How to Use

Vaginal estrogen products usually come with patient directions Read them carefully before using this drug .

Wash your hands before and after using the drug. Always keep the drug out of your eyes. If this drug does get into your eyes, wash them out immediately, but carefully, with large amounts of tap water. If your eyes still burn or are painful, check with your family doctor.

Use this drug only as directed. Do not use more of it and do not use it for a longer time than your family doctor ordered . It can take up to 4 months to see the full effect of the estrogens. Your family doctor may reconsider continuing your estrogen treat or may lower your dose few times within the first one or two months and every 3 to 6 months after that. Sometimes a switch to oral estrogens may be required for added benefits or for higher doses. When using the estradiol vaginal insert, you will need to replace it every 3 months or remove it after 3 months.

For vaginal creams or suppositories Vaginal creams and some vaginal suppositories are inserted with a plastic applicator. Directions for using the applicator are supplied with your drug. If you do not see your dose marked on the applicator, ask your health care professional for more information.

• To fill the applicator for cream dosage forms :
  • Break the metal seal at the opening of the tube by using the point on the top of the cap.
  • Screw the applicator onto the tube.
  • Squeeze the drug into the applicator slowly until it is measured properly.
  • Remove the applicator from the tube. Replace the cap on the tube.
• To fill the applicator for suppository dosage form
  • Place the suppository into the applicator.
• To place the dose using the applicator for cream and suppository dosage forms :
  • Relax while lying on your back with your knees bent or stand with one foot on a chair.
  • Hold the full applicator in one hand. Slide the applicator slowly into the vagina. Stop before it becomes uncomfortable.
  • Slowly press the plunger until it stops.
  • Withdraw the applicator. The drug will be left behind in the vagina.
• To care for the applicator for cream and suppository dosage forms :
  • Clean the applicator after use by pulling the plunger out of the applicator and washing both parts completely in warm, soapy water Do not use hot or boiling water .
  • Rinse well.
  • After drying the applicator, replace the plunger.

For vaginal insert dosage form

• To place the vaginal insert
  • Relax while lying on your back with your knees bent or stand with one foot on a chair.
  • Pinch or press the sides of the vaginal insert together, between your forefinger and middle finger.
  • With one hand, part the folds of skin around your vagina.
  • Slide the vaginal insert slowly into the upper third of your vagina. Stop before it becomes uncomfortable. The exact location is not too important but it must be comfortable.
  • If it seems uncomfortable, then carefully push the vaginal insert higher into the vagina.
• To remove the vaginal insert
  • Stand with one foot on a chair.
  • Slide one finger into the vagina and hook it around the closest part of the vaginal insert.
  • Slowly pull the vaginal insert out.
  • Dispose of the vaginal insert by wrapping it up and throwing it into the trash Do not flush it down the toilet .

Dosage

For conjugated estrogens
• For vaginal dosage form - cream:
  • For treating a genital skin condition - vulvar atrophy and inflammation of the vagina - atrophic vaginitis:
    • Adults: 0.3 to 1.25 milligrams - mg of conjugated estrogens - one half to two grams of cream inserted into the vagina once a day or as directed by your family doctor to achieve the lowest dose possible. Usually your family doctor will want you to use this drug for only three weeks of each month - three weeks on and one week off.

For dienestrol
• For vaginal dosage form - cream:
  • For treating a genital skin condition - vulvar atrophy and inflammation of the vagina - atrophic vaginitis:
    • Adults: At first, one applicatorful of 0.01% cream inserted into the vagina one or two times a day for one to two weeks, decreasing the dose by one half over two and four weeks. After four weeks, your family doctor will probably ask you to use the drug less often, such as one applicatorful one to three times a week and for only three weeks of each month - three weeks on and one week off.

For estradiol
• For vaginal dosage form - cream:
  • For treating a genital skin condition - vulvar atrophy and inflammation of the vagina - atrophic vaginitis:
    • Adults: 200 to 400 micrograms - mcg of estradiol - two to four grams of cream inserted into the vagina once a day for one to two weeks, decreasing the dose by one half over two and four weeks. After four weeks, your family doctor will probably ask you to use the drug less often, such as 100 mcg - one gram of cream one to three times a week and for only three weeks of each month - three weeks on and one week off.
• For vaginal dosage form - insert:
  • For treating a genital skin condition - vulvar atrophy, inflammation of the vagina - atrophic vaginitis in postmenopausal women and inflammation of the urethra - urethritis in postmenopausal women:
    • Adults: 2 milligrams - mg of estradiol - 7.5 mcg released every twenty-four hours with continuous use and replaced every three months.

For estrone
• For vaginal dosage form - cream:
  • For treating a genital skin condition - vulvar atrophy and inflammation of the vagina - atrophic vaginitis in postmenopausal women:
    • Adults: 2 to 4 milligrams - mg of estrone - two to four grams of cream inserted into the vagina once a day or as directed by your family doctor.
• For vaginal dosage form - suppository:
  • For treating a genital skin condition - vulvar atrophy and inflammation of the vagina - atrophic vaginitis in postmenopausal women:
    • Adults: 250 to 500 micrograms - mcg inserted into the vagina once a day or as directed by your family doctor.

For estropipate
• For vaginal dosage form - cream:
  • For treating a genital skin condition - vulvar atrophy and inflammation of the vagina - atrophic vaginitis:
    • Adults: 3 to 6 milligrams - mg of estropipate - two to four grams of cream inserted into the vagina once a day. Your family doctor will probably ask you to use the drug for only three weeks of each month - three weeks on and one week off.

Missed dose When using the suppository or cream few times a week: If you miss a dose of this drug and remember it within 1 or 2 days of the missed dose, use the missed dose as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

When using the cream or suppositories more than few times a week: If you miss a dose of this drug, use it as soon as possible if remembered within 12 hours of the missed dose. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage To store this drug:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Keep the drug from freezing.
• Do not keep outdated drug or drug no longer needed. Be sure that any discarded drug is out of the reach of children.