Estring side effects and drug information

Estring is an estradiol vaginal ring that is intended to be used for the discomforts caused by postmenopausal symptoms. The primary purpose of Estring vaginal is to offer some relief and treat specific symptoms that include: pain in the vaginal area like burning and itching feeling, irritation with urination, and dryness. Your perfectly optimized content goes here! This medication is soft and flexible and has an off white center that contains 2 mg of estradiol. The ring, on the other hand, is made up of barium sulfate combined with estradiol and silicone polymers. Estradiol is an estrogen hormone. The way Estring works is that it needs to be placed in the upper 3rd part of the vagina either by the patient herself or a healthcare professional such as a doctor or a nurse. Tell your doctor or call right away if you may feel any abnormalities or report side effects. Using estrogen, one is prone to get cancer of the uterus (womb). You may report right away if there is unusual vaginal bleeding while using estring. It should also be taken with progestins to prevent heart disease, heart attacks, possible stroke and dementia. The maximum length of use of estring is 90 days, thus it should be replaced once you want to continue with the therapy. Stop using in case there is vaginal bleeding. Estrogens should be taken at the lowest dosage, talking with your physician about it regularly is a must and if you still need it or not. It is slightly opaque with a core that is whitish and it contains the angioedema drug, a 2 mg estradiol. The ring is a combination of estradiol, silicone polymers and barium sulfate. After it is placed properly in the vagina, the estradiol is released at approximately 7.5 mcg for every 24 hours at a consistent pace and manner for 90 days. The dimensions of estring (estradiol vaginal ring) are: 55 mm for the diameter 9 mm for the cross-sectional diameter 2 mm for the core diameter Lastly, it should be inserted into the vaginal vault at the upper third and it should be worn for 3 months. This treatment is intended to be used for 90 consecutive days wherein estradiol is released into the vagina in a stable and coherent manner. After the 90 days, this estradiol vaginal ring must be removed. Should the treatment from your healthcare professionals be continued, a new flexible ring must be placed. As in any other prescription, Estring carries some possible side effects that can range from common symptoms to severe, or depending on the patient, may also cause some unusual side effects. Before using this burning medication, it is best to consult the best healthcare professionals so you can discuss whether this product is appropriate for you. If already on the treatment, it is always best to call your doctor regularly for some medical advice, like a 3 to the 6-month interval, to be sure that you are on the right track. If you experience any side effects or unusual discomfort at any point during the treatment period, it is best that you report side effects to your local healthcare provider.

Side Effects

Like any other prescription, Estring can also cause some report side effects on the patient. The commonly reported side effect is the increase in vaginal secretions. Still, if the user starts to experience vaginal discomfort such as itching or the presence of vaginal infection along with a bad odor, it then becomes an unusual condition that must be discussed right away with a healthcare professional. Aside from this most reported symptom, other Estring side effects that potential patients must learn about before proceeding to use this product.

Common Side Effects

• Nausea
• Abdominal pain
• Vaginal discomfort
• Increase in vaginal discharge
• Vomiting
• Bloating
• Insomnia
• Hot flashes
• Breast pain
• Unusual vaginal bleeding
• Headache
• Urinary tract infection
• Weight changes
• Breast tenderness
• Back pain
• Upper respiratory tract infection
• Bleeding
• Vaginal yeast infection
• Fluid retention
• Genital itching

Apart from the reported common side effects, this medication is reported to also have less common side effects but more on the severe side. Among these are a stroke, dementia, blood clots, certain types of cancer like breast, ovarian and uterus lining, cause heart attack, high blood pressure, gallbladder disease, swelling of benign tumors in the uterus, and problems in the liver. It is important to tell your doctor about your personal as well as your family’s medical history or you can ask advice about side effects to be sure that you will not have allergic reactions to this kind of treatment as it may also cause some severe future effects

Serious Side Effects

• Breast lumps
• Uncommon vaginal bleeding or spotting that is recurrent or is experienced for an extended period.
• Swelling of some body parts such as feet, hand, and ankles
• Frequent urination or increased thirst
• Changes in mood, such as experiencing memory loss, depression, and the like.
• Severe abdominal feel pain
• Dark urine
• Yellowing of the skin or the eyes
• Constant nausea or vomiting

Other possible side effects you may experience or may arise are perforation or wearing away of the ring, harsh allergic reactions like swelling of the face, eyelids, throat, and tongue, bacterial infection and obstruction of the bowel movement. In addition to the mentioned effects, some other unusual symptoms may be experienced like severe chest pain, memory loss, changes in speech or vision, uncommon bleeding in the vagina, and severe headaches.

