Last checked November 2026 against 9 sources · Editorial policy
Imvexxy: vaginal estradiol insert, price and generic
Imvexxy is a small soft vaginal insert of estradiol, 4 mcg or 10 mcg, made by Mayne Pharma for painful sex caused by vaginal atrophy after menopause. You use one a day for 2 weeks, then twice a week, with no applicator. Drugs.com lists 8 inserts of 4 mcg from $229.07. Teva's generic was approved on December 8, 2025.
Imvexxy vaginal estradiol insert: 4 and 10 mcg doses, how to use it, cash price, the Teva generic approved December 2025, residue and FDA reports, checked November 2026.
Imvexxy vs Vagifem side by side
| Imvexxy (Mayne Pharma) | Vagifem (Novo Nordisk) | |
|---|---|---|
| What it is | Soft insert with estradiol, put in with a finger. | Small film-coated tablet in a disposable applicator. |
| Doses | 4 mcg or 10 mcg. | 10 mcg. |
| Schedule | Daily for 2 weeks, then twice a week. | Daily for 2 weeks, then twice a week. |
| Approved for | Moderate to severe painful sex from vaginal atrophy after menopause. | Atrophic vaginitis, vaginal atrophy, after menopause. |
| Main trial | 574 women, 12 weeks: both doses beat placebo for painful sex. | 10 mcg beat placebo on vaginal cell changes at week 12. |
| Cash price | From $229.07 for 8 inserts of 4 mcg. | See your pharmacy; generics of the 10 mcg tablet exist. |
| Generic | Teva, approved December 8, 2025; no price listed as of September 2026. | Yes, generic estradiol vaginal inserts. |
What it is
- Imvexxy (Mayne Pharma)
- Soft insert with estradiol, put in with a finger.
- Vagifem (Novo Nordisk)
- Small film-coated tablet in a disposable applicator.
Doses
- Imvexxy (Mayne Pharma)
- 4 mcg or 10 mcg.
- Vagifem (Novo Nordisk)
- 10 mcg.
Schedule
- Imvexxy (Mayne Pharma)
- Daily for 2 weeks, then twice a week.
- Vagifem (Novo Nordisk)
- Daily for 2 weeks, then twice a week.
Approved for
- Imvexxy (Mayne Pharma)
- Moderate to severe painful sex from vaginal atrophy after menopause.
- Vagifem (Novo Nordisk)
- Atrophic vaginitis, vaginal atrophy, after menopause.
Main trial
- Imvexxy (Mayne Pharma)
- 574 women, 12 weeks: both doses beat placebo for painful sex.
- Vagifem (Novo Nordisk)
- 10 mcg beat placebo on vaginal cell changes at week 12.
Cash price
- Imvexxy (Mayne Pharma)
- From $229.07 for 8 inserts of 4 mcg.
- Vagifem (Novo Nordisk)
- See your pharmacy; generics of the 10 mcg tablet exist.
Generic
- Imvexxy (Mayne Pharma)
- Teva, approved December 8, 2025; no price listed as of September 2026.
- Vagifem (Novo Nordisk)
- Yes, generic estradiol vaginal inserts.
Imvexxy: expectation vs reality
What people often expect
“With a generic approved, Imvexxy should now be cheap at any pharmacy”
What the evidence shows
The FDA approved Teva's generic on December 8, 2025, but in September 2026 Drugs.com still had no generic price and said it did not appear to be commercially available. Listed patents on Imvexxy run to November 21, 2032. Until the generic reaches shelves, the cheaper route is often another vaginal estrogen.
Imvexxy: what you need to know
What Imvexxy is and what it treats
Imvexxy is an estrogen insert you put into the vagina. It's approved for one use: moderate to severe pain during sex caused by vulvar and vaginal atrophy, the thinning and drying of tissue after menopause. It isn't a treatment for hot flashes, because the dose is far too low to act on the whole body. Mayne Pharma makes it; it was first approved on May 29, 2018.
