Short answer: The Imvexxy label generally starts with the 4 mcg insert placed about two inches into the vagina, smaller end up. One insert is used daily at about the same time for 2 weeks, then one insert twice a week, every three to four days, such as Monday and Thursday. The dose is adjusted based on response, and a 10 mcg strength is also available.
This is what the FDA label says. Follow your prescriber. Your prescriber may use a different dose or pace than the label's standard schedule.
What Imvexxy is approved for: Imvexxy is a small, light pink, tear-shaped vaginal insert holding 4 mcg or 10 mcg of estradiol. It is approved to treat moderate to severe dyspareunia (pain with sex), a symptom of vulvar and vaginal atrophy, due to menopause (section 1.1).
Source
IMVEXXY (estradiol vaginal inserts) prescribing information, Patient Information and Instructions for Use. Mayne Pharma. DailyMed, version published October 1, 2026. DailyMed setid 6ce645c0-a550-4ae9-8dbd-3853ee8b7d26
The insert goes into the vagina with the smaller end up, to a depth of about two inches (section 2.1).
One insert daily at about the same time for 2 weeks, then one insert twice weekly, every three to four days (for example, Monday and Thursday) (section 2.1).
Imvexxy is only for use in the vagina and is not taken by mouth. The Instructions for Use suggest writing down the days the insert will be used (Patient Information, Instructions for Use).
Cartons hold 18 inserts (starter pack) or 8 inserts (maintenance pack) (section 16.1).
The table below is the label's schedule, from the Dosage and Administration section. Numbers are copied exactly; the section is in brackets.
| Item | What the label says |
|---|---|
| Usual start | Imvexxy 4 mcg |
| Weeks 1-2 | 1 insert daily at approximately the same time |
| After 2 weeks | 1 insert twice weekly, every three to four days (for example, Monday and Thursday) |
| Adjustment | Based on the clinical response |
| Strengths | 4 mcg and 10 mcg estradiol |
| Placement | Smaller end up, about two inches into the vaginal canal |
| Packs | 18 inserts (starter) or 8 inserts (maintenance) |
Estrogen is used at the lowest effective dose for the shortest duration consistent with treatment goals and risks, and women are re-evaluated periodically to see if treatment is still needed.
For a postmenopausal woman with a uterus, adding a progestogen is generally considered to reduce endometrial cancer risk. A woman without a uterus generally does not need one, though some with a history of endometriosis may.
If feasible, estrogens are stopped at least 4 to 6 weeks before surgery linked to a higher risk of blood clots, or during long immobilization.
Serum FSH and estradiol levels have not been shown to be useful in managing moderate to severe vulvar and vaginal atrophy.
Talks about the dose and whether treatment is still needed happen regularly, for example every 3 to 6 months.
The Imvexxy label gives no missed-dose instruction. The maintenance schedule is one insert twice weekly, every three to four days. Ask your prescriber what to do if an insert is missed.
In Dose Track you set up Imvexxy as a protocol with the dose and schedule your prescriber gave you. A protocol can hold dose steps, each with its own dose and length in days or weeks, so a step-up plan like the one on the label can be entered once and the app moves to the next step on its own. Reminders follow the schedule, and every dose is logged with the date and time, so you can see which step you are on and when your last dose was. The app follows what you enter; it does not choose or change a dose.
This page is what the FDA label says, in plain words. It is not medical advice. Follow your prescriber, and ask them or your pharmacist about anything here.