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, pain during intercourse, a burning sensation and frequent urinary discomfort. It contains a low dose of estradiol, a form of oestrogen, which is gradually released over a period of 90 days.

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

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:

Vagifem (Estradiol Vaginal Tablets)

Vagifem is a localised oestrogen 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.

Estradiol Vaginal Cream (Ovestin)

Vaginal oestrogen creams provide localised oestrogen 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 customisable but may require more frequent application than Estring.

Replens (Non-Hormonal Moisturizer)

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

Senshio (Ospemifene)

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

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.

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

• 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.
• Pelvic Pain or Discomfort: Mild pelvic pain or discomfort can occur, especially if the ring is not positioned correctly in the vagina.
• 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:

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.

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.

History of Hormone-Dependent Tumors

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

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.

Sources

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