Short answer: Both put estradiol in the vagina for menopause symptoms.12 Imvexxy is a 4 or 10 mcg insert, used daily for 2 weeks, then twice a week, for painful sex. Estrace Cream has 0.1 mg estradiol per gram; its label dose is 2 to 4 g daily for one or two weeks, tapering to 1 g one to three times a week. Both carry the estrogen boxed warning.
| Imvexxy | Estrace Cream | |
|---|---|---|
| Form | Small vaginal insert, 4 mcg or 10 mcg estradiol1 | Vaginal cream with a measuring applicator, 0.1 mg estradiol per gram2 |
| Approved for | Moderate to severe painful sex, a symptom of vulvar and vaginal atrophy, from menopause1 | Moderate to severe symptoms of vulvar and vaginal atrophy from menopause2 |
| Start | Usually 4 mcg, one insert daily for 2 weeks1 | 2 to 4 g daily for one or two weeks, then about half that for a similar period2 |
| After that | One insert twice a week, every three to four days1 | May go to 1 g one to three times a week once the vaginal lining has recovered2 |
| Side effects | 12-week trial: headache 3.7% on 4 mcg and 2.6% on 10 mcg vs 3.1% on placebo, the only reaction listed at 3% or more1 | No percentages; the Patient Information lists headache, breast pain, irregular bleeding, cramps, bloating, nausea, yeast infection and vaginal burning or itching2 |
| Missed dose | No instruction in the label1 | No instruction in the label2 |
| Boxed warning | Endometrial cancer, cardiovascular disorders, probable dementia and breast cancer1 | Endometrial cancer, cardiovascular disorders, breast cancer and probable dementia2 |
Nearly. Both rest on the Women's Health Initiative studies of oral conjugated estrogens with or without medroxyprogesterone acetate. The Imvexxy label says the relevance of those findings to lower doses and to vaginal use is not known and the risks cannot be definitively excluded.1 The Estrace Cream label says that without comparable data, the risks should be assumed similar for other doses and dosage forms of estrogen.2 Both say some estradiol is absorbed into the body, and both say a woman with a uterus generally adds a progestin or progestogen to lower endometrial cancer risk.
After 14 daily Imvexxy doses, average blood estradiol was 3.6 pg/mL on 4 mcg and 4.6 pg/mL on 10 mcg, vs 4.3 pg/mL on placebo.1 The Estrace Cream label gives no comparable average, and a 1 g dose holds 0.1 mg (100 mcg) of estradiol.2 Estrace Cream is also not used in known or suspected pregnancy.2
Which, if either, fits is for your prescriber. More detail: Imvexxy side effects, Estrace Cream side effects, the Imvexxy and Estrace Cream dosing schedules, Imvexxy vs Vagifem: how do the two vaginal estradiol inserts differ? and Estrace Cream vs Vagifem: how do the two vaginal estradiol products differ?.