Vaginal estrogen

CAUTION:
Estrogen increases the risk that you will develop endometrial cancer (cancer of the lining of the uterus [womb]). The longer you use estrogen, the greater the risk that you will develop endometrial cancer. If you have not had a hysterectomy (surgery to remove the uterus), you may be given another medication called a progestin to take with vaginal estrogen. This may decrease your risk of developing endometrial cancer, but may increase your risk of developing certain other health problems, including breast cancer. Before you begin using vaginal estrogen, inform your doctor if you are breast-feeding cancer and if you have unusual vaginal bleeding. call your doctor without delay if you have abnormal or unusual vaginal bleeding during your treatment with vaginal estrogen.

General Information and Indications:

Vaginal estrogen is used to treat vaginal dryness, itching, and burning; painful or difficult urination; and sudden need to urinate immediately in women who are experiencing or have experienced menopause (change of life; the end of monthly menstrual periods).

Information For Users:

Vaginal estrogen comes as a flexible ring and a tablet to insert in the vagina, and as a cream to apply to the inside of the vagina. Estrogen vaginal rings are usually inserted in the vagina and left in place for 3 months. After 3 months, the ring is removed, and a new ring may be inserted if treatment is still needed. Estrogen vaginal tablets are usually inserted once a day for the first 2 weeks of treatment and then are inserted twice a week as long as treatment is needed.

To use the vaginal ring, follow these steps:

o Wash and dry your hands
o Remove the vaginal ring from its pouch.
o Stand with one leg up on a chair, step or other object, squat, or lie down. Choose the position that is most comfortable for you.
o Hold the vaginal ring between your thumb and index finger and press the sides of the ring together. You may want to twist the ring into a figure-of-eight shape.
o Hold open the folds of skin around your vagina with your other hand.
o Place the tip of the ring into your vagina and then use your index finger to gently push the ring inside your vagina as far as you can.
o The vaginal ring does not have to be positioned a certain way inside your vagina, but it will be more comfortable and less likely to fall out when it is placed as far back in your vagina as possible. The ring cannot go past your cervix, so it will not go too far in your vagina or get lost when you push it in. If you feel discomfort, use your index finger to push the ring further into your vagina.
o Wash your hands again.
o Leave the ring in place for 3 months. The ring may fall out if you have not inserted it deeply in your vagina, if your vaginal muscles are weak, or if you are straining to have a bowel movement. If the ring falls out, wash it with warm water and replace it in your vagina following the directions above. If the ring falls out and is lost, insert a new ring and leave the new ring in place for up to 3 months. Call your doctor if your ring falls out often.
o You can leave the ring in place when you have sex. If you choose to remove it or if it falls out, wash it with warm water and replace it in your vagina as soon as possible.
o When you are ready to remove the ring, wash your hands and stand or lie in a comfortable position.
o Put a finger into your vagina and hook it through the ring. Gently pull downward and forward to remove the ring.
o Wrap the ring in a tissue or a piece of toilet paper and throw it away in a trash can. Do not flush the ring in a toilet.
o Wash your hands again.

To use the vaginal tablet, follow these steps:

o Tear off one applicator from the strip of applicators in your carton.
o Open the plastic wrap and remove the applicator.
o Stand with one leg up on a chair, step, or other object, or lie down. Choose the position that is most comfortable for you.
o Hold the applicator in one hand with a finger on the end of the plunger.
o Use the other hand to gently guide the applicator into the vaginal opening. If the tablet falls out of the applicator, do not try to replace it. Throw away that applicator and tablet and use a fresh applicator.
o Insert the applicator into your vagina as far as is comfortable. Do not force the applicator into your vagina or insert more than half of the applicator into your vagina.
o Gently press the plunger until you hear a click.
o Remove the empty applicator from your vagina and throw it away as you would a plastic tampon applicator. Do not save or reuse the applicator.

To use the vaginal cream, follow these steps:

o Remove the cap from the tube of cream.
o Screw the nozzle end of the applicator onto the open end of the tube.
o Gently squeeze the tube from the bottom to fill the applicator with the amount of cream that your doctor has told you to use. Look at the markings on the side of the applicator to help measure your dose.
o Unscrew the applicator from the tube.
o Lie on your back and pull your knees up toward your chest.
o Gently insert the applicator into your vagina and press the plunger downward to release the cream.
o Remove the applicator from your vagina.
o To clean the applicator, pull the plunger to remove it from the barrel. Wash the applicator and plunger with mild soap and warm water. Do not use hot water or boil the applicator.

