doctors believe that small doses of vaginal estrogens, like Vagifem, seem to be the safest way to treat vaginal atrophy. Furthermore, a recent position paper from the North American Menopause Society concluded that women could stay on a vaginal estrogen as long as necessary to treat vaginal atrophy or other problems, as long as other symptoms, such as vaginal bleeding, spotting, and breast pain did not occur.
Many women find that once the vagina is “plumped up” they can use a low dose of Vagifem intermittently. Some have found that using Replens, a vaginal moisturizer that can be purchased over the counter, can decrease their need to use Vagifem. Others have found that once the Vagifem improves the vagina, using lubricants, like KY Jelly or Astroglide when having sex, helps address their problems. (Sex, in and of itself, is good for the vagina because it helps keep the muscles in shape.)
We currently have no data on the use of Vagifem in women who have had breast cancer. But because of the very low systemic absorption and because vaginal dryness and painful intercourse can be a real quality-of-life issue, oncologists have become more comfortable having women who have had breast cancer use either Vagifem or the Estring to relieve vaginal dryness.
Women who have a history of endometriosis are advised to be cautious about their use of Vagifem. It’s typically suggested that women who have endometriosis use Vagifem for only a few weeks or months (if at all). Then, they should try to sustain the plumpness with other non-hormonal moisturizers, like Replens.
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