Estring vs. Femring for Menopause Symptoms
Key takeaways:
Common symptoms of menopause include hot flashes, night sweats, and vaginal dryness or irritation. Vaginal estrogen rings can help relieve symptoms.
Estring (estradiol) and Femring (estradiol acetate) are both vaginal rings that are inserted for 90 days at a time. Estring treats vaginal menopause symptoms. Femring treats hot flashes and night sweats, but it may also help with vaginal symptoms.
There are many ways to save on Estring and Femring. GoodRx can help make your prescription more affordable.
Table of contents
Menopause takes place when your menstrual cycles permanently stop. Hot flashes and night sweats are the most common menopause symptoms. These are known as vasomotor symptoms of menopause (VMS). Some people also experience vaginal or urinary symptoms, like vaginal dryness. These are called genitourinary syndrome of menopause (GSM). Sometimes vaginal symptoms are referred to as vulvar and vaginal atrophy (VVA).
If your menopause symptoms are bothersome, your healthcare provider might suggest a type of hormone replacement therapy (HRT). HRT comes in many different dosage forms, including pills, patches, and vaginal rings.
In this article, we’ll discuss two HRT vaginal rings: Estring (estradiol) and Femring (estradiol acetate). Read on to learn how they compare.
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What is Estring?
Estring is a vaginal ring containing estradiol, a lab-made form of an estrogen hormone. Your body uses the estradiol in Estring similarly to how it uses estrogen.
Each Estring vaginal ring has 2 mg of estradiol in it. It slowly releases a very small amount of estradiol: 0.0075 mg per day for 90 days (3 months).
What conditions is Estring approved to treat?
Estring is FDA-approved to treat moderate to severe VVA. This medication only releases hormones locally to the vulva and vagina. This means that it replaces estrogen only in this area and not the whole body.
What is Femring?
Like Estring, Femring is a vaginal ring that contains a lab-made form of an estrogen hormone. This ring contains estradiol acetate, which is a slightly different form of estrogen than the one in Estring.
Femring has two strengths that slowly release estrogen over 90 days. The lower-strength ring releases 0.05 mg of estradiol acetate per day. The higher-strength ring releases 0.1 mg per day.
What conditions is Femring approved to treat?
Femring has more approved uses than Estring. Femring is also FDA-approved for moderate to severe VVA. But unlike Estring, Femring works systemically. This means it has body-wide effects. So Femring can treat moderate to severe hot flashes and night sweats too.
How do estrogen vaginal rings work for menopause symptoms?
During menopause, your natural levels of estrogen drop. This affects different tissues throughout your body.
In the case of GSM, low estrogen causes vaginal dryness, pain during sex, and discomfort when urinating. In the case of VMS, low estrogen causes hot flashes and night sweats.
Estring and Femring work to replace the estrogen your body has lost. Adding estogen back to the body can help relieve menopause symptoms.
How are Estring and Femring dosed?
The way you use Estring and Femring vaginal rings is very similar. Regardless of which ring you’re using, you should talk to your healthcare provider every 3 to 6 months to see if you still need to use it.
Estring
Estring is inserted into the upper part of the vagina and left in place for 90 days. If the ring comes out during this time, rinse it with lukewarm water and reinsert it for the remaining time. After 90 days, replace your Estring with a new vaginal ring.
Femring
Insert Femring into the upper part of the vagina and leave it in place for 90 days. If it comes out, rinse the ring with lukewarm water and place it back in your vagina. At the end of 90 days, replace it with a new Femring.
It’s recommended to start with the lower dose ring (0.05 mg per day). If your symptoms don’t seem to improve after about 3 to 6 months of using Femring, speak with your healthcare provider. They may suggest using the higher dose (0.1 mg per day).
How effective are Estring and Femring for treating menopause symptoms?
Estring is very effective for GSM symptoms. Women usually see results about 3 months after starting Estring. In studies, Estring was similarly effective to other vaginal estrogen products. But because everyone is unique, it’s possible you may prefer one product over another.
