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If you have not had a hysterectomy, oestrogen raises your risk of developing endometrial cancer, a cancer of the lining of the uterus (womb), while you are undergoing therapy or for up to 15 years after (surgery to remove the uterus [womb]). Your chance of developing endometrial cancer increases the longer you use oestrogen. You might be prescribed a progestin to take along with vaginal oestrogen if you have not undergone a hysterectomy. By doing so, you may have a lower risk of getting endometrial cancer, but you may also have a higher chance of getting breast cancer and other health issues. Inform your doctor if you have or have ever had cancer as well as if you experience unusual vaginal bleeding prior to starting to use vaginal oestrogen. You can be advised by your doctor not to use vaginal oestrogen. If you experience unusual or unexpected vaginal bleeding while taking vaginal oestrogen, call your doctor right once. To assist ensure that you do not develop endometrial cancer during or after your treatment, your doctor will keep a careful eye on you.
A significant study found that dementia, blood clots in the legs or lungs, breast cancer, and heart attacks were all more common in women who took oral oestrogen and progestins (loss of ability to think, learn, and understand). These disorders may also be more likely to affect women who use vaginal oestrogen, either alone or in combination with progestins. Inform your doctor if you’ve ever experienced a heart attack, a stroke, blood clots, breast cancer, or if anybody in your family has. or if you have a health issue that makes blood clots more likely to occur. 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 address symptoms like abrupt, intense urges to urinate, painful or difficult urination, and vaginal dryness, itching, and burning (change of life; the end of monthly menstrual periods). The Femring® brand vaginal ring is also used to treat hot flushes (commonly known as “hot flashes,” which are abrupt, intense feelings of heat and perspiration in menopausal women). Moreover, kraurosis vulvae is 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 menopausal women’s dyspareunia (painful or uncomfortable sex). A group of drugs known as hormones includes vaginal oestrogen. It functions by substituting the body’s natural production of oestrogen.
How should this medicine be used?
Vaginal estrogen comes as a flexible ring, a vaginal insert, as a tablet to insert in the vagina, and as a cream to apply to the inside of the vagina. Estrogen vaginal rings are usually inserted in the vagina and left in place for 3 months. After 3 months, the ring is removed, and a new ring may be inserted if treatment is still needed. Vaginal estrogen inserts are usually inserted once daily at the same time for 2 weeks, then used once every 3 to 4 days (twice weekly) as long as treatment is needed. Estrogen vaginal tablets are usually inserted once a day for the first 2 weeks of treatment and then are inserted twice a week as long as treatment is needed. Estrace® brand vaginal cream is usually applied once daily for 2 to 4 weeks, and then applied one to three times a week. Premarin® brand vaginal cream product is usually applied according to a rotating schedule that alternates several weeks when the cream is applied every day with one week when the cream is not applied. Use vaginal estrogen at around the same time of day every time you use it. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use vaginal estrogen exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.
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.
- The plunger must be pulled out of the barrel to clean the applicator. With mild soap and warm water, clean the applicator and plunger. The applicator should not be boiled or used with hot water.
For a copy of the manufacturer’s information for the patient, ask your chemist or doctor.
Other uses for this medicine
Ask your doctor or chemist 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 chemist know right away. For a list of the chemicals, consult your chemist or the manufacturer’s patient information.
- Inform your doctor and chemist 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. When utilising oestrogen vaginally, be careful to tell your doctor and chemist that you are taking these prescriptions. 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. inherited gioedema (inherited condition that causes episodes of swelling in the hands, feet, face, airway, or intestines), uterine fibroids (uterine growths that are not cancerous), endometriosis (a disorder in which the tissue that borders the uterus [womb] develops in other parts of the body), asthma, migraines, seizures, porphyria (a blood disorder where aberrant substances accumulate and create issues with the skin or brain system), extremely high or extremely low blood calcium levels, disease affecting the thyroid, kidneys, gallbladder, or pancreas, or hypoparathyroidism (condition in which the body does not create enough parathyroid hormon. A vaginal infection, any condition that makes your vagina more prone to get irritated, a narrow vagina, or a condition where the rectum, bladder, or uterus has bulged or dropped into the vagina should also be disclosed to your doctor if you intend to use the vaginal ring.
- If you are breastfeeding a child or intend to become pregnant, let your doctor know. Call your doctor as soon as possible if you fall pregnant while using vaginal oestrogen.
- You should be aware that the maker of one type of oestrogen vaginal cream (Premarin®) warns against using the cream with latex or rubber contraceptives like condoms or diaphragms. If you utilise these tools while using an oestrogen vaginal cream, they might not be as effective. See your doctor for advice on birth control options that will work 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?
Estrogen vaginal may have negative effects. If any of these symptoms are severe or do not go away, let your doctor know right once:
- Achy or sensitive breasts
- 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
- Bloating or stomach ache
- 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
- Continuous stomach pain that occasionally radiates to the back and is accompanied by nausea, vomiting, or an 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 chemist or the garbage/recycling agency in your city. If you do not have access to a take-back programme, see the FDA’s Safe Disposal of Medications website at http://goo.gl/c4Rm4p 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. http://www.upandaway.org
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:
- Abdominal pain
- Uterine bleeding
- Achy or sensitive breasts
- 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 prescription refills should be directed to your chemist.
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.
- Estrace® Cream
- Estring® Insert
- Femring® Insert
- Ogen® Cream
- Premarin® Cream
- Vagifem® Vaginal Tablets