Estring

Overview

Estring is a vaginal ring used to treat vaginal dryness, soreness and irritation caused by low oestrogen levels after the menopause (atrophic vaginitis). It is a type of hormone replacement therapy (HRT) that releases a small, steady amount of oestrogen directly into the vagina. Because the dose is low and acts mainly in the vagina, it is used to relieve local symptoms rather than other menopausal complaints such as hot flushes. Estring is for use in postmenopausal women only.

Directions

Wash your hands before handling the ring. Choose a comfortable position, such as standing with one foot raised, squatting, or lying down. Use one hand to open the folds of skin around the vagina. With your other hand, press the ring into an oval shape and push it into the vagina, as far up and back as it will go, towards the small of your back. Once in place, leave the ring in the vagina for 90 days. After 90 days, remove the ring by hooking a finger around it and gently pulling it downwards and forwards, then insert a new ring. Treatment should use the lowest effective dose for the shortest time needed, and should not normally continue for more than two years.

Side Effects

Possible side effects include:

• Urinary tract infection
• Vaginal infection
• Vulvovaginal discomfort
• Genital itching
• Abdominal pain or lower abdominal pain
• Abdominal or anorectal discomfort
• Bladder discomfort
• Generalised itching
• Increased sweating
• Hypersensitivity (allergic) reactions

Please read the patient information leaflet for a full list of side effects.

How it works

Estring contains estradiol, a hormone that is the same as the natural oestrogen made by the ovaries. After the menopause, oestrogen levels drop, which can cause the lining of the vagina to become thin, dry and sore. The ring sits in the vagina and slowly releases a small amount of estradiol directly into the surrounding tissue. This helps restore the vagina’s natural pH and reduces the local symptoms and signs of oestrogen deficiency.

Delivery

e-Surgery uses Royal Mail delivery with choices starting from; Royal Mail 48 tracked delivery, Royal Mail tracked 24 and Royal Mail 1pm special delivery (discover more about e-Surgery delivery). When you buy products online they will arrive in discreet, recyclable packaging at a delivery address of your choice. Find out to recycle packaging from e-Surgery.

Ingredients

The active ingredient is estradiol hemihydrate 2.0 mg per ring, which corresponds to 1.94 mg of estradiol. Each ring releases an average of 7.5 micrograms of estradiol per 24 hours.

The other ingredients are: silicone elastomer Q7-4735 A, silicone elastomer Q7-4735 B, silicone fluid, and barium sulfate.

Warnings

Do not use Estring if any of the following apply to you:

• You have, have had, or are suspected of having breast cancer
• You have or are suspected of having an oestrogen-dependent cancer, such as cancer of the womb lining (endometrial cancer)
• You have vaginal bleeding that has not been investigated
• You have untreated thickening of the womb lining (endometrial hyperplasia)
• You have or have had a blood clot in a vein, such as deep vein thrombosis or pulmonary embolism
• You have a known blood-clotting disorder (such as protein C, protein S, or antithrombin deficiency)
• You have or have recently had a problem caused by blood clots in the arteries, such as angina or a heart attack
• You have active liver disease or a history of liver disease where liver function tests have not returned to normal
• You are allergic to estradiol or any of the other ingredients
• You have porphyria

Talk to your doctor or pharmacist before using Estring if any of the following apply to you:

• You have fibroids in the womb or endometriosis
• You have risk factors for blood clots, or a family history of blood clots
• You have a family history of breast cancer or other oestrogen-dependent cancers
• You have high blood pressure
• You have a liver disorder, such as a non-cancerous liver tumour
• You have diabetes, with or without effects on your blood vessels
• You have gallstones
• You suffer from migraine or severe headaches
• You have systemic lupus erythematosus (SLE)
• You have a history of thickening of the womb lining (endometrial hyperplasia)
• You have epilepsy
• You have asthma
• You have a hearing disorder called otosclerosis
• You have had your womb removed because of endometriosis, especially if any endometriosis tissue remains
• You have heart or kidney problems, as oestrogens can cause fluid retention
• You have a history of, or risk factors for, hereditary or acquired angioedema (swelling under the skin)
• You have high levels of fats called triglycerides in your blood
• You have a short or narrow vagina, severe vaginal prolapse, or vaginal tissue that does not respond to oestrogen
• You are on long-term steroid treatment or have a condition such as Cushing’s disease that affects the skin and tissues
• You could become pregnant — use a non-hormonal method of contraception

Stop using Estring and contact your doctor if you develop jaundice or problems with your liver, a significant rise in blood pressure, new migraine-type headaches, signs of a blood clot (such as a painful swollen leg, sudden chest pain or shortness of breath), or if you become pregnant.