What is Vagifem?
Vagifem (generic name estradiol 17-B) is a synthetic estrogen replacement medication used in postmenopausal women. It functions to treat atrophic vaginitis. Vagifem helps restore this lack of estrogen and relieves the symptoms of atrophic vaginitis.
What is atrophic vaginitis?
Atrophic vaginitis is an inflammation of the vagina due to a thinning and shrinking of the tissues surrounding the vagina, as well as a decrease in the lubrification of the vaginal area. The most common cause is due to menopause and the subsequent decreased levels of estrogen. Symptoms include vaginal soreness, painful intercourse, dryness, pressure andwhite discharge due to increased infections. Urinary symptoms may include painful urination, blood in the urine, incontinence, and increased frequency of urination.
How do I take Vagifem?
Vagifem is supplied as a tablet with an applicator device to be inserted into the vagina. DO NOT SWALLOW A VAGIFEM TABLET. Using the applicator device, a tablet is inserted into the vagina as far as is comfortable. It is important to remember not to insert the applicator too high into the vagina as this may cause accidental injury. Upon initiation of Vagifem therapy, one tablet is inserted into the vagina daily (usually at bedtime) for the first 2 weeks, then twice weekly thereafter. It is important to note that usually a patient will not notice an improvement in their symptoms for the first 2 weeks as the estrogen levels will accumulate slowly to premenopausal levels.
What are the potential side effects of Vagifem?
Vagifem, in general will not have the side effects of oral estrogen therapy (estrogen tablets, most commonly used-Conjugated estrogens).
The potential side-effects and their potential occurrence are listed below. Further, it is important to note that usually side-effects will occur early in treatment and subside or occur with a decreased frequency as a patient will adapt to Vagifem treatment.
-postmenopausal bleeding (13%)
-breast pain (7%)
-vaginal itching (5%)
-headache (4%)
-abdominal pain (4%)
-perineal pain (6%)
-yeast infections (1%)
There exists significant debate about the appropriate usage of any estrogen product in postmenopausal women. Many patients may have heard about the WHI (Women's Health Initiative) trial. In this trial, it was discovered that estrogen supplementation in postmenopausal women caused an increased risk of heart attacks, strokes, and coronary events in treated patients. Further, it is also noted that estrogen supplementation may increase the risk of certain cancers, ex. breast and uteran cancers.
Outlined below, is an important guide to who should not take Vagifem and some general monitoring parameters.
1. Patients with a history of breast cancer. This may include family members with breast cancer. Vagifem may potentially increase the risk of this occurrence and is strongly contraindicated in any patient who may be at risk. Further, regular self-monitoring of potential tumors is indicated.
2. Patients with a history of high blood pressure. Estrogen may increase blood pressure levels. Only under the careful monitoring of your primary care physician, Vagifem should be used in such patients. Also, regular monitoring of blood pressure is advised during Vagifem treatment.
3. Patients with a history of cancer of the uterus. Estrogen may increase the potential development of uteran cancers. Patients should monitor for any signs of bleeding of the uterus and report immediately to their primary care physician if this occurs.
4. Any history of clots. This may include clots in the lungs or legs. Vagifem may cause an increased level of clotting in the body and this can be a potential lethal side effect.
IMPORTANT POINTS FOLLOWING VAGIFEM TREATMENT
1. Patients should be assessed annually for Vagifem treatment. The patient should discuss with their primary care physician, the benefits versus the risks of Vagifem therapy. Generally, it is advised not to continue Vagifem treatment for more than 5 years.
2. Patients should conduct regular self breast examinations.
3. Patients should report immediately any bleeding in the vaginal area.
4. Patients 65 years or older treated with an estrogen may be at increased risk to develop potential dementia, such patients should discuss actively with their primary care physician the risk versus the benefit of Vagifem therapy.
5. Patients with a history of migraines or epilepsy may develop an increased occurrence of migraine headaches or epileptic seizures. Discussion of the risk versus the benefit of administration in these patients is advised.
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