Vaginal estradiol, available as a cream, insert, or ring, is a form of estrogen hormone used to increase estrogen levels in the vagina. It is often prescribed to postmenopausal women to alleviate vaginal dryness and itching. Yuvafem is one brand of vaginal estradiol.
What is Yuvafem and What is it Used For?
Yuvafem, also known as estradiol, is commonly used to reduce postmenopausal vaginal symptoms, such as vaginal dryness, burning, or itching. These symptoms arise due to the decline in natural estrogen levels during menopause, which can lead to vaginal dryness and irritation. Vaginal estradiol may reduce symptoms of menopause by raising estrogen levels in the vagina to improve vaginal health.
Estradiol may also be used for other conditions as determined by your healthcare provider.
How Yuvafem Works
Estrogen is an important hormone for maintaining vaginal health. During menopause, natural estrogen levels decrease, leading to vaginal dryness and irritation. Vaginal estradiol works by increasing estrogen levels in the vagina, thus improving vaginal health and reducing menopausal symptoms.
Dosage Forms and Strengths
Vaginal estradiol is supplied in various forms:
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- Vaginal Ring: 0.05 mg, 0.1 mg, 2 mg (e.g., Estring, Femring)
- Vaginal Insert: 10 mcg (e.g., Vagifem, Yuvafem)
- Vaginal Cream: 0.01% (e.g., Estrace)
Yuvafem is formulated as a white, round, film-coated tablet. It is intended only for vaginal administration.
How to Use Yuvafem
Yuvafem is intended for vaginal administration only and should be used as prescribed by your healthcare provider.
Each estradiol vaginal tablet is supplied in a single-use disposable applicator. Gently insert the applicator into the vagina as directed and press the plunger to release the medication. If the tablet falls out before using, throw it away and use a new applicator/tablet.
After starting with daily use for two weeks, vaginal estradiol is typically used twice a week (vaginal insert) or three times a week (vaginal cream). Follow your dosing schedule carefully. Do not increase the dosage or misuse the medication for a longer period than prescribed.
Vaginal estradiol rings should be removed after 90 days. If you are to continue using vaginal estradiol, a new ring can be put in after the old one is removed. If the ring comes out before 90 days have passed, rinse it with lukewarm water and put it back in place. Call your healthcare provider if you have trouble putting it back in.
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It is best to use the lowest dose of estrogen that works for the shortest length of time. Ask your healthcare provider how much and for how long you should use vaginal estradiol.
Consider using a calendar or app to help you remember when to use it next.
Storage Instructions
Proper storage is essential to maintain the efficacy of vaginal estradiol:
- Vaginal Insert: Store at room temperature, between 68°F to 77°F (20°C to 25°C). It can be exposed to temperatures between 59°F to 86°F (15°C to 30°C) for shorter periods. Store in a cool, dry place. Do not refrigerate.
- Vaginal Ring: Store at room temperature, between 68°F to 77°F (20°C to 25°C).
- Vaginal Cream: Store at room temperature, between 68°F to 77°F (20°C to 25°C). Avoid exposing it to temperatures above 104°F (40°C).
Store at room temperature away from moisture and heat. Do not store in the bathroom. Do not flush medications down the toilet or pour them into a drain unless instructed to do so.
Keep vaginal estradiol out of the reach of children.
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Common Side Effects
The most common side effects of vaginal estradiol are generally mild. Tell your healthcare provider if you have any of these side effects that bother you. These include:
- Headache
- Back pain
- Breast pain and tenderness
- Abnormal vaginal bleeding or spotting
- Itching, irritation, or burning sensation in the vagina
- Stomach cramps, bloating, nausea, vomiting, or diarrhea
- Hair loss
- Fluid retention (edema)
- Vaginal yeast infection
- Weight changes
There may be other side effects of vaginal estradiol that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine.
Serious Side Effects
While less common, vaginal estradiol can cause serious side effects. It is critical to be aware of these and seek immediate medical attention if they occur.
- Blood Clots: Vaginal estradiol may cause blood clots in your arteries or veins and could cause a stroke, heart attack, or venous thromboembolism, including a blood clot in the back of the eye (retinal vein occlusion), in the lungs (pulmonary embolism), or deep venous thrombosis (DVT). Stop using vaginal estradiol and get emergency help if you have any of the following signs of blood clots:
- Chest pain or pressure
- Fast or abnormal heartbeat
- Trouble breathing
- Pain in your back, jaw, throat, or arm
- Sweating, upset stomach, vomiting, or dizziness
- Sudden weakness on one side of your body
- Sudden and severe headache
- Slurred speech or trouble understanding speech
- Pain, swelling, or tenderness in your arm or leg
- Vision loss
- Bulging eyes
- Double vision
- Endometrial Cancer: You may be at higher risk for cancer in the lining of your uterus (endometrial cancer) if you use vaginal estradiol. Call your healthcare provider right away if you have any abnormal vaginal bleeding.
