Vagifem is a well-known brand of a vaginal tablet containing estradiol, which is used in the treatment of vaginal atrophy due to oestrogen deficiency in postmenopausal women. Is Vagifem the only option? Today I am looking at Vagifem alternatives, which are available in the UK.
What is Vagifem?
I already established that Vegifem is a type of hormone replacement medication (HRT) which contains estradiol hemihydrate. Each vaginal tablet contains estradiol hemihydrate equivalent to estradiol 10 micrograms.
Vagifem is administered into the vagina (this form of medicine is called a pessary) with an applicator to provide a local oestrogen therapy. In the UK Vagifem is supplied in a box containing 24 vaginal tablets and an equivalent number of applicators.
What is Vagifem used for?
As stated earlier, Vagifem is used for the management of vaginal atrophy. Vaginal atrophy is a common condition affecting postmenopausal women, which is characterised by vaginal discomfort, dryness, itching and painful intercourse (Lethaby et al., 2016).
Topical medicines containing oestrogens are the mainstream treatment of the above symptoms. These include estradiol gels, creams and pessaries. Systemic HRT medicines containing estradiol, for exampe Oestrogel and Oestrogel alternatives are unlikely to be prescribed just for the reatment of vaginal atrophy.
Topical oestrogens may be offered to women who also use a systemic form of HRT (tablets, patches). Women can manage symptoms of vaginal dryness with lubricants and moisturisers, which can be used alongside oestrogen treatment (NICE, 2019).
Can you buy Vagifem over the counter?
Vagifem is classified as prescription-only medication (POM) and therefore can only be issued on a prescription written by a qualified prescriber. However, a new medication will be launched in pharmacies in the UK called Gina. Gina is the brand name of the first over the counter estradiol vaginal tablets. Gina is equivalent to Vagifen, over the counter option since both medicines come in the same form and contain the same amount of active ingredient (10 micrograms of estradiol per pessary).
Vagifem alternatives: prescription only alternatives
All prescription-only Vagifem alternatives are licensed for the treatment of vaginal atrophy.
Vagirux 10 micrograms vaginal tablets
Vagirux is the first Vagifem alternative available in the UK since Vagifem came off the patent. Patents give exclusive marketing rights for a specific time period. Once expired, other companies can manufacture and supply the same drug to the market.
Since Vagirux is cheaper than Vagifem, pharmacies started to supply Vagirux instead of Vagifem on prescriptions written in a generic form (estradiol 10 micrograms vaginal tablets).
Can is still get Vagifem on a ‘generic’ prescription?
It depends, most pharmacies will supply the cheapest available drug if a prescription is written in a generic form. Otherwise, a pharmacy would make a loss when supplying Vagifem. Some pharmacies may have ‘deals’ with manufacturers of the drug, which may allow them to supply a branded product on a generic prescription without making a loss.
Women who want to get a supply of Vagifem instead of Vagirux should ask their GP or prescriber to issue a prescription calling for the supply of Vagifem and not the generic form of the drugs.
Vagifem vs Vagirux: what is the difference?
Both Vagifem and Vagirux contain the same active ingredient (10 micrograms of estradiol) and come in the same form (vaginal tablet).
The main difference between Vagifem and Vagirux from a patient’s point of view is the number of applicators available with each medication. Vagifem comes with an equivalent number of applicators to the number of doses (24), whereas Vagirux comes with a multiple-use applicator, which can be used up to 24 times.
Estring vaginal delivery system
Estring vaginal delivery system delivers 7.5 micrograms of estradiol per 24 hours over 90 days. Estring is not a popular method of estradiol delivery among women in the UK. Only 5964 prescriptions were issued for the Estring vs over 577012 for Vagifem during the same period (Mar ’21—Feb ’22, OpenPrescribing.net, 2022).
Estring is placed in the upper third of the vagina and left for 90 days. After 90 days, a new ring needs to be placed. The longest recommended treatment duration with Estring is two years.
Vagifem alternatives: Estriol alternatives
Estriol is also classified as oestrogen, however, it is less ‘strong’ than estradiol. Estriol is a metabolite of estradiol (estradiol is converted into estriol). Nevertheless, estriol has the same therapeutic application as estradiol and can be used to manage vaginal atrophy in postmenopausal women.
Ovestin cream as alternative to Vagifem
Ovestin cream contains 1mg of estriol (the strength of the cream is 0.1%). Women who use Ovestin cream to treat vaginal atrophy, usually apply the cream each day during the initiation of the treatment (up to 4 weeks), with frequency reduction of the application, aiming at 1 application twice a week. Ovestin comes with a reusable applicator allowing administration of the cream at the required dose (amount of the cream).
Estriol 0.01% cream
Estriol 0.01% cream contains 10 times less estriol as compared to Ovestin cream. Estriol cream 0.01% is commonly dispensed as a generic product or as Gynest 0.01% w/w cream. Estriol 0.01% cream is applied intravaginal, initially twice a day with a recommended maintenance dose of two applications per week. Follow the directions of the prescriber on Estriol 0.01% usage.
Blissel vaginal gel
Blissel gel contains 50 micrograms of estriol per 1 g of gel, giving its strength of 0.005%, which is the lowest strength of estriol containing creams/gels.
Initial, once-daily application is required, for up to 3 weeks. Two applications of gel are recommended as the maintenance dose. Blissel gel is applied with a reusable, dose marked applicator.
Imvaggis pessaries for vaginal atrophy
Each Imvaggis pessary contains 0.03mg of estriol. Pessaries are administered deep into the vagina. Initially, one Imvaggis pessary is administered daily (preferably at night) with a reduction of administration to one pessary twice a week as a maintenance dose. Imvaggis pessaries are not commonly prescribed in the UK (less than 5000 items in the last 12 months).
Vagifem alternatives: moisturises and lubricants
Vaginal lubricants can be used alongside HRT treatment. Vaginal lubricants are much less prescribed, since a good availability of different over the counter products, which do not require a prescription. A few common brands are listed below.
Replens MD vaginal moisturiser
Replens MD can be used to manage the main symptoms of vaginal atrophy including itching, irritation and discomfort. Replens MD does not contain any active drugs. As advertised, Replens MD is hormone-free.
Each application should provide symptom control for up to 3 days. Replens MD is available with a single reusable applicator, but also comes in a form of pre-filled single-use applicators.
A popular vaginal moisturiser. Sylk is advertised as a natural lubricant (drug, hormone, chemical-free) which can be used daily to control symptoms of vaginal dryness.
Vagisil medicated cream
Vagisil is a popular brand of vaginal creams, which can be used to manage symptoms of itching, burning and irritation. Vagisil cream contains a local anaesthetic called lidocaine. Vagisil, however, should not be used for longer than one week.
A number of other brands of vaginal moisturisers. A local pharmacy may stock one or two popular brands. Patients have a good choice of other similar products, which are available online.
Lethaby A, Ayeleke RO, Roberts H. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2016 Aug 31;2016(8):CD001500. doi: 10.1002/14651858.CD001500.pub3. PMID: 27577677; PMCID: PMC7076628. Available at: https://doi.org/10.1002/14651858.cd001500.pub3 Accessed on 02/05/2022
NICE (2019). Menopause: diagnosis and management. Available at: https://www.nice.org.uk/guidance/ng23/chapter/recommendations Accessed on 02/05/2022