What is Estring?Estring is a type of estrogen therapy used after menopause to treat moderate to severe itching, burning, and dryness in or around the vagina.
What is the most important information I should know about Estring?Estrogens, such as those found in Estring, increase the risk of cancer of the uterus in postmenopausal women. Contact your healthcare provider if you experience vaginal bleeding of unknown cause.
Do not use estrogens with or without progestins to prevent heart disease, heart attacks, strokes, or dementia. Using estrogens with or without progestins may increase your risk of heart attack, stroke, breast cancer, and blood clots. Using estrogens with or without progestins may increase your risk of dementia, based on a study of women age ≥65 years.
You and your healthcare provider should talk regularly about whether you still need treatment with Estring.
Who should not take Estring?Do not start using Estring if you have unusual vaginal bleeding, currently have or have had certain cancers, had a stroke or heart attack in the past year, currently have or have had blood clots or liver problems, think you may be pregnant, or are allergic to any of the ingredients in Estring.
What should I tell my doctor before I take the first dose of Estring?Tell your doctor about all prescription, over-the-counter, and herbal medications you are taking before beginning therapy with Estring. Also, talk to your doctor about your complete medical history, especially if you have asthma (wheezing), epilepsy (seizures), migraine, endometriosis, lupus, problems with your heart, liver, thyroid, kidneys, or high calcium levels in your blood.
Tell your doctor if you are breastfeeding, if you are going to have surgery, or will be on bedrest.
What is the usual dosage?The information below is based on the dosage guidelines your doctor uses. Depending on your condition and medical history, your doctor may prescribe a different regimen. Do not change the dosage or stop taking your medication without your doctor's approval.
Estring should be inserted into the vagina and left in place for 90 days. After this time, if it is necessary, Estring should be replaced. Estring can be inserted and removed by you or your doctor or healthcare provider.
Estrogens should be used only as long as needed. You and your healthcare provider should talk regularly (for example, every 3 to 6 months) about whether you still need treatment with Estring.
It will take about 2 to 3 weeks to restore the tissue of the vagina and urinary tract to a healthier condition and to feel the full effect of Estring in relieving vaginal and urinary symptoms. If your symptoms persist for more than a few weeks after beginning Estring therapy, contact your doctor or healthcare provider.
How should I take Estring?To insert Estring, choose the position that is most comfortable for you: standing with one leg up, squatting, or lying down. After washing and drying your hands, remove Estring from its pouch using the tear-off notch on the side.
Hold Estring between your thumb and index finger and press the opposite sides of the ring together; the ring should be pressed into an oval. Gently push the compressed ring into your vagina as far as you can. The exact position is not critical as long as it is placed in the upper third of the vagina. Wash your hands immediately after using Estring.
When Estring is in place, you should not feel anything. If you feel discomfort, it is probably not far enough inside. Gently push it further into the vagina. There is no danger of Estring being pushed too far up in the vagina or getting lost. Estring can only be inserted as far as the end of the vagina, where the cervix (the narrow, lower end of the uterus) will block Estring from going any further.
Estring may slide down into the lower part of the vagina as a result of the abdominal pressure or straining that sometimes accompanies constipation. If this should happen, gently guide Estring back into place with your finger.
There have been rare reports of Estring falling out in some women following intense straining or coughing. If this should occur, simply wash Estring with lukewarm (not hot) water and reinsert it.
Most women and their partners experience no discomfort with Estring in place during intercourse, so it is not necessary that the ring be removed before intercourse. If Estring does cause discomfort, you may remove it prior to intercourse. Be sure to reinsert Estring as soon as possible afterward.
To remove Estring, wash and dry your hands thoroughly. Assume a comfortable position, either standing with one leg up, squatting, or lying down. Hook your finger through the ring and gently pull it out. Discard the used ring in a waste receptacle; do not flush it.
What should I avoid while taking Estring?Do not miss your doctor appointments, as they are important in evaluating your therapy. Do not give Estring to other people.
What are possible food and drug interactions associated with Estring?If Estring is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Estring with the following: carbamazepine, clarithromycin, erythromycin, grapefruit juice, itraconazole, ketoconazole, phenobarbital, rifampin, ritonavir, or St. John's wort.
What are the possible side effects of Estring?Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking this drug.
Side effects may include: bloating (water retention), breast tenderness/enlargement, hair loss, headache, nausea, spotty darkening of skin on the face, vomiting
Serious side effects may include: abnormal vaginal bleeding, breast lumps, changes in vision or speech, coughing blood, dizziness, faintness, pain in the lower legs or chest, pain/swelling/tenderness of the stomach, severe headache, shortness of breath, vomiting, weakness/numbness of arm(s) or leg(s)
One of the most frequently reported side effects associated with Estring is an increase in vaginal secretions. These secretions are like those that occur normally prior to menopause and indicate that Estring is working. However, if the secretions are associated with a bad odor, vaginal itching or discomfort, or you think you have developed an infection, be sure to contact your doctor.
Can I receive Estring if I am pregnant or breastfeeding?Do not use Estring if you are pregnant, plan to become pregnant, or are breastfeeding.
What should I do if I miss a dose of Estring?If you forget and have not inserted a new ring after 90 days, contact your doctor to establish a new schedule for Estring.
How should I store Estring?Store Estring at room temperature. Store in the original packaging until just before use.
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