Comprehensive medication guide to Vagifem including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$60–$80 copay for most commercial insurance plans covering Vagifem (approximately 76% of commercial plans); fewer than 10% of Medicare Part D plans cover Vagifem. Generic estradiol vaginal inserts are often covered at lower Tier 1–2 copays. Prior authorization and step therapy may apply.
Estimated Cash Pricing
$278–$377 retail for brand-name Vagifem (8 inserts, 10 mcg); as low as $47–$81 with GoodRx or SingleCare coupons for generic estradiol vaginal inserts (Yuvafem) at a 30-day supply.
Medfinder Findability Score
78/100
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Vagifem is the brand name for estradiol vaginal inserts (10 mcg), manufactured by Novo Nordisk and FDA-approved since 1999. Each insert is a small, white, film-coated tablet that is placed inside the vagina using a disposable applicator. Once inserted, it dissolves slowly over several hours, releasing estradiol directly to vaginal tissue.
Vagifem is prescribed to treat moderate to severe genitourinary syndrome of menopause (GSM) — also called vulvovaginal atrophy — including vaginal dryness, burning, irritation, itching, painful intercourse (dyspareunia), and discomfort during urination. These symptoms affect up to 50% of postmenopausal women and worsen without treatment.
FDA-approved generic versions of Vagifem — including Yuvafem (Amneal Pharmaceuticals) and unbranded generics from Teva and Glenmark — are bioequivalent and available at significantly lower cost. Vagifem is not a controlled substance and can be prescribed by any licensed healthcare provider.
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Vagifem delivers estradiol directly to vaginal tissue via a dissolvable insert. Because it is administered vaginally rather than orally, it bypasses first-pass hepatic metabolism, allowing a very small dose to act locally with minimal systemic absorption. After 12 weeks of use, mean blood estradiol levels remain at approximately 5.5 pg/mL — near normal postmenopausal baseline.
Estradiol from Vagifem binds to estrogen receptors (ERα and ERβ) in vaginal epithelial cells, activating genes that stimulate cell proliferation and tissue restoration. This causes the vaginal lining to thicken and become more elastic, increases glycogen production (which feeds beneficial Lactobacillus bacteria), lowers vaginal pH toward its naturally acidic state, and restores natural lubrication through improved blood flow and secretory activity.
Because it acts locally with minimal systemic estrogen elevation, Vagifem does not relieve systemic menopause symptoms such as hot flashes or night sweats. It is intended specifically for the treatment of vaginal and genitourinary symptoms.
10 mcg — vaginal insert
Standard FDA-approved strength; one insert daily for 2 weeks (loading), then one insert twice weekly (maintenance)
As of 2026, Vagifem is not on the FDA's official Drug Shortage list. It is generally available at major chain pharmacies (CVS, Walgreens, Walmart, Kroger) and through mail-order pharmacy services. However, because it is a specialty brand-name vaginal estrogen insert manufactured in Denmark, individual pharmacy locations may carry limited stock. Localized, temporary out-of-stock situations are common — particularly at smaller pharmacies or those that primarily stock the generic (Yuvafem) rather than the brand.
FDA-approved generic estradiol vaginal inserts (Yuvafem, Teva, Glenmark) are more broadly stocked at many pharmacies and are typically easier to find. If you need help locating Vagifem or its generic at a pharmacy near you, medfinder contacts local pharmacies on your behalf to find out which ones can fill your prescription and texts you the results.
Patients on Vagifem are advised to refill prescriptions proactively — 7-10 days before running out — and to request 90-day supplies when possible to reduce the frequency of refill searches. Mail-order pharmacy is an excellent option for consistent supply.
Because Vagifem is not a controlled substance, it can be prescribed by any licensed healthcare provider authorized to write prescriptions in their state. There are no special DEA registration requirements or quantity/refill restrictions beyond standard prescription rules.
