What Is Vagifem? Uses, Dosage, and What You Need to Know in 2026

Vagifem is a prescription vaginal estrogen therapy used to treat common and often uncomfortable symptoms of menopause that affect the vagina and surrounding area. If you or your provider has mentioned Vagifem as a treatment option, here's a complete overview of what it is, what it treats, how to use it, and what to expect.

What Is Vagifem?

Vagifem is the brand name for estradiol vaginal inserts, manufactured by Novo Nordisk and first approved by the FDA in 1999. Each Vagifem insert contains 10 micrograms (mcg) of estradiol — the same type of estrogen your ovaries naturally produce before menopause.

The insert is a small, white, film-coated tablet about 6 millimeters in diameter that is placed inside the vagina using a disposable, single-use applicator. Once inserted, it dissolves slowly over several hours, releasing estradiol directly into vaginal tissue.

What Is Vagifem Used For?

Vagifem is FDA-approved to treat moderate to severe menopausal changes in and around the vagina — a condition now called genitourinary syndrome of menopause (GSM), sometimes also called vulvovaginal atrophy or atrophic vaginitis. Symptoms that Vagifem treats include:

• Vaginal dryness
• Vaginal burning and irritation
• Vaginal itching and soreness
• Painful intercourse (dyspareunia) related to vaginal dryness and thinning
• Painful urination related to vaginal changes

These symptoms occur because estrogen levels decline after menopause, causing the vaginal lining to thin, dry out, and become more fragile. GSM affects up to 50% of postmenopausal women and doesn't improve on its own without treatment — in fact, it typically worsens over time if untreated.

Is Vagifem a Controlled Substance?

No. Vagifem is not a controlled substance and has no DEA schedule. It requires a prescription, but any licensed prescriber — including your primary care doctor, OB/GYN, nurse practitioner, or a telehealth provider — can prescribe it without special authorization.

Vagifem Dosage: How to Use It

The FDA-approved dosing schedule for Vagifem is:

1. Loading phase: 1 insert placed inside the vagina once daily for 2 weeks.
2. Maintenance phase: 1 insert twice weekly (e.g., every Tuesday and Friday) ongoing.

You should use Vagifem at the same times on your chosen dosing days. It can be used at any time of day that is most comfortable for you. The insert dissolves over several hours inside the vagina — you don't need to remove it.

How to Insert Vagifem (Step by Step)

1. Wash your hands thoroughly with soap and water.
2. Tear off a single applicator from the strip and open the plastic packaging.
3. Select a comfortable position — either lying on your back with knees slightly bent, or standing with one foot on a raised surface.
4. Gently insert the applicator into your vagina as far as is comfortable (no more than halfway in) without forcing.
5. Press the plunger fully to release the insert. Remove and dispose of the applicator.
6. Wash your hands again.

How Long Until Vagifem Works?

Some patients notice improvement in vaginal dryness and comfort within the first few weeks of treatment, particularly during the daily loading phase. Maximum benefit is typically seen after 8-12 weeks of regular use. For painful intercourse and significant atrophy, allow 12 weeks to fully assess the medication's effect.

How Is Vagifem Stored?

Store Vagifem at room temperature: 68°F to 77°F (20°C to 25°C), with brief excursions permitted between 59°F and 86°F (15°C to 30°C). Do not refrigerate. Keep out of reach of children.

What Are the Available Formats?

Vagifem comes in cartons of 8 inserts (NDC 0169-5176-03) or 18 inserts (NDC 0169-5176-04). The 8-count carton covers the 2-week loading phase exactly; the 18-count carton provides approximately 9 weeks of maintenance dosing (twice weekly).

Want to know what side effects to expect? Read our complete guide to Vagifem side effects.