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Estradiol ring

Pronunciation

Generic Name: estradiol (ES-tra-DYE-ol)
Brand Name: Femring

Estradiol ring should not be used to prevent heart disease, heart attacks, strokes, or dementia. Estrogens have been shown to increase the risk of heart disease (including heart attack), stroke, dementia, serious blood clots (eg, in the lungs or legs), breast cancer, and cancer of the uterus in some women. Tell your doctor right away if you have any unusual or persistent vaginal bleeding while you use estradiol ring. Talk with your doctor if you have any questions about the benefits and risks of using estradiol ring.

Estradiol ring should be used for the shortest possible time at the lowest effective dose to minimize the risk of its side effects. Talk with your doctor regularly about your need to use estradiol ring.


Estradiol ring is used for:

Treating symptoms caused by menopause (eg, hot flashes; itching, burning, and dryness in or around the vaginal area). It may also be used for other conditions as determined by your doctor.

Estradiol ring is an estrogen. It works by increasing the amount of estrogen in the body in certain women who do not produce enough on their own.

Do NOT use estradiol ring if:

  • you are allergic to any ingredient in estradiol ring
  • you have a history of angioedema (swelling of the hands, face, lips, eyes, throat, or tongue; difficulty swallowing or breathing; or hoarseness) caused by estradiol ring
  • you are pregnant or think you may be pregnant
  • you have unexplained, abnormal vaginal bleeding; known or suspected cancer of the breast or uterus; estrogen-dependent tumors; bleeding problems; or a condition that may increase your risk of blood clots
  • you have a history of breast cancer, blood clots (eg, deep vein thrombosis, pulmonary embolism), heart attack, stroke, or liver problems

Contact your doctor or health care provider right away if any of these apply to you.

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Before using estradiol ring:

Some medical conditions may interact with estradiol ring. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

  • if you are pregnant, planning to become pregnant, or are breast-feeding
  • if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
  • if you have allergies to medicines, foods, or other substances
  • if you or a family member has a history of lumps in the breast, an abnormal mammogram, or breast cancer
  • if you have uterine problems (eg, uterine fibroids/endometriosis), or vaginal conditions (eg, abnormal vaginal bleeding, recurring vaginal infections, prolapse, stenosis)
  • if you have a history of yellowing of the eyes or skin during pregnancy or with past estrogen use, or high blood pressure during pregnancy (toxemia)
  • if you have high calcium levels in the blood, asthma, cancer, cholesterol or lipid problems, depression, diabetes, epilepsy, excessive weight gain, gallbladder disease, heart disease or other heart problems, high blood pressure, kidney or liver problems, low thyroid hormone levels, lupus, migraine headaches, vision problems, pancreas disease, the blood disease porphyria, or seizures
  • if you have a condition called hereditary angioedema
  • if you smoke, will be having surgery, or will be on bed rest

Some MEDICINES MAY INTERACT with estradiol ring. Tell your health care provider if you are taking any other medicines, especially any of the following:

  • Barbiturates (eg, phenobarbital), hydantoins (eg, phenytoin), or rifampin because they may decrease estradiol ring's effectiveness
  • Anticoagulants (eg, warfarin), azole antifungals (eg, ketoconazole), corticosteroids (eg, prednisone), macrolide antibiotics (eg, erythromycin), ritonavir, succinylcholine, or tacrine because their actions and the risk of their side effects may be increased by estradiol ring

This may not be a complete list of all interactions that may occur. Ask your health care provider if estradiol ring may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use estradiol ring:

Use estradiol ring as directed by your doctor.

  • An extra patient leaflet is available with estradiol ring. Talk to your pharmacist if you have questions about this information.
  • Wash and dry your hands before removing the ring from the pouch. The ring becomes slippery when wet, so make sure your hands are dry.
  • To insert the ring, choose a comfortable position, such as lying down, squatting, or standing with one leg up. Hold the ring between your thumb and index finger and press the opposite sides of the ring together. Gently push the folded ring as deeply as possible into the upper one-third of the vagina. The exact position of the ring in the vagina is not important for it to work.
  • You may not feel the ring once it is in place. If you feel discomfort, the ring is probably not inserted far enough in your vagina. Use your finger to gently push the ring further into your vagina. There is no danger in the ring being pushed too far up the vagina or getting lost. You can only insert it as far as the end of the vagina. The cervix will block it from going any further.
  • Wash your hands immediately after using estradiol ring.
  • Estradiol ring is usually left in place for 90 days. You will need to remove estradiol ring and replace it with a new ring after 90 days if you continue therapy. Do not leave the ring in place for longer than 90 days. Follow the dosing schedule carefully.
  • Some women may experience moving or gliding of the ring within the vagina caused by bowel movements, straining, constipation, or coughing. If this occurs, push it back into place with your finger. If the ring is removed or falls out of the vagina, rinse the ring with lukewarm water and reinsert.
  • To remove the ring, wash and dry your hands thoroughly. Find a comfortable position, either standing, squatting, or lying down. Loop your finger through the ring and gently pull it out. Discard the used ring in a trash container, out of the reach of children and away from pets. Do not flush it down the toilet.
  • It may take 2 to 3 weeks for estradiol ring to work. If your symptoms do not get better, contact your doctor.
  • If you forget and have not inserted a new ring after 90 days, contact your doctor to establish a new schedule for estradiol ring.

