Brand name:

Femring

Why is Femring prescribed?

Femring is an estrogen replacement system used to relieve moderate-to-severe hot flashes that occur during menopause. Hot flashes are marked by feelings of warmth in the face, neck, and chest or sudden intense episodes of heat and sweating.

Femring also provides relief for the vaginal dryness and irritation that can accompany menopause. However, when vaginal symptoms occur without hot flashes, your doctor will most likely prescribe a treatment other than Femring.

Most important fact about Femring

Estrogens increase the risk of cancer in the lining of the uterus, called the endometrium. Because estrogen replacement therapy is not advisable if you are in any danger of developing cancer, your doctor should take a complete medical and family history, and perform a complete physical exam, before prescribing Femring. It is important to have regular check-ups (at least once a year) and to report any unusual vaginal bleeding to your doctor immediately.

Femring and other estrogen drugs, with or without progesterone, should not be used to prevent heart disease. Recent studies have confirmed an increased rate of heart attack, stroke, and dangerous blood clots among women taking estrogen or estrogen combinations for 5 years. Blood clots can lead to phlebitis, stroke, heart attack, a loss of blood supply to the lungs, a blockage in the blood vessels leading to the eye, and other serious disorders.

How should you take Femring?

Each Femring is left in place for 3 months. Press the Femring into an oval or a figure 8 and insert it as deeply as possible into the upper third of the vagina. The exact position is unimportant as long as you don't feel the ring. If Femring causes discomfort, it is probably not far enough inside. There is no danger of pushing the ring too far up in the vagina, or of it getting lost.

If the ring slips down into the lower part of the vagina, push it back up with your finger. If it falls out, rinse it in warm water and reinsert it. When replacing the ring, simply hook a finger through it and pull it out.

Femring should not interfere with sexual intercourse. It can also be left in place if you need to use medication for a vaginal infection.

--If you miss a dose...

If the ring is not replaced after 90 days, the dose of estrogen will gradually decline and your symptoms are likely to return.

--Storage instructions...

Store at room temperature.

Femring side effects

Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe to continue using Femring.

• Side effects may include:
  Abdominal cramps, back pain, bloating, breast tenderness, hair loss, headache, high blood pressure, high blood sugar, irregular vaginal bleeding or spotting, liver problems, nausea and vomiting, uterine pain (due to enlargement of benign tumors known as fibroids), vaginal yeast infections, water retention

Why should Femring not be prescribed?

You should not use Femring if you have ever had breast cancer or another cancer stimulated by estrogen. Also, do not use Femring if you have ever had blot clots, or if you've had a stroke or heart attack in the past year.

Do not use Femring if you have unexplained vaginal bleeding. You must also avoid it if you are pregnant.

You will not be able to use Femring if it causes an allergic reaction.

Special warnings about Femring

If Femring does not stay in place and comes out often, tell your doctor. Femring may not be right for you.

Estrogen replacement therapy increases the risk of developing cancer of the lining of the uterus. The risk increases with longer use and higher doses. Therefore, you should use Femring for as short a time and at as low a dose as is necessary to relieve your symptoms. Report any unusual bleeding to you doctor immediately.

Using estrogen may also increase your chances of breast cancer, ovarian cancer, heart attack, stroke, blood clots, and gallbladder disease.

Use estrogen with caution if you have severely low blood levels of calcium (hypocalcemia).

Your doctor may also prescribe a drug containing the hormone progesterone while you are using Femring. Combining estrogen and progesterone reduces the risk of endometrial cancer caused by estrogen alone. This combination is not recommended for women who have had a hysterectomy (removal of the uterus), since they are not at risk for endometrial cancer. Combining estrogen and progesterone could increase the risk of breast cancer, raise cholesterol levels, and cause blood sugar problems.

Tell your doctor if you've ever had liver problems, high cholesterol, high blood pressure, thyroid problems, or vision problems. Using estrogen could make these conditions worse.

Estrogens can cause water retention. If you have a condition that could be affected by this—such as heart or kidney problems—your doctor will monitor you closely.

Using estrogen could worsen certain conditions, including endometriosis, asthma, diabetes, epilepsy, migraine, or the genetic disorder porphyria. Be sure your doctor is aware of any medical problems you have.

While using Femring, contact your doctor right away if you develop any of the following:

Abdominal cramps or swelling
Abnormal vaginal bleeding
Breast lumps
Dizziness and fainting
Pains in your chest or legs
Problems with speech
Severe headache or vomiting
Shortness of breath
Vision changes
Yellowing of the skin or whites of the eyes

Let your doctor know if you're going to have surgery or will be on bed rest; you may need to stop taking estrogens.

Possible food and drug interactions when taking Femring

If you use Femring while taking certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before using Femring with any of the following:

Carbamazepine (Tegretol)
Clarithromycin (Biaxin)
Erythromycin (E-Mycin, Erytab, Erythrocin, and others)
Itraconazole (Sporanox)
Ketoconazole (Nizoral)
Phenobarbital
Rifampin (Rifadin, Rifamate, Rimactane)
Ritonavir (Norvir)
St. John's wort

Also, drinking large amounts of grapefruit juice could alter the effects of Femring.

Special information if you are pregnant or breastfeeding

Femring should not be used during pregnancy. Notify your doctor immediately if you are pregnant or plan to become pregnant.

The estrogens in Femring can show up in breast milk. Because estrogens may decrease the quantity and quality of breast milk, your doctor may advise you not to breastfeed while using Femring.

Recommended dosage for Femring

There are two doses of Femring available: 0.05 milligrams a day and 0.10 milligrams a day. Each ring should remain in the vagina for 3 months.

Femring should only be used as long as medically necessary. Your doctor will examine you periodically and recommend when to end treatment.

Overdosage

It is difficult to overdose on Femring because of how it is administered. If you suspect an overdose, seek emergency treatment immediately.

• Symptoms of estrogen overdose may include:
  Nausea, vomiting, withdrawal bleeding