Estrogen Vaginal

Estrogen vaginal may be used to treat the following, depending on the specific product being prescribed:

• vaginal dryness, itching, and burning; painful or difficult urination; and sudden need to urinate immediately in women who are experiencing or have experienced menopause (change of life; the end of monthly menstrual periods).
• hot flushes ('hot flashes'; sudden strong feelings of heat and sweating) in women who are experiencing or have experienced menopause (change of life; the end of monthly menstrual periods).
• kraurosis vulvae (a condition that may cause vaginal dryness and discomfort in women or girls of any age).
• dyspareunia (difficult or painful sexual intercourse) in menopausal women.

Estrogen vaginal is in a class of medications called hormones. It works by replacing estrogen that is normally produced by the body.

Estrogen vaginal comes as a flexible ring, a vaginal insert, and as a cream to apply to the inside of the vagina. How often you will insert Estrogen vaginal depends on the form you are using:

• vaginal rings are inserted in the vagina and left in place for 3 months before being removed.
• vaginal inserts are inserted once daily for 2 weeks then inserted twice weekly.
• vaginal cream is applied once daily to once weekly depending on the product being prescribed. Follow the directions on your prescription label carefully.

Use vaginal estrogen exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

You will receive specific instructions for use based on the product you are prescribed. Read the instructions for use carefully and ask your doctor or pharmacist about any part you don't understand.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before using vaginal estrogen,

• tell your doctor or pharmacist if you are allergic to this medication, any part of this medication, or any other medications, foods or substances. Tell your doctor or pharmacist about the allergy and what symptoms you had.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements, you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor what nonprescription or herbal products you are taking, especially St. John's wort. Be sure to let your doctor and pharmacist know that you are taking these medications before you start using estrogen vaginal. Do not start any of these medications while using estrogen vaginal without discussing with your healthcare provider.
• tell your doctor if you have liver disease or a blood disorder such as protein C deficiency, protein S deficiency, or an antithrombin deficiency that may increase your risk of developing abnormal blood clots or have or have ever had a blood clot or history of stroke or myocardial infarction (heart attack). Tell your doctor if you have or have ever had breast, endometrial or ovarian cancers or unexplained vaginal bleeding. Your doctor will probably tell you not to use estrogen vaginal products.
• tell your doctor if you have or have ever had yellowing of the skin or eyes during pregnancy or during your treatment with an estrogen product, hereditary angioedema (inherited condition that causes episodes of swelling in the hands, feet, face, airway, or intestines), endometriosis (a condition in which the type of tissue that lines the uterus [womb] grows in other areas of the body), uterine fibroids (growths in the uterus that are not cancer), asthma, migraine headaches,dementia, seizures, porphyria (condition in which abnormal substances build up in the blood and cause problems with the skin or nervous system), very high or very low levels of calcium in your blood, hypoparathyroidism (condition in which the body does not produce enough parathyroid hormone), or thyroid, kidney, gallbladder, or pancreatic disease. If you will be using the vaginal ring, also tell your doctor if you have a vaginal infection; any condition that makes your vagina more likely to become irritated; a narrow vagina; or a condition where the rectum, bladder, or uterus has bulged or dropped into the vagina.
• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while using vaginal estrogen, call your doctor immediately.
• you should know that the estrogen vaginal cream may weaken latex or rubber birth control devices such as condoms or diaphragms. These devices may not be effective if you use them during your treatment with estrogen vaginal cream. Talk to your doctor about methods of birth control that will work for you.

Talk to your doctor about eating grapefruit and drinking grapefruit juice while using this medicine.

Apply or insert the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not use a double dose or apply extra cream to make up for a missed dose.

Vaginal estrogen may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• back pain
• diarrhea
• vaginal itching, swelling, and white discharge
• irregular vaginal bleeding
• breast pain or tenderness
• abdominal bloating
• headache
• nausea and vomiting

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or seek emergency treatment:

• swelling, pain or warmth in one arm or leg
• sudden shortness of breath, sharp or stabbing chest pain, or coughing up blood
• chest pain, sweating, nausea
• sudden numbness or weakness in face or arm or leg, difficulty speaking, vision problems, severe headaches
• bulging eyes, loss of vision, double vision or migraine
• ongoing pain that begins in the stomach area but may spread to the back nausea, vomiting, or loss of appetite
• rash, hives, itching, hoarseness, or difficulty breathing or swallowing
• swelling of the eyes, face, tongue, throat, hands, arms, feet, ankles, or lower legs
• fever, nausea or vomiting, diarrhea, muscle pain, dizziness or fainting, or rash on face or body
• memory difficulties, disorientation, confusion

Estrogen may increase your risk of developing cancer of the ovaries or gallbladder disease that may need to be treated with surgery. Talk to your doctor about the risks of using vaginal estrogen.

Vaginal estrogen may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

Dispose of unneeded medications in a way so that pets, children, and other people cannot take them. Do not flush this medication down the toilet. Use a medicine take-back program. Talk to your pharmacist about take-back programs in your community. Visit the FDA's Safe Disposal of Medicines website https://goo.gl/c4Rm4p for more information.

Keep all medication out of sight and reach of children as many containers are not child-resistant. Always lock safety caps. Place the medication in a safe location – one that is up and away and out of their sight and reach. https://www.upandaway.org

If someone swallows vaginal estrogen, uses extra tablets or rings, or applies extra cream, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose may include the following:

• nausea
• vomiting
• stomach pain
• vaginal bleeding
• breast pain or tenderness
• dizziness
• drowsiness or fatigue

Keep all appointments with your doctor.

Before having any laboratory test, tell your doctor and the laboratory personnel that you are using vaginal estrogen.

Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.

Keep a written list of all of the prescription and nonprescription (over-the-counter) medicines, vitamins, minerals, and dietary supplements you are taking. Bring this list with you each time you visit a doctor or if you are admitted to the hospital. You should carry the list with you in case of emergencies.

• Estrace^® Cream
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• Imvexxy^®
• Ogen^® Cream^¶
• Premarin^® Cream
• Vagifem^® Vaginal Tablets

• conjugated estrogens
• estradiol