Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Estring (Estradiol-vaginal).
Note the following important information about estrogen replacement therapy:
The Women's Health Initiative (WHI) study results indicated an increased risk of heart attack, stroke, Breast Cancer, blood clots in the lungs, and blood clots in the leg veins in postmenopausal women during 5 years of treatment with 0.625 mg conjugated equine estrogens and 2.5 mg medroxyprogesterone compared to women receiving sugar tablets. Other combinations of estrogen and progestins were not studied. However, until additional data are available, the risks should be assumed to be similar for other hormone replacement products. Therefore,
- estrogens with or without progestins should be used at the lowest dose that relieves your menopausal symptoms for the shortest time period possible, as directed by your doctor
- estrogens with or without progestins should not be used to prevent heart disease, heart attacks, or strokes
Blood clotting disorders: Estrogens with or without progestins are associated with an increased risk of blood clots in the lungs and legs. This risk also increases with age; a personal or family history of blood clots; smoking; and Obesity. The risk of blood clots is also increased if you are immobilized for prolonged periods and with major surgery. If possible, Estring (Estradiol-vaginal) should be stopped 4 weeks before major surgery. Talk about the risk of blood clots with your doctor.
Blood pressure: Women may experience increased blood pressure when using estrogen replacement therapy. Talk to your doctor about how often you should have your blood pressure checked.
Bone disease: If you have bone disease due to cancer or a metabolic condition causing too much calcium in your body, discuss with your doctor how Estring (Estradiol-vaginal) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Estring (Estradiol-vaginal), and whether any special monitoring is needed.
Breast and Ovarian Cancer: Studies indicate an increased risk of breast and ovarian cancer with the use of combined estrogen and progestin therapy. Women who have a history of breast cancer should not use estrogens. Women with a family history of breast cancer or women with a history of breast lumps, breast biopsies, or abnormal mammograms should be closely monitored by their doctor if they use estrogens. Women should have a mammogram before starting hormone replacement therapy. Women taking estrogens should have regular breast examinations and should be taught how to do a breast self-examination.
Dementia: Women over age 65 receiving combined estrogen and progestin replacement therapy may be at increased risk of developing dementia (loss of memory and intellectual function). If you are over 65, talk to your doctor about whether you should be tested for dementia.
Diabetes: If you have diabetes, your doctor should closely monitor your condition while you are taking Estring (Estradiol-vaginal), as it may affect blood sugar control.
Endometrial cancer: Medications containing estrogen increase the risk of cancer of the endometrium (lining of the uterus) in women who have had menopause. If you use any estrogen-containing medication, it is important to visit your doctor regularly and report any unusual vaginal bleeding right away.
Endometriosis: Estrogen replacement therapy can cause endometriosis to reappear or get worse. If you have or have had endometriosis, discuss with your doctor how Estring (Estradiol-vaginal) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Estring (Estradiol-vaginal), and whether any special monitoring is needed.
Fibroids: Estring (Estradiol-vaginal) may worsen fibroids by causing sudden enlargement, pain, or tenderness. If you notice these effects, contact your doctor.
Fluid retention: Estrogen may cause fluid retention, and worsen heart disease, high blood pressure, Kidney Disease, or Asthma. Talk to your doctor if you have any concerns. If you experience worsening of these conditions while using Estring (Estradiol-vaginal), contact your doctor.
Follow-up examinations: It is important to have a follow-up examination 3 to 6 months after starting Estring (Estradiol-vaginal) to assess the response to treatment. Examinations should be done at least once a year after the first one.
Gallbladder: Estring (Estradiol-vaginal) can aggravate gallbladder disease or increase the risk of developing it. If you have gallbladder disease, discuss with your doctor how Estring (Estradiol-vaginal) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Estring (Estradiol-vaginal), and whether any special monitoring is needed.
Heart disease and stroke: Studies indicate an increased risk of heart disease and stroke with estrogen (with or without progestin) for postmenopausal women. If you experience symptoms of a heart attack (chest pain, tightness or pressure, sweating, nausea, feeling of impending doom) or stroke (sudden dizziness, headache, loss of speech, changes in vision, weakness or numbness in the arms and legs) while taking Estring (Estradiol-vaginal), get immediate medical attention.
Liver disease: If you have liver disease, discuss with your doctor how Estring (Estradiol-vaginal) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Estring (Estradiol-vaginal), and whether any special monitoring is needed. See your doctor as soon as possible if you develop signs of liver problems such as yellow eyes or skin, abdominal pain, dark urine, pale stools, or itchy skin.
Seizures: Estradiol may cause an increase in the frequency of seizures. If you have a history of Epilepsy or medical conditions that increase the risk of seizures, discuss with your doctor how Estring (Estradiol-vaginal) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Estring (Estradiol-vaginal), and whether any special monitoring is needed.
Thyroid disease: Estring (Estradiol-vaginal) may affect how thyroid hormone is used by the body. If you are taking thyroid hormone for an underactive thyroid gland, discuss with your doctor how Estring (Estradiol-vaginal) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Estring (Estradiol-vaginal), and whether any special monitoring is needed.
Vaginal infections: Vaginal infections should be treated by your doctor before starting Estring (Estradiol-vaginal). If a vaginal infection develops while using estradiol vaginal ring, remove the ring until the infection has cleared, and then re-insert it into the vagina.
X-ray procedures: Remove the vaginal ring before having any X-ray procedures of the lower abdominal tract. Be sure to tell all your doctors that you are using an estrogen vaginal ring.
Pregnancy: Estrogen vaginal ring must not be used during pregnancy. If you become pregnant while using Estring (Estradiol-vaginal), contact your doctor immediately.
Breast-feeding: Estring (Estradiol-vaginal) passes into breast milk. If you are a breast-feeding mother and are taking Estring (Estradiol-vaginal), it may affect your baby. Estring (Estradiol-vaginal) is not recommended for breast-feeding women.
Children: The safety and effectiveness of using Estring (Estradiol-vaginal) have not been established for children. Estring (Estradiol-vaginal) is not intended for use by children.