Ask your health care provider any questions you may have about how to use estradiol ring.

Important safety information:

  • Toxic shock syndrome (TSS) has been reported in a few patients using vaginal rings. TSS is a rare but serious and sometimes fatal condition. Symptoms of TSS may include diarrhea, dizziness or light-headedness, fainting, fever, muscle pain, nausea, a sunburn-like rash, or vomiting. Tell your doctor right away if you notice these effects.
  • There have been a few reports of estradiol ring becoming attached to the vaginal wall. This may make removal of the ring difficult. Tell your doctor if you have trouble removing the ring.
  • Estradiol ring may cause dizziness. This effect may be worse if you use it with alcohol or certain medicines. Use estradiol ring with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
  • Limit alcoholic beverages while you are using estradiol ring.
  • Estradiol ring may cause dark skin patches on your face (melasma). Exposure to the sun may make these patches darker and you may need to avoid prolonged sun exposure and sunlamps. Consult your doctor regarding the use of sunscreens and protective clothing.
  • Estradiol ring may increase the risk of blood clots (especially in women older than 35 years old). The risk may be greater if you smoke.
  • Contact your health care provider if vaginal bleeding of unknown cause occurs. This could be a sign of a serious condition requiring immediate medical attention.
  • Contact your health care provider if vaginal discomfort occurs or if you suspect you have developed an infection while taking estradiol ring.
  • Follow your doctor's instructions for examining your breasts, and report any lumps immediately.
  • If you wear contact lenses and you develop problems with them, contact your doctor.
  • If you will be having surgery or will be confined to a chair or bed for a long period of time (eg, a long plane flight), notify your doctor beforehand. Special precautions may need to be taken in these circumstances while you are using estradiol ring.
  • Nonprescription therapy to help prevent bone loss includes a weight-bearing exercise plan, as well as adequate daily calcium and vitamin D intake. Check with your doctor or pharmacist for more details.
  • Estradiol ring may increase the risk of breast and endometrial cancer. Your doctor may prescribe another hormone (progestin) to decrease this risk.
  • Your doctor should reevaluate you every 3 to 6 months to determine whether or not you need to continue using estradiol ring.
  • Estradiol ring may interfere with certain lab tests. Be sure your doctor and lab personnel know you are using estradiol ring.
  • Diabetes patients - Estradiol ring may affect your blood sugar. Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine.
  • Lab tests, including physical exams, hormone levels, or blood pressure, may be performed while you use estradiol ring. You should have breast and pelvic exams and a Pap test at least once a year. You should also have periodic mammograms as determined by your doctor. Be sure to keep all doctor and lab appointments.
  • Use estradiol ring with caution in the ELDERLY; they may be more sensitive to its effects, including an increased risk of heart problems, stroke, breast or uterine cancer, and certain mental problems (eg, dementia).
  • Estradiol ring should not be used in CHILDREN; safety and effectiveness in children have not been confirmed.
  • PREGNANCY and BREAST-FEEDING: Do not use estradiol ring if you are pregnant. Avoid becoming pregnant while you are using it. If you think you may be pregnant, contact your doctor right away. Estradiol ring is found in breast milk. Do not breast-feed while taking estradiol ring.

Possible side effects of estradiol ring:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Breast pain or tenderness; hair loss; headache; mild burning, irritation, or itching after insertion; mild nausea or vomiting; spotting or breakthrough bleeding; stomach cramps or bloating.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); back pain; breast lumps or nipple discharge; calf or leg pain or swelling; changes in vaginal bleeding (eg, spotting, breakthrough bleeding, prolonged bleeding); chest pain; constipation; coughing up blood; dark urine; diarrhea; dizziness; fainting; fever; irregular heartbeat; memory problems; mental or mood changes (eg, depression); muscle pain; one-sided weakness; painful or difficult urination; persistent or severe breast pain or tenderness; persistent or severe headache, nausea, or vomiting; severe or persistent stomach pain or swelling; severe vaginal pain or bleeding during ring removal; slurred speech; sudden shortness of breath; sunburn-like skin rash; swelling of feet, hands, or legs;unusual vaginal discharge, itching, or odor; unusual weight changes; vision changes; weakness or numbness of an arm or leg; yellowing of the skin or eyes.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately.

Proper storage of estradiol ring:

Store estradiol ring at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Store in the original packaging until just before use. Store away from heat, moisture, and light. Do not store in the bathroom. Keep estradiol ring out of the reach of children and away from pets.

General information:

  • If you have any questions about estradiol ring, please talk with your doctor, pharmacist, or other health care provider.
  • Estradiol ring is to be used only by the patient for whom it is prescribed. Do not share it with other people.
  • If your symptoms do not improve or if they become worse, check with your doctor.
  • Check with your pharmacist about how to dispose of unused medicine.

This information should not be used to decide whether or not to take estradiol ring or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about estradiol ring. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to estradiol ring. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using estradiol ring.

Issue Date: September 3, 2014
Database Edition 14.3.1.003
Copyright © 2014 Wolters Kluwer Health, Inc.

Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using this medicine.

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