Estring

Estring treats vaginal symptoms of menopause. This medication is a flexible ring that is inserted into the vagina.

Estring Overview

Reviewed: October 5, 2012
Updated: 

Estring is a prescription medication used to treat symptoms of menopause including thinning, drying and inflammation of the vagina.  

Estring contains estradiol, which is a form of the hormone estrogen, and it replaces estrogen that is not naturally produced by the ovaries.

This medication is available as a vaginal ring and is usually inserted for a 3 month period (90 days).

Common side effects of Estring include headache, back pain, and a whitish or yellowish discharge from the vagina.

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  • Other
  • Hot Flashes
  • Hypogonadism
  • Menopause, Premature
  • Menorrhagia
  • Osteoporosis, Postmenopausal
  • Primary Ovarian Insufficiency
  • Prostatic Neoplasms

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  • A couple weeks
  • A month or so
  • A few months
  • A year or so
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Estring Cautionary Labels

precautions

Uses of Estring

Estring is a prescription medication used to treat symptoms of menopause including thinning, drying and inflammation of the vagina.  

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Manufacturer

Estring Drug Class

Estring is part of the drug class:

Side Effects of Estring

Serious side effects have been reported with Estring. See the “Estring Precautions” section.

Common side effects of Estring include the following:

  • headache
  • breast pain or tenderness
  • nausea
  • vomiting
  • constipation
  • gas
  • heartburn
  • weight gain or loss
  • hair loss
  • swelling, redness, burning, irritation or itching of the vagina
  • vaginal discharge
  • painful menstrual periods
  • anxiety
  • depression
  • changes in mood
  • change in sexual desire
  • back, neck, or muscle pain
  • runny nose or congestion
  • cough
  • unwanted hair growth

This is not a complete list of Estring side effects. Ask your doctor or pharmacist for more information.

Tell your doctor if you have any side effect that bothers you or that does not go away.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Estring Interactions

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

  • Amiodarone (Cordarone, Pacerone)
  • Antifungals such as itraconazole (Sporanox) and ketoconazole (Nizoral)
  • Aprepitant (Emend)
  • Carbamazepine (Carbatrol, Epitol, Tegretol)
  • Cimetidine (Tagamet)
  • Clarithromycin (Biaxin)
  • Cyclosporine (Neoral, Sandimmune)
  • Dexamethasone (Decadron, Dexpak)
  • Diltiazem (Cardizem, Dilacor, Tiazac, others)
  • Erythromycin (E.E.S, Erythrocin)
  • Fluoxetine (Prozac, Sarafem)
  • Fluvoxamine (Luvox)
  • Griseofulvin (Fulvicin, Grifulvin, Gris-PEG)
  • Lovastatin (Altocor, Mevacor)
  • Medications for human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) such as atazanavir (Reyataz), delavirdine (Rescriptor), efavirenz (Sustiva), indinavir (Crixivan), lopinavir (in Kaletra), nelfinavir (Viracept), nevirapine (Viramune), ritonavir (Norvir, in Kaletra), and saquinavir (Fortovase, Invirase)
  • Medications for thyroid disease
  • Nefazodone
  • Other medications that contain estrogen
  • Phenobarbital
  • Phenytoin (Dilantin, Phenytek); rifabutin (Mycobutin)
  • Rifampin 
  • Sertraline (Zoloft)
  • Troleandomycin (TAO)
  • Verapamil (Calan, Covera, Isoptin, Verelan)
  • Zafirlukast (Accolate)
  • St. John's Wort

This is not a complete list of Estring drug interactions. Ask your doctor or pharmacist for more information.

Estring Precautions

Serious side effects have been reported with Estring including the following:

  • bulging eyes
  • yellowing of the skin or eyes
  • itching
  • loss of appetite
  • fever
  • joint pain
  • stomach tenderness, pain, or swelling
  • movements that are difficult to control
  • hives
  • rash or blisters on the skin
  • swelling, of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs
  • hoarseness
  • wheezing
  • difficulty breathing or swallowing

Do not use Estring if you:

  • are allergic to Estring or to any of its ingredients
  • have abnormal vaginal bleeding
  • have a known or suspected history of breast cancer
  • have a known or suspected estrogen-dependent cancer
  • have a history of blood clots
  • have blood clots
  • have or had a stroke
  • have or had a heart attack
  • have liver disease
  • have certain bleeding conditions
  • are pregnant or possibly pregnant

Estring Food Interactions

Grapefruit and grapefruit juice may interact with Estring and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor.

Inform MD

Before using Estring, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

  • are allergic to Estring or to any of its ingredients
  • have or have ever had asthma
  • have seizures
  • have migraine headaches
  • have a history of strokes
  • have a history of heart attack
  • have a known or suspected history of breast cancer
  • have a known or suspected estrogen-dependent cancer
  • have a history of blood clots
  • have endometriosis (a condition in which the type of tissue that lines the uterus [womb] grows in other areas of the body)
  • have uterine fibroids (growths in the uterus that are not cancer)
  • have or have had yellowing of the skin or eyes, especially during pregnancy or while you were using an estrogen product
  • have very high or very low levels of calcium in your blood
  • have porphyria (condition in which abnormal substances build up in the blood and cause problems with the skin or nervous system) or gallbladder, thyroid, pancreas, liver or kidney disease
  • are pregnant or breastfeeding

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Estring and Pregnancy

Tell your doctor if you are pregnant or plan to become pregnant.

