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Treats some of the symptoms of menopause, such as hot flashes, dryness and itching in the vagina, pain when you urinate, or feeling like you have to urinate right away. The cream and tablet forms of this medicine only treat dryness and itching in the vagina.
There may be other brand names for this medicine.
Vagifem, Estrace, Estring, Femring, Estring Ring
When This Medicine Should Not Be Used
You should not use this medicine if you have had an allergic reaction to estrogen, or if you are pregnant or breastfeeding. Do not use this medicine if you have unusual vaginal bleeding that has not been checked by a doctor. You should not use this medicine if you have had blood clots (such as deep vein thrombosis or pulmonary embolism), liver disease, or if you have had a stroke or heart attack in the past 12 months. 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
- Your doctor will tell you how much of this medicine to use and how often. Do not use more medicine or use it more often than your doctor tells you to.
- This medicine comes with patient instructions. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions.
- Wash your hands with soap and water before and after using this medicine or inserting the ring.
To use the vaginal ring:
- This medicine is contained in a ring that you or your health caregiver will put into your vagina. The ring will slowly release small amounts of medicine for your body to absorb. Your health 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 the ring. If you feel uncomfortable, the ring may not be pushed in 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. One thing that could make this happen is straining 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 before you put it in your vagina, do not use the tablet or applicator. Use a new applicator that still has the tablet inside it.
- Take the applicator out of the plastic wrap before using it.
- Use the applicator only one 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 two weeks, then change to inserting a new tablet only 2 days each week. Carefully follow the schedule that your health caregiver tells you to.
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, so 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.
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 away from children and 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 are also using 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 are using 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 using any other products or medicines in your vagina. You might need to remove the ring when using other vaginal products.
Warnings While Using This Medicine
- It is unlikely that a postmenopausal woman may become pregnant. But, you should know that using this medicine while you are pregnant could harm your unborn baby. If you think you have become pregnant while using the medicine, tell your doctor right away.
- Make sure your doctor knows 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 calcium problems (low or high levels 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 other medical conditions that are in the pelvic area. This includes problems with your reproductive organs, bladder, or rectum.
- Very rarely, this medicine can cause serious side effects such as heart attack or stroke. You are much more likely to have these side effects if you smoke cigarettes or are overweight, or if you have diabetes, high blood pressure, or high blood cholesterol. Talk with your doctor if you think you might be at risk.
- Using large doses of estrogen over a long period of time may increase your risk of some kinds of cancer. 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.
- Using this medicine may increase the risk of having dementia in elderly women (above 65 years of age). Talk with your doctor if this concerns you.
- Make sure any doctor or dentist who treats you knows that you are using this medicine. This medicine may affect the results of certain medical tests. Also, you may need to stop using this medicine for a few weeks before and after having surgery, or if you are inactive for a period of time.
- Check with your doctor immediately if blurred vision, difficulty in reading, or any other change in vision occurs during or after treatment. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).
- It is important that you have a pelvic exam, breast exam, and breast x-ray every year or as directed by your doctor. These exams are very important if you have a family history of breast cancer.
- Your doctor will need to check your progress at regular visits while you are using this medicine. Be sure to keep all appointments.
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 pain, swelling, or tenderness in or near your stomach.
- Swelling in your hands, ankles, or feet.
- Unusual or unexpected vaginal bleeding or heavy bleeding.
- Vision problems or changes, or bulging eyeballs.
- Yellowing of your skin or the whites of your eyes.
If you notice these less serious side effects, talk with your doctor:
- Light, irregular vaginal bleeding or spotting.
- Nausea, diarrhea, mild cramps, or bloated feeling.
- Swollen or tender breasts.
- Trouble wearing contact lenses.
If you notice other side effects that you think are caused by this medicine, tell your doctor