Vaginal Estrogen Suppositories: The Good, the Bad, and the Unexpected

Your vagina loves estrogen. The hormone keeps vaginal tissue flexible and well-lubricated and maintains the thickness of the vaginal lining.¹ It also increases blood flow, which, in turn, promotes beneficial vaginal discharge and collagen production (collagen provides tissue support and structure).² So when perimenopause comes along, and estrogen levels begin to decline, your vagina can get pretty unhappy. Enter vaginal estrogen suppositories.

The technical term for vaginal discomfort during the menopause transition is genitourinary syndrome of menopause (GSM). Its symptoms include painful intercourse, a weak pelvic floor (cue bladder leaks), and itching and burning sensations.

As many as half of postmenopausal women are impacted by GSM, yet research shows the majority don’t receive diagnosis or treatment. That’s a problem because GSM is entirely treatable.

No matter what your age or stage of menopause, strategic estrogen replacement can keep your vaginal tissue healthy and comfortable.³

Vaginal estrogen suppositories—small inserts containing a type of estrogen called estradiol—deliver estrogen directly to the vaginal tissues, offering relief where it’s needed most.

“Vaginal dryness and pain with intercourse improve in about two weeks, with other symptoms like vaginal irritation and itching improving in about 12 weeks,” says hormone specialist Marilyn Lajoie, M.D.

Wondering if vaginal suppositories could be right for you? Like any medication, they have their pros and cons.

About the Expert

Marilyn Lajoie, M.D., a doctor of internal medicine and hormone specialist.

How Estrogen Suppositories Work

Estrogen suppositories like Vagifem deliver estradiol directly to dry or irritated vulvar and vaginal tissues. “Because the skin barrier is thinner in menopause, the estrogen absorbs very quickly, helping to alleviate symptoms that affect the vulva, vagina, and lower urinary tract,” says Lajoie.

• Estrogen suppositories can help with:
• Vaginal dryness, itching, and burning
• Pain or discomfort during intercourse
• Preventing urinary tract infections
• Thinning and loss of sensation in vaginal tissue

Unlike systemic HRT (hormone replacement therapy, also called menopause hormone therapy or MHT), which treats a range of menopause symptoms like hot flashes and night sweats, via non-vaginal creams or estrogen patches, vaginal estrogen is targeted to treat symptoms that affect the vulva, vagina, and lower urinary tract.

This local application gives estrogen suppositories an advantage for treating GSM over estrogen pills or patches, which circulate estrogen throughout the body.

Pros of Estrogen Suppositories

Estrogen suppositories successfully replace the lost estrogen that your vaginal tissues need to be healthy. That’s also true of other forms of estrogen treatment, including topical estrogen creams and systemic (body-wide) menopause hormone therapy (MHT), but suppositories have some distinct advantages:

• A few benefits specific to estrogen suppositories:
• Targeted relief
• Lower risk of side effects
• Fewer long-term health risks
• Convenience

Targeted relief

If your primary menopause symptoms are vaginal dryness and irritation, itching, pain during sex, bladder issues, or vaginal fissures (small cracks or tears in vulvar skin), a local estrogen treatment like a suppository may be all you need, says Lajoie.

While lifestyle changes like using vaginal lubricants and moisturizers are effective, hormonal therapy with local estrogen, including vaginal suppositories, is considered the gold-standard treatment for GSM.

Lower risk of side effects

Systemic HRT can sometimes cause side effects like headaches and breast tenderness (which often go away with continued treatment). Because estrogen suppositories use low-dose estrogen that’s only applied vaginally, research suggests that these side effects may be less likely to occur.⁴

Fewer long-term health risks

While systemic HRT is safe and effective for most women, there are ongoing debates about its associated risks around heart disease, stroke, blood clots, and breast cancer. Some research suggests that local vaginal estrogen treatment may not have these same concerns. ⁵,⁶,⁷

Many experts argue that the risks of HRT have been overstated, and there is an active effort to have the black box warning removed from vaginal estrogen products—including suppositories—due to its localized nature and lower associated risks. Talking to your doctor will help you make the most informed choice based on your health history and symptoms.

Convenience

Using an estrogen suppository is simple: Insert a new one daily for two weeks, then switch to one, twice a week. If you miss a dose, adjust your weekly dose for that week only and then return to your regularly scheduled routine, says Lajoie.

Estrogen suppositories are also easy to store and travel with. They’re typically stored at room temperature. If you’re taking them on a trip, Lajoie recommends storing the med in your carry-on bag to avoid extreme temperatures that checked bags can experience.

Cons of Estrogen Suppositories

While there are plenty of upsides of estradiol suppositories, there are some potential drawbacks:

• Limited relief for other menopause symptoms
• Insertion might be uncomfortable
• Potential irritation
• May not be covered by insurance
• Increase in vaginal discharge (which can be normal or signal an infection).

