Estring

Generic name: Estradiol

What is Estring?

Estring is a type of estrogen therapy used to relieve vaginal and urinary symptoms that occur when there is no estrogen in a woman's body after menopause.

What is the most important information I should know about Estring?

Estrogens, as those found in Estring, may increase the risk of cancer of the uterus in post-menopausal women. Contact your healthcare provider if you experience vaginal bleeding of unknown cause.

Estrogens should not be used during pregnancy. Estrogens do not prevent miscarriage (spontaneous abortion) and are not needed in the days following childbirth. If you take estrogens during pregnancy, your unborn child has a greater than usual chance of having birth defects. The risk of developing these defects is small, but greater than the risk in children whose mothers did not take estrogens during pregnancy. These birth defects may affect the baby's urinary system and sex organs.

Do not use estrogens with or without progestins to prevent heart disease, heart attacks, stroke or dementia. Using estrogens with or without progestins may increase your chances of getting heart attacks, stroke, breast cancer, and blood clots. Also, using estrogens with or without progestins may increase your risk of dementia.

Toxic shock syndrome (TSS) has been reported in a few patients using vaginal rings. TSS is a rare but serious and sometimes fatal condition. Symptoms of TSS may include fever nausea, vomiting, diarrhea, muscle pain, dizziness or lightheadedness, fainting, or a sunburn-like rash. Tell your doctor right away if you notice these effects.

If you have high blood pressure, high cholesterol (fat in the blood), diabetes, are overweight, or if you use tobacco, you may have a higher chance for developing heart disease. Ask your healthcare provider for ways to lower your risk for heart disease.

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.

Do not drive or perform other possibly unsafe tasks until you know how you react to Estring; this drug may cause dizziness. This effect may be worse if you take it with alcohol or certain medicines.

Limit alcoholic beverages while you are using Estring.

Estring may cause dark skin patches on your face (melasma). Exposure to the sun may make these patches darker and you may need to avoid prolonged exposure to sun, sunlamps, and tanning beds. Consult your doctor regarding the use of sunscreens and protective clothing.

Estring may increase the risk blood clots (especially in women older than 35 years). The risk may be greater if you smoke.

Contact your health care provider if vaginal discomfort occurs or if you suspect you have developed an infection while taking Estring.

If you wear contact lenses and you develop problems with them, contact your doctor.

If you will be having surgery or will be confined to a chair or bed for a long period of time (such as a long plane flight), notify your doctor beforehand. Special precautions may need to be taken in these circumstances while you are taking Estring.

Your doctor should reevaluate you every 3 to 6 months to determine whether or not you need to continue taking Estring.

Estring may interfere with certain lab tests. Be sure your doctor and lab personnel know you are using Estring.

Estring may affect your blood sugar. Check blood sugar levels closely and discuss with your doctor before changing the dose of your diabetes medicine.

Have a breast exam and mammogram (breast X-ray) every year unless your healthcare provider tells you something else. If members of your family have had breast cancer or if you have ever had breast lumps or an abnormal mammogram, you may need to have breast examinations more often.

One of the most frequently reported effects associated with the use of 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 or vaginal itching or discomfort, be sure to contact your doctor or healthcare provider.

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 should cause you or your partner any discomfort, you may remove it prior to intercourse. Be sure to reinsert Estring as soon as possible afterwards.

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.

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.

Who should not take Estring?

Estring should not be used if you are pregnant, plan to become pregnant, or breastfeeding. This therapy may cause birth defects in your child. Also, do not use Estring if you have unusual vaginal bleeding, or a history of certain types of cancer (eg, breast or uterine).

Do not use Estring if you currently have or have had blood clots. Do not use Estring if you have had a stroke or heart attack within the past year. Do not use Estring if you have known liver disease. In addition, do not use Estring if you have a known hypersensitivity to any of the ingredients found in this product.

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 had cancer of the breast(s) or uterus; abnormal vaginal bleeding; yellowing of the eyes or skin during pregnancy or with past estrogen use; have a vaginal infection or womb problems (uterine fibroids, endometriosis, or other uterine problems); asthma; a certain blood disorder (porphyria); cholesterol or lipid problems; depression; diabetes; excessive weight gain; gallbladder disease; high blood pressure; lupus; low thyroid hormone levels; migraine headaches; pancreas disease; seizures; if you smoke; currently have or have had kidney or liver problems in the past; and if you will be having surgery. In addition, tell your doctor if you are pregnant, plan on becoming pregnant, or are breastfeeding.

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. (Since the ring becomes slippery when wet, be sure your hands are dry before handling it.)

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, Estring 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.

After 90 days there will no longer be enough estradiol in the ring to maintain its full effect in relieving your vaginal or urinary symptoms. Estring should be removed at that time and replaced with a new Estring, if your doctor determines that you need to continue your therapy.

To remove Estring, wash and dry your hands thoroughly. Assume a comfortable position, either standing with one leg up, squatting, or lying down.

Loop (or hook) your finger through the ring and gently pull it out. Discard the used ring in a waste receptacle. (Do not flush Estring.)

What should I avoid while taking Estring?

Do not miss your doctor appointments as they are important in evaluating your therapy. Avoid giving Estring to other people.

Do not use estrogens with or without progestins to prevent heart disease, heart attacks, or strokes.

Do not drive or perform other possibly unsafe tasks until you know how you react to Estring; this medication may cause dizziness.

Limit alcoholic beverages while you are taking Estring.

Avoid prolonged sun exposure and sunlamps because Estring may cause dark skin patches on your face (melasma); exposure to the sun may make these patches darker.

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: anticoagulants (blood thinning medications) such as warfarin; azole antifungals such as ketoconazole; erythromycin; phenobarbital; phenytoin; prednisone; rifampin; ritonavir; succinylcholine; and tacrine.

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)

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, between 59 and 86 degrees F (15 and 30 degrees C). Store in the original packaging until just before use. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Estring out of the reach of children.