- Follow the instructions provided with your Estring vaginal ring carefully.
- Using oestrogen-only HRT tablets or patches for a long time can increase the risk of cancer of the lining of the womb (the endometrium). It is possible there may be a similar risk when oestrogen rings or creams are used in the vagina for repeated treatments, or over a long period of time. If you experience any vaginal bleeding or spotting, abnormal vaginal discharge or vaginal discomfort while you are using Estring, you should consult your doctor so that this can be investigated.
- Women using any form of HRT should have regular medical and gynaecological check-ups. Your need for continued HRT should be reviewed with your doctor at least once a year.
- It is important to be aware that women using HRT have an increased risk of being diagnosed with breast cancer compared with women who don’t use HRT. This risk needs to be weighed against the personal benefits to you of taking HRT. There is more detailed information about the risks and benefits associated with HRT in the factsheet about the menopause linked above. You should discuss these with your doctor before starting HRT. Women using HRT should have regular breast examinations and mammograms and should examine their own breasts regularly. Report any changes in your breasts to your doctor or nurse.
- It is important to be aware that women using HRT have a slightly increased risk of stroke and of blood clots forming in the veins (eg deep vein thrombosis/pulmonary embolism) compared with women who don’t use HRT. The risk is higher if you have existing risk factors (eg personal or family history, smoking, obesity, certain blood disorders – see cautions below) and needs to be weighed against the personal benefits to you of taking HRT. There is more detailed information about the risks and benefits associated with HRT in the factsheet about the menopause linked above. Discuss these with your doctor before starting treatment.
- The risk of blood clots forming in the veins (thromboembolism) while taking HRT may be temporarily increased if you experience major trauma, have surgery, or are immobile for prolonged periods of time (this includes travelling for over three hours). For this reason, your doctor may recommend that you stop using HRT for a period of time (usually four to six weeks) prior to any planned surgery, particularly abdominal surgery or orthopaedic surgery on the lower limbs, or if you are to be immobile for long periods. The risk of blood clots during long journeys may be reduced by appropriate exercise during the journey and possibly by wearing elastic hosiery. Discuss this with your doctor.
- Stop using this medicine and inform your doctor immediately if you experience any of the following symptoms: stabbing pains or swelling in one leg; pain on breathing or coughing; coughing up blood; breathlessness; sudden chest pain; sudden numbness affecting one side or part of the body; fainting; worsening of epilepsy; migraine or severe headaches; visual disturbances; severe abdominal complaints; increased blood pressure; itching of the whole body; yellowing of the skin or eyes (jaundice); or severe depression.
Estring should be used with caution by
- Women with a risk of developing cancers that are stimulated by oestrogen, for example women whose mother or sister has had breast cancer.
- Women with a history of benign breast lumps (fibrocystic breast disease).
- Women with fibroids in the womb.
- Women with a history of endometriosis.
- Women with a history of overgrowth of the lining of the womb (endometrial hyperplasia).
- Women with a personal or family history of blood clots in the veins (venous thromboembolism, eg deep vein thrombosis or pulmonary embolism).
- Women taking medicines to prevent blood clots (anticoagulants), eg warfarin.
- Women who are very overweight or obese.
- Women with severe varicose veins.
- Women with high blood pressure.
- Women with diabetes.
- Women with raised levels of fats such as cholesterol or triglycerides in their blood.
- Women with a history of gallbladder disease.
- Women with a long-term condition called systemic lupus erythematosus (SLE).
- Women who suffer from migraines or severe headaches.
- Women with inherited blood disorders called porphyrias.
- Women with a history of irregular brown patches appearing on the skin, usually of the face, during pregnancy or previous use of hormone preparations such as contraceptive pills (chloasma). Women with a tendency to this condition should minimise their exposure to the sun or UV light while using HRT.
Estring should not be used by
- Women with known, suspected, or a past history of breast cancer.
- Women with known or suspected cancer in which growth of the cancer is stimulated by oestrogen, eg cancer of the lining of the womb (endometrial cancer).
- Women with untreated overgrowth of the lining of the womb (endometrial hyperplasia).
- Women with vaginal bleeding where the cause is not known.
- Women with blood disorders that increase the risk of blood clots in the veins, eg antiphospholipid syndrome, factor V Leiden, protein C deficiency, protein S deficiency or antithrombin deficiency.
- Women with a blood clot in a vein of the leg (deep vein thrombosis) or in the lungs (pulmonary embolism).
- Women with inflammation of a vein caused by a blood clot (thrombophlebitis).
- Women who have recently had a stroke caused by a blood clot.
- Women who have recently had a heart attack.
- Women with angina pectoris.
- Women with active liver disease, eg hepatitis, liver cancer, or a history of liver disease when liver function has not returned to normal.
- Women who are pregnant or breastfeeding.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- This medicine should not be used by women who are pregnant or breastfeeding. You should stop using this medicine and consult your doctor immediately if you think you could be pregnant during treatment.
- A woman is considered fertile for two years after her last menstrual period if she is under 50, or for one year if over 50. HRT does not provide contraception for women who fall within this group. If you could get pregnant while using this HRT, you should use a non-hormonal method of contraception (eg condoms or contraceptive foam). Seek further medical advice from your doctor.
Possible side effects of Estring
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all women using this medicine will experience that or any side effect.
- Vaginal irritation.
- Vaginal itching.
- Vaginal infection.
- Abdominal pain or discomfort.
- Feeling of pressure in the vagina, or on the bladder or rectum.
- Urinary tract infection.
- Increased sweating.
The following side effects have been associated with tablet and skin patch forms of oestrogen for HRT. Due to the low absortion of estradiol from the vagina into the bloodstream these are unlikely to occur with short-term use of Estring:
- Gut disturbances, such as nausea and vomiting, abdominal pain, bloating, flatulence, indigestion.
- Menstrual bleeding or spotting. See important information above.
- Vaginal thrush.
- Increase in the size of uterine fibroids.
- Breast pain, tenderness or enlargement.
- Fluid retention, causing swelling (oedema).
- Headache or migraine.
- Premenstrual-like symptoms.
- Depression, anxiety or mood changes.
- Changes in sex drive.
- Weight changes.
- Leg cramps.
- Rise in blood pressure.
- Steepening of corneal curvature, which may make contact lenses uncomfortable.
- Skin reactions such as rash and itching.
- Irregular brown patches on the skin, usually of the face (chloasma).
- Disturbance in liver function and jaundice.
- Gallbladder disease.
- Inflammation of the pancreas (pancreatitis).
- Blood clots in the blood vessels (eg, DVT, pulmonary embolism, stroke, heart attack – see important information above).
The side effects listed above may not include all of the side effects reported by the medicine’s manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
If you think you have experienced a side effect from a medicine or vaccine you should check the patient information leaflet. This lists the known side effects and what to do if you get them. You can also get advice from your doctor, nurse or pharmacist. If they think it’s necessary they’ll report it for you.
You can also report side effects yourself using the yellow card website: www.mhra.gov.uk/yellowcard.
How can Estring affect other medicines?
As the estradiol from Estring is absorbed into the bloodstream only in very low amounts, it is not expected to significantly affect any other medicines that are being taken by mouth or injection.
However, you should always tell your doctor what medicines you are taking (including herbal medicines and those bought without a prescription) before you start treatment with this medicine. Similarly, always check with your doctor or pharmacist before taking any new medicines while using this one, to make sure that the combination is safe.
If you need to use any other vaginal medicines, for example pessaries or vaginal creams for thrush or other vaginal infections, your doctor may want you to remove your Estring during the treatment. Always check with your doctor.