This medication can increase the risk of developing a condition (endometrial hyperplasia) that may lead to cancer of the lining of the uterus. Taking progestins, another hormone medication, with this medication lowers the risk of developing this condition. Therefore, if your uterus has not been removed (by a hysterectomy), your care team may prescribe a progestin for you to take together with your estrogen. You should know, however, that taking estrogens with progestins may have additional health risks. You should discuss the use of estrogens and progestins with your care team to determine the benefits and risks for you. Research suggests that people who use the vaginal ring have a small increased risk of being diagnosed with breast cancer compared with those who don't. But this reduces with time after you've stopped using the ring. Signs of liver problems like dark urine, feeling tired, not hungry, upset stomach or stomach pain, light-colored stools, throwing up, or

if you were not planning to have a ring-free break, take out the ring and insert a new ring straight away An unusual or allergic reaction to estrogens, other hormones, medications, foods, dyes, or preservatives Common (1% to 10%): Abdominal pain, nausea, diarrhea, lower abdominal pain, abdominal discomfort, anorectal discomfort, dyspepsia If you get a vaginal infection while using this ring, it is recommended that you remove the ring and resume treatment only after the infection has been treated. Consult your doctor or pharmacist for more information.

D. Drug and Laboratory Test Interactions

For the treatment of postmenopausal symptoms, Hormone Replacement Therapy (HRT) should only be initiated for symptoms that adversely affect quality of life. In all cases, a careful appraisal of the risks and benefits should be undertaken at least annually and HRT should only be continued as long as the benefit outweighs the risk. A very small number of people using the vaginal ring may develop a blood clot in a vein or an artery. Don't use the ring if you've had a blood clot before. Cancer A meta-analysis from 52 epidemiological studies reported an increased risk of ovarian cancer in women currently using systemic HRT compared to women who have never used HRT (RR 1.43, 95% CI 1.31-1.56). For women aged 50 to 54 years taking 5 years of HRT, this results in about 1 extra case per 2000 users. In women aged 50 to 54 who are not taking HRT, about 2 women in 2000 will be diagnosed with ovarian cancer over a 5-year period. Risk factors for blood clots in the veins (venous thromboembolism or deep vein thrombosis), see later in Section 2 where the risks of taking Estring are described Estradiol vaginal insert is also used to treat moderate to severe painful sexual intercourse caused by menopause.

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. If you're under 16 and want contraception, the doctor, nurse or pharmacist won't tell your parents (or carer) as long as they believe you fully understand the information you're given, and the decisions you're making. Additionally, you are advised to join mammography screening programs when offered to you. Ovarian cancer As a general rule, oestrogen replacement therapy should not be prescribed for longer than one year without another physical, including gynaecological examination being performed.

with clean hands, squeeze the ring between your thumb and finger, and gently insert the tip into your vagina Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your You can start using the vaginal ring 42 days after giving birth if you are breastfeeding. You will need to use additional contraception for 7 days (such as condoms). Use Estring exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

Grapefruit and grapefruit juice may interact with estradiol and lead to unwanted side effects. Avoid the use of grapefruit products. Estring side effects If you develop any of the conditions listed under ‘Do not use Estring’ if you have the following conditions’ or those listed under ‘Stop taking Estring and see a doctor immediately’ or if you have any of the following side-effects, remove Estring vaginal delivery system and see your doctor straight away. If you experience difficulty or pain when trying to remove the vaginal ring please do not continue and see your doctor. Oestrogens may cause fluid retention and therefore patients with cardiac or renal dysfunction should be carefully observed.

Patient leaflet - ESTRING 7.5 MICROGRAMS / 24 HOURS VAGINAL DELIVERY SYSTEM

Estring vaginal rings contain estradiol. Estradiol (a form of estrogen) is a female sex hormone necessary for many processes in the body. Estring releases estrogen that is absorbed directly through the skin of the vaginal wall. Tell the medical doctor or dentist in charge that you are using this medicine before any kind of surgery (including dental surgery) or emergency treatment. Your doctor will decide whether you should continue using this medicine. This medicine may also affect the results of certain medical tests. Assessment of each woman prior to taking hormone replacement therapy (and at regular intervals thereafter) should include a personal and family medical history. Physical examination should be guided by this and by the contraindications (see section 4.3) and warnings (see section 4.4) for this product. During assessment of each individual woman, clinical examination of the breasts and pelvic examination should be performed where clinically indicated rather than as a routine procedure. Women should be encouraged to participate in the national cervical cancer screening programme (cervical cytology) and the national breast cancer screening programme (mammography) as appropriate for their age. Breast awareness should also be encouraged and women advised to report any changes in their breasts to their doctor or nurse. Estrogens may raise the chance of uterine cancer. Progestins may lower this chance. A warning sign for cancer of the uterus is vaginal