Femring 0.1mg/day

Estradiol is an estrogen, a hormone that binds to and activates estrogen receptors (ERs) located in various target tissues, including the female reproductive tract, breast, hypothalamus, and pituitary gland. This binding leads to gene transcription and protein synthesis, mediating the physiological effects of estrogen. In menopause, it replaces declining endogenous estrogen levels to alleviate symptoms like hot flashes and vaginal atrophy.

Urgent Side Effects: Seek Medical Help Right Away

Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:

Signs of an allergic reaction: rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, difficulty breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat.
Signs of liver problems: dark urine, fatigue, decreased appetite, stomach pain or upset, light-colored stools, vomiting, or yellow skin and eyes.
Signs of gallbladder problems: pain in the upper right belly area, right shoulder area, or between the shoulder blades, yellow skin and eyes, fever with chills, bloating, or severe stomach upset or vomiting.
Signs of pancreatitis (pancreas problem): severe stomach pain, severe back pain, or severe stomach upset or vomiting.
Signs of high blood pressure: severe headache or dizziness, fainting, or changes in vision.
Weakness on one side of the body, difficulty speaking or thinking, balance changes, drooping on one side of the face, or blurred vision.
Changes in eyesight or loss of eyesight, bulging eyes, or changes in how contact lenses feel.
Breast lump, breast pain or tenderness, or nipple discharge.
Vaginal itching or discharge.
Abnormal vaginal bleeding.
Depression or other mood changes.
Memory problems or loss.
Fever.
Difficulty urinating or changes in urine output.
Pain while urinating.

This medication may cause fluid retention or swelling in the body. Inform your doctor if you experience swelling, weight gain, or breathing difficulties.

Additional Urgent Side Effects:

Signs of a blood clot: chest pain or pressure, coughing up blood, shortness of breath, swelling, warmth, numbness, color changes, or pain in a leg or arm, or difficulty speaking or swallowing.
Signs of high calcium levels: weakness, confusion, fatigue, headache, stomach upset or vomiting, constipation, or bone pain.
Toxic shock syndrome (TSS): a rare but potentially life-threatening condition. Seek medical help immediately if you experience diarrhea, dizziness, fainting, fever, muscle pain, stomach upset, vomiting, or a sunburn-like rash.

Other Possible Side Effects:

Most medications can cause side effects, but many people experience none or only mild side effects. If you are concerned about any of the following side effects or if they persist, contact your doctor:

Dizziness or headache.
Hair loss.
Stomach upset or vomiting.
Constipation.
Stomach pain or cramps.
Bloating.
Breast enlargement or tenderness.
Vaginal bleeding or spotting.
Painful periods.
Common cold symptoms.
Nose or throat irritation.
Weight changes.
Joint pain.
Leg cramps.
Changes in sex drive.
Irritation at the application site.

This list is not exhaustive. If you have questions about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following conditions to ensure safe use of this medication:

Any allergies you have, including allergies to this drug, its components, or other substances. Be sure to describe the allergic reaction and its symptoms.
A history of certain health conditions, such as:
+ Bleeding disorders or blood clots
+ A higher risk of blood clots
+ Breast cancer
+ Liver problems or liver tumors
+ Heart attack or stroke
+ Tumors that are influenced by estrogen
Unexplained vaginal bleeding
Pregnancy or potential pregnancy. Note: This medication should not be taken during pregnancy.
* Certain vaginal problems, including:
+ Narrow vagina
+ Vaginal infection
+ Uterus not in its normal position
+ Other conditions that may increase the risk of vaginal irritation, ulcers, or cause the vaginal ring to be dislodged. If you are unsure about any of these conditions, consult your doctor.

This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health problems with your doctor and pharmacist. They will help determine if it is safe to take this medication with your other drugs and health conditions. Never start, stop, or change the dosage of any medication without first consulting your doctor.

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Your doctor may advise you to stop taking this drug before certain surgical procedures, and will provide guidance on when to resume taking it after the surgery or procedure.

If you will be immobile for extended periods, such as during long trips, bedrest after surgery, or illness, discuss this with your doctor, as prolonged inactivity may increase your risk of developing blood clots. Additionally, if you have diabetes, you will need to closely monitor your blood sugar levels.

Be aware that medications like this one can cause high blood pressure. Follow your doctor's instructions for regular blood pressure checks. You should also have your blood work and bone density checked as directed by your doctor.

Regular breast exams and gynecology check-ups are crucial, and you should also perform breast self-exams as instructed by your doctor. The risk of certain side effects, such as heart attack, stroke, breast cancer, and ovarian cancer, may vary depending on factors like the duration of estrogen use, whether it is taken with or without a progestin, and other individual factors. Discuss the benefits and risks of using this medication with your doctor.

