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Overview: Vaginal estradiol is available as a cream, insert, or ring that is inserted into the vagina to increase estrogen levels. It is used after menopause to reduce vaginal dryness and itching. The most common side effects are headache and breast pain and tenderness. Talk with your healthcare provider right away about any unusual vaginal bleeding or vaginal discharge.

Uses

What is vaginal estradiol used for?

Vaginal estradiol is commonly used to reduce postmenopausal vaginal symptoms, such as vaginal dryness, or itching.

Estradiol may also be used for other conditions as determined by your healthcare provider.

How does vaginal estradiol work (mechanism of action)?

Estrogen is an important hormone for the health of the vagina. During menopause natural estrogen levels go down. When this happens, the vagina can become dry and irritated. Vaginal estradiol may reduce symptoms of menopause by raising estrogen levels in the vagina to improve vaginal health.

How is vaginal estradiol supplied (dosage forms)?

Brands and other names

  • Estrace
  • Estring
  • Vagifem

Dosage forms and strengths

  • 0.05 mg, 0.1 mg, 2 mg vaginal ring
  • 10 mcg vaginal insert
  • 0.01% vaginal cream

How should I store vaginal estradiol?

Vaginal Insert. Vaginal estradiol inserts should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place. Do not refrigerate.

Vaginal Ring. Vaginal estradiol ring should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). 

Vaginal Cream. Vaginal estradiol cream should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). Avoid exposing it to temperatures above 104 F (40 C).

Side Effects

What are the most common side effects of vaginal estradiol?

The most common side effects of vaginal estradiol are listed below. Tell your healthcare provider if you have any of these side effects that bother you.

  • Headache
  • Back Pain
  • Breast pain and tenderness
  • Abnormal vaginal bleeding or spotting
  • Itching, irritation, or burning sensation in the vagina
  • Stomach cramps, bloating, nausea, vomiting, or diarrhea
  • Hair loss
  • Fluid retention (edema)
  • Vaginal yeast infection

There may be other side effects of vaginal estradiol that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of vaginal estradiol?

While less common, the most serious side effects of vaginal estradiol are described below, along with what to do if they happen.

Blood Clots. Vaginal estradiol may cause blood clots in your arteries or veins and could cause a stroke, heart attack, or venous thromboembolism, including a blood clot in the back of the eye (retinal vein occlusion), in the lungs (pulmonary embolism), or deep venous thrombosis (DVT). Stop using vaginal estradiol and get emergency help if you have any of the following signs of blood clots.

  • Chest pain or pressure
  • Fast or abnormal heartbeat
  • Trouble breathing
  • Pain in your back, jaw, throat, or arm
  • Sweating, upset stomach, vomiting, or dizziness
  • Sudden weakness on one side of your body
  • Sudden and severe headache
  • Slurred speech or trouble understanding speech
  • Pain, swelling, or tenderness in your arm or leg
  • Vision loss
  • Bulging eyes 
  • Double vision

Endometrial Cancer. You may be at higher risk for cancer in the lining of your uterus (endometrial cancer) if you use vaginal estradiol. Call your healthcare provider right away if you have any abnormal vaginal bleeding.

Breast Cancer. You may be at higher risk for breast cancer if you use vaginal estradiol. Call your healthcare provider right away if you have any of the following symptoms.

  • New lump in your breast or armpit
  • Changes in the size, shape, texture, or temperature of your breast
  • Nipple changes

Ovarian Cancer. You may be at higher risk for cancer in your ovaries (ovarian cancer) if you use vaginal estradiol. Call your healthcare provider right away if you have any of the following symptoms.

  • Unusual vaginal discharge
  • Belly or back pain
  • Need to pee more often or urgently

Gallbladder Problems. Using vaginal estradiol may cause gallbladder problems, including cholecystitis and cholelithiasis (also known as gallstones). Call your healthcare provider right away if you have any of the following symptoms.

  • Your skin or the whites of your eyes turning yellowish in color (also called jaundice)
  • Fever
  • Pain in your upper stomach area
  • Stool (poop) that is clay-colored

Memory Problems. Using vaginal estradiol may increase your risk for memory problems (dementia), especially if you are 65 or older. Call your healthcare provider if you or friends or family notice that you are having trouble with your memory.