Learn more →How to use Imvexxy
Use one insert a day at about the same time for 2 weeks, then one insert twice a week, every 3 to 4 days, for example Monday and Thursday. With clean hands, put the insert in smaller end up, about two inches into the vagina with your finger. There's no applicator to wash or throw away. Store inserts at room temperature, 68°F to 77°F.
Learn more →Imvexxy 4 mcg vs 10 mcg
Both strengths beat placebo in the main trial. It enrolled 574 women aged 40 to 75, mean age 59, for 12 weeks: 191 on 4 mcg, 191 on 10 mcg and 192 on placebo. More than 90% also had moderate to severe dryness at the start. Both doses reduced painful sex and improved vaginal cell measures and pH at week 12. Your prescriber picks the strength; there's no rule that you must start high.
Is there a generic Imvexxy?
Approved, but not yet priced. Drugs.com lists an FDA-approved generic estradiol vaginal insert from Teva, approved on December 8, 2025, in both 4 mcg and 10 mcg. On its September 2026 update, Drugs.com had no pricing for it and said it didn't appear to be commercially available, and patents listed for Imvexxy run to November 21, 2032. Ask your pharmacy if they can order it.
Learn more →Imvexxy price
Drugs.com lists 8 inserts of 4 mcg from $229.07 for cash payers in November 2026, about $28.63 an insert. At two inserts a week, a box lasts a month after the first 2 weeks. That's well above generic estradiol cream or generic 10 mcg vaginal tablets, so ask your prescriber about those if you pay cash.
Learn more →Imvexxy residue and discharge
Imvexxy's soft shell can leave residue. In the FDA's adverse event database, 145 of 2,893 reports (5.0%) mention product residue and 372 (12.9%) vaginal discharge. Some women use the insert at bedtime and wear a panty liner the next morning. Residue on its own doesn't mean the dose was lost.
Imvexxy safety and the boxed warning
Like all estrogen products, Imvexxy carries a boxed warning about endometrial cancer, heart disease, stroke, blood clots, breast cancer and dementia, based mostly on studies of higher-dose pills. Low-dose vaginal estrogen puts much less estrogen into the blood. The label says to report any vaginal bleeding after menopause, and to use the lowest dose for as long as needed.
Learn more →Imvexxy by the numbers
From the studies on this page
of FDA reports about Imvexxy came from patients themselves
94.3%
574
$229.07
December 8, 2025
Prices are cash prices in November 2026 and vary by pharmacy.
What people report to the FDA about Imvexxy
Imvexxy (estradiol vaginal inserts): 2,893 reports to the FDA, 215 serious · data through July 30, 2026
| Reaction | Reports | Share |
|---|---|---|
| Used off label | 1,115 | 38.5% |
| Vaginal discharge | 372 | 12.9% |
| Headache | 288 | 10.0% |
| Vulvovaginal burning | 196 | 6.8% |
| Vaginal bleeding | 159 | 5.5% |
| Residue of the insert | 145 | 5.0% |
- Serious reports: 215 of 2,893 (7.4%). Most reports came from patients: 2,727 (94.3%).
Imvexxy or another vaginal estrogen: who each one suits
Imvexxy if you want no applicator and the lowest dose
Strong evidenceThe 4 mcg insert is less than half the 10 mcg dose of Vagifem, and it goes in with a finger, so there's nothing to clean or throw away. It suits women whose main problem is pain during sex and who have coverage for the brand.
Related guide →Generic 10 mcg vaginal tablets if price matters
Strong evidenceVagifem and its generics use the same schedule, daily for 2 weeks then twice a week, with a small tablet in a disposable applicator. Generics usually cost far less than Imvexxy for cash payers.
Related guide →Estradiol cream if dryness outside the vagina bothers you too
Strong evidenceA cream can be spread on the vulva as well as used inside, which helps when itching and soreness are outside too. It's messier and the dose is measured with an applicator.
Related guide →A ring if you'd rather not think about it
Some evidenceEstring sits in the vagina and releases estradiol for 90 days, so there's nothing to do twice a week.