Menopause-specialized telehealth services have made obtaining a Vagifem prescription more accessible than ever, allowing patients to complete a virtual consultation and receive a prescription without an in-person appointment. This is particularly valuable for patients in rural areas or those with limited access to gynecology specialists.
No. Vagifem (estradiol vaginal inserts) is not a controlled substance and has no DEA schedule. Estradiol is an estrogen hormone therapy, and hormone therapies are not subject to the prescribing restrictions, quantity limits, or refill limitations that apply to controlled medications such as opioids or benzodiazepines.
Because Vagifem is not controlled, it can be prescribed by any licensed healthcare provider — including primary care physicians, OB/GYNs, nurse practitioners, physician assistants, and telehealth providers — without special DEA authorization. Prescriptions can be written for up to a 90-day supply in most states, and refills can be authorized on the original prescription up to the state-permitted maximum.
The most common side effects of Vagifem (reported in ≥5% of patients in clinical trials) are:
Serious side effects — call your doctor right away if you experience:
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Yuvafem
FDA-approved branded generic of Vagifem (Amneal); same 10 mcg estradiol insert; bioequivalent; typically lower cost
Imvexxy
Estradiol soft gel insert (4 or 10 mcg) by TherapeuticsMD; no applicator needed; brand-only; approved for dyspareunia
Estring
Estradiol vaginal ring (75 mcg/day) by Pfizer; 3-month duration; brand-only; treats GSM symptoms continuously
Estrace Vaginal Cream
Estradiol vaginal cream; generic available; often less expensive; applied with measured applicator; clinically equivalent to inserts
Premarin Vaginal Cream
Conjugated estrogens cream by Pfizer; brand-only; effective for GSM; no generic available
Intrarosa
Prasterone (DHEA) vaginal insert; daily use; estrogen-free systemically; approved for dyspareunia due to menopause
Osphena
Ospemifene oral tablet 60 mg; SERM; approved for vaginal dryness and dyspareunia; no vaginal administration needed
Prefer Vagifem? We can find it.
Rifampin
moderatePotent CYP3A4 inducer; may significantly decrease estradiol plasma concentrations and reduce Vagifem effectiveness
St. John's Wort
moderateHerbal CYP3A4 inducer; can substantially reduce estradiol levels and decrease Vagifem effectiveness
Phenobarbital / Carbamazepine / Phenytoin
moderateAnti-seizure medications; CYP3A4 inducers; may decrease estradiol levels
Ketoconazole / Itraconazole
moderateAzole antifungals; CYP3A4 inhibitors; may increase estradiol plasma concentrations
Erythromycin / Clarithromycin
minorMacrolide antibiotics; CYP3A4 inhibitors; may increase estradiol levels during antibiotic course
Ritonavir
moderateHIV protease inhibitor; potent CYP3A4 inhibitor; may significantly increase estradiol levels
Levothyroxine (thyroid replacement)
minorEstrogens may increase thyroid-binding globulin; monitor thyroid function tests; dose adjustment may be needed
Warfarin
moderateEstrogens may alter anticoagulant response; monitor INR when starting or stopping vaginal estrogen
Vagifem (estradiol vaginal inserts) is an effective, FDA-approved treatment for vaginal dryness, irritation, and painful intercourse caused by menopause. Its locally-acting, low-dose design means it provides meaningful relief with minimal systemic hormone exposure — making it a favorable option for many postmenopausal women, including those who are not candidates for systemic hormone therapy. FDA-approved generic versions (Yuvafem, Teva generics) are bioequivalent and available at significantly lower cost.
While Vagifem is not on the FDA's drug shortage list in 2026, localized availability gaps at individual pharmacies do occur. Patients should plan refills proactively, ask about generic availability, and consider mail-order pharmacy for consistent supply.
If you're having trouble finding Vagifem at your pharmacy, medfinder can help by contacting pharmacies near you to find out which ones have your medication in stock, and texting you the results.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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