Estring is a soft, flexible vaginal ring that contains estradiol. It is placed inside the vagina, where it slowly releases a small amount of estrogen over time.
The ring is designed to remain in place continuously for 90 days. After that, it should be removed and replaced with a new ring if your healthcare provider wants you to continue treatment.
Wash Your Hands Before Use
Before inserting or removing Estring, wash your hands thoroughly with soap and water and dry them well.
Clean hands help reduce the chance of introducing bacteria into the vaginal area.
Remove the Ring From the Pouch
Open the package and remove Estring from its protective pouch.
Hold the ring between your thumb and index finger. Gently press the sides together so the ring becomes narrower and easier to insert.
Find a Comfortable Position
Choose a position that allows you to relax your pelvic muscles.
You may lie on your back with your knees bent, squat, or stand with one leg raised on a chair or stool. Use whichever position feels easiest and most comfortable.
Insert Estring Gently
Using your fingers, gently guide the compressed ring into the vagina.
Push it upward and backward as far as is comfortable. Estring does not need to be placed in one exact location. It simply needs to sit high enough inside the vagina that it stays in place comfortably.
Do not force the ring if you feel pain or strong resistance.
How the Ring Should Feel
When Estring is positioned correctly, you usually should not feel it during normal daily activities.
If you can feel the ring near the vaginal opening or notice mild pressure or discomfort, it may not be inserted far enough. Wash your hands and use a clean finger to gently push the ring higher into the vagina.
If discomfort continues after repositioning the ring, contact your healthcare provider.
How Long Estring Stays in Place
Estring should remain inside the vagina continuously for 90 days.
During this time, it gradually releases estradiol into the vaginal tissues. You do not need to remove and reinsert it every day.
At the end of 90 days, the old ring should be removed. If treatment is continuing, replace it with a new Estring as directed by your healthcare provider.
Estring During Everyday Activities
You can usually leave Estring in place while walking, exercising, bathing, showering, sleeping, and performing other normal activities.
Because it is designed for continuous use, there is generally no need to remove it during your daily routine.
Estring and Sexual Activity
Estring can usually remain in place during sexual intercourse.
Some people or their partners may occasionally notice the ring, but it should not normally interfere with sexual activity. If the ring causes discomfort, talk to your healthcare provider about the best way to manage it.
If Estring Moves Out of Position
The ring may occasionally shift lower in the vagina, especially during straining or bowel movements.
If you can feel it near the vaginal opening, use a clean finger to gently push it back upward.
If the ring repeatedly moves out of position, contact your healthcare provider.
If Estring Falls Out
Estring may occasionally fall completely out of the vagina.
If this happens, rinse the ring with lukewarm water, then reinsert it using the same gentle technique. Avoid using hot or boiling water.
If the ring falls out frequently or you are unable to keep it in place, contact your healthcare provider.
How to Remove Estring
After 90 days, wash and dry your hands before removing the ring.
Insert a finger into the vagina and hook it through the center of the ring or around its lower edge. Gently pull downward and outward until the ring comes out.
If removal is difficult or painful, do not force it. Contact your healthcare provider for assistance.
Replacing Estring
If your healthcare provider wants you to continue treatment, insert a new Estring after removing the old one.
Keeping track of the replacement date can help ensure the ring is not left in place longer than recommended.
Do Not Leave the Same Ring in Too Long
Estring is designed to provide medication for about 90 days.
Leaving the same ring in longer than recommended may mean you are no longer receiving the intended amount of estradiol. Replace it on schedule unless your healthcare provider gives you different instructions.
When to Contact Your Healthcare Provider
Contact your healthcare provider if you experience persistent vaginal pain, unusual bleeding, severe irritation, repeated ring expulsion, difficulty inserting or removing the ring, or other symptoms that concern you.
Your healthcare provider can check whether Estring is positioned properly and determine whether the treatment remains appropriate for you.
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