Vaginal oestrogen: what is Estring and how do I use it?

Estring is a soft, flexible, silicon ring that continuously releases oestrogen into the vagina over a 90-day period. It’s used to treat changes in and around the vagina that commonly occur when levels of estrogen begin to decline during the perimenopause and menopause.

This includes symptoms of vaginal dryness, such as soreness, itching, pain during sex and repeated episodes of thrush or urinary tract infections (UTIs) like cystitis. Declining levels of oestrogen can also cause urinary symptoms such urgency or occasional leaks.

RELATED: Vaginal dryness factsheet

How does Estring work?

Estring contains 2mg of a type of estrogen called estriol, which is slowly released over 90 days. This is the same type of oestrogen that’s made by your ovaries.

Once inserted into the upper third of your vagina, Estring slowly releases oestrogen directly to the area where it’s needed most. It works for three months, at which point it needs to be replaced.

When and how do I use Estring?

Estring is worn continuously, and there’s no need to remove it before sex.

If you prefer to take it out, it should be rinsed in lukewarm water and reinserted as soon as possible. You shouldn’t be able to feel Estring once it’s in place – if you can, this means it’s too low in the vagina and needs to be inserted a little higher up. If you’re not confident about inserting Estring yourself, a healthcare professional can do it for you.

RELATED: Urinary incontinence in menopause: are you ignoring the symptoms?

What are the benefits?

Estring is a convenient option as, unlike topical creams and gels, it only has to be inserted once every three months.

Once it’s in place, you shouldn’t even know it’s there. Some people prefer Estring to creams, gels and pessaries, which can be messy to use as they leave a sticky residue when they leak out of the vagina. It’s also a good option if you rely on barrier forms of contraception such as condoms or a diaphragm. Unlike oil-based creams and pessaries, there’s no risk of Estring damaging the latex.

Who is Estring suitable for?

Estring is safe to use alongside HRT including gels, sprays and patches, and may also be suitable for people who are unable to take HRT. The main advantage of vaginal oestrogen is that it can be safely and effectively used for long periods of time, with no associated risks.

Can I expect any side effects?

You might notice some soreness or irritation when you first start using Estring, but this usually settles. You may also notice increased vaginal discharge.

References

British National Formulary: Estradiol

Estring manufacturer website