Vaginal estradiol (Vagifem): low-dose help for dryness

• What it is: estradiol 10 mcg in a small vaginal tablet with a single-use applicator.
• Rx status: prescription only.
• Price: ₱154.50 per tablet (Watsons). Prices checked October 2026.
• Used for: GSM (genitourinary syndrome of menopause): vaginal dryness, itching, pain with sex, and urgency or frequent urination.
• Used with: can be used alone, or alongside systemic HRT.
• Alternative in PH: estriol cream (Ovestin).

For a monthly cost at your doctor's schedule, use the cost calculator.

Low estrogen thins the tissue of the vagina and urethra. Unlike hot flashes, this does not fade with time; it tends to get worse. Vaginal estrogen puts a small dose right where it is needed.

The UK label (SmPC) lists one tablet daily for two weeks, then one tablet twice a week (Vagifem SmPC). Check the leaflet in your PH pack. Your doctor sets your schedule.

What the guidelines say:

• The Menopause Society 2022: vaginal estrogen can be used at any age and for as long as needed.
• NICE NG23 (2024): offer vaginal estrogen to women with these symptoms, including women already on systemic HRT, and continue as long as needed (summary).

Because the dose is low and stays mostly local, the label says adding a progestogen is not recommended, and use should be reviewed at least once a year (Vagifem SmPC). It takes a few weeks to feel the difference, so give it time before deciding it does not work.

For the full comparison with Ovestin, see vaginal estrogen.

The UK label lists these as reasons not to use it, so talk to your doctor first if you have (Vagifem SmPC):

• Vaginal bleeding that has not been checked. Bleeding after menopause always needs a doctor first.
• Current or past breast cancer, especially if you take an aromatase inhibitor. Your oncologist should be part of the decision.
• A past estrogen-sensitive cancer of the womb.
• Active liver disease, a past blood clot, or recent angina or heart attack (the label lists these, though the dose is very low).

Side effects listed on the UK label include vaginal discharge or discomfort, vaginal bleeding or spotting, thrush, headache, tummy pain and nausea (Vagifem SmPC).

See a doctor soon for any new bleeding after menopause, or for pain, fever or unusual discharge.

Prices checked October 2026. One is priced per tablet and the other per tube, so compare monthly costs on the cost calculator using your doctor's schedule.

Both are prescription only, both are vaginal estrogen, and both are supported for long-term use. The choice is mostly about comfort and what your doctor prefers.

Dryness and pain with sex are easy to skip in a short consult. Bring them up first. You can ask:

• Are my symptoms from low estrogen, or could it be an infection or skin condition?
• Should I start with daily tablets, and when do I go to twice a week?
• Can I use this with my HRT, or instead of it?
• I had breast cancer: can I still use it, and should my oncologist agree first?
• What should I do if I spot or bleed?
• When should we review whether it is working?

Need the Taglish words to start the talk? See talk to your doctor.

• Estriol cream (Ovestin): a cream instead of a tablet, with a weaker estrogen.
• Systemic HRT, such as estradiol gel, can help dryness too, but many women still need vaginal estrogen on top. See HRT for menopause.
• Non-prescription vaginal moisturisers and lubricants can help comfort, especially during sex. They do not reverse the tissue changes.

More on symptoms: vaginal dryness and bladder. Ready to ask? Find a doctor.