Increased Blood Pressure (Hypertension). Vaginal estradiol may increase your blood pressure or worsen it if you have a history of high blood pressure. Call your healthcare provider if your blood pressure increases while using this medicine.

If you measure your blood pressure and the top number (systolic) is 180 mm Hg or higher or the bottom number (diastolic) is 120 mm Hg or higher, get medical attention right away. Increases in blood pressure may not be noticeable but look out for any of the following symptoms of severely high blood pressure.

  • Sudden severe headache
  • Chest pain
  • Dizziness or confusion
  • Trouble breathing
  • Nausea or vomiting
  • Blurry or other changes to vision
  • Anxiety
  • Buzzing in the ears
  • Nosebleed
  • Feeling of skipped heart beats

Fluid Retention (Edema). Vaginal estradiol can cause fluid retention, also called edema. Fluid retention can cause serious issues in people with certain conditions, such as heart failure or kidney disease. Call your healthcare provider right away if you have any of the following symptoms. 

  • Chest pain
  • Irregular heartbeat
  • Shortness of breath
  • Stretched or shiny skin
  • Swollen body parts, such as the belly or ankles

Severe Allergic Reactions. Vaginal estradiol may cause allergic reactions, which can be serious. Stop using vaginal estradiol and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat (angioedema)
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Toxic Shock Syndrome. Toxic shock syndrome may happen in people using an estradiol vaginal ring. Toxic shock syndrome happens when an infection produces toxins that enter your blood. This triggers an immune response, which can be life-threatening. Remove your estradiol vaginal ring and call your healthcare provider right away if you have any of the following serious symptoms.

  • Fever
  • Nausea, vomiting, or diarrhea
  • Dizziness or fainting
  • Muscle pain
  • A rash on your face and body that looks like a sunburn

Vaginal Sores. Sometimes using a vaginal estradiol ring can cause some of the lining of the vagina to get very thin, or for sores to develop. This can be very painful. Remove your estradiol vaginal ring and call your healthcare provider right away if you have any of the following symptoms of vaginal thinning or sores.

  • Pain or soreness of the vagina
  • Vaginal bleeding
  • Swelling, redness, or scapes in the vagina

Warnings & Precautions

Who should not use vaginal estradiol?

Allergies to Ingredients. People who are allergic to any of the following should not use vaginal estradiol products.

  • Estradiol
  • Estrace
  • Estring
  • Vagifem
  • Femring
  • Yuvafem
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific vaginal estradiol products they stock.

Blood Clots. Vaginal estradiol should not be used if you have now or have a history of blood clots in your veins, such as a deep venous thrombosis (DVT), or your lungs, such as a pulmonary embolism (PE).

Breast Cancer. Vaginal estradiol should not be used if you have, are being evaluated to see if you have, or have previously had breast cancer.

Estrogen Dependent Cancer. Vaginal estradiol should not be used if you have cancer that needs estrogen to grow. Examples of these cancers include ovarian cancer and endometrial or uterine cancer. 

Stroke or Heart Attack. Vaginal estradiol should not be used if you have had a stroke or heart attack.

Unusual Vaginal Bleeding. Vaginal estradiol should not be used if you have abnormal bleeding from your vagina that has not been diagnosed by a healthcare provider.

Thrombophilia. Vaginal estradiol should not be used if you have low blood levels of protein C, protein S, or antithrombin, or if you have a condition that increases your risk of developing a blood clot.

Liver Problems. Vaginal estradiol should not be used if your liver is not working as well as it should be. If there is a concern about the health of your liver, your healthcare provider may do tests to determine if it is working well enough to use this medicine.

Pregnancy. Do not use vaginal estradiol if you are pregnant. If you become pregnant, contact your healthcare provider right away. See the Pregnancy section for more details.

What should I know about vaginal estradiol before using it?

If you have a uterus, talk to your healthcare provider about whether adding a progestin is right for you.

Do not use vaginal estradiol unless it has been prescribed to you by a healthcare provider. Use it as prescribed.

Do not share vaginal estradiol with other people, even if they have the same condition as you. It may harm them.

Keep vaginal estradiol out of the reach of children.

People who are aged 65 or older can be at greater risk for some side effects from vaginal estradiol. Talk to your healthcare provider about your risks if you are in this age group.