- Breast Cancer: You may be at higher risk for breast cancer if you use vaginal estradiol. Call your healthcare provider right away if you have any of the following symptoms:
- New lump in your breast or armpit
- Changes in the size, shape, texture, or temperature of your breast
- Nipple changes
- Ovarian Cancer: You may be at higher risk for cancer in your ovaries (ovarian cancer) if you use vaginal estradiol. Call your healthcare provider right away if you have any of the following symptoms:
- Unusual vaginal discharge
- Belly or back pain
- Need to pee more often or urgently
- Gallbladder Problems: Using vaginal estradiol may cause gallbladder problems, including cholecystitis and cholelithiasis (also known as gallstones). Call your healthcare provider right away if you have any of the following symptoms:
- Your skin or the whites of your eyes turning yellowish in color (also called jaundice)
- Fever
- Pain in your upper stomach area
- Stool (poop) that is clay-colored
- Memory Problems: Using vaginal estradiol may increase your risk for memory problems (dementia), especially if you are 65 or older. Call your healthcare provider if you or friends or family notice that you are having trouble with your memory.
- Increased Blood Pressure (Hypertension): Vaginal estradiol may increase your blood pressure or worsen it if you have a history of high blood pressure. Call your healthcare provider if your blood pressure increases while using this medicine. If you measure your blood pressure and the top number (systolic) is 180 mm Hg or higher or the bottom number (diastolic) is 120 mm Hg or higher, get medical attention right away. Increases in blood pressure may not be noticeable but look out for any of the following symptoms of severely high blood pressure:
- Sudden severe headache
- Chest pain
- Dizziness or confusion
- Trouble breathing
- Nausea or vomiting
- Blurry or other changes to vision
- Anxiety
- Buzzing in the ears
- Nosebleed
- Feeling of skipped heart beats
- Fluid Retention (Edema): Vaginal estradiol can cause fluid retention, also called edema. Fluid retention can cause serious issues in people with certain conditions, such as heart failure or kidney disease. Call your healthcare provider right away if you have any of the following symptoms:
- Chest pain
- Irregular heartbeat
- Shortness of breath
- Stretched or shiny skin
- Swollen body parts, such as the belly or ankles
- Severe Allergic Reactions: Vaginal estradiol may cause allergic reactions, which can be serious. Stop using vaginal estradiol and get help right away if you have any of the following symptoms of a serious allergic reaction:
- Breathing problems or wheezing
- Racing heart
- Fever or general ill feeling
- Swollen lymph nodes
- Swelling of the face, lips, mouth, tongue, or throat (angioedema)
- Trouble swallowing or throat tightness
- Itching, skin rash, or pale red bumps on the skin called hives
- Nausea or vomiting
- Dizziness, feeling lightheaded, or fainting
- Stomach cramps
- Joint pain
- Toxic Shock Syndrome: Toxic shock syndrome may happen in people using an estradiol vaginal ring. Toxic shock syndrome happens when an infection produces toxins that enter your blood. This triggers an immune response, which can be life-threatening. Remove your estradiol vaginal ring and call your healthcare provider right away if you have any of the following serious symptoms:
- Fever
- Nausea, vomiting, or diarrhea
- Dizziness or fainting
- Muscle pain
- A rash on your face and body that looks like a sunburn
- Vaginal Sores: Sometimes using a vaginal estradiol ring can cause some of the lining of the vagina to get very thin, or for sores to develop. This can be very painful. Remove your estradiol vaginal ring and call your healthcare provider right away if you have any of the following symptoms of vaginal thinning or sores:
- Pain or soreness of the vagina
- Vaginal bleeding
- Swelling, redness, or scapes in the vagina
Yuvafem and Weight Gain
While "weight changes" is listed as a potential side effect of Yuvafem, it's crucial to understand the nuances. Estrogen can influence fluid balance, which might lead to temporary fluid retention and a perceived change in weight. However, significant weight gain directly attributed to Yuvafem is not a commonly reported or well-established side effect.
Who Should Not Use Vaginal Estradiol?
Vaginal estradiol is not suitable for everyone. Contraindications include:
- Allergies to Ingredients: People who are allergic to estradiol, Estrace, Estring, Vagifem, Femring, Yuvafem, or any of the ingredients in the specific product dispensed should not use vaginal estradiol products.
- Blood Clots: Vaginal estradiol should not be used if you have now or have a history of blood clots in your veins, such as a deep venous thrombosis (DVT), or your lungs, such as a pulmonary embolism (PE).
- Breast Cancer: Vaginal estradiol should not be used if you have, are being evaluated to see if you have, or have previously had breast cancer.
- Estrogen Dependent Cancer: Vaginal estradiol should not be used if you have cancer that needs estrogen to grow. Examples of these cancers include ovarian cancer and endometrial or uterine cancer.
- Stroke or Heart Attack: Vaginal estradiol should not be used if you have had a stroke or heart attack.
- Unusual Vaginal Bleeding: Vaginal estradiol should not be used if you have abnormal bleeding from your vagina that has not been diagnosed by a healthcare provider.
