Generic Name and Formulations:
Estradiol acetate 0.05mg/day, 0.1mg/day; vaginal ring.
Indications for FEMRING:
Moderate to severe vasomotor symptoms or vulvar and vaginal atrophy due to menopause.
Use lowest effective dose for shortest duration consistent with treatment goals. Insert 1 ring vaginally once every 3 months; replace. Initially 0.05mg/day ring; may increase to 0.1mg/day ring if needed.
Thrombophlebitis or thromboembolic disorders. Protein C, protein S, or antithrombin deficiency, or other thrombophilias. Breast or other estrogen-dependent neoplasms. Undiagnosed abnormal genital bleeding. Hepatic disease or tumors. Pregnancy.
Increased risk of endometrial carcinoma or hyperplasia in women with intact uterus (adding progestin is essential). Increased risk of cardiovascular events (eg, MI, stroke, VTE); discontinue if occurs. Manage risk factors for cardiovascular disease and venous thromboembolism appropriately. Risk of invasive breast cancer with estrogen/progestin combination. Risk of probable dementia in women >65yrs of age. Discontinue if thrombotic event, unexplained visual changes, or jaundice occurs, and at least 4 weeks before through 2 weeks after surgery associated with increased risk of thromboembolism. Diabetes. Hypertriglyceridemia. Gallbladder disease. Metabolic bone disease associated with hypercalcemia. Pregnancy-related cholestasis. Hypothyroidism (monitor). Fluid retention. Hypoparathyroidism. Residual endometriosis post-hysterectomy; consider adding progestin. Hereditary angioedema. Asthma. Epilepsy. Migraines. Porphyria. SLE. Hepatic hemangiomas. Women with a predisposition to vaginal irritation, ulceration, or ring expulsion (eg, vaginal stenosis, cervical prolapse, rectoceles, cystoceles). May use ring while treating vaginal infections. Do regular complete physical exams. Reevaluate periodically. Nursing mothers: not recommended.
May be affected by CYP3A4 inducers or inhibitors. May affect lab tests (eg, coagulation factors, triglycerides, lipids, glucose tolerance, binding proteins, hormone binding globulins, thyroid).
Vaginal bleeding, breast tenderness, vaginal candidiasis, headache; serious thromboembolic events, malignant neoplasms.
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