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Conjugated Estrogens (Generic Estrogen Vaginal)

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Ask your doctor or pharmacist for more details if you believe this drug should be used for something else. If you have not had a hysterectomy, oestrogen raises your risk of developing endometrial cancer, a kind of uterine lining cancer, during treatment or for up to 15 years following treatment (surgery to remove the uterus [womb]). The chance of developing endometrial cancer increases with the duration of oestrogen use. If you haven’t undergone a hysterectomy, you might also be prescribed a progestin to take along with vaginal oestrogen. The risk of having endometrial cancer may be reduced, but your risk of acquiring certain other health issues, such as breast cancer, may increase. If you have cancer or have ever had cancer, as well as if you experience unusual vaginal bleeding, let your doctor know before you start using vaginal oestrogen. Not using vaginal oestrogen may be advised by your physician. If you experience abnormal or unexpected vaginal bleeding while receiving vaginal oestrogen, contact your doctor right once. When you are receiving treatment or afterward, your doctor will keep a close eye on you to help prevent the development of endometrial cancer.

Using oestrogen and progestins orally increased the risk of dementia, blood clots in the legs or lungs, breast cancer, and heart attacks in women, according to a big study (loss of ability to think, learn, and understand). Moreover, these disorders may be more likely to affect women who use vaginal oestrogen alone or in combination with progestins. If you have ever had breast cancer, a blood clot, a heart attack, or a stroke, or if anyone in your family has, you should mention it to your doctor. or if you have a health issue that raises your risk of blood clots. You can be advised by your doctor not to use vaginal oestrogen. Moreover, let your doctor know if you smoke or use tobacco, have breast lumps, an abnormal mammogram, high blood pressure, high cholesterol or fat levels, diabetes, heart disease, lupus (a condition in which the body attacks its own tissues), have any of these conditions or have ever had them (x-ray of the breasts used to find breast cancer).

The major medical disorders mentioned above can present with any of the symptoms below. If you suffer any of the following signs while using vaginal oestrogen, call your doctor right away: Speech difficulties, dizziness or faintness, sudden complete or partial vision loss, double vision, numbness or weakness in one arm or leg, crushing chest pain or chest heaviness, coughing up blood, sudden shortness of breath, trouble thinking clearly, remembering, or learning new things, breast lumps or other breast changes, discharge from nipples, or pain, tenderness, or redness in one leg are all symptoms of a sudden severe headache, vomiting, and headache of equal severity.

You can take precautions to lessen your chance of experiencing a significant health issue when using vaginal oestrogen. To avoid dementia, heart disease, heart attacks, or strokes, do not take vaginal oestrogen by itself or in combination with a progestin. Take vaginal oestrogen only as long as necessary and at the lowest oestrogen dose that manages your symptoms. Every three to six months, discuss with your doctor whether you should reduce your oestrogen dosage or stop taking the drug.

To help find breast cancer as early as possible, you should check your breasts monthly and get a mammography and breast exam conducted by a doctor once a year. If you have a personal or family history of illness, your doctor will advise you on how to properly inspect your breasts and whether you need to have them checked more frequently than once a year.

If you are undergoing surgery or will be recovering in bed, let your doctor know. In order to reduce your risk of developing blood clots, your doctor may advise you to cease taking vaginal oestrogen 4-6 weeks before to the procedure or place you on bed rest.

Regularly discuss the advantages and disadvantages of utilising vaginal oestrogen with your doctor.

Why is this medication prescribed?

In women who are going through or have gone through menopause, vaginal oestrogen is used to treat vaginal dryness, itching, and burning as well as painful or challenging urination and an unexpected urge to urinate right away (change of life; the end of monthly menstrual periods). Hot flushes (also known as “hot flashes,” which are rapid, intense feelings of heat and perspiration in menopausal women) are also treated with vaginal rings of the Femring® brand. Kraurosis vulvae is also treated with vaginal cream from the Premarin® brand (a condition that may cause vaginal dryness and discomfort in women or girls of any age). Vaginal inserts under the Imvexxy® name are used to treat dyspareunia (painful or uncomfortable sex) in menopausal women. The hormones drug class includes vaginal oestrogen. It functions by substituting the body’s natural production of oestrogen.

How should this medicine be used?

A flexible ring, a vaginal insert, a tablet to implant in the vagina, and a cream to apply to the inside of the vagina are all forms of vaginal oestrogen. Typically, oestrogen vaginal rings are placed in the vagina and left there for three months. If treatment is still required after three months, a replacement ring may be implanted. Vaginal oestrogen inserts are typically administered twice weekly for as long as treatment is required. They are typically inserted once daily at the same time for two weeks. For the first two weeks of treatment, oestrogen vaginal pills are typically inserted once daily; after that, they are inserted twice weekly for the duration of the treatment period. Vaginal cream of the Estrace® brand is typically used once daily for two to four weeks, and thereafter once to three times per week. Premarin® brand vaginal cream is often applied on a rotating regimen that alternates between several weeks of daily application and one week of no application. Every time you take vaginal oestrogen, use it around the same time of day. Ask your doctor or pharmacist to explain any instructions on your prescription label that you are unsure about following. Use vaginal oestrogen as indicated. Use it only as directed by your doctor, neither more nor less often.