- Thrombophilia: Vaginal estradiol should not be used if you have low blood levels of protein C, protein S, or antithrombin, or if you have a condition that increases your risk of developing a blood clot.
- Liver Problems: Vaginal estradiol should not be used if your liver is not working as well as it should be.
- Pregnancy: Do not use vaginal estradiol if you are pregnant.
Precautions Before Using Vaginal Estradiol
Before starting vaginal estradiol, inform your healthcare provider about all your health conditions and medications. Key considerations include:
- If you have a uterus: talk to your healthcare provider about whether adding a progestin is right for you.
- Surgery or Bedrest: Tell your healthcare provider about any bedrest or upcoming surgery that will require you to be immobile or not be able to get up and walk around normally.
- Current and Past Health Conditions: Disclose any history of unusual vaginal bleeding or spotting after menopause, cancer, heart problems, stroke, blood clots, high blood pressure, liver problems, asthma, diabetes, seizures, migraines, endometriosis, systemic lupus erythematosus, porphyria, thyroid or parathyroid problems, kidney problems, high blood calcium levels, hereditary angioedema, smoking, or gallbladder problems.
- High Triglyceride Levels: If you have high triglyceride levels, vaginal estradiol may make your triglycerides even higher.
- Pregnancy and Breastfeeding: People who can become pregnant are not usually prescribed vaginal estradiol. Estradiol passes into breast milk and can reduce milk production.
Drug Interactions
Vaginal estradiol may interact with other medicines and supplements. Always inform your healthcare provider about all medications, vitamins, and herbal products you are using. Significant interactions can occur with:
- St. John’s wort
- Phenobarbital or carbamazepine
- Rifampin
- Erythromycin or clarithromycin
- Ketoconazole or itraconazole
- Ritonavir
Also, avoid eating or drinking grapefruit or grapefruit juice while using vaginal estradiol, as it can increase estradiol levels in your blood and potentially cause serious side effects. Limit alcohol consumption, as it may increase the risk of liver damage.
Warnings and Precautions
Several warnings and precautions are associated with vaginal estradiol use:
- Yuvafem is intended only for vaginal administration.
- Systemic absorption occurs with the use of Yuvafem.
- Increased risks of stroke and DVT are reported with estrogen-alone therapy.
- Increased risks of PE, DVT, stroke and MI are reported with estrogen plus progestin therapy.
- Immediately discontinue estrogen with or without progestogen therapy if any of these occur or are suspected.
- Manage appropriately any risk factors for arterial vascular disease (for example, hypertension, diabetes mellitus, tobacco use, hypercholesterolemia and obesity) and/or venous thromboembolism (VTE) (for example, personal history or family history of VTE, obesity and systemic lupus erythematosus).
- An increased risk of endometrial cancer has been reported with the use of unopposed estrogen therapy in a woman with a uterus.
- Adding a progestogen to estrogen therapy in postmenopausal women has been shown to reduce the risk of endometrial hyperplasia, which may be a precursor to endometrial cancer.
- The use of estrogen-alone and estrogen plus progestin therapy has been reported to result in an increase in abnormal mammograms requiring further evaluation.
- All women should receive yearly breast examinations by a healthcare provider and perform monthly breast self-examinations.
- In addition, mammography examinations should be scheduled based on patient age, risk factors, and prior mammogram results.
- Estrogen administration may lead to severe hypercalcemia in women with breast cancer and bone metastases.
- Retinal vascular thrombosis has been reported in women receiving estrogens.
- Estrogens may be poorly metabolized in women with hepatic impairment.
- Estrogen administration leads to increased thyroid-binding globulin (TBG) levels.
- Estrogens may cause some degree of fluid retention.
- Exogenous estrogens may exacerbate symptoms of angioedema in women with hereditary angioedema.
- Estrogen therapy may cause an exacerbation of asthma, diabetes mellitus, epilepsy, migraine, porphyria, systemic lupus erythematosus and hepatic hemangiomas.
Monitoring and Follow-Up
Regular medical check-ups are essential while using vaginal estradiol. These visits may be every 3 to 6 months. Pelvic exams, breast exams, and mammograms may be needed to check for unwanted effects, unless your doctor tells you otherwise. Be sure to keep all appointments.
Important Considerations
- Do not share vaginal estradiol with other people, even if they have the same condition as you. It may harm them.
- People who are aged 65 or older can be at greater risk for some side effects from vaginal estradiol.
- It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly and does not cause unwanted effects.
- Using this medicine over a long period of time may increase your risk of breast cancer, endometrial cancer, or uterine cancer.
- Using this medicine may increase your risk of dementia, especially in women 65 years of age and older.
- Using this medicine may increase your risk for having blood clots, strokes, or heart attacks.
- This medicine may also affect the results of certain medical tests.
Managing Side Effects
If you experience any side effects, contact your healthcare provider. Some strategies for managing common side effects include:
- Headache: Over-the-counter pain relievers may help.
- Breast tenderness: Wearing a supportive bra may provide relief.
- Vaginal irritation: Ensure proper hygiene and avoid harsh soaps.