Femring is also an effective treatment for menopause symptoms. Symptoms may start improving as soon as 4 weeks after starting it. When compared to other systemic estrogen products (like oral pills or patches), Femring provided similar benefits for hot flashes and night sweats. Femring was also shown to be very effective for vaginal symptoms.
The choice between Estring and Femring will likely come down to which menopause symptoms you’re experiencing. Local vaginal estrogen, like Estring, is preferred when you only have vaginal symptoms.
What are the known side effects of Estring and Femring?
The common side effects for Estring and Femring are similar. Keep in mind, the side effects listed here aren’t the only ones you could experience — just the most common. Let your healthcare provider know if you notice bothersome side effects after starting Estring or Femring.
| Side effect | Estring | Femring 0.05 mg per day | Femring 0.1 mg per day |
|---|---|---|---|
| Headache | 13% | 7% | 10% |
| Vaginal bleeding or spotting | 4% | 8% | 10% |
| Yeast infection | 6% | 6% | 11% |
| Breast tenderness | 1% | 6% | 11% |
| Back pain | 6% | 6% | 4% |
| Bloating | Not listed | 7% | 3% |
| Vaginal discharge | 7% | Not listed | Not listed |
| Urinary tract infections (UTIs) | 2% | 1% | 4% |
What are the serious side effects of Estring and Femring?
All estrogen-containing medications include a boxed warning about several serious side effects. A boxed warning is the strictest warning the FDA can give for a prescription medication. But the risk of these complications is different for each of the two vaginal rings.
Your body absorbs less estrogen with Estring than with Femring. Because of this, Estring has a lower risk of serious side effects. Femring, on the other hand, is designed to be absorbed in greater amounts. So it has a higher risk.
Serious side effects of estrogen-containing HRT include:
Blood clots in the lung or legs
Endometrial (uterine) cancer
Ovarian cancer
Dementia
If you still have your uterus, you’ll likely also have to take a form of progesterone while using Femring. Using estrogen by itself can cause the lining of the uterus to thicken or grow out of control. Over time, this raises the risk for endometrial cancer. Taking progesterone helps lower this risk. If your uterus has been surgically removed, you shouldn’t need progesterone.
Because Estring only acts locally, a progesterone medication may not be needed. In clinical studies of Estring, uncontrolled uterine growth wasn’t seen.
What interactions do Estring and Femring have?
Interaction studies haven’t been done for either Estring or Femring. This is because the interactions for estrogen are already known.
The effects of Estring and Femring could be lessened by:
Carbamazepine (Tegretol)
St. John’s Wort (an over-the-counter supplement)
The following may raise your risk of side effects from Estring and Femring:
These aren’t the only possible interactions for Estring and Femring. Always provide a current medication list to your healthcare provider and pharmacist so they can double check for interactions.
How to save on Estring and Femring
Estring and Femring are only available as brand-name medications. But GoodRx can help you navigate ways to save on your prescription.
Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for Estring’s patient assistance programs, which offer the medication at no charge.
Save with a copay savings card. If you have commercial insurance and meet eligibility requirements, Estring’s price is as little as $45 if you use the manufacturer’s savings card. Femring’s price is as little as $25 if you use the manufacturer’s savings card.
The bottom line
Estring and Femring vaginal rings are effective ways to improve certain menopause symptoms. Estring may be useful if you’re experiencing only the urinary or vaginal symptoms. Femring contains a higher dose of estrogen. In addition to vaginal symptoms, it works well for hot flashes and night sweats.
If you’re experiencing menopause symptoms, discuss your options with your healthcare provider. Together, you can choose the best option to treat your symptoms.
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References
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Pfizer Laboratories. (2021). Estring [package insert].
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Thurston, R. C., et al. (2012). Vasomotor symptoms and menopause: Findings from the study of women's health across the nation. Obstetrics and Gynecology Clinics of North America.
