Femring (Estradiol acetate)

Femring (estradiol acetate) is a hormonal replacement therapy that comes as a soft, flexible vaginal ring used to treat symptoms of menopause in women. It works by releasing estradiol, a form of estrogen, directly into the body to replace the hormones that decrease during menopause. Femring is an estrogen therapy and may be prescribed to relieve moderate to severe hot flashes, night sweats, and vaginal dryness or irritation caused by menopause.

Directions

Femring is a flexible vaginal ring that is placed in the upper part of the vagina for three months. It releases estrogen over time and comes in two strengths: a lower dose of 0.05 mg per day and a higher dose of 0.10 mg per day. Each ring is replaced after 90 days if treatment is continued.

The ring does not need to be placed in an exact position to work. It should sit comfortably high in the vagina. Once in place, most people do not feel it, and it usually does not interfere with everyday activities or sex. If the ring slips out, it can be rinsed with lukewarm water and put back in.

Ingredients

The active ingredient in Femring is estradiol acetate.

Cautions

Before using this medication, you may want to consult a healthcare provider about the following:

• Any existing health conditions
• Any allergies
• A list of all medications currently being taken

Femring is used in the vagina, but estrogen from Femring can still affect the rest of the body. Therefore, the same general risks seen with estrogen therapy should be considered.

Femring can increase the risk of blood clots in the legs or lungs, stroke, and heart attack, and the medication should be stopped if any of these are suspected. The risk of clots or stroke can be higher with certain risk factors such as smoking, high blood pressure, diabetes, high cholesterol, obesity, or a personal or family history of blood clots.

Estrogen therapy may increase the risk of endometrial (uterine) cancer in people who still have a uterus when estrogen is used without a progestin, so unusual vaginal bleeding should be evaluated promptly.

Estrogen plus progestin therapy has been linked to a higher risk of breast cancer in some studies, and hormone therapy can also lead to abnormal mammograms that need follow-up testing.

Some research has found a higher risk of ovarian cancer in people using hormone therapy, although the exact amount of risk and the role of how long it is used are not fully clear.

In women aged 65 and older, estrogen therapy with or without a progestin has been linked to a higher risk of probable dementia, and it is not known if this applies to younger postmenopausal women.

Estrogen can raise triglycerides in some people and, in those who already have high triglycerides, it can rarely lead to pancreatitis.

Estrogen may cause fluid retention, which can worsen conditions like heart or kidney problems.

Estrogen may affect thyroid hormone levels in the blood, so people taking thyroid replacement may need monitoring and a dose adjustment.

Rare but serious eye problems have been reported with estrogens, so sudden vision changes, new severe headaches, double vision, or eye bulging should be treated as urgent.

Femring may be more likely to cause irritation or fall out in people with certain vaginal conditions, and it may not be appropriate if the vagina is narrow, irritated, infected, or affected by prolapse.

If you need treatment for a vaginal infection, Femring can usually stay in place during that treatment, but ongoing irritation or symptoms should be discussed with a clinician.

Contraindications

Avoid taking or using this medication if any of the following apply:

• Undiagnosed abnormal genital bleeding
• Known, suspected, or history of breast cancer
• Known or suspected estrogen-dependent cancer
• Active deep vein thrombosis (DVT), pulmonary embolism (PE), or history of these conditions
• Active arterial thromboembolic disease (such as stroke or myocardial infarction), or history of these conditions
• Known anaphylactic reaction or angioedema to estradiol acetate or any ingredients in Femring
• Known liver impairment or disease
• Known protein C, protein S, or antithrombin deficiency, or other known thrombophilic disorders
• Known or suspected pregnancy

Side Effects

Common side effects of Femring include:

• Headache
• Breast tenderness or pain
• Irregular vaginal bleeding or spotting
• Abdominal cramps, bloating, nausea, or vomiting
• Hair loss, fluid retention, or vaginal yeast infection
• Local vaginal irritation, burning, or itching after insertion

These side effects are generally mild and often related to estrogen exposure or local effects from the vaginal ring. Spotting or breast tenderness may be more noticeable when starting treatment or after dose changes. Local vaginal irritation is usually temporary and improves as the body adjusts to the medication.

More serious side effects may include blood clots, heart attack, stroke, certain cancers (such as breast, uterine, or ovarian cancer), liver problems, or gallbladder disease. Estrogen therapy may also increase the risk of high blood pressure, high blood sugar, or dementia in some patients. Contact a healthcare provider if you develop new breast lumps, unusual vaginal bleeding, sudden vision or speech changes, severe headaches, chest pain, or leg pain with swelling or shortness of breath.