Estring

Estring is used after menopause to treat moderate to severe menopausal changes in and around thevagina, such as vaginal dryness, burning, and irritation caused by vulvar and vaginal atrophy; urgency or irritation with urination; and pain during sexual intercourse. It is a soft, flexible ring that releases estradiol into the upper third of the vagina consistently for 90 days. Estring vaginal ring can be inserted by a physician or the patient and removed after 90 days or replaced if continuous therapy is needed.

Estring contains estradiol, a form of estrogen, which is a female sex hormone that regulates many processes in the body. Estrogens are produced by the ovaries until menopause (ages 45-55). Declining estrogen causes menopause symptoms like hot flashes, sweating, vaginal atrophy, and dryness. Estring releases estrogen that provides local relief of vaginal symptoms of menopause only.

Estring (estradiol vaginal ring) gained FDA approval on February 2, 2026.

You should not use Estring if you have: undiagnosed vaginal bleeding, liver disease, a bleeding disorder, if you will have major surgery, or if you have ever had a heart attack, a stroke, a blood clot, or cancer of the breast, uterus/cervix, or vagina. Using Estring can increase your risk of blood clots, stroke, or heart attack, or cancer of the breast, uterus, or ovaries. Do not use Estring to prevent heart disease, heart attacks, strokes, or dementia.

Do not use an Estring vaginal ring if you are pregnant.

Estradiol may increase your risk of developing a condition that may lead to uterine cancer. Report any unusual vaginal bleeding right away.

Do not start using Estring if you:

• Have any unusual vaginal bleeding. Vaginal bleeding after menopause may be a warning sign of cancer of the uterus (womb). Your healthcare provider should check any unusual vaginal bleeding to find out the cause
• Currently have or have had certain cancers. Estrogens may increase the chances of getting certain types of cancers, including cancer of the breast or uterus (womb). If you have or have had cancer, talk with your healthcare provider about whether you should use Estring
• Had a stroke or heart attack
• Currently have or have had blood clots
• Currently have or have had liver problems
• Have been diagnosed with a bleeding disorder
• Are allergic to Estring, estradiol, or any of the inactive ingredients in the insert (see the end of this guide for a list of ingredients)
• Think you might be pregnant. Estring is not for pregnant women. If you think you might be pregnant, you should have a pregnancy test and know the results. Do not use Estring if the test is positive and talk to your healthcare provider.

Before you use the Estring vaginal ring, tell your healthcare provider about all your medical conditions, including if you:

• Have any unusual vaginal bleeding
• Have any other medical conditions. Your healthcare provider may need to check you more carefully if you have certain conditions, such as asthma (wheezing), epilepsy (seizures), diabetes, migraine, endometriosis, lupus, angioedema (swelling of face and tongue), or problems with your heart, liver, thyroid, kidneys, or have high calcium levels in your blood.
• Are going to have surgery or will be on bedrest. Your healthcare provider will let you know if you need to stop using Estring
• Are breastfeeding. The hormone in Estring can pass into breast milk.

If you experience any of the following side effects, immediately remove Estring if possible and contact your healthcare provider. If you experience difficulty or pain when trying to remove the ring, do not continue and contact your healthcare provider:

• Cases of toxic shock syndrome (TSS) have been reported in women using vaginal rings. Toxic shock syndrome is a rare but serious illness caused by a bacterial infection. Symptoms of TSS include fever, nausea, vomiting, diarrhea, muscle pain, dizziness, faintness, or a sunburn-like rash on the face and body.
• Cases of the vaginal ring becoming attached to the vaginal wall, making ring removal difficult, have occurred. Some women have needed surgery to remove vaginal rings.
• Cases of erosion (wearing away) and ulceration (holes) of the vaginal lining have also occurred. Symptoms of vaginal erosion and ulceration can include vaginal pain or soreness, vaginal bleeding, and redness, swelling, or scrapes in the vagina.
• Cases of bowel obstruction have been reported.
• Severe allergic reactions have been reported, including skin rash, giant hives, swelling of theeyelids, face, lips, tongue, or throat.

Serious, but less common side effects include:

• Heart attack
• Stroke
• Blood clots
• Dementia
• Breast cancer
• Cancer of the lining of the uterus (womb)
• Cancer of the ovary
• High blood pressure
• High blood sugar
• Gallbladder disease
• Liver problems
• Changes in your thyroid hormone levels
• Enlargement of benign tumors of the uterus (“fibroids”)
• High or low blood calcium, changes in vision, high levels of fat (triglycerides) in your blood, worsening of endometriosis, and worsening swelling of face and tongue (angioedema).

Call your healthcare provider right away if you get any of the following warning signs or any other unusual symptoms that concern you:

• New breast lumps
• Unusual vaginal bleeding
• Changes in vision or speech
• Sudden new severe headaches
• Severe pains in your chest or legs with or without shortness of breath, weakness, and fatigue
• Memory loss or confusion
• Swelling of your face, lips, or tongue with or without red, itchy bumps

Common Side Effects

The most common side effect of Estring is increased vaginal secretions.

• Many of these vaginal secretions are like those that occur normally before menopause and indicate that Estring is working.
• Vaginal secretions that are associated with a bad odor, vaginal itching, or other signs of vaginal infection are NOT normal and may indicate a risk or a cause for concern.

Other side effects may include:

• Vaginal discomfort
• Abdominal pain
• Genital itching
• Headache
• Breast pain
• Irregular vaginal bleeding or spotting
• Stomach or abdominal cramps, bloating
• Nausea and vomiting
• Fluid retention
• Vaginal yeast infection.