Use the vaginal ring as directed by these steps:

  • Clean, then dry your hands.
  • Take the vaginal ring out of the pouch it is in.
  • Squat, lie down, or stand with one leg raised on a step, chair, or other object. The position you feel most comfortable in should be chosen.
  • Press the sides of the vaginal ring together while holding it between your thumb and index finger. The ring could be twisted into a figure-eight configuration.
  • Using your other hand, hold the folds of skin around your vagina open.
  • Use your index finger to gently push the ring as far into your vagina as you can after inserting the tip into your vagina.
  • It is not necessary to set the vaginal ring in a specific manner within your vagina, although doing so will make it more comfortable and less likely to come loose. When you push the ring in, it won’t travel too far or get lost because it can’t go past your cervix. If you experience any discomfort, insert the ring even deeper into your vagina with your index finger.
  • Rewash your hands.
  • For three months, leave the ring in place. If you have not inserted the ring deeply enough in your vagina, if your vaginal muscles are weak, or if you are trying to go potty, the ring may come out. If the ring comes off, wash it in warm water, then reinstall it in your vagina as described above. To rinse the ring, avoid using hot water. Replace the missing ring by placing a new one and leaving it in place for up to three months. If your ring comes off frequently, call your doctor.
  • When having sex, you can keep the ring on. If you decide to remove it or if it comes out accidentally, wash it in warm water, then put it back in your vagina as soon as you can.
  • When you’re prepared to take off the ring, wash your hands and find a comfortable posture to stand or lay in.
  • Hook a finger through the ring by inserting it into your vagina. To remove the ring, gently pull downward and forward.
  • To safely dispose of the ring, wrap it in tissue or toilet paper and place it where children and animals cannot access it. Avoid flushing the ring down the toilet.
  • Rewash your hands.

To utilise the vaginal pill, perform the following actions:

  • Take one applicator off the carton’s strip of applicators.
  • Remove the applicator by cracking up the plastic wrap.
  • Lay down or stand with one leg up on a step, chair, or other object. The position you feel most comfortable in should be chosen.
  • Place a finger on the plunger end of the applicator and hold it in one hand.
  • The applicator should be carefully inserted into the vaginal opening using the other hand. Do not attempt to replace the tablet if it pops out of the applicator. Use a new applicator and throw away the tablet and the previous one.
  • The applicator should be inserted as far into the vagina as is comfortable. Avoid forcing the applicator into your vagina or sticking it in there more than halfway.
  • Push the plunger slowly until you hear a click.
  • Like you would with a plastic tampon applicator, take the empty applicator out of your vagina and throw it away. Don’t keep or use the applicator again.

The Imvexxy® vaginal insert should be used as described below:

  • Handling the vaginal insert requires washing and drying your hands beforehand.
  • One vaginal insert should be pushed through the blister package’s cellophane.
  • The bigger end of the vaginal insert should be held between your fingers.
  • Whether you’re standing or lying down, choose the ideal insertion posture for vaginal insertion.
  • Use your finger to place the insert into your vagina with the smaller end facing up.

Do the following actions to apply the vaginal cream:

  • The cream tube’s cap should be removed.
  • Onto the tube’s open end, screw the applicator’s nozzle or threaded end.
  • Fill the applicator with the recommended amount of cream by gently squeezing the tube from the bottom. To help you measure your dose, look at the markings on the applicator’s side.
  • The applicator from the tube by unscrewing it.
  • Pull your knees up towards your chest while lying on your back.
  • To release the cream, gently put the applicator into your vagina and depress the plunger downward.
  • From your vagina, take the applicator out.
  • Pull the plunger out of the barrel to remove the applicator for cleaning. Use warm water and mild soap to clean the plunger and applicator. Never boil the applicator or use boiling water.

For a copy of the manufacturer’s information for the patient, ask your pharmacist or doctor.

Other uses for this medicine

Ask your doctor or pharmacist for more details if you believe this drug should be used for something else.

What special precautions should I follow?

