WARNING

Estring is a vaginal insert used in hormone replacement therapy (HRT) to treat symptoms of menopause such as vaginal dryness and discomfort during intercourse. While generally considered safe and effective, there are potential risks associated with its use:

• Increased Risk of Cancer: Like other forms of hormone therapy, Estring may slightly increase the risk of certain cancers, including breast cancer and endometrial cancer. The risk varies depending on factors such as age, duration of use, and personal medical history.
• Cardiovascular Risks: Hormone therapy, including Estring, may increase the risk of cardiovascular events such as heart attacks and strokes, especially in older women or those with pre-existing cardiovascular conditions.
• Blood Clot Formation: Estring use can increase the risk of blood clots, particularly deep vein thrombosis (DVT) and pulmonary embolism. This risk is higher in women with a history of blood clots or clotting disorders.
• Gallbladder Disease: Hormone therapy may increase the risk of developing gallbladder disease, particularly in postmenopausal women.
• Fluid Retention and Swelling: Some women may experience fluid retention and swelling (edema) as a side effect of Estring use.
• Breast Changes: Estring may cause breast tenderness, enlargement, or discharge in some women.
• Other Side Effects: Other potential side effects include headache, nausea, vaginal discharge, and vaginal bleeding.

It’s important for individuals considering Estring or any form of hormone therapy to discuss the potential risks and benefits with their healthcare provider, especially considering their personal medical history and risk factors. Hormone therapy should be used at the lowest effective dose for the shortest duration necessary to achieve treatment goals. Regular follow-up appointments with a healthcare provider are recommended to monitor for any adverse effects.

Why is this medication prescribed?

Estring is prescribed primarily to alleviate symptoms of vaginal atrophy due to menopause. Vaginal atrophy is characterized by thinning, drying, and inflammation of the vaginal walls, often resulting in symptoms such as vaginal dryness, itching, burning, discomfort during intercourse, and increased susceptibility to urinary tract infections.

Estring inserts are designed to release a low dose of estrogen directly into the vagina, which helps to restore vaginal tissue health and relieve symptoms associated with vaginal atrophy. It’s particularly beneficial for women who experience vaginal symptoms but prefer localized estrogen therapy over systemic hormone replacement therapy (HRT).

How should this medicine be used?

Here’s how Estring inserts are typically used:

• Insertion: Estring comes as a soft, flexible ring that is inserted into the vagina by the patient or a healthcare provider. It’s typically inserted high into the vagina and left in place for up to 90 days.
• Duration of Use: Each Estring insert provides continuous release of estrogen over the course of three months. After 90 days, the ring should be removed and replaced with a new one, if continued therapy is necessary.
• Frequency of Replacement: Estring inserts are usually replaced every three months. It’s important to follow the prescribed schedule for removal and replacement to maintain the effectiveness of treatment.
• Cleaning: Estring does not need to be removed during sexual intercourse or urination. However, it’s advisable to rinse the Estring with lukewarm water if it is accidentally expelled from the vagina and reinsert it as soon as possible.
• Monitoring: Regular follow-up appointments with a healthcare provider are recommended to monitor the effectiveness of treatment and assess any side effects or changes in symptoms.

It’s essential to follow the specific instructions provided by your healthcare provider regarding the use of Estring inserts, including proper insertion technique and timing of replacement. Additionally, any concerns or questions about Estring therapy should be discussed with a healthcare provider.

Other uses for this medicine

Some potential alternative uses include:

• Management of vaginal atrophy due to hormonal imbalances.
• Treatment of certain cases of vaginal prolapse.
• Support in managing urinary incontinence in certain situations.

What special precautions should I follow?

Regarding special precautions for Estring use, individuals should follow these guidelines:

• Medical History: Before using Estring, inform your healthcare provider about your complete medical history, including any allergies, medical conditions, and current medications, especially if you have a history of breast cancer, blood clots, heart disease, liver disease, or vaginal bleeding of unknown cause.
• Regular Check-ups: Attend regular follow-up appointments with your healthcare provider to monitor the effectiveness of treatment and assess any potential side effects or changes in symptoms.
• Breast Exams: Perform regular breast self-exams and undergo regular clinical breast exams as recommended by your healthcare provider while using Estring.
• Vaginal Bleeding: Contact your healthcare provider if you experience any unexplained vaginal bleeding or spotting while using Estring, as this may indicate a serious medical condition.
• Interaction with Other Medications: Inform your healthcare provider about all medications you are taking, including prescription, over-the-counter, herbal, or dietary supplements, as they may interact with Estring.
• Smoking: Avoid smoking while using Estring, as smoking may increase the risk of certain side effects associated with estrogen therapy, such as blood clots and cardiovascular events.
• Pregnancy and Breastfeeding: Estring is not indicated for use during pregnancy or breastfeeding. If you become pregnant while using Estring, discontinue use and consult your healthcare provider.