Special precautions:

o Inform your doctor or pharmacist if you have allergy to vaginal estrogen, any other estrogen products, any other medications, or any of the ingredients in the type of vaginal estrogen you plan to use. Ask your pharmacist or check the manufacturer's patient information for a list of the ingredients.
o Inform your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements, you are taking or plan to take. Be sure to mention any of the following: amiodarone (Cordarone, Pacerone); certain antifungals such as itraconazole (Sporanox) and ketoconazole (Nizoral);aprepitant (Emend); carbamazepine (Carbatrol, Epitol, Tegretol);cimetidine (Tagamet); clarithromycin (Biaxin); cyclosporine (Neoral, Sandimmune); dexamethasone (Decadron, Dexpak); diltiazem (Cardizem, Dilacor, Tiazac, others); erythromycin (E.E.S, Erythrocin);fluoxetine (Prozac, Sarafem); fluvoxamine (Luvox); griseofulvin (Fulvicin, Grifulvin, Gris-PEG); lovastatin (Altocor, Mevacor); medications for human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) such as atazanavir (Reyataz), delavirdine (Rescriptor), efavirenz (Sustiva), indinavir (Crixivan), lopinavir (in Kaletra), nelfinavir (Viracept), nevirapine (Viramune), ritonavir (Norvir, in Kaletra), and saquinavir (Fortovase, Invirase); medications for thyroid disease; other medications that are used vaginally; nefazodone; phenobarbital; phenytoin (Dilantin, Phenytek); rifabutin (Mycobutin); rifampin (Rifadin, Rimactane, in Rifamate);sertraline (Zoloft); troleandomycin (TAO); verapamil (Calan, Covera, Isoptin, Verelan); and zafirlukast (Accolate). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
o Inform your doctor what herbal products you are taking, especially St. John's wort.
o inform your doctor if you are breast-feeding yellowing of the skin or eyes, jaundice during pregnancy or during your treatment with an estrogen product, endometriosis (a condition in which the type of tissue that lines the uterus [womb] grows in other areas of the body), uterine fibroids (growths in the uterus that are not cancer), asthma, migraine headaches, seizures, porphyria (condition in which abnormal substances build up in the blood and cause problems with the skin or nervous system), very high or very low levels of calcium in your blood, or thyroid, liver, kidney, gallbladder, or pancreatic disease. If you will be using the vaginal ring, also Inform your doctor if you have a vaginal infection; any condition that makes your vagina more likely to become irritated; a narrow vagina; or a condition where the rectum, bladder, or uterus has bulged or dropped into the vagina.
o Inform your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using vaginal estrogen, call your doctor without delay.
o you should know that the manufacturer of one brand of estrogen vaginal cream states that use of the cream may weaken latex or rubber birth control devices such as condoms or diaphragms. These devices may not be effective if you use them during your treatment with estrogen vaginal cream. Talk to your doctor about methods of birth control that will work for you.

Possible Adverse Effects:

Vaginal estrogen may cause adverse effects. Inform your doctor if any of the following symptoms are severe or do not go away:

o breast pain or tenderness
o upset stomach
o heartburn
o vomiting
o dizziness
o nervousness
o depression
o irritability
o difficulty falling asleep or staying asleep
o changes in sexual desire
o hair loss
o unwanted hair growth
o spotty darkening of the skin on the face
o sudden feelings of heat or sweating
o difficulty wearing contact lenses
o leg cramps
o swelling, redness, burning, itching, or irritation of the vagina
o vaginal discharge
o painful or difficult urination
o back pain
o cold symptoms
o flu symptoms

Some adverse effects could be serious. If you experience any of these symptoms, call your doctor without delay:

o bulging eyes (Exophthalmos or Proptosis)
o pain, swelling, or tenderness in the stomach
o loss of appetite (anorexia)
o weakness
o yellowing of the skin or eyes, jaundice
o joint pain
o movements that are difficult to control
o rash or blisters
o hives (Urticaria)
o itching
o swelling of the eyes, face, tongue, throat, hands, arms, feet, ankles, or lower legs
o hoarseness
o difficulty swallowing or breathing

Estrogen may increase your risk of developing cancer of the ovaries or gallbladder disease that may need to be treated with surgery. Talk to your doctor about the risks of using vaginal estrogen.

Estrogen may cause growth to slow or stop early in children who receive large doses for a long time. Vaginal estrogen may also affect the timing and speed of sexual development in children.Your child's doctor will monitor her carefully during her treatment with estrogen. Talk to your child's doctor about the risks of giving this medication to your child.
 

Possible Symptoms of Overdose:

o upset stomach
o vomiting
o vaginal bleeding

Brand Name(s):

o Estrace®
o Estring®
o Femring®
o Premarin®
o Vagifem®

Other Name(s):

o conjugated estrogens
o estradiol