Interesting! As far as the tamoxifen staying local in the vaginal area and not being absorbed systemically - I still have a difficult time understanding how the mucus membrane of the vagina doesn’t have a superior drug uptake like mucus membrane in other parts of the body. That superior uptake is why people chew tobacco for the nicotine absorption in the mouth, and why people push drugs up their nose. It is known that men’s genitals have the ability to absorb topicals at a higher rate than their regular skin, what about women (not studied??)

Tamoxifen (pills) has reduced my vaginal atrophy, and has increased estrogen-like responses in other parts of my body. It is dose dependent - there is a difference between the response from 20 mg and 5 mg. I saw noticeable difference in the skin elasticity of my face and upper arms at 20 mg along with stronger fingernails. Vaginally, the skin condition is better than it was pre-treatment, but the thickness of the skin has lessened with 5 mg.

So how high a dose of tamoxifen is needed in a vaginal tablet to make a difference? We should be able to see studies where they took blood samples to see how much tamoxifen, or endoxifen, is in the blood after using the tablet. And, is there an immediate response or does the vaginal tablet need to be used over enough time to have an effect, meaning we’re dosing our bodies with a steady amount of tamoxifen. Tamoxifen is well known to increase the incidence of uterine cancer and endometrial polyps.

When considering tamoxifen you have to look at the side effects. I realize you could ask 100 of us about side effects and the answer is all over the place, from none to horrible. Regardless of the inconsistent answers, tamoxifen is a powerful drug. It crosses the blood brain barrier. It affects a variety of organs in the body. It is being studied to be used for bipolar disease to reduce mania.
At 20 mg I had pretty major brain fog, headaches 24/7, and body temperature dysregulation (not hot flashes, but overheating more easily and cooling off more slowly). At 5 mg, no headaches, minor brain fog, minor body overheating.

I’m living proof that tamoxifen improves vaginal atrophy. And it would be great if a vaginal tablet would do the same without systemic absorption. But I am skeptical of the drug industry - how long did women take tamoxifen in doses greater than 20 mg unnecessarily. Is 20 mg even required? Drugs are often produced using the maximum dose that provides a response. The minimal effective dose is often unknown.