Estring

• Risk factors: Personal or family history of blood clots | High blood pressure | Diabetes | High cholesterol | Smoking | People who identify as obese | Systemic lupus erythematosus (SLE)

Estrogen therapy, like Estring (estradiol), can raise your risk of blood clots. Sometimes, these blood clots can be very dangerous and lead to a heart attack, stroke, or a blood clot in your lungs (called a pulmonary embolism). Because of this risk, Estring (estradiol) shouldn't be used to prevent heart disease.

Tell your prescriber about your full medical history, especially if you've ever had a blood clot. Also let them know if you have a planned surgery or expect to be on bedrest for a long time. Your prescriber will let you know when to stop Estring (estradiol) before your procedure and when to restart it after you're moving around again to lower your risk of blood clots. In general, you should use the lowest dose for the shortest amount of time to stay safe.

Know the signs of a blood clot or related problem:

• Blood clot in arm or leg: swelling or pain in the arm or leg
• Blood clot in the lung: chest pain, trouble breathing
• Blood clot in the eye: sudden partial or complete vision loss, bulging eyes, double vision
• Heart attack: chest pain, arm pain, shortness of breath, a cold sweat, lightheadedness
• Stroke: sudden weakness on one side of the body, drooping face, trouble breathing, bad headache, changes in speech or vision

Remove Estring (estradiol) and get medical help right away if you have any signs or symptoms of a blood clot.

• Risk factors: Taking Estring (estradiol) by itself without additional progestin if you have a uterus | Taking estrogen therapy for more than one year | High estrogen dose

Estrogens like estradiol, found in Estring (estradiol), can thicken and change the lining of your uterus (called the endometrium). This can lead to uncontrolled growth of the uterine lining and put people who have a uterus at risk for uterine cancer (or endometrial cancer). Watch for warning signs like vaginal bleeding after menopause or pelvic pain, and let your prescriber know if you notice anything unusual.

Because of this cancer risk, if you haven't had your uterus removed (through a hysterectomy), your prescriber will usually have you take a progestin along with Estring (estradiol). Progestins help balance estrogen's effect and protect the uterus. Speak with your prescriber if you have questions about uterine cancer risk and how to lower it.

• Risk factors: Personal or family history of breast cancer | Taking estrogen and progestin together | Taking estrogen for many years

Studies suggest that taking estrogens like Estring (estradiol) for several years might raise the risk for breast cancer. This risk is even higher if you take estrogen with a progestin. Don't take Estring (estradiol) if you currently have or have ever had breast cancer.

To lower your risk for breast cancer, take the lowest dose of Estring (estradiol) for the shortest time needed. Regularly check your breasts for any changes and get recommended breast scans (mammograms). Let your prescriber know if you notice any lumps, pain, or swelling in your breasts.

• Risk factors: Taking estrogen and progestin together

Some studies suggest that people who take estrogens like Estring (estradiol) for menopause symptoms might have a higher risk for ovarian cancer. Speak with your prescriber if you're concerned about this risk. Let your care team know if you have any unusual bloating, pelvic pain, trouble eating, or feeling full quickly. These can be signs of ovarian cancer.

• Risk factors: Older adults

People ages 65 and older who take estrogen medications like Estring (estradiol) might have a higher risk of developing dementia. Because of this, estrogen therapy shouldn’t be used to prevent dementia.

Be aware of the early signs of dementia, such confusion, memory loss, getting lost, or struggling to do everyday tasks. If you’re worried about the risk for dementia, talk to your prescriber.

• Risk factors: History of liver disease or jaundice

The risk for gallbladder problems is higher for people who have gone through menopause and are taking estrogen therapy, like Estring (estradiol). In some cases, these problems have required surgery. Let your prescriber know if you've ever had jaundice (yellowing of your skin or whites of your eyes). Also tell your care team right away if you notice jaundice, stomach pain that doesn't go away, nausea, or vomiting while you're taking this medication — these could be signs of liver damage or gallbladder problems.

• Risk factors: History of high triglyceride levels in the blood

Let your prescriber know if you've ever had high triglyceride levels. Estrogens like estradiol (found in Estring (estradiol)) can sometimes raise the amount of triglycerides (fat) in your blood. Having too much can lead to swelling of the pancreas (pancreatitis). Tell your care team right away if you have symptoms like sudden stomach or back pain, nausea, vomiting, fever, or weakness.

Estrogen therapy like Estring (estradiol) can affect the calcium levels in your blood. People with breast cancer or cancer that's spread to the bones are at higher risk of dangerously high calcium levels while they're taking estrogens. Tell your care team if you have any symptoms of high calcium levels like tiredness, muscle weakness, bone pain, nausea, constipation, and thirst.

On the other hand, if you have low parathyroid hormone levels, estrogen can cause your calcium to drop too low. Call your care team if you have signs of low calcium, like muscle cramps, brittle nails, or tingling in your fingers, toes, or lips.

• Risk factors: Conditions that cause low thyroid hormone levels

Estrogen therapy like Estring (estradiol) can change thyroid hormone levels. If you have low thyroid hormone levels (hypothyroidism), it might be harder for your body to adjust. If you're taking thyroid replacement medication, you might need a higher dose while using estrogen therapy. Talk to your prescriber so they can help adjust your medication if needed.

• Risk factors: Certain heart conditions | Kidney damage

Estrogen therapy like Estring (estradiol) can make your body hold onto extra fluids. This can sometimes cause swelling of your hands and feet. Fluid retention can worsen symptoms of certain heart conditions like heart failure, or kidney damage. If you have heart or kidney problems, tell your healthcare team right away if you notice swelling, sudden weight gain, or other signs of fluid retention while taking Estring (estradiol).

Before you start Estring (estradiol), talk to your care team about your medical history. Estrogen-containing medications can make certain health conditions worse, and you might need closer monitoring. These conditions include diabetes, asthma, migraine, lupus, seizures, and hereditary angioedema.

Estring (estradiol) might not be the best choice if you have certain vaginal problems like a narrow or shortened vagina or a history of vaginal infections. These conditions can make your vagina more sensitive and more likely to get irritated or develop sores from using the ring. Let your prescriber know right away if you feel any discomfort, irritation, or pain while using the ring.

Because of changes in your vaginal environment after menopause, you might also be more likely to get vaginal infections. If you already have a vaginal infection, it should be treated before starting Estring (estradiol). If an infection starts while you're using the ring, you should remove it and reinsert it only after the infection has been treated. Always tell your care team if you notice symptoms like itching, burning, or unusual discharge.