Estring vaginal rings contain estradiol. Estradiol (a form of estrogen) is a female sex hormone necessary for many processes in the body. Estring releases estrogen that is absorbed directly through the skin of the vaginal wall.

Estring is used after menopause to treat moderate to severe menopausal changes in and around the vaginal area such as dryness, burning, and itching of the vaginal area, urgency or irritation with urination, and pain during sexual intercourse. 

Estring is an off-white, soft, flexible ring with a center that contains 2 mg of estradiol. The ring releases estradiol into the vagina in a consistent, stable manner for 90 days. It should be removed after 90 days of continuous use. If continued therapy is required, the ring should be replaced.

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

Wash your hands before and after inserting an Estring vaginal ring.

To use the Estring vaginal ring:

• Squeeze the sides of the Estring vaginal 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 Estring vaginal 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 Estring vaginal 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.

Your doctor should check your progress on a regular basis to determine whether you should continue this treatment. Self-examine your breasts for lumps on a monthly basis and have a mammogram every year while using Estring.

If you need major surgery or will be on long-term bed rest, you may need to stop using this medicine for a short time. Any doctor or surgeon who treats you should know that you are using Estring.

Before using Estring, 

• tell your doctor if you are allergic to any brand of Estradiol, anything in it, and any other allergies you have
• tell your doctor if you have experienced any of the following: unusual vaginal bleeding that has not been checked by a doctor; liver disease; a history of heart attack, stroke, or blood clot; an increased risk of having blood clots due to a heart problem or a hereditary blood disorder; or a history of hormone-related cancer, or cancer of the breast, uterus/cervix, or vagina; gallbladder disease, asthma, a seizure disorder, migraines, porphyria, a thyroid disorder; or high or low levels of calcium in your blood.

• Do not use Estring if you are pregnant. Tell your doctor right away if you become pregnant during treatment.
• Tell your doctor if you are breast-feeding. Estradiol lowers the hormone needed to produce breast milk and can slow breast milk production. 

Using this medicine can increase your risk of blood clots, stroke, or heart attack. You are even more at risk if you have high blood pressure, high cholesterol, diabetes, if you are overweight, or if you smoke.

Use of estradiol may increase your risk of cancer of the breast, uterus, or ovaries. Talk with your doctor about this risk.

Common side effects include but are not limited to:

• nausea, vomiting, bloating, stomach cramps;
• headache;
• swelling in your hands or feet, weight gain; 
• breast pain; or
• vaginal itching or discharge, changes in your menstrual periods, breakthrough bleeding

Tell your doctor if any of these symptoms are severe or do not go away.

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately, or get emergency medical help:

• signs of an allergic reaction to Estring: hives; rash; difficulty breathing; swelling of your face, lips, tongue, or throat.
• heart attack symptoms - chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating;
• signs of a stroke - sudden numbness or weakness (especially on one side of the body), sudden severe headache, slurred speech, problems with vision or balance;
• signs of a blood clot - sudden vision loss, stabbing chest pain, feeling short of breath, coughing up blood, pain or warmth in one or both legs;
• swelling or tenderness in your stomach;
• jaundice (yellowing of the skin or eyes);
• memory problems, confusion, unusual behavior;
• unusual vaginal bleeding, pelvic pain; 
• a lump in your breast; or
• high levels of calcium in your blood - constipation, nausea, vomiting, increased thirst or urination, muscle weakness, bone pain, lack of energy.

Remove the vaginal ring and seek emergency medical attention if you have: fever with nausea, vomiting, diarrhea, muscle pain, dizziness, fainting, and/or sunburn-like skin rash. These may be signs of a life-threatening disease called toxic shock syndrome.

Q: Why is Estring prescribed?

A: Estring is used to treat moderate to severe menopausal changes in and around the vaginal area such as dryness and irritation of the vagina

Q: What things should I avoid while taking Estring?

A: Avoid smoking as this will greatly increase your risk of blood clots, stroke, or heart attack while using Estring. Also avoid the use of grapefruit products including grapefruit juice. 

Q: Does Estring have a generic alternative?

A: Estring is available in its brand name only. 

Q: How long until I see the effects of Estring?

A: It may take about 2 weeks to feel the full effect of the medication 

Q: What if I miss a dose of Estradiol?

A: Use the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time. Remove the vaginal ring and insert a new one as soon as you remember. Do not use an extra vaginal ring to make up the missed wearing time.

Q: What if a vaginal ring falls out?

A: Rinse it with warm water and reinsert it. If it slides down into the lower part of the vagina, use your finger to push it in farther.

Q: How should I store this medication?

A: Store at room temperature away from moisture and heat. Keep the Estring vaginal ring in its protective pouch until you are ready to use it.