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What should I discuss with my health care provider before using estradiol vaginal (systemic) (Femring)?

Do not use estradiol vaginal if you have:

• a history of stroke, heart attack, or blood clot;
• abnormal vaginal bleeding that a doctor has not checked; or
• any type of breast, uterine, or hormone-dependent cancer.

If you have any of these other conditions, you may need a dose adjustment or special tests to safely use estradiol vaginal:

• angina (chest pain), heart disease;
• risk factors for coronary artery disease (such as smoking, being overweight, and having high blood pressure or high cholesterol);
• liver or kidney disease;
• asthma;
• epilepsy or other seizure disorder;
• migraines;
• diabetes;
• depression;
• gallbladder disease;
• uterine fibroids;
• a narrow, short, or prolapsed vagina;
• vaginal irritation or infection; or
• if you have had your uterus removed (hysterectomy).

Estradiol increases your risk of developing endometrial hyperplasia, which may lead to cancer of the uterus. Taking progestins while using estradiol may lower this risk. If your uterus has not been removed, your doctor may prescribe a progestin for you to take while you are using estradiol vaginal.

Estradiol vaginal should not be used to prevent heart disease or dementia, because this medication may actually increase your risk of developing these conditions.

Long-term estradiol treatment may increase your risk of stroke. Talk with your doctor about your individual risks before using estradiol long-term. Your doctor should check your progress on a regular basis (every 3 to 6 months) to determine whether you should continue this treatment.

FDA pregnancy category X. This medication can cause birth defects. Do not use estradiol vaginal if you are pregnant. Tell your doctor right away if you become pregnant during treatment. Use an effective form of birth control while you are using this medication.

Estradiol can pass into breast milk and may harm a nursing baby. This medication may also slow breast milk production. Do not use if you are breast-feeding a baby.

How should I use estradiol vaginal (systemic) (Femring)?

Use this medication exactly as it was prescribed for you. Do not use the medication in larger amounts, or use it for longer than recommended by your doctor. Follow the directions on your prescription label.

Wash your hands before and after inserting the vaginal ring.

To insert the estradiol vaginal ring:

• Squeeze the sides of the ring together and insert it into the vagina as far as possible. You should not be able to feel the ring once it is in place. If you can feel it, use a finger to push it in farther. It is not possible for the ring to go too far in or become lost.
• Leave the ring in place for 90 days. If the ring ever falls out, rinse it with warm water and reinsert it. If it slides down into the lower part of the vagina, use a finger to push it in farther. After 90 days, remove the ring. Your doctor may want you to replace it with a new ring.
• The ring does not need to be removed during sexual intercourse. Neither partner should be able to feel the ring when it is in place. If the ring is bothersome, you may remove it, rinse it with warm water, and reinsert it after intercourse.
• The estradiol vaginal ring does not prevent pregnancy and should not be used in place of effective birth control.

To remove the ring, loop a finger through the ring and gently pull it from the vagina. Call your doctor if you have trouble removing a vaginal ring.

Have regular physical exams and self-examine your breasts for lumps on a monthly basis while using estradiol vaginal.

If you need to have any type of surgery or be on bed rest, tell your surgeon or doctor ahead of time that you are using the estradiol vaginal ring. You may need to remove the ring 4 to 6 weeks before your surgery.

Keep the vaginal ring in its protective pouch until you are ready to use it. Store the pouch at room temperature away from moisture and heat.

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