Related guide →
When to call a doctor on Imvexxy
Any vaginal bleeding after menopause
See your doctor soon. It needs checking even on low-dose vaginal estrogen.
Urgent: Chest pain, sudden shortness of breath, a painful swollen leg or stroke signs
Call 911.
No improvement after 12 weeks
Ask whether the dose, the form or another treatment would work better.
More →
Imvexxy: questions women ask
Is there a generic for Imvexxy?
An FDA-approved generic from Teva, in 4 mcg and 10 mcg, was approved on December 8, 2025. In September 2026 Drugs.com had no price for it and said it didn't appear to be commercially available yet. Ask your pharmacy whether it can be ordered.
How much does Imvexxy cost?
Drugs.com lists 8 inserts of 4 mcg from $229.07 for cash payers in November 2026. After the first 2 weeks you use two a week, so a box lasts about a month. With insurance you pay your plan's brand copay.
Related →What is the difference between Imvexxy and Vagifem?
Imvexxy is a soft insert put in with a finger, in 4 mcg or 10 mcg. Vagifem is a 10 mcg tablet in a disposable applicator. Both are used daily for 2 weeks and then twice a week. Vagifem has generics on the market; Imvexxy's generic is approved but not yet priced.
Related →How do you insert Imvexxy?
Wash your hands, then put the insert in smaller end up, about two inches into the vagina, using your finger. Many women do it at bedtime. Use one a day for 2 weeks, then twice a week, every 3 to 4 days.
Does Imvexxy help hot flashes?
No. Imvexxy is approved only for painful sex from vaginal atrophy, and its dose is too low to treat hot flashes. For those, a body-wide estrogen such as a patch, gel or pill, or a non-hormonal drug, is used.
Related →Why is there white residue after using Imvexxy?
Part of the soft insert can come out as residue. It's reported in 145 of 2,893 FDA reports (5.0%). It doesn't mean the dose was lost. Some women use it at bedtime and wear a panty liner the next day.
Do I need progesterone with Imvexxy?
Usually not for low-dose vaginal estrogen, but tell your doctor about any bleeding. The label says women with a uterus who have unexpected bleeding need checking for problems with the uterine lining.
Related →Sources
- Prescribing information: Imvexxy (estradiol vaginal inserts). Mayne Pharma, 2025. DailyMed, US National Library of Medicine.
- Drugs.com. Imvexxy prices, coupons, copay cards and patient assistance. Accessed November 2, 2026.
- Drugs.com. Generic Imvexxy availability: FDA-approved generics, manufacturers and approval dates. Accessed November 2, 2026.
- US Food and Drug Administration. FDA Adverse Event Reporting System (FAERS): reports naming Imvexxy (estradiol vaginal insert), via openFDA. Data through July 30, 2026.
- NHS. Vaginal oestrogen: about.
- Prescribing information: Vagifem (estradiol vaginal inserts). Novo Nordisk, 2025. DailyMed, US National Library of Medicine.
- Prescribing information: Estrace cream (estradiol vaginal cream 0.01%). Allergan, 2024. DailyMed, US National Library of Medicine.
- Prescribing information: Estring (estradiol vaginal ring). Pfizer, 2026. DailyMed, US National Library of Medicine.
- National 911 Program. 911.gov.
See our editorial policy.
Related guides
Vaginal estrogen inserts and rings
Vaginal tablets (10 mcg), softgels and 3-month rings deliver low-dose estrogen locally. How to use each, cost …
Vaginal estrogen cream (estradiol cream)
Low-dose vaginal estrogen treats dryness, painful sex and recurrent UTIs with minimal absorption. How to apply…
Vaginal dryness and vulvar itching in menopause
Genitourinary syndrome of menopause causes dryness, itching, burning and pain. Moisturizers, lubricants and va…
Estrogen patch brands, ranked
Every US estradiol patch ranked by size, change schedule, adhesion data, cash price and FDA reports: Dotti, Mi…
HRT cost and insurance coverage
Most US plans cover generic estradiol and progesterone; brand names and compounded hormones cost more. Price r…