Estradiol Vaginal Ring (Vaginal Symptoms of Menopause)

What is this medication?

ESTRADIOL (es tra DYE ole) relieves the symptoms of menopause, such as vaginal irritation, dryness, or pain during sex. It works by increasing levels of the hormone estrogen in the body. It is an estrogen hormone.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Estring

What should I tell my care team before I take this medication?

They need to know if you have any of these conditions:

• Asthma
• Blood clotting disorder or history of blood clots
• Cancer, such as breast, cervical, or liver cancer
• Diabetes
• Gallbladder disease
• Having surgery
• Heart or blood vessel conditions
• Hereditary angioedema, a genetic condition that causes episodes of severe swelling
• High blood pressure
• High cholesterol
• High levels of calcium in your blood
• History of heart attack
• History of stroke
• Hysterectomy
• Kidney disease
• Liver disease
• Lupus
• Migraine or other severe headaches
• Porphyria
• Seizures
• Thyroid disease
• Tobacco use
• Unusual vaginal bleeding
• An unusual or allergic reaction to estrogens, other medications, foods, dyes, or preservatives
• Pregnant or trying to get pregnant
• Breastfeeding

How should I use this medication?

This medication may be inserted by you or your care team. Follow the directions that are included with your prescription. If you are unsure how to insert the ring, contact your care team. The vaginal ring should remain in place for 90 days. After 90 days, replace your old ring and insert a new one. Keep using this medication unless your care team tells you to stop.

This medication comes with INSTRUCTIONS FOR USE. Ask your pharmacist for directions on how to use this medication. Read the information carefully. Talk to your pharmacist or care team if you have questions.

A patient package insert for the product will be given with each prescription and refill. Read this sheet carefully each time. The sheet may change frequently.

Contact your care team about the use of this medication in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, use it as soon as you can. If it is almost time for your next dose, use only that dose. Do not use double or extra doses.

What may interact with this medication?

This medication may affect how other medications work, and other medications may affect the way this medication works. Talk with your care team about all of the medications you take. They may suggest changes to your treatment plan to lower the risk of side effects and to make sure your medications work as intended.

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medication?

Visit your care team for regular checks on your progress. Tell your care team if your symptoms do not start to get better or if they get worse. Talk to your care team about how often you should have a pelvic exam, breast exam, and a mammogram.

Talk to your care team about your risk of cancer. You may be more at risk for certain types of cancer if you take this medication. Talk to your care team right away if you have vaginal bleeding while on this medication.

If you have a uterus, talk to your care team about whether adding a progestin to your hormone therapy is right for you. Taking progestins with estrogen therapy may lower the risk of uterine cancer, but can have other health risks.

Talk to your care team if you use tobacco products. Changes to your treatment plan may be needed. Tobacco increases the risk of getting a blood clot or having a stroke while you are taking this medication. This risk is higher if you are 35 years or older.

Tell your care team right away if you have any change in your eyesight.

If you are going to need surgery or other procedure, tell your care team that you are using this medication.

You may leave this medication in place during sex or if you need to use a medicine for a vaginal infection. If it comes out during the 90-day period, clean it with warm water and put it back in.

If you may be pregnant, stop taking this medication right away and contact your care team.

What side effects may I notice from receiving this medication?

Side effects that you should report to your care team as soon as possible:

• Allergic reactions or angioedema—skin rash, itching or hives, swelling of the face, eyes, lips, tongue, arms, or legs, trouble swallowing or breathing
• Blood clot—pain, swelling, or warmth in the leg, shortness of breath, chest pain
• Breast tissue changes, new lumps, redness, pain, or discharge from the nipple
• Change in vision
• Gallbladder problems—severe stomach pain, nausea, vomiting, fever
• Increase in blood pressure
• Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
• Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
• Unusual vaginal discharge, itching, or odor
• Vaginal bleeding after menopause, pelvic pain

Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):

• Bloating
• Breast pain or tenderness
• Hair loss
• Nausea
• Stomach pain
• Swelling of the ankles, hands, or feet
• Vaginal irritation at application site

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medication?

Keep out of the reach of children and pets.

Store at room temperature between 15 and 25 degrees C (59 and 77 degrees F). Get rid of any unused medication after the expiration date.

To get rid of medications that are no longer needed or have expired:

• Take the medication to a medication take-back program. Check with your pharmacy or law enforcement to find a location.
• If you cannot return the medication, ask your pharmacist or care team how to get rid of this medication safely.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.