This medicine comes with a patient information leaflet. Read and follow these instructions carefully. Ask your doctor if you have any questions. cancer that is sensitive to oestrogen e.g. endometrial cancer (cancer of the womb) or if you are suspected of having it 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. After the ring has been in your vagina for 21 days (3 weeks), you remove it. This should be on the same day of the week that you put it in. To remove the ring:

Applies to estradiol topical: transdermal film extended release, vaginal cream, vaginal insert, vaginal ring, vaginal tablet. General The name of your medicine is Estring 7.5 micrograms/24 hours vaginal delivery system but will be referred to as Estring throughout this leaflet. Endogenous estrogens are largely responsible for the development and maintenance of the female reproductive system and secondary sexual characteristics. Although circulating estrogens exist in a dynamic equilibrium of metabolic interconversions, estradiol is the principal intracellular human estrogen and is substantially more potent than its metabolites, estrone and estriol, at the receptor level. Although appropriate studies on the relationship of age to the effects of estradiol vaginal gel, insert, or ring have not been performed in the geriatric population, no geriatric-specific problems have been documented to date. However, elderly patients are more likely to have breast cancer, strokes, or dementia, which may require caution in patients receiving estradiol vaginal gel, insert, or ring. BreastfeedingThe risk of getting stroke is about 1.5 times higher in HRT users than in non-users. The number of extra cases of stroke due to use of HRT will increase with age. Other things that can increase the risk of stroke include: Use of systemic HRT has been associated with a slightly increased risk of having ovarian cancer diagnosed (see section 4.4). If you don't smoke and there are no medical reasons why you can't use the ring, you can use it until you're 50 years old. After giving birth

A very serious allergic reaction to this product is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/ tongue/throat), severe dizziness, trouble breathing. Once the ring is in place inside your vagina, you should not be able to feel it. If you feel uncomfortable, the ring may not be inserted far enough. Gently push the ring farther into your vagina. If you feel pain, talk to your doctor. You may be able to start using the ring earlier than this – on day 21 after giving birth – if you're not breastfeeding, but your doctor will advise you. You do not then need to use additional contraception. Endometrial overstimulation, as evaluated in non-hysterectomized patients participating in the U.S. study by the progestogen challenge test and pelvic sonogram, was reported for none of the 58 (0 percent) patients receiving ESTRING and 4 of the 35 patients (11 percent) receiving conjugated estrogens vaginal cream.

Before Using

If you are switching from another type of contraception (excluding condoms) or you have taken emergency contraception recently, the advice on when to start using the ring and how soon you'll be protected may be different. Appropriate studies have not been performed on the relationship of age to the effects of estradiol vaginal gel, insert, or ring in the pediatric population. Use of estradiol vaginal gel, insert, or ring is not indicated for use in children. Geriatric One ring to be inserted into the upper third of the vagina. Once inserted it is left in the vagina continuously for 90 days and replaced by a new ring as appropriate. For initiation and continuation of treatment of postmenopausal symptoms, the lowest effective dose for the shortest duration (See also Section 4.4) should be used. The maximum recommended duration of continuous therapy is two years. Epidemiological evidence from a large meta-analysis suggests a slightly increased risk in women taking oestrogen-only systemic HRT, which becomes apparent within 5 years of use and diminishes over time after stopping. In the U.S. study, symptoms of dysuria and urinary urgency improved in 74 percent and 65 percent, respectively, of patients receiving ESTRING as assessed by the patient. In the Australian study, symptoms of dysuria and urinary urgency improved in 90 percent and 71 percent, respectively, of patients receiving ESTRING as assessed by the patient.