These are not all the possible side effects of Estring. For more information, ask your healthcare provider or pharmacist for advice about side effects. Tell your healthcare provider if you have any side effect that bothers you or does not go away.

Call your healthcare provider for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088. You may report side effects to Pfizer at 1-800-438-1985.

What can I do to lower my chances of getting a serious side effect with Estring?

Follow the instructions for use carefully.

Talk with your healthcare provider regularly about whether you should continue using Estring.

• If you have a uterus, talk to your healthcare provider about whether the addition of a progestogen is right for you to reduce the chance of getting cancer of the uterus.
• See your healthcare provider right away if you get vaginal bleeding while using Estring.
• If you have fever, nausea, vomiting, diarrhea, muscle pain, dizziness, faintness, or a sunburn-like rash on your face and body, remove Estring and contact your healthcare provider.
• Contact your healthcare provider if you have difficulty removing the vaginal ring.
• Have a pelvic exam, breast exam, and mammogram (breast X-ray) every year unless your healthcare provider tellsyou something else. If members of your family have had breast cancer or if you have ever had breastlumps or an abnormal mammogram, you may need to have breast examinations more often.
• If you have high blood pressure, high cholesterol (fat in the blood), diabetes, are overweight, or if you use tobacco, you may have a higher chance of getting heart disease. Ask your healthcare provider for ways to lower your chances of getting heart disease

Estring is a local estrogen therapy used after menopause to treat moderate to severe menopausal changes in and around the vagina. Estring provides relief of local symptoms of menopause only (this means only those symptoms in and around the vagina).

Estrogens should be used only as long as needed. You and your healthcare provider should talk regularly (for example, every 3 to 6 months) about whether you still need Estring treatment.

Estring Insertion

Estring can be inserted and removed by you, your doctor, or your healthcare provider. To insert Estring yourself, choose the position that is most comfortable for you: standing with one leg up, squatting, or lying down.

• After washing and drying your hands, remove Estring from its pouch using the tear-off notch on the side. (Since the ring becomes slippery when wet, be sure your hands are dry before handling it.)
• Hold Estring between your thumb and index finger and press the opposite sides of the ring together.
• Gently push the compressed ring into your vagina as far as you can

Estring Placement

The exact position of Estring is not critical, as long as it is placed in the upper third of the vagina.

• When Estring is in place, you should not feel anything. If you feel uncomfortable, Estring is probably not far enough inside. Use your finger to gently push Estring further into your vagina.
• There is no danger of Estring being pushed too far up in the vagina or getting lost. Estring can only be inserted as far as the end of the vagina, where the cervix (the narrow, lower end of the uterus) will block Estring from going any further.

Estring Use

Once inserted, Estring should remain in place in the vagina for 90 days.

• Most women and their partners experience no discomfort with Estring in place during intercourse, so the ring doesn't need to be removed. If Estring should cause you or your partner any discomfort, you may remove it before intercourse (See Estring Removal, below). Be sure to reinsert Estring as soon as possible afterwards.
• Estring may slide down into the lower part of the vagina as a result of the abdominal pressure or straining that sometimes accompanies constipation. If this should happen, gently guide Estring back into place with your finger.
• There have been rare reports of Estring falling out in some women following intense straining or coughing. If this should occur, simply wash Estring with lukewarm (NOT hot) water and reinsert it.

Estring Drug Delivery

Once in the vagina, Estring begins to release estradiol immediately. Estring will continue to release a low, continuous dose of estradiol for the full 90 days it remains in place.

• It will take about 2 to 3 weeks to restore the tissue of the vagina and urinary tract to a healthier condition and to feel the full effect of Estring in relieving vaginal and urinary symptoms. If your symptoms persist for more than a few weeks after beginning Estring therapy, contact your doctor or healthcare provider.
• One of the most frequently reported effects associated with the use of Estring is an increase in vaginal secretions. These secretions are like those that occur normally before menopause and indicate that Estring is working. However, if the secretions are associated with a bad odor or vaginal itching or discomfort, be sure to contact your doctor or healthcare provider.

Estring Removal

After 90 days, there will no longer be enough estradiol in the ring to maintain its full effect in relieving your vaginal or urinary symptoms. Estring should be removed at that time and replaced with a new Estring, if your doctor determines that you need to continue your therapy.

To remove Estring:

• Wash and dry your hands thoroughly.
• Assume a comfortable position, either standing with one leg up, squatting, or lying down.
• Loop your finger through the ring and gently pull it out.
• Discard the used ring in a waste receptacle. (Do not flush Estring.)

If your Estring vaginal ring falls out, or you take it out temporarily, rinse it with warm water and reinsert it. If it slides down into the lower part of the vagina, use your finger to push it in farther.

Avoid smoking. It can greatly increase your risk of blood clots, stroke, or heart attack while using Estring.

Avoid using other vaginal products without your doctor's advice.

Grapefruit and grapefruit juice may interact with estradiol and lead to unwanted side effects. Avoid the use of grapefruit products.

Tell your healthcare provider about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. Some medicines may affect how Estring works. Estring may also affect how your other medicines work.

Tell your doctor about all your current medicines and any medicine you start or stop using.

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

Estring is distributed by Pharmacia & Upjohn Company LLC, a subsidary of Pfizer Inc.

Active ingredient: Estradiol.

Inactive ingredients: silicone polymers, barium sulfate, and silicone fluid (as dispersing agent) are combined to form the ring.

Estring (estradiol vaginal system) is a slightly opaque ring with a whitish core containing a 2 mg drug reservoir of estradiol (an estrogen hormone).