Estring should not be used during pregnancy. There appears to be little or no increased risk of birth defects in children born to women who inadvertently used estrogens and progestins as an oral contraceptive inadvertently during early pregnancy.

Estring and Lactation

Tell your doctor if you are breastfeeding or plan to breastfeed.

Estring should not be used during lactation. Estrogen administration to nursing women has been shown to decrease the quantity and quality of the breast milk. Detectable amounts of estrogens have been identified in the breast milk of mothers receiving estrogens. Caution should be exercised when Estring is administered to a nursing woman.

Estring Usage

Use Estring exactly as prescribed.

This medication is available as vaginal ring and is usually inserted for a 3 month period (90 days). 

One Estring is to be inserted as deeply as possible into the upper one-third of the vaginal vault. The ring is to remain in place continuously for three months, after which it is to be removed and, if appropriate, replaced by a new ring. The need to continue treatment should be assessed at 3 or 6 month intervals.

Should the ring be removed or fall out at any time during the 90-day treatment period, the ring should be rinsed in lukewarm water and re-inserted by the patient, or, if necessary, by a physician or nurse.

Retention of the ring for greater than 90 days does not represent overdosage but will result in progressively greater underdosage with the attendant risk of loss of efficacy and increasing risk of vaginal infections and/or erosions.

Instructions for Use

Estring insertion

The ring should be pressed into an oval and inserted into the upper third of the vaginal vault. The exact position is not critical. When Estring is in place, the patient should not feel anything. If the patient feels discomfort, Estring is probably not far enough inside. Gently push Estring further into the vagina.

Estring use

Estring should be left in place continuously for 90 days and then, if continuation of therapy is deemed appropriate, replaced by a new Estring.

The patient should not feel Estring when it is in place and it should not interfere with sexual intercourse. Straining at defecation may make Estring move down in the lower part of the vagina. If so, it may be pushed up again with a finger.

If Estring is expelled totally from the vagina, it should be rinsed in lukewarm water and reinserted by the patient (or doctor/nurse if necessary).

Estring removal

Estring may be removed by hooking a finger through the ring and pulling it out.

 

Estring Dosage

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The dose your doctor recommends may be based on the following:

  • the condition being treated
  • other medical conditions you have
  • other medications you are taking
  • how you respond to this medication

The recommended dose of Estring for the treatment of menopause symptoms is one ring (2 mg) inserted into the vagina every 3 months.

Estring Overdose

If you take insert too much Estring, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

Other Requirements

Store Estring at 15° to 30° C (59° to 86° F).

Keep this and all medicines out of the reach of children.

Estring FDA Warning

WARNINGS: ENDOMETRIAL CANCER, CARDIOVASCULAR DISORDERS, BREAST CANCER AND PROBABLE DEMENTIA

Estrogen-Alone Therapy

Endometrial Cancer

There is an increased risk of endometrial cancer in a woman with a uterus who uses unopposed estrogens. Adding a progestin to estrogen therapy has been shown to reduce the risk of endometrial hyperplasia, which may be a precursor to endometrial cancer. Adequate diagnostic measures, including directed and random endometrial sampling when indicated, should be undertaken to rule out malignancy in all cases of undiagnosed persistent or recurring abnormal genital bleeding. 

Cardiovascular Disorders and Probable Dementia

Estrogen-alone therapy should not be used for the prevention of cardiovascular disease or dementia. 

The Women's Health Initiative (WHI) estrogen-alone substudy reported increased risks of stroke and deep vein thrombosis (DVT) in postmenopausal women (50 to 79 years of age) during 7.1 years of treatment with daily oral conjugated estrogens (CE) [0.625 mg]-alone, relative to placebo. 

The WHI Memory Study (WHIMS)estrogen-alone ancillary study of the WHI reported an increased risk of developing probable dementia in postmenopausal women 65 years of age or older during 5.2 years of treatment with daily CE (0.625 mg)-alone, relative to placebo. It is unknown whether this finding applies to younger postmenopausal women. 

In the absence of comparable data, these risks should be assumed to be similar for other doses of CE and other dosage forms of estrogens.

Estrogens with or without progestins should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals and risks for the individual woman.

Estrogen Plus Progestin Therapy

Cardiovascular Disorders and Probable Dementia

Estrogen plus progestin therapy should not be used for the prevention of cardiovascular disease or dementia. 

The WHI estrogen plus progestin substudy reported increased risks of DVT, pulmonary embolism (PE), stroke and myocardial infarction (MI) in postmenopausal women (50 to 79 years of age) during 5.6 years of treatment with daily oral CE (0.625 mg) combined with medroxyprogesterone acetate (MPA) [2.5 mg], relative to placebo. 

The WHIMS estrogen plus progestin ancillary study of the WHI reported an increased risk of developing probable dementia in postmenopausal women 65 years of age or older during 4 years of treatment with daily CE (0.625 mg) combined with MPA (2.5 mg), relative to placebo. It is unknown whether this finding applies to younger postmenopausal women. 

Breast Cancer

The WHI estrogen plus progestin substudy also demonstrated an increased risk of invasive breast cancer. 

In the absence of comparable data, these risks should be assumed to be similar for other doses of CE plus MPA, and other combinations and dosage forms of estrogens and progestins.

Estrogens with or without progestins should be prescribed at the lowest doses and for the shortest duration consistent with treatment goals and risks for the individual woman.