Estring Vaginal Ring

Estring Vaginal Delivery System

What is the Estring vaginal ring used for?

Estring is used to treat vaginal discomfort caused by the menopause.

As women approach and pass the menopause, the ovaries produce less oestrogen. This drop in oestrogen can cause vaginal atrophy – where the vaginal tissues become thinner, drier and less elastic. Estring is a local hormone replacement therapy designed to treat vaginal atrophy in postmenopausal women.

Symptoms of vaginal atrophy include:

• Vaginal dryness
• Itching and irritation
• Soreness or burning
• Painful or uncomfortable sex
• Increased susceptibility to vaginal or urinary infections

Estring works directly in the vaginal area rather than releasing hormones into the bloodstream. It doesn’t treat other menopause symptoms like hot flushes or night sweats. If you also experience these symptoms, speak to your doctor about additional menopause treatment options.

How does Estring HRT work?

Estring is a flexible vaginal ring containing estradiol hemihydrate, a naturally occurring form of the hormone oestrogen. Once inserted, the ring slowly and continuously releases estradiol directly to the vaginal tissues over 3 months.

This local oestrogen helps restore moisture and elasticity to the vaginal walls, relieving dryness, itching and discomfort. Because the hormone is delivered locally rather than into the bloodstream, only very small amounts are absorbed systemically. This reduces the risk of side effects associated with systemic HRT and makes Estring a suitable option for women who want targeted relief with minimal systemic oestrogen exposure.

You may notice an increase in vaginal lubrication as the ring begins to work – this is normal and a sign the treatment is taking effect. It can take several weeks to feel the full benefit.

How to Use Estring

Wash your hands thoroughly before inserting or removing the ring. Find a comfortable position – either standing with one foot raised on a chair, or lying on your back with your knees bent.

Inserting the Ring

1. With one hand, open the folds of skin around the vagina
2. Press the ring into an oval shape with your other hand
3. Gently push the ring as far into the vagina as it will go, directing it upwards and backwards towards the small of your back
4. Wash your hands once inserted

The ring may feel noticeable at first, but this should settle. If you can still feel it after a few days, try pushing it further in. If the ring falls out, rinse it in lukewarm water and reinsert it.

Removing the Ring

1. Hook your index finger around the ring
2. Pull it gently downwards and forwards
3. Wash your hands after removal

Each ring lasts 90 days before it needs to be replaced by a new ring.

Most women and their partners find it acceptable to leave the ring in place during sex. If either of you finds it uncomfortable, it can be removed temporarily. If you are constipated or need to strain to empty your bowels, remove the ring first to prevent it from slipping out of position.

If you stop using Estring, your symptoms may return within around 3 weeks.

Estring Side Effects

Like all medicines, Estring can cause side effects, though not everyone experiences them.

Because Estring releases estradiol locally with very low absorption into the bloodstream, the risk of side effects is generally lower than with systemic HRT.

Common Side Effects

These may affect up to 1 in 10 people:

• Urinary tract infection
• Vaginal infection or itching
• Stomach discomfort or pain
• Discomfort from the ring pressing on the bladder or rectum
• Pain when passing urine
• Generalised itching
• Increased sweating

Uncommon side effects

These may affect up to 1 in 100 people:

• Allergic reaction, including skin rash, hives or itching
• Vaginal inflammation or = thrush
• Changes in sex drive
• Mood changes or anxiety
• Headache or migraine
• Dizziness
• Nausea, bloating or abdominal pain
• Gallbladder disease
• Skin discolouration, particularly on the face or neck
• Rash or itchy skin
• Changes in vaginal discharge

For a full list of side effects, read the Estring Patient Information Leaflet.

If you experience any severe side effects or signs of an allergic reaction, remove the ring and seek immediate medical attention by calling 999 or going to A&E.

If you notice any side effects, tell your doctor or pharmacist even if they are not listed here. You can also report side effects through the Yellow Card Scheme, which helps improve the safety of medicines.

Estring Vaginal Ring Ingredients

Active ingredient: Estradiol hemihydrate 2mg (equivalent to 1.94mg estradiol), releasing 7.5 micrograms of estradiol per 24 hours.

Other ingredients: Silicone fluid, barium sulfate, silicone elastomer Q7-4735A, silicone elastomer Q7-4735B.

Warnings and Precautions

• Do not use Estring if you have or have had breast cancer, oestrogen-sensitive cancer, unexplained vaginal bleeding, blood clots, liver disease, or a hereditary blood disorder called porphyria
• Tell your doctor if you have a history of endometriosis, fibroids, high blood pressure, migraines, epilepsy, diabetes, gallstones, asthma, or lupus before using Estring
• Estring is not a contraceptive. If it has been less than 12 months since your last period, or you are under 50, you may still need additional contraception
• If you are scheduled for surgery, tell your doctor you are using Estring. You may need to stop using it 4 to 6 weeks before the operation, as HRT can increase the risk of blood clots during periods of immobility
• Some medicines can affect how Estring works, including certain epilepsy medications, rifampicin, some HIV treatments and St John’s Wort. Always tell your doctor or pharmacist you are using Estring if new medicines are prescribed
• There have been rare reports of the ring becoming attached to the vaginal wall, making removal difficult. If you experience difficulty or pain when removing the ring, see your doctor
• Tell your doctor you are using Estring before having any blood tests, as the ring can affect results
• Keep out of the sight and reach of children
• Do not store above 25°C
• Do not use after the expiry date shown on the packaging
• Used rings still contain some active ingredient. Place the used ring back in its original pouch or a sealed plastic bag before disposing of it safely