Indication and Dosage

Estring is an estrogen-based treatment that is intended to provide comfort and relief and solve moderate to severe postmenopausal symptoms. This product must be used in a conscientious manner to avoid possible allergic reactions and to minimize the experience of some reported side effects you may report side to your doctor, whether frequent or severe. This medication should not be used for an extended time, thus it is essential to have a regular dialogue with your physician about the use of Estring.

Dosage and Administration

To use Estring, the vaginal ring needs to be inserted as far as possible into the upper one-third of the vaginal vault. This estrogen-based treatment is intended to be used for 90 consecutive days and must remain in place in that treatment period. After three months, Estring needs to be removed. If the treatment is to be continued, as a patient you should call your doctor regularly for some medical advice about side effects and to coordinate in a 3 to the 6-month interval. In case the vaginal ring gets removed at any point during the treatment period, the ring can be rinsed using lukewarm water, and then should be re-inserted either by the patient or the physician. Just call your doctor immediately for help. Estring should only be used in the prescribed amount of time as prolonged usage will cause the loss of the product’s potency, and may cause vaginal infections. If you are putting the ring on your own, find a position where you will be most comfortable. Make sure that you wash your hands and dry them first before removing the product from its pouch. Hold the merchandise between your thumb and index finger and press the opposite sides of the ring, then gently push into the vagina as deep as possible.

Drug Interaction

This drug is reported to have possible interactions with some products such as:

• Fulvestrant
• Raloxifene
• Toremifene
• Travexamic acid
• Tamoxifen
• Ospemifene
• Aromatase inhibitors such as exemestane, letrozole, and anastrozole

Aside from these, Estring may also interact with anticoagulants, diabetes, or thyroid medicines; and may also affect some laboratory tests, therefore, causing unreliable results. Before getting a laboratory test, make sure that you inform the lab personnel and all your physicians that you are under this medication. This product must not at any time be used during pregnancy as it can be passed into the breastmilk. It is then necessary to have a list of all your medications, whether prescription, herbal, or non-prescription, and let your healthcare provider know about them.

Warnings and Precautions

Proper product knowledge must be implemented before using this medication because of its possible side effects. During the clinical trials, several adverse reaction rates have been observed due to different conditions. In the 2 studies, patients request discontinuation of the treatment due to an unfortunate event and the other is due to receiving joint estrogens vaginal cream. However, the most frequent reason for patients to withdraw from the treatment is because of patients having vaginal discomfort and developed gastrointestinal symptoms. Other unfortunate events in post-marketing experience, some patients reported about toxic shock syndrome (TSS), a ring adherence to the vaginal wall, bowel obstruction and recurrent abdominal complaints.

Warnings for Estrogen- Alone Treatment

• Cardiovascular Diseases and the possible occurrence of dementia
• Endometrial cancer

Warnings for Estrogen with Progestin Treatment

• Certain cancers like breast , ovarian , and endometrial cancer
• Cardiovascular diseases like coronary heart disease, stroke, and venous thromboembolism
• Gallbladder disease
• Dementia
• Visual abnormalities
• Hereditary angioedema
• Hypercalcemia

Whether the patient is using estrogen-based treatment with or without progestin, the lowest possible doses should be prescribed for the shortest time to avoid or minimize the risk for side effects.

Precautions

• Fluid retention
• High blood pressure
• Hypothyroidism
• Hypocalcemia
• Hypertriglyceridemia
• Vaginal infection and irritation

When you are using this product, do not smoke or use tobacco as it will make you more susceptible to blood clots, stroke, heart attack, or high blood pressure. Also, avoid too much exposure to sunlight as this will worsen skin and face blotchiness. In the case of vaginal infection, it is advised to remove the ring first and treat the disease before proceeding with the treatment.f

Overdose and Contraindications

Be careful not to overdose estrogen as it may cause the following side effects:

• Abdominal pain
• Nausea and vomiting
• Breast pain or tenderness
• Drowsiness
• Fatigue

Women with any of these conditions should not use this product:

• Known or suspected pregnancy
• Deficiency in Protein C and Protein S
• Liver disease
• History, suspected or known breast cancer

Clinical Pharmacology

Estrogens are mainly responsible for the maintenance and development of a woman’s reproductive system and their secondary sexual problems. The primary intracellular human estrogen is called estradiol, which is known to be stronger than estrone and estriol at the receptor level. In a woman’s normal menstrual cycle, around 70 to 500 mcg of estradiol is secreted, but during the postmenopausal stage, estrone and estrone sulfate becomes the most abundant. Estradiol is transformed into estrone, and both can turn into estriol, which is a primary metabolite. There are no studies done on formal drug interactions with Estring.

Medication Guide

Before using this medication, read the patient information, and also every time you refill as there may be added new information about the product. Estring is a soft, flexible vaginal ring that contains 2 mg of estradiol, which is placed into the vagina for 90 consecutive days. This product is used to treat moderate to severe postmenopausal symptoms.