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The primary source of estrogen in normally cycling adult women is the ovarian follicle, which secretes 70 to 500 mcg of estradiol daily, depending on the phase of the menstrual cycle. After menopause, most endogenous estrogen is produced by conversion of androstenedione, secreted by the adrenal cortex, to estrone in the peripheral tissues. Thus, estrone and the sulfate conjugated form, estrone sulfate, are the most abundant circulating estrogens in postmenopausal women. Looking at women in their 50s who are not taking HRT – on average, over a 5-year period, 8 in 1000 would be expected to have a stroke. This medicine is contained in a ring that you or your caregiver will put into your vagina. The ring will slowly release small amounts of medicine for your body to absorb. Your caregiver will show you how to insert the ring. Blood clots can be serious, and if one travels to the lungs , it can cause chest pain, breathlessness, fainting or even death. This condition is called pulmonary embolism , or PE. Tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription.

Appropriate studies have not been performed on the relationship of age to the effects of estradiol vaginal gel, insert, or ring in the pediatric population. Use of estradiol vaginal gel, insert, or ring is not indicated for use in children. Geriatric Signs of high blood pressure like very bad headache or dizziness, passing out, or change in eyesight. You may report side effects to the FDA at 1-800-332-1088. You may also report side effects at https://www.fda.gov/medwatch. Vaginal discomfort, bleeding or pain in your vagina including irritation or discharge which may be due to ulcers or infection Adapted from numerous WHI publications. WHI publications can be viewed at https://www.nhlbi.nih.gov/whi/. † Results are based on centrally adjudicated data. ‡ Nominal confidence intervals unadjusted for multiple looks and multiple comparisons. § Not included in "global index". ¶ Includes metastatic and non-metastatic breast cancer with the exception of in situ breast cancer. # All deaths, except from breast or colorectal cancer, definite or probable CHD, PE or cerebrovascular disease. Þ A subset of the events was combined in a "global index", defined as the earliest occurrence of CHD events, invasive breast cancer, stroke, pulmonary embolism, endometrial cancer, colorectal cancer, hip fracture, or death due to other causes.If you need major surgery or will be on long-term bed rest, you may need to stop using this medicine for a short time. Any doctor or surgeon who treats you should know that you are using Estring. Read the Patient Information Leaflet if available from your pharmacist before you start using this medication and each time you get a refill. Learn how to use this medication properly. If you have any questions, ask your doctor or pharmacist. In women with no personal history of VTE but with a first degree relative with a history of thrombosis at young age, screening may be offered after careful counselling regarding its limitations (only a proportion of thrombophilic defects are identified by screening).

If any of the above conditions appear for the first time while taking Estring, stop taking it at once and consult your doctor immediately. All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical The low systemic absorption of estradiol with vaginal administration (see section 5.2) may result in less pronounced effects on plasma binding proteins than with oral hormones. Note: Estring is not a contraceptive. If it is less than 12 months since your last menstrual period or you are under 50 years old, you may still need to use additional contraception to prevent pregnancy. Speak to your doctor for advice.

6. Visual abnormalities

If any of the side effects gets serious, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4. Adults—At first, 0.25 grams applied on the skin of either right or left upper thigh once a day. Your doctor may adjust your dose as needed up to a maximum of 1.25 grams once a day. If you notice any of the following when taking HRT remove Estring vaginal delivery system and see your doctor straight away. If you experience difficulty or pain when trying to remove the vaginal ring please do not continue and see your doctor: The most commonly reported side effects were headache, upper respiratory tract infection, moniliasis, genital pruritus, vulvovaginal mycotic infection, and diarrhea. [ Ref] Cardiovascular

For those outcomes included in the WHI "global index" that reached statistical significance, the absolute excess risk per 10,000 women-years in the group treated with CE-alone was 12 more strokes, while the absolute risk reduction per 10,000 women-years was 7 fewer hip fractures. The absolute excess risk of events included in the "global index" was a non-significant 5 events per 10,000 women-years. There was no difference between the groups in terms of all-cause mortality. This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours. These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical The risk of blood clots in the veins is about 1.3 to 3– times higher in HRT users than in non-users, especially during the first year of taking it.Adults—10 micrograms (mcg) or one insert into the vagina once a day for 2 weeks, followed by one insert 2 times a week. Smoking increases the risk of getting a blood clot or having a stroke while you are taking this medication, especially if you are more than 35 years old. You are strongly advised not to smoke.