Estradiol vaginal ring

What are estradiol vaginal rings?
ESTRADIOL (Estring™, Femring™) vaginal ring is an insert that contains a natural estrogen female hormone. Estradiol is essential for maintaining normal female functions and is normally produced by the ovaries. After menopause, the ovaries decrease their production of this hormone. Estradiol vaginal rings can help relieve symptoms of vaginal irritation and dryness and urinary tract irritation that occurs in some women during menopause. In addition, the Femring™ vaginal ring can help relieve hot flashes, as it contains a higher estrogen dosage than other vaginal rings. Generic estradiol vaginal rings are not yet available.

What should my health care professional know before I use estradiol vaginal rings?
They need to know if you have any of these conditions:

asthma
blood vessel disease, blood clotting disorder, or suffered a stroke
breast, cervical, endometrial or uterine cancer
diabetes
fibroids in the womb, or endometriosis
heart, kidney or liver disease
high blood lipids or cholesterol
high blood pressure
high level of calcium in the blood
hysterectomy
mental depression
migraine
porphyria
systemic lupus erythematosus (SLE)
tobacco smoker
vaginal bleeding
an unusual or allergic reaction to estrogens, other hormones, medicines, foods, dyes, or preservatives
pregnant or trying to get pregnant
breast-feeding

How should I use this medicine?
Estrogen vaginal ring may be inserted by you or your physician. The vaginal ring should be inserted while in a comfortable position: standing with one leg up, squatting, or lying down. After washing and drying your hands, remove the vaginal ring from its pouch; make sure hands are dry because the vaginal ring becomes slippery when wet. Hold the vaginal ring between your thumb and index finger and press the opposite sides of the vaginal ring together. Gently push the compressed vaginal ring into your vagina as far as you can. The exact position of the vaginal ring is not critical, as long as it is placed in the upper third of the vagina. When the vaginal ring is in place, you should not feel anything. If you feel uncomfortable, the vaginal ring is probably not far enough inside. Use your finger to gently push the vaginal ring further into your vagina. The vaginal ring should remain in place for 90 days. Use for the complete length of time prescribed. Do not stop using except on your prescriber’s advice.

You may bathe or participate in other activities while using the vaginal ring. You do not need to remove the vaginal ring during sexual or other activities unless you are more comfortable doing so. Within the 90-day dosage period, you may remove the vaginal ring, rinse it with clean lukewarm (not hot or boiling) water, and re-insert the ring as needed.

After 90 days (3 months) you should replace your old ring and insert a new one. To remove the vaginal ring, wash and dry hands thoroughly. Assume a comfortable position, either standing with one leg up, squatting, or lying down. Loop your finger through the ring and gently pull it out. Discard the used ring in a waste receptacle; do not flush the vaginal ring. Throw it away in an area where children or pets cannot reach it.

For this medicine:

Before starting this medication, read the paper on your prescription provided by your pharmacist or health care professional. This paper will tell you about the specific product you are taking. Make certain you understand the instructions. Different ring brands are not interchangeable so make sure you always receive the brand that you were prescribed.

This vaginal medication is not prescribed for children.

What if I miss a dose?
If you miss a dose, use it as soon as you can. If it is almost time for your next dose, use only that dose and resume your normal schedule. Do not use double or extra doses.

What drug(s) may interact with estradiol vaginal rings?
Do not use other vaginal medications without the advice of your health care professional. Other medications that might increase or decrease the effects of estradiol include:

some antibiotics used to treat infections
some medications used to treat HIV (human immunodeficiency virus) infection or AIDS
ascorbic acid/vitamin C supplements
barbiturates or benzodiazepines used for inducing sleep or treating seizures (convulsions)
bromocriptine
carbamazepine
cimetidine
clofibrate
cyclosporine
dantrolene
medications for diabetes
griseofulvin
hormones
hydrocortisone, cortisone, or prednisolone
imipramine or some other antidepressants
isoniazid (INH)
methotrexate
mineral oil
phenytoin
raloxifene or tamoxifen
rifabutin, rifampin, or rifapentine
some medications for treating migraines
theophylline
thyroid hormones
topiramate
tricyclic antidepressants
warfarin

Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.

What side effects may I notice from using estradiol vaginal rings?
Side effects that you should report to your prescriber or health care professional as soon as possible:

breakthrough bleeding and spotting
breast enlargement, tenderness, unusual discharge or milk production
chest pain
leg, arm or groin pain
nausea, vomiting
severe headaches
stomach pain (severe)
sudden shortness of breath
swelling of the hands, feet or ankles, or rapid weight gain
vision or speech problems
yellowing of the eyes or skin

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):

change in sexual desire
mild stomach upset
mood changes, anxiety, depression, frustration, anger, or emotional outbursts
increased or decreased appetite
skin rash, acne, or brown spots on the face
tiredness
vaginal irritation or itching
vaginal yeast infection (irritation and itching with a white discharge)
weight gain

What should I watch for while taking estradiol vaginal rings?
Visit your prescriber or health care professional for regular checks on your progress. You should have a complete check-up every 6 months. You will also need a regular breast and pelvic exam and ‘Pap’ smear while on estrogens therapy. You should also discuss the need for regular mammograms with your health care professional, and follow his or her guidelines for these tests. If you have any unusual bleeding contact your prescriber or health care professional for advice.

Estrogens can make your body retain fluid, making your fingers, hands, or ankles swell. Your blood pressure can go up. Contact your prescriber or health care professional if you feel you are retaining fluid.

If you have any reason to think you are pregnant; stop using estrogens at once and contact your prescriber or health care professional.

Tobacco smoking increases the risk of getting a blood clot or having a stroke while you are using estrogens, especially if you are more than 35 years old. You are strongly advised not to smoke.

If you wear contact lenses and notice visual changes, or if the lenses begin to feel uncomfortable, consult your eye prescriber or health care professional.

In women who still have their uterus, estrogens increase the risk of developing a condition (endometrial hyperplasia) that may lead to cancer of the lining of the uterus. Taking progestins, another hormone drug, with estrogens lowers the risk of developing this condition. Therefore, if your uterus has not been removed (by a hysterectomy), your doctor may prescribe a progestin for you to take together with your estrogen. You should know, however, that taking estrogens with progestins may have additional health risks. You should discuss the use of estrogens and progestins with your health care professional to determine the benefits and risks for you.

If you are going to have elective surgery, you may need to stop taking your estrogens one month beforehand. Consult your health care professional for advice prior to scheduling the surgery.

Where can I keep my medicine?
Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medicine after the expiration date.

Estradiol vaginal ring

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