Vaginal Atrophy

Vaginal atrophy is the name given to the deterioration of vaginal tissues due to loss of oestrogen. This occurs in over 50% of postmenopausal women. This deterioration of vaginal tissue may cause a dry and uncomfortable feeling which unlike other symptoms of menopause such as hot flushes will not improve on its own.1,2

This reduction in oestrogen can cause vaginal dryness, pain/burning sensation, or severe itching.3

These symptoms can lead to discomfort during sex, urgency with urination and recurrent urinary tract infections.4,5

The lining of the vagina before menopause

The lining of the vagina after menopause

This diagram is an example of the lining of the vagina before menopause (left side of diagram) and after menopause (right side of diagram).

Adapted from Johnston S. Urogenital Concerns. Journal of Obstetrics and Gynaecology Canada. 2006 Feb, 28(2):S33-S42.

Vaginal Atrophy

Vaginal atrophy is the name given to the deterioration of vaginal tissues due to loss of oestrogen. This occurs in over 50% of postmenopausal women. This deterioration of vaginal tissue may cause a dry and uncomfortable feeling which unlike other symptoms of menopause such as hot flushes will not improve on its own.1,2

This reduction in oestrogen can cause vaginal dryness, pain/burning sensation, or severe itching.3

These symptoms can lead to discomfort during sex, urgency with urination and recurrent urinary tract infections.4,5

The lining of the vagina before menopause

The lining of the vagina after menopause

This diagram is an example of the lining of the vagina before menopause (left side of diagram) and after menopause (right side of diagram).

Adapted from Johnston S. Urogenital Concerns. Journal of Obstetrics and Gynaecology Canada. 2006 Feb, 28(2):S33-S42.

How Vaginal Atrophy can affect my life

Vaginal atrophy can cause a lot of discomfort which can make it uncomfortable to sit, stand and exercise. Some women find it painful to urinate as well as causing pain during sex. This discomfort can make it difficult to go about daily life and some people find it can even affect their work. These symptoms can have a significant impact on a person’s quality of life and can lead to loss in self-confidence and sexual confidence which may lead to sexual dysfunction disorders.2,6,7

Some signs of sexual dysfunction may include; difficulty in becoming aroused, reduced vaginal lubrication, issues climaxing or achieving orgasm, reduced ability to relax the vaginal muscles leading to sex becoming more difficult.8 As regular sexual activity increases blood flow which can help to maintain healthy vaginal tissues, less frequent sexual activity may lead to poor urinary tract health.6,9

How is vaginal atrophy treated?

Treatments range from over the counter vaginal moisturisers or lubricants which can help improve some symptoms to prescription only medications in the form of a pessary, cream, tablet, ring or gel. One such medication is Imvaggis (estriol) 0.03mg, an ultra-low dose estriol (oestrogen) pessary.1,10,11

Understanding my Imvaggis Treatment

What is Imvaggis?

Imvaggis (estriol) 0.03mg pessary for vaginal atrophy.

An ultra-low dose, smooth estriol pessary that is easily inserted
without the need for an applicator.10

What is Imvaggis used for?

It is used to relieve postmenopausal symptoms in the vagina, which in medical terms is known as ‘vaginal atrophy’. Symptoms of vaginal atrophy can include dryness, pain or irritation and it is caused by a drop in the levels of oestrogen in your body. This happens naturally after the menopause.10

How to use Imvaggis?10

Please read the package leaflet that comes with your medicine before using it.

Imvaggis works by replacing the oestrogen which is normally produced in the ovaries of women. It is a smooth pessary that is inserted into your vagina. Always use this medicine exactly as your healthcare professional has told you, if you are not sure you can check with your pharmacist or doctor.

It is best to use Imvaggis in the evening before going to bed. With clean hands simply remove the smooth pessary from the foil packaging and holding the pessary between your index finger and thumb, insert the pessary into the vagina. Once inserted, push the pessary as far as possible into the vagina using your finger.

Recommended dosing schedule

During the first 3 weeks of treatment, one pessary is administered daily (in the evening).

Thereafter, a maintenance dose of one pessary twice a week is recommended.

