Medication guide

The low-dose vaginal ring (Estring)

Local estrogen for vaginal and urinary symptoms — one ring, three months, minimal absorption into the rest of the body.

First, an important distinction. Estring is local therapy. It releases a very low dose of estradiol that works directly on the tissue of the vagina and urinary tract — treating dryness, irritation, painful sex, and urinary symptoms. It will not treat hot flashes, night sweats, or sleep — for whole-body coverage you need systemic estrogen (a patch, gel, or the systemic ring, Femring). And because the dose stays local, Estring does not require progesterone on its own.

How it works

Estring is a soft, flexible silicone ring with a core containing 2 mg of estradiol — the same estrogen your ovaries produced. Once inserted, it begins releasing a low, continuous dose immediately and keeps doing so for 90 days. The estrogen goes to work restoring the vaginal and urinary tissue itself: thickness, elasticity, blood flow, and natural moisture.

Expect the full effect in about 2 to 3 weeks, as the tissue rebuilds. If your symptoms haven't budged after a few weeks, message us.

Inserting the ring

Wash and dry your hands — the ring gets slippery when wet. Get comfortable: lying down, squatting, or standing with one leg up.

  1. Remove the ring from its pouch using the tear-off notch.
  2. Press the opposite sides of the ring together between your thumb and index finger.
  3. Gently push the compressed ring into the vagina as far as you comfortably can.

The exact position doesn't matter, as long as it sits in the upper third of the vagina. Once it's in place, you shouldn't feel it at all — if you do, it isn't far enough in; use your finger to push it a little further. There's no danger of it going too far or getting lost: the cervix blocks it from going anywhere. Wash your hands, and mark your calendar for 90 days out.

Removing the ring

  1. Wash and dry your hands, and get into a comfortable position.
  2. Loop your finger through the ring and gently pull it out.
  3. Wrap it in tissue and put it in the trash — don't flush it. Wash your hands.

If you're continuing treatment, insert the new ring right away.

Living with it

  • Sex: the ring can stay in during intercourse — most women and their partners don't notice it. If it causes either of you any discomfort, remove it beforehand and reinsert it as soon as possible afterward.
  • If it slides down: straining — with constipation, for example — can push the ring into the lower vagina. Just guide it back into place with your finger.
  • If it comes out: rare, but it can happen with intense straining or coughing. Wash it with lukewarm (not hot) water and reinsert it. If it comes out often, message us.
  • More moisture is the point: an increase in vaginal secretions is the most common effect — these are like the secretions your body made before menopause, and they're a sign the ring is working. Secretions with a bad odor, itching, or discomfort are not normal — message us.
  • Bathing, swimming, exercise: no restrictions.

What you might notice early on

Beyond the increase in normal secretions, some women notice mild vaginal discomfort, genital itching, headache, or abdominal cramping early on. These typically settle. If anything bothers you or doesn't fade, log it in your tracker and message us.

Two things to message us about promptly: unusual vaginal bleeding — it's usually benign, but it always gets checked — and vaginal pain, soreness, or redness that develops while the ring is in, which can be a sign the ring is irritating the vaginal wall and needs a look.

Go to urgent care or the ER if you have:

  • Difficulty or pain when trying to remove the ring — don't keep trying
  • Fever with vomiting, diarrhea, muscle pain, dizziness, or a sunburn-like rash — remove the ring first if you can, then go. These are warning signs of toxic shock syndrome, which is rare but serious.
  • A severe allergic reaction: widespread rash or hives, or swelling of the eyelids, face, lips, tongue, or throat

The 90-day rhythm

After 90 days there's no longer enough estradiol in the ring to keep the tissue healthy, and symptoms will start creeping back. Replace it on schedule, every time. Put the swap date in your phone the day you insert a new ring.

Go deeper

For the full picture of how estrogen works, what it treats, the safety evidence, and what to expect month by month, read Estrogen: the in-depth guide. Wondering about the whole-body version of the ring? That's Femring.

The Menopause Clinic · 700 Camp St, New Orleans · 504-389-2078
Questions about your ring? Message us anytime — that's what membership is for.