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[joziel]

I know it's always said that Vagifem is incredibly low dose blah etc, and that a year's worth of Vagifem is the same as one HRT oral tablet. 

But someone explain this to me then...

Vagifem is 10mcg of estradiol, right? And a 25mcg patch releases 25mcgs of estradiol into you each day, right?? Am I missing something?

How is Vagifem such a low dose then? It's under half a 25mcg patch, but it's not THAT low and definitely not the equivalent of a year's worth of transdermal HRT...??

   Someone explain... have I totally misunderstood something?!

[Taz2]

IGood question! Is it based on how often we use vagifem i.e. the instructions after initial loading are twice a week not every night.

Taz 

[Tora]

Perhaps the size of the compared one pill per year is a 2mg dose?
Vagifem twice a week would be 20mcg. 52 weeks would total 1040mcg which is less than 2mg.
Can’t think of other explanation but it’s very late!

[Dierdre]

Yes, it's compared to the oral pill dosage which is usually 1mg or 2mg tablet per day. There's1000 mcg in 1mg and Vagifem is only 10mcg. If you use 5 vagifem per week = 50mcg x 52 weeks = 2600 mcg. Thats 2.6 1mg tablets per year.

[joziel]

Thanks Dierdre I see that….

But why are we choosing to compare it to an oral pill instead of transdermal?

It just seems a bit arbitrary. I mean I think it’s said that a 1mg oral pill is equivalent to a 25mcg patch (trying to remember off top of my head).

So a 10mcg pessary, especially when used every day (as I’ve been using it) doesn’t sound low in that case. 10mcg vaginally compared to 25mcg transdermally 🤷‍♀️🤔?

I’m questioning this because I’ve had bad side effects from taking estrogen by way of palpitations for hours and high blood pressure. I had to stop all patches or systemic estrogen about 11 days ago now. My blood pressure is now normal and for most of the days I’m fine but I’m still palping all night. And night is of course when I use my nightly Vagifem and Ovestin.

I know it’s said we don’t absorb these systemically but I’ve done a lot of googling of people’s experiences with it and it seems that some people definitely believe they absorb it systemically…..

[Joaniepat]

Joziel, the monograph for Vagifem, which was actually trialled on the old 25 mcg version, showed that it did not increase serum beta estradiol levels in the trial participants. I think that's the main thing, ie, local oestrogen stays local.
JP x

[Tora]

Hi Joaniepat, do you know what was the reasoning behind the strength reduction in Vagifem please?

[joziel]

Hmm, thanks JP, that reassures me a bit. And I’ve heard that before…

But definitely there are women who have experienced palps after taking Vagifem. These are women in a vaginal atrophy group who aren’t also on systemic HRT.

And there was one member here in a post that came up many years ago who could tolerate Vagifem 2x weekly but more frequently meant she got the palps that estrogen caused her.

And many other women believe it affects them systemically (many positively, not just negatively). 

The vagina (and anus) are known ways that many other meds can be taken for systemic effect. 🤷‍♀️

[Jenna]

Thought this might interest you joziel:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4354766/

[CLKD]

Some have experienced headaches when they begin with Vagifem which go away after a couple of weeks. 

My GP never hesitated to prescribe 'ovestin' even though I had breast surgery in the 1990s.  I couldn't have coped with the VA symptoms with treatment.

[Marchlove]

Here’s another one Joziel

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3234898/

[Joaniepat]

Hi Joaniepat, do you know what was the reasoning behind the strength reduction in Vagifem please?

I believe they had two versions in production, 10 & 25 mcg. The higher dose was discontinued for "commercial reasons". It is worth noting that the licensed dose for this product is still 50 mcg per week, as they did not apply for a new license for the lower dose product.
JP x

[Ayesha]

What an interesting thread! I have been taking Vagifem pessary daily for nearly a year now with Ovestin locally. Just lately I have noticed slight hot flushes returning, and those palps I have read so much about on here too also mild anxiety like I used to get years ago.

[Dierdre]

Women managed  much better for years on the 25mcg dose twice weekly  and now have to use more to achieve the same level of comfort on the 10mcg dose. Both dosages were classed as safe but I think a lot more profit would be involved in the lower dose as we have to now use twice as much! This was highlighted at the time if I remember when the 25mcg was discontinued and there were many posts on here regarding this.

Not sure why we compare to the oral tablet instead of transdermal.  I didnt realise 25mcg  patch was equivalent to 1mg tablet.

Vagifem definately went systemic for weeks when I first used it, sore boobs, cramps etc but after the vaginal tissue plumps up less gets through. Some always goes systemic but as its such a minuscule amount we don't need a progesterone and I hope I benefit from the extra estrogen.

You must be super sensitive to the smallest amounts joziel,  not sure how long you've been on Vagifem, maybe it will settle after using a while.

[Dierdre]

What an interesting thread! I have been taking Vagifem pessary daily for nearly a year now with Ovestin locally. Just lately I have noticed slight hot flushes returning, and those palps I have read so much about on here too also mild anxiety like I used to get years ago.

I suffered very badly with night sweats and palpatations after a dose of covid at Christmas. Had ecg and was ok after a few weeks but this is common after covid and also the vaccination . Makes you think your HRT is not working.