This medication can cause elevated triglyceride levels. If you have a history of high triglyceride levels, inform your doctor. Prolonged use of this medication may lead to the development of dark skin patches on your face, so it is essential to avoid sun exposure, sunlamps, and tanning beds, and to use sunscreen and protective clothing and eyewear.

This medication may affect the results of certain laboratory tests, so be sure to inform all your healthcare providers and lab personnel that you are taking this medication. Smoking can increase the risk of heart disease, so it is recommended that you do not smoke. Limit your alcohol consumption, and if you regularly drink grapefruit juice or eat grapefruit, discuss this with your doctor.

If you experience difficulty removing the ring, inform your doctor, as it may become stuck to the vaginal wall and require surgical removal. Contact with blood during use may cause the ring to change color, but this will not affect its efficacy.

In rare cases, this medication may affect growth in children and teenagers, and they may require regular growth checks. If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects. If you are breastfeeding, discuss the potential risks to your baby with your doctor.

• CYP3A4 inducers (e.g., rifampin, carbamazepine, phenobarbital, phenytoin, St. John's Wort) - may significantly decrease estrogen levels, reducing efficacy.
• Aromatase inhibitors (e.g., anastrozole, letrozole, exemestane) - concomitant use is generally not recommended as estrogens would counteract their effect.

• CYP3A4 inhibitors (e.g., ketoconazole, erythromycin, ritonavir, grapefruit juice) - may increase estrogen levels, potentially increasing adverse effects.
• Thyroid hormone replacement therapy (e.g., levothyroxine) - estrogens can increase thyroid-binding globulin (TBG), potentially increasing the need for thyroid hormone.
• Corticosteroids (e.g., prednisone) - estrogens may decrease the clearance of corticosteroids, leading to increased effects.
• Oral anticoagulants (e.g., warfarin) - estrogens may reduce the anticoagulant effects of warfarin, requiring dose adjustments.

• Certain herbal supplements (e.g., black cohosh - theoretical interaction, but not well-established for vaginal rings).

• Signs of blood clots (e.g., leg pain/swelling, chest pain, shortness of breath, sudden severe headache, vision changes)
• Signs of stroke (e.g., sudden numbness/weakness, confusion, trouble speaking, vision problems, dizziness, severe headache)
• Signs of heart attack (e.g., chest pain, discomfort in other areas of upper body, shortness of breath)
• Abnormal vaginal bleeding (e.g., spotting, breakthrough bleeding, prolonged or heavy bleeding)
• Breast lumps or changes
• Jaundice (yellowing of skin or eyes)
• Severe abdominal pain

Contraindicated. Femring is not indicated for use in pregnant women. Estrogen exposure during pregnancy has been associated with an increased risk of birth defects in the fetus.

Not recommended. Estrogens are excreted in human milk and may decrease the quantity and quality of breast milk. Potential adverse effects on the nursing infant have been reported (e.g., breast enlargement, vaginal bleeding).

Not indicated for use in pediatric patients. Safety and efficacy have not been established in this population.

Use with caution in women 65 years of age or older. The Women's Health Initiative Memory Study (WHIMS) reported an increased risk of probable dementia in postmenopausal women 65 years of age or older treated with CE alone or CE plus MPA. The overall risks of estrogen therapy, including cardiovascular events and breast cancer, may be higher in older women.

• Femring provides continuous, low-dose systemic estradiol, which can be beneficial for women who prefer a long-acting, non-oral estrogen therapy.
• Ensure proper insertion and removal technique is taught to the patient. The ring should be placed as high as possible in the vagina.
• Patients should be advised that the ring can be removed for short periods (e.g., during intercourse) but should be reinserted as soon as possible.
• Regular follow-up appointments are crucial to monitor for adverse effects and assess the continued need for therapy.
• Emphasize the importance of the Black Box Warning regarding cardiovascular risks, breast cancer, endometrial cancer, and dementia, especially for women with existing risk factors.

• Other systemic estrogen therapies: oral tablets (e.g., estradiol, conjugated estrogens), transdermal patches (e.g., Estraderm, Vivelle-Dot), gels (e.g., EstroGel), sprays (e.g., Evamist).
• Other vaginal estrogen therapies (primarily for local symptoms): vaginal creams (e.g., Estrace, Premarin), vaginal tablets (e.g., Vagifem, Imvexxy), other vaginal rings (e.g., Estring - lower dose, primarily for local symptoms).
• Non-hormonal therapies for vasomotor symptoms: SSRIs/SNRIs (e.g., paroxetine, venlafaxine), gabapentin, clonidine.
• Non-hormonal therapies for vulvar and vaginal atrophy: vaginal moisturizers and lubricants.

If your symptoms or health issues persist or worsen, it is essential to contact your doctor promptly. To ensure safe and effective treatment, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so it is a good idea to check with your pharmacist for more information. If you have any questions or concerns about this medication, consult with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When seeking help, be prepared to provide details about the overdose, including the medication taken, the amount, and the time it occurred.