Short answer: The Vagifem label dose is one 10 mcg insert placed in the vagina with the supplied applicator every day for 2 weeks, then one insert twice a week, for example Tuesday and Friday. It is used at the lowest effective dose for the shortest time, with periodic review. Women with a uterus may also need a progestogen. The label gives no missed-dose rule.
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 Vagifem is approved for: Vagifem is an estrogen approved to treat atrophic vaginitis due to menopause (section 1.1), which the Patient Information describes as moderate to severe menopausal changes in and around the vagina.
Source
VAGIFEM (estradiol vaginal inserts), prescribing information, Patient Information and Instructions for Use. Novo Nordisk. DailyMed, version published February 12, 2025. DailyMed setid e5ad3cf6-dd96-4e64-af21-c1eee38d0b88
Each 10 mcg insert comes in a disposable single-use applicator. It is pushed gently into the vagina, no further than comfortable or halfway, and the plunger releases the insert, which dissolves over several hours (sections 2.1 and 3; Instructions for Use).
Insertion can be done at any time of day; the Instructions for Use say it is advisable to use the same time for each application.
If the insert falls out of the applicator before insertion, it is thrown away and a new one is used (Instructions for Use).
The table below is the label's schedule, from the Dosage and Administration section. Numbers are copied exactly; the section is in brackets.
| Phase | Dose | How often | How long |
|---|---|---|---|
| Start | 1 insert (10 mcg) intravaginally | Daily | 2 weeks |
| Maintenance | 1 insert (10 mcg) intravaginally | Twice weekly (for example, Tuesday and Friday) | As long as needed, reevaluated periodically |
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.
Vagifem is used at the lowest effective dose and for the shortest duration consistent with treatment goals and risks, and women are reevaluated periodically. The Patient Information suggests talking about it every 3 to 6 months.
If feasible, estrogens are stopped at least 4 to 6 weeks before surgery linked to a higher clot risk, or during prolonged immobilization.
In the 12-month trial, women used one insert daily for 14 days, then twice weekly for the remaining 50 weeks.
Stored at 20 to 25 C (68 to 77 F), with excursions from 15 to 30 C; the Patient Information says not to refrigerate.
The Vagifem label gives no missed-dose rule. Neither the prescribing information, the Patient Information nor the Instructions for Use says what to do if an insert is missed.
In Dose Track you set up Vagifem 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.