I believe that Vagifem is not absorbed into the bloodstream, at least only a microscopic amount.
Did I read somewhere on this forum that the amount absorbed is something like the same as one HRT pill in a whole year?
I have seen women quote this but I'm not sure where it comes from! I would want to see the data personally.
Whatever it is, the research (from the manufacturer and possibly elsewhere) shows that oestrogen levels are maintained within the normal post-menopausal range once the loading period has been completed but there are no studies on the long term effects of Vagifem.
Nevertheless the BMS 2013 guidelines recommend long term use and without progestogen:
Section on Urogenital symptoms:
Low-dose vaginal estrogen preparations can be used long-term in symptomatic women as required, and all topical estrogen preparations have been shown to be effective in this context.
There is no requirement to combine this with systemic progestogen treatment for endometrial protection, as low-dose vaginal estrogen preparations do not result in significant systemic absorption.
However, there is little evidence to prove the safety of vaginal preparations beyond one year of use; clinicians should therefore aim to use the lowest effective dose for symptom control and counsel women regarding this. Section on routes and regimens:
Low-dose vaginal estrogenic creams, rings, tablets and pessaries should be considered for all women with symptoms of urogenital atrophy.
Local estrogenic preparations and may be more effective than systemic therapy and can be used in conjunction with oral/transdermal HRT.
Indefinite usage is usually required as symptoms often return when treatment is discontinued – progestogenic opposition is not required as systemic absorption is minimal with estradiol and estriol preparations.
This is the paper - published 18 months ago and from which we have quoted extensively on here in the past:
http://min.sagepub.com/content/19/2/59It can be downloaded free and I would recommend anyone to do so, to have the information to hand!
![Smiley :)](https://www.menopausematters.co.uk/forum/Smileys/extended/smiley.gif)
Hurdity x