What is estradiol (topical)?
Estradiol (a form of estrogen) is a female sex hormone necessary for many processes in the
body. Estradiol vaginal products release estrogen that is absorbed directly through the skin of the
vaginal wall.
Estradiol topical is used to treat certain symptoms of menopause such as dryness, burning, and
itching of the vaginal area and urgency or irritation with urination.
Estradiol may also be used for purposes other than those listed in this medication guide.
What should I discuss with my healthcare provider before taking estradiol (topical)?
Do not use estradiol without first talking to your doctor if you have
-
a circulation, bleeding, or blood-clotting disorder;
-
undiagnosed, abnormal vaginal bleeding; or
-
any type of breast, uterine, or hormone-dependent cancer.
Using estradiol may be dangerous in some cases if you have any of the
conditions listed above.
Before using estradiol, tell your doctor if you have
-
high blood pressure, angina, or heart disease;
-
high levels of cholesterol or triglycerides in your blood;
-
liver disease;
-
kidney disease;
-
asthma;
-
epilepsy;
-
migraines;
-
diabetes;
-
depression;
-
gallbladder disease;
-
uterine fibroids;
-
had a hysterectomy (uterus removed);
-
a narrow, short, or prolapsed vagina;
-
vaginal irritation; or
-
a vaginal infection.
You may not be able to use estradiol, or you may require a dosage
adjustment or special monitoring during treatment if you have any of the conditions listed above.
Treatment with estradiol long-term may increase the risk of stroke. Because of this risk, you
should contact your doctor or healthcare provider to discuss your individual risks and benefits before
taking estradiol long-term. You should also talk to your doctor or healthcare provider on a regular basis
(for example, every 3-6 months) about whether you should continue this treatment.
The Women's Health Initiative (WHI) study reported increased risks of myocardial infarction,
stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women
(50-79 years of age) during 5 years of treatment with oral conjugated estrogens combined with
medroxyprogesterone acetate.
The Women's Health Initiative Memory Study (WHIMS) found that postmenopausal women
65 years of age or older who were treated with oral conjugated estrogens plus medroxyprogesterone
acetate had an increased risk of developing dementia. It is unknown whether this finding applies to
younger postmenopausal women or to women using estrogen only therapy.
Estradiol is in the FDA pregnancy category X. This means that estradiol will cause birth
defects in an unborn baby.
Do not
use estradiol if you are pregnant or are planning a
pregnancy.
Estradiol may decrease milk flow and have other effects on milk composition. Do not use
estradiol without first talking to your doctor if you are breast-feeding a baby.
How should I take estradiol (topical)?
Use estradiol exactly as directed by your doctor. If you do not understand these directions, ask
your pharmacist, nurse, or doctor to explain them to you.
To use the Estring vaginal ring:
-
Squeeze the sides of the ring together and insert it into the vagina
as far as possible (into the upper 1/3 of the vagina). You should not be able to feel the ring once
it is in position. If you can feel it, use a finger to push it further into the vagina. It is not possible
for the ring to go too far in or become lost.
-
The ring should remain in place for 90 days. It should then
be removed and replaced by a new ring, if prescribed by your doctor. If at any time the ring falls
out, rinse it with warm water and reinsert it. If it slides down into the lower part of the vagina,
use a finger to reinsert it.
-
The ring does not need to be removed during sexual
intercourse. It should not be felt by either partner. If it is bothersome, it can be removed, rinsed
with warm water, and reinserted following intercourse.
-
To remove the ring, loop a finger through the ring and
gently pull it from the vagina.
To use the estradiol vaginal cream:
-
Using the marked applicator provided, measure the prescribed
dose of cream.
-
Lie on your back with your knees drawn up, sit, or stand in
a position that allows you comfortable access to the vaginal area. To deliver the medication,
gently insert the applicator deeply into your vagina and press the plunger downward to its
original position.
-
Clean the applicator by pulling the plunger to remove it
from the barrel. Wash it with mild soap and warm water.
Have yearly physical exams and examine your breasts for lumps on a
monthly basis while using estradiol.
Store the vaginal rings and cream at room temperature away from moisture and heat.
What happens if I miss a dose of estradiol (topical)?
Insert the next dose of cream or ring as soon as you remember. Continue to follow your regular
schedule. Do not use two doses simultaneously unless your doctor directs otherwise.
