Estring (Estradiol) vaginal ring are used to treat changes in and around the vagina (such as vaginal dryness, itching, and burning) caused by low estrogen levels or menopause. Estradiol vaginal ring is also used to treat moderate to severe hot flashes and other symptoms of menopause or low amounts of estrogen. The hormone from the vaginal ring is absorbed through your vagina. It works by replacing estrogen that is normally produced by the body which prevent symptoms, such as feelings of warmth in the face, neck, and chest, or sudden strong feelings of heat and sweating (hot flashes) in women during menopause. It is also used to treat moderate to severe painful sexual intercourse caused by menopause.

Doctor's prescription is required to use this medicine.

Always use Estring as directed by your physician.

Follow all directions on your prescription label and read all medication guides or instruction sheets. 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.

• Estring vaginal ring is to be used only in the vagina. Use it at bedtime unless your doctor tells you otherwise. 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.

• 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.

Always use Estring exactly as directed by your doctor.

Before using Estring, tell your doctor or pharmacist if you are allergic to it or any other medications. Tell your doctor or pharmacist about your medical history. Tell your doctor about all the other prescription and nonprescription medications you are taking.

Do not use Estring if you are pregnant. Tell your doctor right away if you become pregnant during treatment.

You should not use Estring if you have: undiagnosed vaginal bleeding, liver disease, a bleeding disorder, if you will have major surgery, or if you have ever had a heart attack, a stroke, a blood clot, or cancer of the breast, uterus/cervix, or vagina.

Estradiol may increase your risk of developing a condition that may lead to uterine cancer. Report any unusual vaginal bleeding right away.

Using Estring can increase your risk of blood clots, stroke, or heart attack, or cancer of the breast, uterus, or ovaries. Estradiol should not be used to prevent heart disease, stroke, or dementia.

NOTE: This medicine is only for you. Do not share this medicine with others.

Get emergency medical help if you have any of these signs of an allergic reaction to Estring: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

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.

Call your doctor at once if you have:

• 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.

• High levels of calcium in your blood - nausea, vomiting, constipation, increased thirst or urination, muscle weakness, bone pain, lack of energy.

Common Estring side effects may include:

• Nausea, vomiting, bloating, stomach cramps.

• Headache.

• Swelling in your hands or feet, weight gain.

• Breast pain. • Vaginal itching or discharge, changes in your menstrual periods, breakthrough bleeding.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

In case of overdose, call the poison control helpline. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services.

Where should I keep my medicine?

Keep out of reach of children.

Store at room temperature.

Throw away any unused medicine after the expiration date.

What should I avoid while using Estring?

Avoid smoking. It can greatly increase your risk of blood clots, stroke, or heart attack while using Estring.

Avoid using other vaginal products without your doctor's advice.

Grapefruit and grapefruit juice may interact with estradiol and lead to unwanted side effects. Avoid the use of grapefruit products.