Estring (Estradiol Hemihydrate)

Do’s

• Read the Patient Information Leaflet provided by your pharmacist before using Estring and each time you get a refill. If you have any questions, ask your healthcare provider for guidance.
• Before handling the ring, wash and dry your hands to maintain hygiene and prevent any potential infections.
• Insert the ring high into the vagina as directed. The ring is typically left in place for 90 days and then replaced with a new ring if the treatment is to be continued. Follow the dosing schedule carefully for the effectiveness of the medication.
• If the ring is inserted properly, it should not be felt, and it should not interfere with sexual intercourse. If you can feel the ring or experience slight discomfort, it may indicate that the ring is not positioned high enough. In such a case, gently push the ring higher with your finger.
• If the ring falls out of the vagina, rinse it with lukewarm water and reinsert it. Contact your healthcare provider if the ring falls out often.
• The ring is removed by hooking your finger through the ring and gently pulling it out. If you encounter any difficulty in removing it, contact your healthcare provider. Discard the used ring in the trash.
• It may take 2 to 3 weeks before the full benefit of Estring is experienced. If there is no improvement in your condition or if it worsens, inform your healthcare provider.

Don’ts

• Do not leave the ring in place for longer than 90 days. 
• Do not flush down the used ring in the toilet.

Common Side Effects:

• Increased vaginal secretions
• Vaginal infection 
• Headache
• Vaginal irritation, dryness, or pain during sex

Serious, but Less Common Side Effects

• Heart attack
• Stroke
• Blood clots
• Dementia
• Breast cancer
• Cancer of the lining of the uterus
• Cancer of the ovary
• High blood pressure
• High blood sugar
• Gallbladder disease
• Liver problems
• Changes in thyroid hormone levels
• Enlargement of benign tumors of the uterus (fibroids) 

This is not an exhaustive list of side effects, and individual experiences may vary. If you have specific concerns about the side effects of Estring, consult your healthcare provider for personalized guidance.

Estring should not be used if you have unusual vaginal bleeding, have or had cancer, had a stroke or heart attack, have or had blood clots or liver problems, have a bleeding disorder, are allergic to any of its ingredients, or suspect pregnancy.

In general, the addition of progestin is recommended for women with a uterus to reduce the chance of getting cancer of the uterus.

An increased risk of stroke, deep vein thrombosis (DVT), pulmonary embolism (PE), and myocardial infarction (MI) has been reported with estrogen plus progestin therapy. Should any of these occur or be suspected, estrogen therapy should be discontinued immediately.

Estring may not be suitable for women with narrow, short, or stenosed vaginas. These conditions can make the vagina more susceptible to Estring-caused irritation.

Cases of toxic shock syndrome (TSS) have been reported in women using vaginal rings. If you experience difficulty or pain when trying to remove the ring, contact your healthcare provider immediately.

Report any unusual vaginal bleeding while using Estring, as it may be a warning sign of uterine cancer. Your healthcare provider should check any unusual vaginal bleeding to determine the cause.

Store Estring at room temperature and do not remove the ring from the pouch until ready for use. Properly discard the product when it is expired or no longer needed.

Carefully consider these warnings and precautions and consult a healthcare provider for personalized advice and guidance regarding the use of Estring.