Comprehensive medication guide to Imvexxy 4 mcg Starter Pack including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$35–$75 copay for commercially insured patients with prior authorization; typically Tier 3–4 on commercial formularies. Most Medicare Part D plans do not cover Imvexxy. The Mayne Pharma savings card can reduce copays to as low as $35/prescription for eligible commercially insured patients.
Estimated Cash Pricing
$543–$647 retail for the 18-insert starter pack; as low as $404 with SingleCare, or $35/prescription with the Mayne Pharma savings card for commercially insured patients. The 8-insert maintenance pack retails for $263–$311 and can be found for as low as $50 with a GoodRx coupon.
Medfinder Findability Score
52/100
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Imvexxy (estradiol vaginal inserts) is a prescription local estrogen therapy approved by the FDA in 2018 to treat moderate to severe dyspareunia — painful sexual intercourse — which is a common symptom of vulvar and vaginal atrophy (VVA) due to menopause. The 4 mcg starter pack contains 18 inserts designed for the initial loading phase of treatment.
Imvexxy is a small, soft, light-pink, tear-shaped softgel that is placed directly into the vagina without an applicator. It is manufactured by Mayne Pharma (formerly TherapeuticsMD) and is available in 4 mcg and 10 mcg doses. The 4 mcg dose is the lowest available estradiol vaginal insert dose.
On December 8, 2025, the FDA approved the first generic version of Imvexxy — estradiol vaginal inserts in both 4 mcg and 10 mcg strengths — providing patients with a more affordable option as generic availability expands in 2026.
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When placed in the vagina, the Imvexxy softgel dissolves on contact with the vaginal mucosa and releases estradiol directly onto vaginal tissue. Estradiol then binds to nuclear estrogen receptors inside vaginal epithelial cells, activating genes responsible for cell growth, proliferation, and differentiation.
This local estradiol stimulation restores the vaginal epithelium by thickening the vaginal lining (increasing superficial cells), improving natural lubrication and blood flow, restoring the vaginal pH to a healthy acidic range (3.8–4.5), and rebuilding collagen and elastin for improved elasticity. These changes reverse the tissue atrophy caused by menopause-related estrogen loss.
Because Imvexxy is delivered locally at a very low dose (4 or 10 micrograms), systemic absorption is minimal — particularly with the 4 mcg dose, where serum estradiol levels in clinical studies remained within the normal postmenopausal range. This makes Imvexxy appropriate for women who prefer local therapy with limited systemic estrogen exposure.
4 mcg — vaginal insert (softgel)
Lowest available dose; recommended starting dose; available in 18-insert starter pack and 8-insert maintenance pack
10 mcg — vaginal insert (softgel)
Higher dose for patients needing more symptom relief; available in 18-insert starter pack and 8-insert maintenance pack
Imvexxy is not on the FDA's drug shortage list, but it can be difficult to find at standard retail pharmacies. As a brand-name-only drug (until the December 2025 generic approval), Imvexxy's higher price point and limited insurance coverage reduce the number of pharmacies that stock it regularly. Many patients report visiting multiple pharmacies before successfully filling their prescription.
The most common availability issues include: pharmacies not stocking Imvexxy routinely due to low local prescription volume; Medicare Part D non-coverage reducing patient traffic; and, during the generic transition, some pharmacies shifting inventory away from the brand. The 4 mcg starter pack (18 inserts) is particularly likely to be out of stock since it is only needed for the initial loading phase.
If your pharmacy doesn't have Imvexxy in stock, medfinder can call pharmacies near you to find which ones currently have it available, saving you hours of searching and calling.
Imvexxy is not a controlled substance, which means any licensed prescriber with prescribing authority can write a prescription for it — no special DEA registration or certification is required. Prescribers who commonly prescribe Imvexxy include:
Imvexxy can be prescribed via telehealth in most states without an in-person visit, making it accessible through platforms like Midi Health, Gennev, Alloy Women's Health, and general telehealth services. This is especially convenient for women in rural areas or those who prefer the privacy of a virtual consultation.
No. Imvexxy (estradiol vaginal inserts) is not a controlled substance. It is not listed on the DEA's schedules and has no abuse potential. Any licensed prescriber with prescribing authority can write a prescription for Imvexxy — no special DEA registration or certification is required.
Because Imvexxy is not a controlled substance, it can be prescribed via telehealth without an in-person visit in most states, and prescribers can provide refills without the limitations that apply to Schedule II–V medications. Patients do not need to physically visit a pharmacy for controlled substance protocols — Imvexxy prescriptions can be sent electronically, called in, or filled via mail-order like any standard prescription medication.
The most common side effects include:
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Generic estradiol vaginal inserts
FDA-approved December 2025; bioequivalent to Imvexxy in 4 mcg and 10 mcg; expected to be more affordable and widely available
Vagifem (estradiol vaginal tablet, 10 mcg)
Applicator-based insert; 10 mcg only; generic available (Yuvafem); widely stocked; lower cost than Imvexxy brand
Estring (estradiol vaginal ring)
Soft vaginal ring replaced every 90 days; steady continuous low-dose estradiol; convenient for patients who prefer less frequent dosing
Estrace Vaginal Cream (estradiol 0.01%)
Vaginal cream with applicator; generic available; most affordable option; flexible dosing schedule
Osphena (ospemifene 60 mg)
Oral SERM tablet; non-vaginal administration; FDA-approved for dyspareunia and vaginal dryness; option for women who cannot use vaginal estrogen
Prefer Imvexxy 4 mcg Starter Pack? We can find it.
CYP3A4 inducers (rifampin, carbamazepine, phenytoin, St. John's Wort)
moderateMay increase estradiol metabolism, reducing Imvexxy effectiveness
CYP3A4 inhibitors (itraconazole, ketoconazole, clarithromycin)
moderateMay decrease estradiol metabolism, increasing systemic estradiol levels
Levothyroxine and thyroid hormone replacements
moderateEstrogen increases thyroid-binding globulin; may require thyroid hormone dose adjustment; monitor TSH
Warfarin and anticoagulants
moderateEstrogen may reduce anticoagulant effect; monitor INR when starting or stopping Imvexxy
Grapefruit juice
minorMinor CYP3A4 inhibition may slightly increase estradiol levels; clinically minor at vaginal doses
Corticosteroids (prednisone, etc.)
minorEstrogen may enhance corticosteroid effects; monitor for enhanced corticosteroid side effects
Imvexxy 4 mcg is one of the most targeted, lowest-dose options for treating the vaginal symptoms of menopause. Its applicator-free design, bioidentical estradiol formulation, and ultra-low dose make it a preferred choice for many postmenopausal women who want local symptom relief with minimal systemic estrogen exposure. Both dose strengths (4 mcg and 10 mcg) were proven effective in clinical trials, with significant improvement in dyspareunia at 12 weeks.
The primary challenges with Imvexxy in 2026 are cost and availability. At $543–$647 for the starter pack without insurance and limited Medicare coverage, affordability remains a barrier for many patients. The December 2025 FDA approval of the first generic estradiol vaginal inserts represents a significant step toward broader access and lower costs.
If you've been prescribed Imvexxy but can't find it at your local pharmacy, medfinder calls pharmacies near you to find which ones have it in stock and texts you the results — saving you the frustration of calling around yourself. Use medfinder to get your prescription filled today.
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