Treats hot flashes and vaginal problems that are symptoms of menopause.
Estrace, Estring, Estring Ring, Femring, VagifemThere may be other brand names for this medicine.
When This Medicine Should Not Be Used
Do not use this medicine if you have had angioedema or an allergic reaction to estrogen. Do not use this medicine if you are pregnant or have unusual vaginal bleeding that has not been checked by a doctor. Do not use this medicine if you have a blood clotting disorder or have had blood clots (such as deep vein thrombosis or pulmonary embolism), liver disease, or if you have had a stroke or heart attack. Make sure your doctor knows if you have any kind of cancer or if you have a history of breast cancer.
How to Use This Medicine
Cream, Insert, Suppository
- Take your medicine as directed.
- Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.
- Wash your hands with soap and water before and after you use this medicine or insert the vaginal ring.
- To use the vaginal cream:
- This cream medicine comes in a tube with a plastic applicator. You will need to use the applicator each time you use the medicine. Wash the applicator with warm, soapy water after each use. Do not use the medicine without the applicator.
- Measure the cream using the marks on the plastic applicator. Make sure you use the correct mark for your specific dose.
- To use the vaginal ring:
- This medicine is contained in a ring that you or your caregiver will put into your vagina. The ring will slowly release small amounts of medicine for your body to absorb. Your caregiver will show you how to insert the ring.
- Leave the ring in its sealed wrapper until you are ready to use it.
- Once the ring is in place in your vagina, you should not be able to feel it. If you feel uncomfortable, the ring may not be inserted far enough. Gently push the ring farther into your vagina. If you feel pain, talk to your doctor.
- You will leave the ring in for 90 days (3 months), unless your doctor tells you a different schedule. After that time, remove the ring and insert a new one. If you forget to remove the ring after 90 days, call your doctor for instructions.
- The ring may move down into the lower part of your vagina accidently. This can happen if you strain to have a bowel movement. Use your finger to gently push the ring back into place. If the ring comes all the way out of your vagina, rinse it off with warm water and put it back in. Call your doctor if the ring comes out several times.
- If you need to remove the ring, hook your finger through the ring and pull it out.
- To use the vaginal tablet:
- The tablet should be used only in your vagina. Do not swallow the tablet.
- Each vaginal tablet comes packaged inside an applicator. Do not take the tablet out of the applicator. If the tablet comes out of the applicator when you open it but has not fallen out of the package, carefully put it back into the applicator for insertion. If the tablet falls out of the applicator when you try to insert it, throw it away and use a new applicator that still has the tablet inside it.
- Take the applicator out of the plastic wrap before you use it.
- Keep your hands clean and dry while you handle the tablet.
- Use the applicator only 1 time and then throw it away. Use a new applicator for each dose.
- It is best to always use this medicine at the same time of day. Most women will start by inserting a new tablet every day for 2 weeks, then change to inserting a new tablet only 2 days each week. Carefully follow the schedule that your caregiver tells you to.
How to Store and Dispose of This Medicine
- Store the unopened packages of this medicine at room temperature, away from heat, moisture, and direct light.
- Wrap the used vaginal ring in tissue and throw it away where children and pets cannot get to it. Do not flush the ring down the toilet.
- Ask your pharmacist, doctor, or health caregiver about the best way to dispose of the used medicine applicator(s), containers and any leftover medicine after you have finished your treatment. You will also need to throw away old medicine after the expiration date has passed.
- Keep all medicine out of the reach of children. Never share your medicine with anyone.
Drugs and Foods to Avoid
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.
- Make sure your doctor knows if you also use carbamazepine (Tegretol®), clarithromycin (Biaxin®), erythromycin (E.E.S.®, Ery-tab®), itraconazole (Sporanox®), ketoconazole (Nizoral®), phenobarbital (Luminal®), rifampin (Rifadin®, Rifater®), ritonavir (Kaletra®, Norvir®), or St John's wort. Tell your doctor if you use a blood thinner (such as warfarin, Coumadin®) or a thyroid medicine (such as levothyroxine, Synthroid®).
- Do not eat grapefruit or drink grapefruit juice while you are using this medicine.
- Ask your doctor before you use any other products or medicines in your vagina. You might need to remove the ring when you use other vaginal products.
Warnings While Using This Medicine
- Pregnancy after menopause is not likely, but if you think you could be pregnant, tell your doctor. This medicine could harm an unborn baby.
- Make sure your doctor knows if you are breastfeeding or if you have kidney disease, liver disease, asthma, diabetes, endometriosis, epilepsy, gallbladder disease, migraine headaches, porphyria, lupus, an underactive thyroid, or a history of cancer. Your doctor needs to know about any problems with your heart or blood, such as heart disease, blood clotting problems, or high blood pressure. Make sure your doctor knows if you have high or low calcium in the blood, high blood cholesterol, or a family history of high cholesterol. Tell your doctor if you have ever had liver problems caused by pregnancy or estrogen.
- Tell your doctor about any problems with your vagina, such as having an unusually shaped or narrow vagina. Tell your doctor if you have problems with your reproductive organs, bladder, rectum, or pelvic area.
- This medicine may increase your risk of heart attack, stroke, or blood clots. Your risk for these serious problems is even greater if you have high blood pressure, high cholesterol, or diabetes. Your risk is also greater if you are overweight or smoke cigarettes. Talk to your doctor about your personal risks compared with the benefits of this medicine.
- Your risk of some kinds of cancer may increase if you use large doses of estrogen over a long period of time. Talk with your doctor about this risk. If you still have your uterus (womb), ask your doctor if you should also use a progestin medicine.
- This medicine may increase the risk of dementia (loss of some mental abilities, such as memory or judgment) in women over 65 years of age. Talk with your doctor about this risk.
- Tell any doctor or dentist who treats you that you are using this medicine. This medicine may affect certain medical test results.You may need to stop using this medicine for a few weeks before and after you have surgery or if you need to stay in bed for a long time.
- Tell your doctor if you have a severe headache or vision changes. Your doctor may want you to have your eyes checked by an eye doctor.
- Your doctor will check your progress and the effects of this medicine at regular visits. Keep all appointments.You should have regular pelvic exams, breast exams, and mammograms as directed by your doctor.
Possible Side Effects While Using This Medicine
Call your doctor right away if you notice any of these side effects:
- Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
- Breast lump
- Chest pain, coughing up blood, or sudden trouble breathing
- Numbness or weakness in your arm or leg, or on one side of your body
- Pain in your lower leg (calf)
- Redness, pain, burning, or itching in or near your vagina
- Sudden or severe headache, problems with speech or walking
- Sudden or severe stomach pain, nausea, vomiting
- Swelling in your hands, ankles, or feet
- Unusual or unexpected vaginal bleeding or heavy bleeding
- Vision changes, bulging eyeballs
- Yellow skin or eyes
If you notice these less serious side effects, talk with your doctor:
- Light, irregular vaginal bleeding or spotting
- Mild nausea, diarrhea, mild cramps, or bloated feeling
- Swollen or tender breasts
If you notice other side effects that you think are caused by this medicine, tell your doctor
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088