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In this Article

• What is estradiol (Estring)?
• What are the possible side effects of estradiol (Estring)?
• What is the most important information I should know about estradiol (Estring)?
• What should I discuss with my healthcare provider before using estradiol (Estring)?
• How should I use estradiol (Estring)?
• What happens if I miss a dose (Estring)?
• What happens if I overdose (Estring)?
• What should I avoid while using estradiol (Estring)?
• What other drugs will affect estradiol (Estring)?
• Where can I get more information?

What should I discuss with my healthcare provider before using estradiol (Estring)?

Do not use estradiol without first talking to your doctor if you have

• a circulation, bleeding, or blood-clotting disorder;
• undiagnosed, abnormal vaginal bleeding; or
• any type of breast, uterine, or hormone-dependent cancer.

Using estradiol may be dangerous in some cases if you have any of the conditions listed above.

Before using estradiol, tell your doctor if you have

• high blood pressure, angina, or heart disease;
• high levels of cholesterol or triglycerides in your blood;
• liver disease;
• kidney disease;
• asthma;
• epilepsy;
• migraines;
• diabetes;
• depression;
• gallbladder disease;
• uterine fibroids;
• had a hysterectomy (uterus removed);
• a narrow, short, or prolapsed vagina;
• vaginal irritation; or
• a vaginal infection.

You may not be able to use estradiol, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.

Treatment with estradiol long-term may increase the risk of stroke. Because of this risk, you should contact your doctor or healthcare provider to discuss your individual risks and benefits before taking estradiol long-term. You should also talk to your doctor or healthcare provider on a regular basis (for example, every 3-6 months) about whether you should continue this treatment.

The Women's Health Initiative (WHI) study reported increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women (50-79 years of age) during 5 years of treatment with oral conjugated estrogens combined with medroxyprogesterone acetate.

The Women's Health Initiative Memory Study (WHIMS) found that postmenopausal women 65 years of age or older who were treated with oral conjugated estrogens plus medroxyprogesterone acetate had an increased risk of developing dementia. It is unknown whether this finding applies to younger postmenopausal women or to women using estrogen only therapy.

Estradiol is in the FDA pregnancy category X. This means that estradiol will cause birth defects in an unborn baby. Do not use estradiol if you are pregnant or are planning a pregnancy.

Estradiol may decrease milk flow and have other effects on milk composition. Do not use estradiol without first talking to your doctor if you are breast-feeding a baby.

How should I use estradiol (Estring)?

Use estradiol exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

To use the Estring vaginal ring:

• Squeeze the sides of the ring together and insert it into the vagina as far as possible (into the upper 1/3 of the vagina). You should not be able to feel the ring once it is in position. If you can feel it, use a finger to push it further into the vagina. It is not possible for the ring to go too far in or become lost.
• The ring should remain in place for 90 days. It should then be removed and replaced by a new ring, if prescribed by your doctor. If at any time the ring falls out, rinse it with warm water and reinsert it. If it slides down into the lower part of the vagina, use a finger to reinsert it.
• The ring does not need to be removed during sexual intercourse. It should not be felt by either partner. If it is bothersome, it can be removed, rinsed with warm water, and reinserted following intercourse.
• To remove the ring, loop a finger through the ring and gently pull it from the vagina.

To use the estradiol vaginal cream:

• Using the marked applicator provided, measure the prescribed dose of cream.
• Lie on your back with your knees drawn up, sit, or stand in a position that allows you comfortable access to the vaginal area. To deliver the medication, gently insert the applicator deeply into your vagina and press the plunger downward to its original position.
• Clean the applicator by pulling the plunger to remove it from the barrel. Wash it with mild soap and warm water.

Have yearly physical exams and examine your breasts for lumps on a monthly basis while using estradiol.

Store the vaginal rings and cream at room temperature away from moisture and heat.