Estring Vaginal Ring (Estradiol)

Estring Vaginal Ring Information:

Estring (containing a form of estrogen called Estradiol-17B) consists of a vaginal ring that releases estrogen consistently for a period of 3 months when inserted into the vagina. Estring is used in post-menopausal women to treat vaginal complaints following menopause. It is used to treat vaginal symptoms such as excessive vaginal dryness, pain during intercourse, pain during urination, and increased urinary urgency.

WARNING: Estrogen products! Estring is an estrogen product (containing Estradiol 17-B). You may or may not be aware of the findings of the Women’s Health Initiative. This study was conducted to assess the health benefits of estrogen products in women between the ages of 50-79 years. It was noted that patients using estrogen products alone or in combination with a progestin were at an increased risk of developing strokes, clots, deep vein thrombosis, breast cancer, and endometrial cancer when used for a long term period. In this case, patients were using estrogens for a period of 5-7 years. THEREFORE, it is highly recommended that estrogen products be used only short term and if used in cases where they may represent a potential cardiovascular risk, patients should be monitored very closely. Further, any patient taking estrogen products should closely follow-up with their primary care physician every 3-6 months regarding development of potential side effects. Also, the patient should annually discuss with their primary care physician the risks versus the benefits of estrogen replacement therapy.

Estring Vaginal Ring Side Effects:

Estring being a potent hormone may have some potential side-effects. The most common side effects of Estring include increased vaginal secretions, mild vaginal discomfort, general itching, and abdominal pain. These side-effects are usually mild and will go away following continued usage.

Estring Vaginal Ring Directions:

As Estring will be inserted into the vagina, some women may not be suited for Estring use. These include women with short narrow vaginas due to previous surgery or atrophy(breakdown) of vaginal tissue. Estring(one ring) will be rolled into an oval shape and inserted as deeply as possible into the upper one third of the vaginal vault. The ring will remain in place for 3 months. Once inserted, the patient should not feel anything, if the patient does feel the ring, it may not be inserted deep enough. Straining, particularly during defecation, may cause the ring to slide down, and if this occurs, the patient is advised to manually reinsert the ring deeper with their finger. To remove the ring, the patient will hook their finger through the ring and pull it out. Retaining the ring in the vagina beyond 90 days does not provide prolonged estrogen release as the ring will no longer contain sufficient estrogen and may contribute to vaginal infections.

Estring Vaginal Ring Precautions:

The following group of patients should not use or should be closely monitored when using Estring.
1) Known or suspected history of breast or endometrial cancer, or any other estrogen dependent cancer.
2) Undiagnosed or abnormal genital bleeding.
3) Known or suspected pregnancy.
4) Liver dysfunction or disease. Estrogens are broken down by the liver, and if there is some extent of liver dysfunction, this may impair the breakdown and elimination of estrogens.
5) Active or past history of thromboembolic diseases (ex. Stroke, heart attack, or coronary heart disease).