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Generic name: Estradiol vaginal tablets
Brand names: Vagifem

Why is Vagifem prescribed?

As estrogen levels decline during menopause, vaginal tissues tend to shrink and lose their elasticity--sometimes producing a condition known as atrophic vaginitis. Inserted in the vagina on a regular basis, Vagifem tablets provide a local source of estrogen replacement without passing through the rest of the system. This helps relieve such symptoms of atrophic vaginitis as vaginal dryness, soreness, and itching.

Most important fact about Vagifem

Because estrogen replacement therapy is not advisable if you are in any danger of developing cancer, your doctor should take a complete medical and family history--and do a complete physical exam--before prescribing Vagifem. As a general rule, you should have an examination at least once a year while using this product.

How should you take Vagifem?

Each Vagifem tablet comes in its own disposable applicator. Insert the applicator as far into the vagina as you find comfortable, stopping when the applicator is half inside. Gently press the plunger in the applicator until you here a click and the plunger is fully depressed. This will release the Vagifem tablet. Conclude by gently removing the applicator and discarding it as you would a tampon applicator.

The Vagifem tablet can be inserted at any time of day, but it's advisable to do each insertion around the same time.

--If you miss a dose...

Apply it as soon as you remember. If it is almost time for your next dose, skip the one you missed and return to your regular schedule. Never try to "catch up" by doubling the dose.

--Storage instructions...

Store at room temperature.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe to continue using Vagifem.

• More common side effects may include:
  Abdominal pain, allergic reactions, back pain, genital itching, headache, skin rash, upper respiratory infection, vaginal spotting or discharge, yeast infection

Why should Vagifem not be prescribed?

Do not use Vagifem if there is any chance that you have breast cancer or any other cancer stimulated by estrogen. Avoid Vagifem if there is a possibility that you are pregnant. Do not use Vagifem if estrogen products have given you clotting problems in the past, or if you currently have phlebitis or other clotting disorders. Also avoid Vagifem if you have unexplained genital bleeding or the metabolic disorder known as porphyria, and do not use this product if it causes an allergic reaction.

Special warnings about Vagifem

Estrogen replacement therapy is associated with a slight increase in the chances of heart disease, high blood pressure, blood clots, gallbladder disease, excessive calcium levels, and cancer of the uterus. There is also mounting evidence that it may increase the risk of breast cancer.

Because of these possibilities, get in touch with your doctor right away if you develop any of the following:

Abdominal pain, tenderness, or swelling
Abnormal bleeding from the vagina
Breast lumps
Coughing up blood
Difficulty with speech
Dizziness or fainting
Pain in your chest or calves
Severe headache or vomiting
Sudden shortness of breath
Vision changes
Weakness or numbness of an arm or leg
Yellowing of the skin or eyes

Because estrogen can affect the ability to handle blood sugar, diabetic women should use this product with caution. Be alert, too, for signs of fluid retention, which can be especially harmful for people with asthma, epilepsy, migraine, a heart condition, or a kidney disorder. Estrogen has also been known to trigger huge spikes in triglyceride levels, leading to problems in the pancreas.

If you have a liver condition, use Vagifem with caution and make sure your doctor is aware of the situation. Women with liver problems have difficulty processing estrogen.

Any vaginal infection you may have should be cleared up before you begin using Vagifem.

Possible food and drug interactions when using Vagifem

There is no information on interactions with Vagifem.

Special information if you are pregnant or breastfeeding

Vagifem must not be used during pregnancy, and is not intended for nursing mothers.

Recommended dosage

The usual dosage is 1 tablet a day for the first 2 weeks, then 1 tablet twice weekly. Every 3 to 6 months, the doctor will see if the dosage can be reduced or discontinued.

Overdosage

An overdose from a vaginal tablet is unlikely. An oral overdose of estrogen could be expected to cause the symptoms listed below.

• Symptoms of estrogen overdose may include:
  Nausea, vomiting, vaginal bleeding