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Estring® (estradiol hemihydrate) Prescribing Information (external link).  Adverse event reporting information can be found at the bottom of the page.

Managing Expectations

Broaden your knowldge of Estring® with these frequently asked patient questions​ to help support and reassure your patients in consultations.

What is Estring?

Estring is a slightly opaque, soft, flexible vaginal ring with a centre that contains 2 mg of estradiol (an oestrogen hormone). It releases estradiol into the vagina in a consistent, stable manner for 90 days. Estring is indicated for the treatment of atrophic vaginitis, (due to oestrogen deficiency) in postmenopausal women.

How do I insert Estring?

Watch our video here for detail on how to insert and remove the ring.
You should wash and dry your hands before removing Estring from the pouch. Then find a comfortable position that works for you. Pinch the ring between your thumb and index finger and gently insert the ring, pushing it as far up into the vagina as you can.
It is as simple as: squeeze the ring and insert the ring. 1a

How do you remove Estring?

Watch our video here for detail on how to insert and remove the ring.
Use your finger to find the bottom part of the ring, loop your finger through the ring and gently pull it out. Then discard the used ring by placing it within the original pouch or in a plastic bag, seal and discard safely.
It is as simple as: Loop pull remove and discard. 1b

Will Estring increase the likelihood of cancer?

Taking oestrogen-only HRT tablets for a long time can increase the risk of developing cancer of the womb lining (the endometrium). It is uncertain whether there is a similar risk with Estring which is used for repeated or long term (more than one year) treatments. However, Estring has been shown to have very low absorption into the blood, therefore the addition of a progestogen is not necessary. 2a

Evidence suggests that using Estring does not increase the risk of breast cancer in women who had no breast cancer in the past. Estring does not have an established saftey profile when used in women who have had brest cancer in the past. Estring must not be used in women who have or have ever had breast cancer, or are suspected of having it. 2b

Ovarian cancer is rare - much rarer than breast cancer. The use of oestrogen-only HRT has been associated with a slightly increased risk of ovarian cancer. The risk of ovarian cancer varies with age. For example, 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. For women who have been taking HRT for 5 years, there will be about 3 cases per 2000 users (i.e. about 1 extra case). 2c

Does the exact position of the ring matter?

No. The exact position of Estring isn’t critical, as long as it is in the upper third of the vagina. Don’t worry about pushing the ring up too far or it getting lost.1b If you can feel the ring, push it further up the vagina.
However, you may be aware of the ring at first but this feeling should go away.2d

Can Estring be inserted too far?

No. Estring cannot be pushed too far up in the vagina or get lost. Estring will not go past the end of the vagina. The cervix (the narrow, lower end of the uterus) blocks Estring from going up any further.2c

What are the common side effects I may get from Estring?

Common side effects may affect up to 1 in 10 people using the Estring vaginal delivery system. These include:

Urinary tract infection, infection and itching inside and around the vagina, discomfort/pain in the abdomen, any persistent feeling of the ring in the vagina or pressing on the bladder/rectum, pain on passing urine, generalised itching, increased sweating.3

How long will it take for Estring to start relieving my symptoms?

The ring may take several weeks to have the full effect. As the ring begins to work you may notice an increase in vaginal lubrication (wetness), this is normal and should be the same as you experienced before the menopause. 1

If you stop using your ring, your symptoms may return after about 3 weeks. 2e

How do I dispose of Estring?

Do not flush Estring down the toilet.
Used rings still contain some of the active hormonal ingredient. The used ring should be placed within the original pouch or in a plastic bag, then sealed and discarded safely, out of the reach and sight of children. Do not throw away any medicines via household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment. 2f

How do I store Estring?

Estring can be kept anywhere convenient. It should be stored at a temperature below 25°C (77°F). 2g

Will I or my partner feel Estring?

Most women and their partners have found it acceptable for the ring to stay in place during sexual intercourse. If you or your partner find the ring uncomfortable or unacceptable it may be removed.2d However, if you choose to remove it, be sure to put it back in soon afterward.

If you take Estring out, rinse it in lukewarm (not hot) water before you put it back in. If you can feel it, Estring may be too low in your vagina. To push it in further, simply use your finger. For more information on how to insert and remove Estring, watch our instructional video. 2h

What are some of the risks of Estring?

The following diseases are reported more often in women using HRT medicines which circulate in the blood compared to women not using HRT. These risks apply less to vaginally administered treatments such as ESTRING:

  •  
  • ovarian cancer;
  • blood clots in the veins of the legs or lungs (venous thromboembolism);
  • stroke;
  • probable memory loss if HRT is started over the age of 65.
  •  

Estring is not for pregnant women. If you think you may be pregnant, you should have a pregnancy test and know the results. Do not use Estring if the test is positive and talk to your healthcare provider 2i

About Estring

Explore more about Estring including: efficacy, acceptability, the low daily dose, convenience and comfort of use, patient candidates and an IMS Statement.

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Patient Download

Download a patient leaflet to send to your patients to ensure they have support and advice during their treatment.

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References:

​​​​​Estring Instructions for use. December 2021. [online] Available at: https://labeling.pfizer.com/ShowLabeling.aspx?id=567&Section=IFU [Accessed
January 2022].
Medicines.org.uk. Estring - Summary of Product Characteristics (SmPC) - (emc). [online] Available
at:https://www.medicines.org.uk/emc/medicine/1512#gref [Accessed January 2022]. 
PP-EST-GBR-0014. January 2022

Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard or search 

for MHRA Yellow Card in Google Play or Apple App Store


Adverse events should also be reported to Pfizer Medical Information on 01304 616161

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