No relief for other menopause symptoms

Vaginal estradiol suppositories treat vaginal, vulvar, and lower urinary tract symptoms caused by declining estrogen. If you’re experiencing hot flashes, mood swings, brain fog, or other body-wide menopause symptoms you may need systemic HRT.⁸

Insertion might be uncomfortable

An estradiol suppository is a very small tablet — Vagifem is six millimeters in diameter, which is less than a quarter-inch in size. The applicator is smaller than a tampon applicator.⁹ Still, if vaginal penetration is uncomfortable for you, a suppository may not be the best option.

Also, the suppository may not dissolve completely if the vagina is too dry, causing incomplete absorption. A lubricant like KY Jelly can make insertion easier.

Potential irritation

Vaginal estrogen—including estrogen suppositories—can occasionally trigger yeast infections¹⁰ or an increase in bacterial vaginosis infections including bacterial vaginosis—a condition where the normal vaginal flora becomes unbalanced, causing an increase in discharge, itching, or burning.

May not be covered by insurance

Insurance coverage for vaginal estrogen varies and out-of-pocket costs can range from $0 to $413. If your plan doesn’t cover Vagifem, using a generic (like Yuvafem Imvexxy) may be cheaper. You can also look for coupons or savings cards on sites like GoodRx.

Are Vaginal Estrogen Suppositories Safe?

Vaginal estrogen suppositories are FDA-approved and recommended by The Menopause Society as a safe and effective treatment for GSM.¹¹ Nonetheless, it’s important to talk to your doctor about whether estrogen suppositories are right for you based on your menopause symptoms and health history.

Side effects of vaginal suppositories

The most common side effects—which occur in less than 10% of Vagifem users—include:

• Bloating
• Breast pain
• Fluid retention
• Hair loss
• Headache
• Irregular vaginal bleeding or spotting
• Nausea and vomiting
• Stomach or abdominal cramps
• Vaginal yeast infection

Who should avoid estrogen suppositories

Despite the safety of vaginal estrogen suppositories, your doctor may recommend an alternative treatment option if you: ¹²

• Experience abnormal vaginal bleeding
• Are allergic to the product or its ingredients
• Have a diagnosed bleeding disorder
• Have a history of a stroke or heart attack
• Have or have had blood clots
• Have or have had liver problems
• Have breast cancer or a history of breast cancer

Estrogen suppositories and breast cancer

A 2025 meta-analysis of eight observational studies published in the American Journal of Obstetrics & Gynecology concluded that women with a history of breast cancer who used vaginal estrogen did not have an increased risk of their cancer returning. The treatment was also not associated with an increased risk of breast cancer mortality or overall mortality. ¹³

The American College of Obstetricians and Gynecologists (ACOG)’s recommendations support the use of low-dose vaginal estrogen for breast cancer survivors dealing with GSM if non-hormonal treatments haven’t worked. ¹⁴

If you’ve had breast cancer, your doctor will weigh the risks and benefits with you before prescribing estrogen therapy. Many gynecologists collaborate with oncologists to determine whether vaginal estrogen is a safe option for managing GSM.

How to Use Estrogen Suppositories

Your medication insert will have all the details, along with pictures to follow, but here’s a quick run-down:

• Wash and dry your hands. (You’ll be inserting the suppository into your vagina, so you don’t want to introduce germs that could disrupt your vaginal microbiome.)
• Hold the applicator with one hand and place your pointer finger on the plunger.
• Lay down or stand up with one leg elevated–or use whatever position you find most comfortable for insertion.
• Insert the applicator into your vaginal opening similar to how you’d insert a tampon. Insert it until half of the applicator is in your vagina or as far as is comfortable.
• Press the plunger, which will push the suppository into your vagina.
• Remove and throw away the applicator.

Sex After Using Estrogen Suppositories

Wait at least 12 hours after using an estrogen suppository before having sex. “Intercourse too soon after insertion would expose your partner to the vaginal estrogen,” says Lajoie. (If you have a male partner, long-term exposure to estrogen can cause feminizing changes, she points out.)

Waiting for intercourse also ensures that the estradiol has been fully absorbed. If insertion is planned on a day to intend to have sex, insert your estrogen suppository after you do the deed.

Estrogen can weaken latex condoms, diaphragms, and cervical caps, so avoid them for 72 hours after using the suppository, adds Lajoie.

Vagifem vs Yuvafem

Yuvafem is the generic version of Vagifem, so it is typically cheaper. Both are placed in the vagina with an applicator and deliver the same dose of estrogen—10 mcg per insert. ¹⁵

Vagifem vs Imvexxy

Imvexxy is another vaginal estradiol insert that is indicated for moderate to severe painful intercourse. ¹⁶While Vagifem comes in a 10 mcg dose, Imvexxy is available in two doses (4 mcg and 10 mcg). While Vagifem is inserted with an applicator, Imvexxy requires you to use your fingers

Suppositories (Vagifem) vs. Estradiol Cream

Like suppositories, estradiol cream delivers estrogen directly to vulvar and vaginal tissue. “Both are equally effective at relieving symptoms of vaginal dryness and irritation,” says Lajoie.

The main difference? Creams can be messier. While many people have no issue with them, some find estradiol suppositories (like Vagifem) more convenient and less likely to cause discharge.