By following these precautions and guidelines, individuals can use Estring safely and effectively under the supervision of a healthcare provider.

What special dietary instructions should I follow?

There are no specific dietary restrictions associated with Estring insert use. However, maintaining a balanced and healthy diet can support overall well-being and may complement your treatment regimen.

What should I do if I forget a dose?

• If you forget to replace your Estring insert after 90 days, contact your healthcare provider for guidance. Depending on the length of time the ring has been out of use, your healthcare provider may recommend inserting a new Estring ring as soon as possible or adjusting your treatment plan accordingly.
• Do not double the dose to make up for a missed dose. Simply resume your regular dosing schedule and follow your healthcare provider’s instructions.

What side effects can this medication cause?

Estring insert, like any medication, can potentially cause side effects, although not everyone will experience them. Common side effects associated with Estring insert may include:

• Vaginal Discomfort: Some women may experience vaginal irritation, itching, or discharge when using Estring insert. This is usually mild and transient.
• Headache: Headaches are a common side effect of hormone therapy, including Estring insert.
• Breast Tenderness: Estring insert may cause breast tenderness or enlargement in some women.
• Nausea: Nausea is a possible side effect, although it is less common with localized vaginal estrogen therapy compared to systemic hormone replacement therapy.
• Vaginal Bleeding or Spotting: Some women may experience vaginal bleeding or spotting, particularly during the first few months of Estring use. If this persists or becomes severe, it should be reported to a healthcare provider.
• Fluid Retention: Estring insert may cause fluid retention or swelling (edema) in some individuals.
• Gastrointestinal Symptoms: These may include bloating, stomach upset, or abdominal discomfort.
• Vaginal Candidiasis: In some cases, Estring insert use may increase the risk of vaginal yeast infections (candidiasis).
• Mood Changes: Some individuals may experience changes in mood or emotional well-being while using Estring insert.
• Skin Irritation: Rarely, Estring insert may cause skin irritation or allergic reactions at the site of insertion.

It’s important to note that the occurrence and severity of side effects can vary from person to person. If you experience any persistent or bothersome side effects while using Estring insert, or if you have any concerns about your treatment, it’s essential to consult your healthcare provider for guidance and possible adjustments to your therapy. Additionally, if you experience any signs of a serious allergic reaction, such as rash, itching, swelling, severe dizziness, or difficulty breathing, seek immediate medical attention.

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

Storage and Disposal:

• Storage:
  • Store Estring inserts at room temperature away from moisture, heat, and direct light.
  • Keep the product out of reach of children and pets.
  • Do not store Estring in the bathroom or near the kitchen sink to prevent exposure to moisture.
• Disposal:
  • After removing an expired Estring insert, dispose of it properly by wrapping it in tissue and throwing it in the trash.
  • Do not flush Estring inserts down the toilet, as they may not fully dissolve and can contribute to environmental pollution.

In case of emergency/overdose

• In case of accidental ingestion of Estring or suspected overdose, seek immediate medical attention or contact a poison control center.
• Symptoms of overdose may include nausea, vomiting, vaginal bleeding, and breast tenderness.

What other information should I know?

• Other Information: Keep all appointments with your healthcare provider for regular follow-up evaluations and monitoring of your response to Estring therapy. Inform any healthcare provider treating you about your use of Estring insert, including dentists and emergency medical personnel. If you are scheduled for surgery or a medical procedure, inform the healthcare provider performing the procedure about your use of Estring, as estrogen therapy may increase the risk of blood clots.
• Pregnancy and Breastfeeding: Estring is not indicated for use during pregnancy or breastfeeding. If you become pregnant while using Estring, discontinue use and consult your healthcare provider.
• Smoking: Avoid smoking while using Estring, as smoking may increase the risk of certain side effects associated with estrogen therapy, such as blood clots and cardiovascular events.
• Regular Follow-up: Attend all scheduled follow-up appointments with your healthcare provider to monitor the effectiveness of treatment and address any concerns or changes in symptoms.
• Storage and Disposal: Keep Estring inserts in their original packaging until ready for use. Do not use Estring inserts beyond the expiration date printed on the packaging. Dispose of expired or unused Estring inserts according to local regulations.

By following these guidelines and staying informed about the proper use, storage, disposal, and potential risks associated with Estring insert, you can use the medication safely and effectively under the guidance of your healthcare provider.