Femring

• 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 such as Femring (estradiol) can raise your risk for blood clots. Sometimes, these blood clots can be very dangerous and lead to a heart attack, stroke, or pulmonary embolism (blood clot in the lungs). Because of these risks, estrogen therapy shouldn't be used to prevent heart disease.

Tell your prescriber about your full medical history so they can check your risk for blood clots. Also tell your prescriber about any planned procedures or long periods of bedrest. Your prescriber will let you know when to stop Femring (estradiol) before your procedure and when to restart it afterwards to lessen your risk for blood clots. In general, you should take the lowest dose of Femring (estradiol) for the shortest period of time possible to lower your risk for blood clots.

Be aware of the signs and symptoms of a blood clot and related complications.

• 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 (blood clot near the heart): chest pain, arm pain, shortness of breath, a cold sweat, lightheadedness
• Stroke (blood clot in the brain): sudden weakness on one side of the body, drooping face, trouble breathing, bad headache, changes in speech or vision

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

• Risk factors: Taking Femring (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 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). Be aware of the warning signs of endometrial cancer, such as vaginal bleeding after menopause and pelvic pain. Let your prescriber know if you notice any unusual vaginal bleeding or pelvic pain.

Because of the risk for endometrial cancer, people who haven't had their uterus removed by hysterectomy will need to take an additional medication called a progestin while they're taking Femring (estradiol). Progestins help balance out estrogen's effect on the growth of the uterine lining, which helps protect the uterus. Speak with your prescriber if you have questions about the risk for endometrial cancer and ways to lower your risk.

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

Studies suggest that taking estrogens such as Femring (estradiol) for several years might raise the risk for breast cancer. This risk is higher if you take estrogens with a progestin. Don't take Femring (estradiol) if you currently have or have had breast cancer in the past.

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

• Risk factors: Taking estrogen and progestin together

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

• Risk factors: Age over 65

People age 65 years and older who take medications with estrogen, such as Femring (estradiol), might have a higher risk of developing dementia. Estrogen therapy shouldn't be used to prevent dementia.

Be aware of the early signs and symptoms of dementia, such as becoming confused or more forgetful, getting lost, and having trouble doing familiar things at home or at work. Speak with your prescriber if the risk for dementia worries you.

• Risk factors: History of liver disease or jaundice

The risk for gallbladder problems is higher for people who've gone through menopause and are taking estrogen therapy like Femring (estradiol). Sometimes, these gallbladder problems required surgery. Let your prescriber know if you've previously had jaundice (yellowing of your skin or whites of the eyes). And tell your care team if you start having jaundice, stomach pain that doesn't go away, nausea, or vomiting while you're taking this medication. These can be signs of liver damage or gallbladder problems.

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

Let your prescriber know if you have a history of having high triglyceride levels. It's possible that estrogens like estradiol can raise the amount of triglycerides (fat) in the blood. And having too much in the blood can lead to swelling of the pancreas (pancreatitis). Tell your care team right away if you have symptoms of pancreatitis, like sudden stomach or back pain, nausea, vomiting, fever, or weakness.

Estrogen therapy, such as Femring (estradiol), can change the calcium levels in the blood. People with breast cancer and people with 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, including tiredness, muscle weakness, bone pain, nausea, constipation, and thirst.

On the other hand, estrogen therapy can make calcium levels drop in people with low parathyroid hormone levels. Contact your care team if you have symptoms of low calcium levels, such as muscle cramps; brittle nails; and tingling in your fingers, toes, or lips.

• Risk factors: Conditions that cause low thyroid hormone levels

Estrogen therapy like Femring (estradiol) can cause changes to the thyroid hormone levels in the body. It's harder for the body to adjust to these changes for people with low thyroid hormone levels (hypothyroidism) than for an average person. If you take thyroid replacement medication for your thyroid condition, you might need a higher dose of your thyroid medication. Work with your prescriber to adjust the dose of your thyroid medication.

• Risk factors: Certain heart conditions | Kidney damage

Estrogen therapy like Femring (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, and kidney damage. Tell your healthcare team if you notice any signs of worsening fluid retention (e.g., swelling, sudden weight gain) while you're taking Femring (estradiol) if you have heart or kidney problems.

Before you start Femring (estradiol), speak with your care team about your medical history. Taking estrogen-containing medications can worsen certain health conditions and you might require closer follow up. These health conditions include diabetes, asthma, migraine, lupus, seizures, and hereditary angioedema.

Femring (estradiol) is inserted into the vagina. Your prescriber might examine your vagina before you start the medication to make sure it's appropriate for you. The vagina might get irritated, sores (ulcers) might develop, and the ring might come out often if you have certain problems with your vagina that make these effects more likely. Examples include having a narrow vagina, a weak pelvic floor, or a vaginal infection.

Although rare, some people had trouble removing the ring. One possible reason for this is that the ring might get stuck to the vaginal wall. If this happens, it might require surgery to remove the ring. Call your prescriber if you're having trouble removing the ring from the vagina to see whether you need to be examined.