If at any time the ring falls out, rinse it with warm water and reinsert it. If it slides down into the
lower part of the vagina, use a finger to reinsert it.
Where can I get more information about estradiol (topical)?
Your pharmacist has information about estradiol (topical) written for health professionals that you may read.
What are the possible side effects of estradiol (topical)?
Estradiol increases the risk of developing a condition (endometrial hyperplasia) that may lead to
cancer of the lining of the uterus. Taking progestins, another hormone drug, while using estradiol lowers
the risk of developing this condition. Therefore, if your uterus has not been removed, your doctor may
prescribe a progestin for you to take together while using estradiol. Visit your doctor regularly and
report any unusual vaginal bleeding right away.
Treatment with estradiol long-term may increase the risk of stroke. Because of this risk, you
should contact your doctor or healthcare provider to discuss your individual risks and benefits before
taking estradiol long-term. You should also talk to your doctor or healthcare provider on a regular basis
(for example, every 3-6 months) about whether you should continue this treatment.
If you experience any of the following serious side effects, stop using estradiol and seek
emergency medical attention:
-
an allergic reaction (difficulty breathing; closing of the throat;
swelling of the lips, tongue, or face; or hives);
-
shortness or breath or pain in the chest;
-
a painful, red, swollen leg;
-
abnormal vaginal bleeding;
-
pain, swelling, or tenderness in the abdomen;
-
severe headache or vomiting, dizziness, faintness or
changes in vision or speech;
-
yellowing of the skin or eyes; or
-
a lump in a breast.
Other, less serious side effects may be more likely to occur. Continue to use
estradiol and talk to your doctor if you experience
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decreased appetite, nausea, or vomiting;
-
swollen breasts;
-
acne or skin color changes;
-
decreased sex drive;
-
migraine headaches or dizziness;
-
vaginal pain, dryness, or discomfort;
-
water retention (swollen hands, feet, or ankles);
-
depression; or
-
changes in your menstrual cycle or break-through bleeding.
Side effects other than those listed here may also occur. Talk to your doctor
about any side effect that seems unusual or that is especially bothersome.
What is the most important information I should know about estradiol (topical)?
Estradiol increases the risk of developing a condition (endometrial hyperplasia) that may lead to
cancer of the lining of the uterus. Taking progestins, another hormone drug, while using estradiol lowers
the risk of developing this condition. Therefore, if your uterus has not been removed, your doctor may
prescribe a progestin for you to take together while using estradiol. Visit your doctor regularly and
report any unusual vaginal bleeding right away.
Treatment with estradiol long-term may increase the risk of stroke. Because of this risk, you
should contact your doctor or healthcare provider to discuss your individual risks and benefits before
taking estradiol long-term. You should also talk to your doctor or healthcare provider on a regular basis
(for example, every 3-6 months) about whether you should continue this treatment.
Have yearly physical exams and examine your breasts for lumps on a monthly basis while using
estradiol.
Do not use this medication if you are pregnant.
The Women's Health Initiative (WHI) study reported increased risks of myocardial infarction,
stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women
(50-79 years of age) during 5 years of treatment with oral conjugated estrogens combined with
medroxyprogesterone acetate.
The Women's Health Initiative Memory Study (WHIMS) found that postmenopausal women
65 years of age or older who were treated with oral conjugated estrogens plus medroxyprogesterone
acetate had an increased risk of developing dementia. It is unknown whether this finding applies to
younger postmenopausal women or to women using estrogen only therapy.
What should I avoid while taking estradiol (topical)?
There are no restrictions on food, beverages, or activity while using estradiol unless your doctor
directs otherwise.
What other drugs will affect estradiol (topical)?
Before using estradiol, tell your doctor if you are taking any of the following medicines:
-
an anticoagulant (blood thinner) such as warfarin (Coumadin);
-
a thyroid medication such as levothyroxine (Synthroid,
Levoxyl, Levothroid, and others);
-
insulin or an oral diabetes medicine such as glipizide
(Glucotrol), glyburide (Diabeta, Micronase), and others; or
-
tamoxifen (Nolvadex).
A dosage adjustment or special monitoring may be required during treatment
if you are taking any of the medicines listed above.
Do not use other vaginal products at the same times as estradiol without first talking to your
doctor.
Drugs other than those listed here may also interact with estradiol. Talk to your doctor and
pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals,
and herbal products.
What happens if I have an overdose of estradiol (topical)?