If you are using the vaginal estradiol insert or vaginal ring, read and follow the “Instructions for Use” that come with it. 

Vaginal estradiol is not always used daily. Consider using a calendar or app to help you remember when to use it next. Vaginal estradiol rings should be removed after 90 days. If you are to continue using vaginal estradiol, a new ring can be put in after the old one is removed. 

It is best to use the lowest dose of estrogen that works for the shortest length of time. Ask your healthcare provider how much and for how long you should use vaginal estradiol. 

Keep all scheduled appointments for breast exams, vaginal exams, and mammograms while using vaginal estradiol. 

What should I tell my healthcare provider before using vaginal estradiol?

Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if vaginal estradiol is right for you.

In particular, make sure that you discuss any of the following.

Surgery or Bedrest. Tell your healthcare provider about any bedrest or upcoming surgery that will require you to be immobile or not be able to get up and walk around normally. Follow any instructions from your healthcare provider about when to stop and restart using vaginal estradiol. 

Current and Past Health Conditions. Tell your healthcare provider if you have any of the following. 

  • Unusual vaginal bleeding or spotting after menopause
  • Cancer
  • Heart problems
  • Stroke
  • Blood clots
  • High blood pressure
  • Liver problems, including growth of abnormal blood vessels in the liver (hemangioma)
  • Asthma
  • Diabetes
  • Seizures
  • Migraines
  • Endometriosis
  • Systemic lupus erythematosus
  • Porphyria
  • Thyroid or parathyroid problems
  • Kidney problems
  • High blood calcium levels
  • Hereditary angioedema
  • Smoking
  • Gallbladder problems with estrogen use or during pregnancy

Other Medicines and Supplements. Vaginal estradiol may interact with other medicines and supplements. Before using vaginal estradiol, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

High Triglyceride Levels. If you have high triglyceride levels, vaginal estradiol may make your triglycerides even higher. Very high triglyceride levels can lead to inflammation of the pancreas, which is called pancreatitis. Tell your healthcare provider if you have high triglyceride levels.

Pregnancy. People who can become pregnant are not usually prescribed vaginal estradiol. Vaginal estradiol should not be used in pregnancy. Tell your healthcare provider if you are, think you are, or plan to become pregnant.

Breastfeeding. Estradiol passes into breast milk. Using vaginal estradiol can reduce the quality and quantity of milk your body makes. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should use vaginal estradiol while breastfeeding. 

Interactions

Does vaginal estradiol interact with foods or drinks?

Do not eat or drink things with grapefruit or grapefruit juice in them while using vaginal estradiol. This could increase the estradiol levels in your blood and may cause serious side effects. 

Limit the amount of alcohol you drink while using vaginal estradiol. There may be increased risk for liver damage if you drink significant amounts of alcohol while using vaginal estradiol.

Does vaginal estradiol interact with other medicines (drug interactions)?

Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using vaginal estradiol.

  • St. John’s wort, which is a supplement that may be used to treat depression
  • Phenobarbital or carbamazepine (Carbatrol, Tegretol, and others), which is a medicine to control seizures
  • Rifampin, which is a medicine commonly used to treat an infection called tuberculosis
  • Erythromycin (Ery-Tab and others) or clarithromycin, which is a medicine used for bacterial infections
  • Ketoconazole or itraconazole (Sporanox, Tolsura), which is a medicine used for fungal infections
  • Ritonavir, which is a medicine commonly used to treat HIV

Some other medicines may alter the blood levels of vaginal estradiol. Tell your healthcare provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with vaginal estradiol. Always check with your healthcare provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much vaginal estradiol?

If you or someone else has used too much vaginal estradiol, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of vaginal estradiol?

An estradiol vaginal ring is placed in the vagina and left there for 90 days. If the ring comes out before 90 days have passed, rinse it with water (lukewarm) and put it back in place. Call your healthcare provider if you have trouble putting it back in. 

After starting with daily use for two weeks, vaginal estradiol is typically used twice a week (vaginal insert) or three times a week (vaginal cream). If you miss a dose of vaginal estradiol, use it as soon as you remember. You can then go back to your normal schedule or start a new two or three days a week schedule using this as one of your days of the week. If it is almost time for your next dose, skip the missed dose. Then use your next dose when you normally would. Do not use double or extra doses.