Before using
Warning: estrogens have been reported to increase the chance of womb (endometrial) cancer in women who have been through menopause, especially in women with a uterus who receive estrogen-only hormone therapy. Estrogens may also increase the risk of cancer of the ovary/breast. Estrogen-containing medicines should not be used to prevent heart disease. Estrogen given in combination with another hormone (progestin) for replacement therapy can infrequently cause heart disease (e.g., heart attacks), stroke, serious blood clots, and cancer of the breast. These risks appear to depend on the length of time this medicine is used and the amount of estrogen per dose. Therefore, this medicine should be used for the shortest possible length of time at the lowest effective dose, so you obtain the benefits and minimize the chance of serious side effects from long-term treatment.

If you use this medicine for an extended period, you should be evaluated at least once yearly (see cautions section). This medicine is not effective in preventing/treating a tendency toward miscarriages nor the threat of miscarriage. This medicine must not be used during pregnancy because its use may result in birth defects or cancer later in the child's life (see cautions section).

Additional monitoring of your dose or condition may be needed if you are using other vaginal medicines. Do not start or stop any medicine without doctor or pharmacist approval. Inform your doctor of any other medical conditions including a family medical history (e.g., especially breast lumps/cancer), asthma, diabetes, seizures, migraine headaches, liver or kidney disease, heart disease (e.g., high blood pressure, heart attacks, congestive heart failure), low thyroid hormone (hypothyroidism), abnormal calcium level in the blood, depression, high blood pressure during pregnancy, yellowing of eyes/skin during pregnancy or with past estrogen use, womb problems (e.g., uterine fibroids/endometriosis), cholesterol/lipid problems, gallbladder disease, excessive weight gain, certain blood disorder (porphyria), allergies, pregnancy, or breast-feeding.

Use of this medicine is not recommended if you have certain medical conditions including undiagnosed abnormal vaginal bleeding, certain cancers (e.g., breast cancer, especially non-metastatic type), blood clots, or active/recent stroke or heart attack. Contact your doctor or pharmacist if you have any questions or concerns about taking this medicine.

Directions
Follow the directions for using this medicine provided by your doctor. This medicine comes with a patient leaflet. Read it carefully. Ask your doctor, nurse, or pharmacist any questions you may have about this medicine. Fill the applicator with the medicine according to the directions. Insert the applicator high into the vagina and press the plunger to release the medicine. Clean the applicator with warm soapy water and rinse well. Do not boil or use hot water to clean the applicator. Follow your dosing schedule closely. It is best to schedule each dose about the same time of the day.

Store this medicine at room temperature 77 degrees f (25 degrees c), away from heat, moisture, and light. If you miss a dose of this medicine, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Cautions
Keep all doctor and laboratory appointments while you are using this medicine. You should have a complete physical examination, including blood pressure measurements, breast and pelvic examinations, and a pap test (for vaginal cancer), at least once a year. You should also have periodic mammograms as determined by your doctor. Follow your doctor's instructions for examining your own breasts, and report any lumps immediately.

This medicine may alter certain lab results. Make sure laboratory personnel and your doctors know that you are using this medicine. If you will be having surgery or will be confined to a chair or bed for a long period of time (e.g., a long plane flight), notify your doctor beforehand. Special precautions may need to be taken in these circumstances while you are taking this medicine.

This medicine may cause dizziness. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to this medicine. Using this medicine alone, with other medicines, or with alcohol may lessen your ability to drive or to perform other potentially dangerous tasks. Limit alcoholic beverages while using this medicine.

This medicine may cause a patchy darkening of the skin on the face (melasma). Sunlight may intensify this darkening and you may need to avoid prolonged sun exposure and sunlamps. Consult your doctor regarding use of sunscreens and protective clothing. Cigarette smoking can increase the chance of blood clots while taking this medicine (especially in women over the age of 35). This medicine can weaken and lead to failure of latex condoms. Consult your doctor about the use of condoms and other vaginal products while using this medicine.

Before you begin taking any new medicine, either prescription or over-the-counter, check with your doctor or pharmacist. For women: this medicine has been shown to cause harm to the human fetus. Do not use this medicine if you are pregnant. If you suspect that you could be pregnant, contact your doctor immediately. It is unknown if this medicine is excreted in breast milk. Do not breast-feed while taking this medicine.

Possible side effects
Side effects, that may go away during treatment, include dizziness, lightheadedness, headache, stomach upset, bloating, nausea, weight changes, increased/decreased interest in sex, or breast tenderness. If they continue or are bothersome, check with your doctor.

Contact your doctor immediately if you experience mental/mood changes (e.g., severe depression), calf/pain swelling, sudden severe headache, chest pain, trouble breathing, one-sided weakness, slurred speech, vision changes (e.g., change in contact lens fit, loss of vision), breast lumps, swelling of hands/feet, changes in vaginal bleeding (e.g., spotting, breakthrough bleeding, or prolonged bleeding), unusual vaginal discharge/itching/odor, or yellowing of the eyes/skin. An allergic reaction to this medicine is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include rash, itching, swelling, severe dizziness, or trouble breathing. If you notice other effects not listed above, contact your doctor, nurse, or pharmacist.

If you take too much
If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include severe nausea/vomiting or excessive vaginal bleeding. This medicine may be harmful if swallowed.

Additional information
Do not share this medicine with others for whom it was not prescribed. Do not use this medicine for other health conditions. Keep this medicine out of the reach of children and pets. If using this medicine for an extended period of time, obtain refills before your supply runs out.

Drug interactions
Drug interactions can result in unwanted side effects or prevent a medicine from doing its job. Some medicines or medical conditions may interact with this medicine. Inform your doctor or pharmacist of all prescription and over-the-counter medicine that you are taking.