Before using vaginal estrogen,

  • If you have any allergies, including to vaginal oestrogen, other oestrogen products, drugs, or any of the substances in the kind of vaginal oestrogen you want to use, let your doctor and pharmacist know right away. For a list of the ingredients, consult your pharmacist or the manufacturer’s patient information.
  • Inform your doctor and pharmacist about any prescription and over-the-counter drugs, vitamins, and dietary supplements you are currently taking or intend to take. Your physician might need to adjust the dosage of your drugs or keep a close eye on you for side effects.
  • Inform your doctor about any over-the-counter or herbal medications you are taking, especially if you take St. John’s wort. Before using oestrogen vaginally, be careful to tell your doctor and pharmacist that you are taking these medications. While using oestrogen vaginally, do not begin any of these medications without first talking to your doctor.
  • Inform your doctor if you have liver illness or a blood condition that could raise your chance of getting an abnormal blood clot, such as protein C, protein S, or antithrombin deficiency. Most likely, your doctor will advise against using oestrogen vaginal products.
  • Inform your doctor if you have or have ever experienced skin or eye yellowing while pregnant or while taking an oestrogen product. Uterine fibroids (growths in the uterus that are not cancerous), hereditary angioedema (an inherited condition that causes episodes of swelling in the hands, feet, face, airway, or intestines), endometriosis (a condition in which the type of tissue that lines the uterus [womb] grows in other areas of the body), asthma, migraine headaches, seizures, and porphyria (condition in which abnormal substances build up in the blood and cause problems with the skin or nervous system), extremely high or extremely low blood calcium levels, hypoparathyroidism (disease in which the body fails to make adequate parathyroid hormone), thyroid, renal, gallbladder, or pancreatic disorders, or any combination of these. Tell your doctor if you have a vaginal infection, any condition that increases the likelihood of your vagina being inflamed, a narrow vagina, or a condition where the rectum, bladder, or uterus has bulged or dropped into the vagina if you intend to use the vaginal ring.
  • Inform your physician if you are nursing a baby, intend to get pregnant, or are already pregnant. Call your doctor right away if you become pregnant while using vaginal oestrogen.
  • You should be aware that one kind of oestrogen vaginal cream (Premarin®) warns against using latex or rubber birth control methods like condoms or diaphragms, saying that the cream may weaken them. If you use these gadgets while receiving treatment with oestrogen vaginal cream, they might not work as well. See your doctor about birth control options that are right for you.

What special dietary instructions should I follow?

If you plan to consume grapefruits or grapefruit juice while taking this medication, consult your doctor.

What should I do if I forget a dose?

As soon as you remember, administer or reintroduce the missed dose. If the next dose is soon due, skip the missed one and carry on with your regular dosing plan. To make up for a missing dose, don’t take two doses or use more cream.

What side effects can this medication cause?

Vaginal estrogen may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • Breast pain or tenderness
  • Nausea
  • Headache
  • Vomiting
  • Diarrhea
  • Having trouble falling or staying asleep
  • Alteration of sexual desire
  • Hair fall
  • Sporadic darkening of the face’s skin
  • Quick onset of heat or perspiration
  • Belly aches or bloating
  • Vaginal enlargement, redness, stinging, itching, or irritation
  • Vaginal oozing
  • Difficult or painful urinating
  • Joint or back ache
  • Nose bleeds or congestion

Certain adverse effects can be very harmful. Call your doctor right away if any of these symptoms occur to you:

  • Enlarged eyes
  • Chronic stomach ache that occasionally radiates to the back nausea, vomiting, or appetite loss
  • Trouble breathing or swallowing, hoarseness, rash, hives, itching, or any of these
  • Swelling of the lower legs, lower arms, hands, feet, ankles, tongue, or throat
  • Fever, sickness or vomiting, diarrhoea, cramps, lightheadedness or vertigo, or a rash on the face or body

Estrogen may raise your risk of getting ovarian cancer or gallbladder disease, both of which may require surgical intervention to address. Discuss the dangers of using vaginal oestrogen with your doctor.

Further negative consequences of vaginal oestrogen could exist. If you experience any strange issues while taking this medicine, contact your doctor right away.

You or your doctor can submit a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting programme online or by phone if you have a serious side event (1-800-332-1088).

What should I know about storage and disposal of this medication?

Keep this medication tightly closed in the original container and out of the reach of children. Keep it away from excessive heat and moisture at room temperature (not in the bathroom).

Unused prescriptions must be disposed of carefully to prevent pets, kids, and other people from ingesting them. You should not, however, dispose of this medication in the toilet. Instead, utilising a medicine take-back programme is the easiest approach to get rid of your medication. To find out about take-back programmes in your area, speak with your pharmacist or the garbage/recycling department in your city. If you do not have access to a take-back programme, see the FDA’s Safe Disposal of Medications website at for additional information.

Although many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and are simple for young children to open, it is crucial to keep all medications out of sight and out of reach of children. Always lock safety caps and promptly stash medication up and away from young children where it is out of their sight and reach to prevent poisoning.

In case of emergency/overdose

Call your local poison control centre at 1-800-222-1222 if someone uses additional cream, tablets, or rings, or ingests vaginal oestrogen. Dial 911 to reach the nearest emergency services if the sufferer has collapsed or has stopped breathing.

Overdose signs could include the following:

  • Nausea
  • Vomiting
  • Abdominal pain
  • Uterine bleeding
  • Achy or sensitive breasts
  • Dizziness
  • Sluggishness or exhaustion

What other information should I know?

Keep all of your doctor’s appointments.

Inform the lab staff and your doctor that you are using vaginal oestrogen prior to any laboratory test.

Do not share your medication with anybody else. Any queries you may have regarding medication refills should be directed to your pharmacist.

You should keep a written record of every medication you take, including any over-the-counter (OTC) items, prescription drugs, and dietary supplements like vitamins and minerals. This list should be brought with you whenever you see a doctor or are admitted to the hospital. You should always have this information with you in case of emergencies.

Brand names

  • Estrace® Cream
  • Estring® Insert
  • Femring® Insert
  • Imvexxy®
  • Ogen® Cream
  • Premarin® Cream
  • Vagifem® Vaginal Tablets
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