Estring Vaginal Ring

What is Estring?

Estring is a small, flexible vaginal ring used for hormone replacement therapy (HRT) to treat symptoms of vaginal atrophy associated with menopause, such as dryness, irritation, itching, and pain during intercourse. It contains a low dose of estradiol, a form of estrogen, which is gradually released over a period of 90 days.

Once inserted into the vagina, Estring works locally by delivering estrogen directly to the vaginal tissues, helping to restore moisture and elasticity without significantly increasing estrogen levels in the rest of the body. It's commonly prescribed to postmenopausal women seeking relief from these specific symptoms while minimizing systemic hormone exposure.

What is Estring used for?

Estring is used to treat symptoms of vaginal atrophy in postmenopausal women. Vaginal atrophy is a condition caused by decreased estrogen levels during menopause, leading to thinning, drying, and inflammation of the vaginal walls. Common symptoms that Estring helps relieve include:

• Vaginal dryness
• Irritation or itching
• Pain during intercourse (dyspareunia)
• Burning sensation
• Frequent urinary discomfort

By delivering localized estrogen directly to the vaginal tissues, Estring helps restore moisture, elasticity, and overall vaginal health, alleviating discomfort and improving quality of life for women experiencing menopausal symptoms.

How does Estring work?

Estring works by releasing a continuous, low dose of estradiol, a form of estrogen, directly into the vaginal tissues. Once inserted into the vagina, the flexible ring delivers a controlled amount of estrogen over a period of 90 days. Here's how it works:

1. Localized oestrogen Delivery: Estring releases estradiol in a low dose directly to the vaginal walls, ensuring the estrogen is concentrated where it's needed most without significantly affecting the rest of the body.
2. Restores Vaginal Health: The estrogen helps rejuvenate and thicken the vaginal tissues, increasing moisture, elasticity, and blood flow. This helps reduce the thinning and dryness that occur during menopause.
3. Symptom Relief: As the vaginal tissue becomes healthier, symptoms such as dryness, itching, burning, and pain during intercourse (dyspareunia) are alleviated, providing long-lasting relief.

Since it works locally, Estring minimises the risk of systemic side effects that might occur with oral or transdermal hormone replacement therapy.

Alternatives to Estring

There are several alternatives to Estring for treating menopausal vaginal symptoms. These alternatives include other forms of localized hormone replacement therapy (HRT) and non-hormonal treatments:

1. Vagifem (Estradiol Vaginal Tablets)

Vagifem is a localized estrogen therapy in the form of small vaginal tablets. Like Estring, it delivers estradiol directly to the vaginal tissue to help restore moisture and thickness. The tablets are inserted into the vagina using an applicator, typically administered daily for the first two weeks, then twice a week for maintenance.

2. Estradiol Vaginal Cream (Ovestin)

Vaginal estrogen creams provide localized estrogen therapy to treat vaginal atrophy. They are applied directly to the vaginal tissue using an applicator, offering flexible dosing depending on symptom severity. Creams can be more customizable but may require more frequent application than Estring.

3. Replens (Non-Hormonal Moisturizer)

Replens is a non-hormonal vaginal moisturizer that helps alleviate dryness without the use of estrogen. It is applied several times a week and provides temporary relief by hydrating and soothing the vaginal tissue.

4. Senshio (Ospemifene)

Osphena is an oral medication that treats pain during intercourse (dyspareunia) caused by vaginal atrophy. It is a selective estrogen receptor modulator (SERM) that mimics estrogen's effects on the vaginal tissue without being a hormone itself.

5. Intrarosa (Prasterone Vaginal Inserts)

Intrarosa is a vaginal insert that contains prasterone (DHEA), a hormone precursor that is converted into estrogen and testosterone in the vaginal tissues. It helps relieve moderate to severe pain during intercourse due to vaginal atrophy.

Sources

• https://www.estring.com/
• https://bnf.nice.org.uk/drugs/...
• https://www.medicines.org.uk/e...

How to use Estring

To insert ESTRING vaginal delivery system into your vagina

• Relax and find a position which feels comfortable for you
• Either stand with one foot on a chair or lie on your back with your knees bent up
• With one hand, open the folds of skin around the vagina
• With the other hand, press the ring into an oval.
• Push the ring into your vagina as far as it will go - upwards and backwards towards the small of the back.
• Finally, wash your hands

To take out Estring vaginal delivery system from your vagina

• Relax and find a position which feels comfortable for you
• Either stand with one foot on a chair or lie on your back with your knees bent up
• With one hand, open the folds of skin around the vagina
• With the other hand, hook your finger around the ring
• Pull the ring gently downwards and forward
• Finally, wash your hands

Estring ingredients

It is important to know what is in any new medication or treatment you decide to use, especially if you have any known allergies.

Each Estring Vaginal Ring contains

• Estradiol Hemihydrate 2.0 mg, corresponding to 1.94 mg estradiol
• Each ring releases estradiol at an average amount of 7.5 microgram per 24 hours, over a period of 90 days

Each Estring ring is made of:

• Silicone elastomer Q7-4735 A
• Silicone elastomer Q7-4735 B
  
• Silicone Fluid
  
• Barium sulfate

You can find the full list of ingredients in the Estring Patient Information Leaflet. You must read this thoroughly before using Estring.

Estring side effects

1. Vaginal Discharge or Irritation: Some women may experience increased vaginal discharge, itching, or irritation due to the presence of the ring or the localized release of estrogen.
2. Pelvic Pain or Discomfort: Mild pelvic pain or discomfort can occur, especially if the ring is not positioned correctly in the vagina.
3. Urinary Tract Infections (UTIs): Estring may slightly increase the risk of urinary tract infections (UTIs) due to changes in the vaginal flora or irritation around the urethra.

While these side effects are typically mild and manageable, it's important to monitor symptoms and consult a healthcare provider if they persist or worsen.

Estring warnings

Before using Estring, there are several important warnings and precautions to consider:

1. Undiagnosed Vaginal Bleeding

Any abnormal or undiagnosed vaginal bleeding should be investigated before starting Estring. Vaginal bleeding after menopause could indicate a serious condition, such as cancer, and should not be overlooked.

2. Allergic Reactions or Sensitivity

Some women may experience an allergic reaction or sensitivity to the materials in Estring or the hormone itself, leading to swelling, itching, or difficulty breathing. If signs of an allergic reaction occur, discontinue use and seek medical attention.

3. History of Hormone-Dependent Tumors

Women with a history of hormone-dependent tumors such as breast cancer, ovarian cancer, or certain uterine cancers should generally avoid estrogen therapies, including Estring, unless prescribed by their healthcare provider for specific reasons.

4. Pregnancy and Breastfeeding

Estring is not for use during pregnancy and should not be used by women who are pregnant or breastfeeding, as it can harm the fetus or nursing infant.

Before starting Estring, it’s important to discuss your full medical history and current medications with your doctor to ensure it's safe for you. Regular follow-ups may also be necessary to monitor for any adverse effects or complications.