Your doctor will aim to prescribe the lowest dose to treat your symptom for as short as necessary. Speak to your doctor if you think this dose is too strong or not strong enough.

Possible side effects10, 11

Like all medicines, Imvaggis (estriol) 0.03mg medicine may cause side effects, although not everybody gets them.

If you experience any of the following, stop using Imvaggis and see your doctor immediately:
  • If you notice any of the conditions mentioned in the “When not to use IMVAGGIS” section of the Package Leaflet that comes with your medicine
  • Yellowing of your skin or whites of your eyes
  • A large rise in your blood pressure (symptoms may be headache, tiredness, dizziness)
  • Migraine-like headaches for the first time
  • If you become pregnant
  • If you notice signs of a blood clot
    • painful swelling and redness of the legs;
    • sudden chest pain;
    • difficulty in breathing.

Please ensure that you read the Package Leaflet that comes with your medicine for a full list of warnings and precautions.

Common side effects may include
  • Vulvovaginal burning, itching or pain sensation
  • Discomfort when urinating

These are often transient, of mild intensity.11

For full information about Imvaggis and possible side effects, please refer to the Package Leaflet

When not to use Imvaggis10

Do not use Imvaggis if any of the following applies to you, if you are not sure about any of the points below, talk to your healthcare professional before using Imvaggis.
  • If you have or have had breast cancer, or if you are suspected of having it
  • If you have cancer which is sensitive to oestrogens, such as cancer of the womb lining (endometrium), or if you are suspected of having it
  • If you have any unexplained vaginal bleeding
  • If you have excessive thickening of the womb lining (endometrial hyperplasia) that is not being treated
  • If you have or have ever had a blood clot in a vein (thrombosis), such as in the legs (deep venous thrombosis) or the lungs (pulmonary embolism)
  • If you have a blood clotting disorder (such as protein C, protein S, or antithrombin deficiency)
  • If you have or recently have had a disease caused by blood clots in the arteries, such as a heart attack, stroke or angina
  • If you have or have ever had a liver disease and your liver function tests have not returned to normal
  • If you have a rare blood problem called “porphyria” which is passed down in families
  • If you are allergic to estriol or any of the other ingredients of this product

If any of the above conditions appear for the first time while using Imvaggis, stop using it at once and consult your doctor immediately.

Side Effect Reporting10

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed on this site. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard. By reporting side effects you can help provide more information on the safety of this medicine.

Side Effect Reporting10

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed on this site. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard. By reporting side effects you can help provide more information on the safety of this medicine.

Patient Resources

What is vaginal atrophy?

Vaginal atrophy is the name given to the deterioration of vaginal tissues due to loss of oestrogen, which most often occurs in women (over 50%) after the menopause. This may cause a dry and uncomfortable feeling which unlike other symptoms such as hot flushes is unlikely to go away on its own.1,2,7

What are the symptoms of vaginal atrophy?

The most common symptoms of vaginal atrophy include3,4

  • Vaginal dryness
  • Pain/burning sensation
  • Pruritus or severe itching
  • Discharge
  • Light bleeding after intercourse
  • Discomfort with intercourse
  • Decreased vaginal lubrication during sexual activity
  • Urgency with urination
  • Frequent urination
  • Recurrent urinary tract infections
  • Urinary incontinence
  • Shortening and tightening of the vaginal canal

What causes vaginal atrophy?1,7

Vaginal atrophy is caused by the reduction of oestrogen in the body and is a common issue for postmenopausal women.

Does vaginal atrophy only happen after menopause?4,5

Vaginal atrophy is caused by a drop in oestrogen, this drop can also occur:

  • During the years leading up to menopause (perimenopause)
  • After surgical removal of both ovaries (surgical menopause)
  • During breast-feeding
  • While taking medications that can affect oestrogen levels, such as some birth control pills
  • After pelvic radiation therapy for cancer
  • After chemotherapy for cancer
  • As a side effect of breast cancer hormonal treatment

References:

Imvaggis Summary of Product Characteristics Available from: https://www.medicines.org.uk/emc/product/10435 Last accessed: October 2020

Imvaggis Package Leaflet Available from: https://www.medicines.org.uk/emc/files/pil.10435.pdf Last accessed: October 2020

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