Imvexxy alternatives: What can I take instead of Imvexxy?

Compare Imvexxy alternatives | Premarin Vaginal cream | Estrace cream | Estring | Vagifem | Osphena | Natural alternatives | How to switch meds

Imvexxy, the brand name for estradiol vaginal inserts, is a prescription-only medicine that treats moderate to severe painful sex, a symptom of vulvar and vaginal atrophy (VVA), after menopause. Imvexxy is manufactured by TherapeuticsMD and was approved by the U.S. Food and Drug Administration (FDA) in 2018. 

Post-menopausal women’s health issues, such as VVA, are a major concern. VVA is a condition caused by decreased levels of estrogen along with a decreased blood supply to the vagina. VVA affects the vagina by impacting its ability to secrete lubricant, expand and contract, and grow new cells. Over time, blood flow diminishes, and the vagina and vulva shrink as cells die off and are not replaced, resulting in thinning, drying, and inflammation of the vaginal walls.

The first symptom of VVA is often lack of vaginal lubrication leading to vulvovaginal dryness and painful sexual intercourse (dyspareunia ). Thinning of the vaginal walls may also cause burning and itching, as well as frequent urination and urinary tract infections. Vaginal spotting, due to small tears in the vaginal skin, may also occur. 

Estrogen therapy, such as Imvexxy, is considered to be the most effective treatment for AVV however other hormone therapies are available. Continue reading to learn more about Imvexxy alternatives and how they work. 

What can I take in place of Imvexxy?

There are several FDA-approved options to treat AVV. Imvexxy alternatives include other estrogen vaginal inserts and estrogen cream products, conjugated estrogens, and an oral tablet. These options may be preferred over Imvexxy because of the different dosage forms and adverse event profiles.

Other alternatives to Imvexxy

• Femring (estradiol acetate vaginal ring)
• Yuvafem (estradiol vaginal tablet)

Top 5 Imvexxy alternatives

1. Premarin Vaginal Cream (conjugated estrogens)

Premarin Vaginal Cream is a cream containing a mixture of estrogen hormones, unlike Imvexxy, which contains the single estrogen hormone estradiol. When comparing the efficacy of estrogen products, estradiol (the ingredient in Imvexxy) and conjugated estrogens (the ingredients in Premarin) were found equally effective in treating menopausal symptoms in clinical studies. 

Premarin Vaginal Cream is applied directly to the affected area in the vagina using a special applicator and can be applied twice a week or in a cyclic regimen of 21 days of therapy followed by seven days off therapy to treat moderate to severe painful intercourse.

The FDA mandates that all products that contain estrogen must include a boxed warning, also called a black box warning, stating that the drugs may slightly increase the risk of heart attacks, strokes, blood clots and breast cancer. Common side effects of Premarin Vaginal Cream include headache, breast pain, irregular vaginal bleeding or spotting, stomach or abdominal cramps or bloating, nausea and vomiting, hair loss, fluid retention, and yeast infection.

2. Estrace Cream (estradiol vaginal cream)

Estrace Cream contains the same hormone (estrogen) as Imvexxy, and both are similar in effectiveness. Estrace Cream is indicated for symptoms of menopause, like vaginal dryness and irritation. Each gram of Estrace Cream contains 0.1 mg of estradiol. The usual dosage range is 2 to 4 g daily for one or two weeks, then gradually reduced to one-half of the initial dosage for a similar period. A maintenance dose of 1 g, one to three times a week, may be used thereafter. Estrace Cream is inserted high into the vagina using an applicator.

Estrace Cream carries the same boxed warning that all estrogen products have, stating that the drugs may slightly increase the risk of heart attacks, strokes, blood clots and breast cancer. Common side effects of Estrace Cream include nausea and vomiting, bloating, breast tenderness, headache, and weight changes. 

3. Estring (estradiol vaginal ring)

Estring is a soft, flexible ring that continuously releases estradiol, the same hormone as in Imvexxy, over a three month period to treat menopausal changes in and around the vagina. One Estring is inserted as deeply as possible into the upper one-third of the vagina. The ring remains in place continuously for three months, after which it is removed and, if deemed appropriate by the healthcare professional, replaced by a new ring. The need to continue treatment should be assessed every three to six months.

Estring carries the same boxed warning that all estrogen products have, stating that the drugs may slightly increase the risk of heart attacks, strokes, blood clots and breast cancer. Common side effects of Estring include headache, breast pain, irregular vaginal bleeding or spotting, stomach/abdominal cramps or bloating, nausea and vomiting, fluid retention, and yeast infection.

4. Vagifem (estradiol vaginal inserts)

Vagifem is a medicine that contains estradiol, the same hormone as in Imvexxy, in a vaginal insert that is placed in the vagina with an applicator. Each applicator contains a single insert containing a 10 mcg dose of Vagifem. During the first two weeks of treatment, one Vagifem 10 mcg insert is applied daily. Thereafter, one insert is applied twice weekly e.g., on Tuesday and Friday), as prescribed by the healthcare professional.

Vagifem carries the same boxed warning that all estrogen products have, stating that the drugs may slightly increase the risk of heart attacks, strokes, blood clots and breast cancer. Common side effects of Vagifem include headache, breast pain, irregular vaginal bleeding or spotting, stomach/abdominal cramps, bloating, nausea and vomiting, hair loss, fluid retention, and yeast infection. 

5. Osphena (ospemifene)

Osphena is a once-daily, oral, systemic, non-hormonal treatment for moderate to severe vaginal dryness and moderate to severe painful intercourse due to menopause. Although Osphena is not an estrogen and is taken by mouth, it works in the vagina by increasing the number of one type of beneficial cell (superficial cells), decreasing the number of another type of undesirable cell (parabasal cells), and lowering vaginal pH to more normal values. The dose for moderate to severe dyspareunia (painful intercourse) is 60 mg once daily with food.

Because Osphena works like an estrogen in the lining of the uterus, it carries the same boxed warning that all estrogen products have, stating that the drugs may slightly increase the risk of heart attacks, strokes, blood clots, and breast cancer. Common side effects of Vagifem include hot flashes or flushes, vaginal discharge, muscle spasms, headache, excessive sweating, heavy vaginal bleeding, and night sweats.

Natural alternatives to Imvexxy

There are a number of natural or over-the-counter treatment options available that are not prescription drugs to ease the discomfort of dyspareunia for women with mild symptoms:

Lubricants

Women experiencing dyspareunia have more difficulty with natural lubrication. When vaginal dryness is a cause of painful sex, using a lubricant can be helpful. OTC lubricants include water-based lubricants, silicon-based lubricants, and oil-based lubricants.

Vaginal Dilators

Vaginal dilator therapy can help with comfort during sexual intercourse and help to reduce or alleviate symptoms from VVA. Vaginal dilators are tools in a variety of sizes that are used to gradually stretch and release the pelvic floor muscles. They are ergonomically designed for smooth insertion to stretch the vagina so it regains or keeps its natural elasticity.

Breathing Exercises

Because of the nature of the abdominal wall, the muscles of the pelvic floor relax and drop slightly while inhaling. During exhalation the pelvic floor tightens and moves upward to its resting position. The appropriate breathing strategy to employ to reduce painful intercourse is to begin the insertion during inhalation and not to press or insert during exhalation. Continue to breathe until the discomfort has faded, then insert slightly more during the next inhalation phase.

Diet

Maintaining a healthy weight and body mass index (BMI) may also help reduce the symptoms of VVA. Also adding foods that contain plant estrogens, or phytoestrogens, such as soybeans, soy products, or flaxseed may help by reducing vaginal dryness. Limiting caffeine and alcohol intake and drinking plenty of water to stay hydrated may help as well. Other vitamins and supplements that may help include:

• Vitamin E
• Vitamin A
• Beta carotene
• B vitamins
• Omega-3 fatty acids

How to switch to an Imvexxy alternative

Switching from one prescription medication to another should be a decision made between you and your healthcare provider. Depending on which preparation of estrogen is being used (i.e., vaginal cream, insert, ring, or oral tablet) and other health conditions, you may need to taper or have a wash-out period before starting a new medication. In some cases, a new medication can be started as soon as the older one is discontinued. It is important to talk with your healthcare provider about changing medications prior to discontinuing the current one. Using a prescription discount card from SingleCare may help reduce the cost of Imvexxy or alternatives at local pharmacies.