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Pelvic Health

Estring: How Long Is It Safe to Use?

Estring: How Long Is It Safe to Use?

by Dr. Barb DePree, MD

Estring, also known as an estradiol vaginal ring, is a flexible silicone ring that is inserted into the vagina after menopause to help manage menopausal & postmenopausal symptoms like vaginal atrophy, pain during sex, and frequent urination.

In this article, we’ll discuss how Estrings work, how long an Estring is safe to use, and common risk factors associated with Estrings. We’ll also outline some highly effective natural treatments that relieve menopause symptoms without worrisome side effects. 

How Estring Works? 

As a soft and flexible silicone ring, the Estring is inserted into the upper third of the vagina, either by the patient or their doctor, where it releases small amounts of estrogen every 24 hours. As a local estrogen replacement therapy, Estrings treat only vaginal and urinary symptoms associated with menopause, but not additional symptoms like hot flashes, mood swings, breast tenderness, or lack of sleep.  

How Long Is it Safe to Use Estring?

Estrings are designed to remain in the vagina for 90 days during which time small amounts of estrogen are released to help treat menopause symptoms in and around the vagina. Estrings that are left in the body for longer than three months will not have any estrogen left to release and are therefore not helping to treat symptoms. 

It is also wise to bear in mind that EStrings should only be used for as long as they are recommended by your healthcare practitioner. So, a check-up every 3 months, when an Estring is due to be removed, is advised. 

Estring: Side Effects & Risk Factors

Although hormone replacement therapy with just estrogen, or a combination of estrogen & progestin, can help to treat menopause symptoms, it is also associated with various risks, particularly when used long-term.

Based on research and clinical trials, using just estrogen as hormone replacement therapy, like Estring, can increase women’s risk of developing growths in the womb and uterine cancer. For this reason, estrogen replacement therapy like Estring is normally only recommended for women who have undergone a hysterectomy. 

Estrogen-only hormone therapy like Estring is known to increase women’s chance of strokes and blood clots too. And a study based on women over the age of 65 concluded that estrogen replacement therapy, with or without the use of progestin, could also increase the risk of dementia.  

Effectively, estrogen replacement should be administered at the lowest possible rates and only for as long as needed. However, if you are using Estring and notice any vaginal bleeding, throbbing, or swelling in the legs or arms, a sudden lack of coordination, numbness, or difficulty speaking, contact your doctor immediately.  

Natural Estring Alternatives

During perimenopause, the amount of estrogen produced by the female body typically drops and continues to decline during menopause, often resulting in some uncomfortable symptoms post-menopause. Vaginal dryness, more frequent urges to pee, a burning sensation while urinating, and painful sex are just some of the symptoms caused by decreasing levels of estrogen.

And while many women are recommended hormone replacement therapy by doctors to treat these symptoms, the risk factors often outweigh the advantages. To avoid any side effects of HRT, or local estrogen therapy like Estrings, consider the following natural remedies that have been proven to be highly effective instead. 

Pelvic Health Physical Therapy

A visit to a pelvic health physical therapist can be incredibly helpful for women suffering from vaginal or urinary menopause symptoms. Due to the drop in estrogen during menopause, not only do the vaginal tissues become dry and tight, the pelvic floor muscles often weaken too. Pelvic health physical therapists specialize in relaxing and healing any sort of pelvic pain, including tight vaginal muscles and weak pelvic floor muscles due to vaginal menopause. 

For women who wish to return to pleasurable sex or even just get back to enjoying life without frustration symptoms, pelvic health physical therapy is the best first step to take. If needed, they will also teach women how to use vaginal dilators to continue therapy at home. 

Vulvar Balms & Vaginal Moisturizers

Vulvar balms and vaginal moisturizers are both soothing natural remedies for treating menopause symptoms like vaginal dryness and vulvar irritation. As well as providing welcome relief from the itching and redness often caused by vaginal dryness, vulvar balms, and vaginal moisturizers also provide long-term benefits.

By absorbing into the skin, balms rehydrate the vulvar tissue and vaginal moisturizers saturate vaginal skin with fortifying nutrients. 

When choosing a vulvar balm or vaginal moisturizer make sure the product is organic, natural, clinician developed, and free of chemicals, parabens, phthalates, and gluten. Like this vulvar balm and vaginal moisturizer from Intimate Rose. 

Water-based Lubricants During Sex

Any woman experiencing vaginal dryness should consider using a water-based personal lubricant during foreplay and sex to reduce any friction or pain and enjoy more pleasurable intercourse. 

When choosing a personal lubricant to relieve vaginal dryness during menopause, it is better to choose a water-based, toxin-free, FDA-approved product that is as close to the vagina's natural PH as possible. Oil-based substances like baby oil and petroleum jelly should be avoided at all costs because they can disrupt the natural pH of a woman’s vagina and increase the chance of a bacterial infection.

Vitex (Chasteberry) Supplements 

Vitex, also known as Chasteberry, is an ancient natural remedy that was used by the Greeks and Romans to treat women’s health and menopause symptoms as many as 2,500 years ago. And recent studies have concluded that in supplement form, it is just as effective today as it was then.

Acting as an adaptogen, Vitex helps the pituitary gland rebalance hormones during all three stages of menopause by slowing down excessive hormone secretion and boosting the production of insufficient hormones.  

Chasteberry is admittedly not as effective in treating vaginal dryness as the combination of physical therapy, vaginal dilators & organic vaginal moisturizers. However, lots of research has shown that Chasteberry supplements significantly reduce menopause symptoms like mood swings, breast tenderness, hot flashes, and interrupted sleep within three months when taken daily. 

Additional Estring FAQs

Should I avoid Estring if I have history of liver damage?

It's highly unlikely that Estring would cause liver damage, so no, you needn't be concerned. Estring releases estrogen locally, in the vagina; this is not metabolized through the liver. We do know that women with significant liver disease are not good candidates for oral estrogen, which is metabolized through the liver.

Can Estring help me regain intimacy?

Estring can potentially aid women in regaining intimacy after menopause by addressing vaginal dryness and discomfort.  Adding estrogen for two to three months will tell you what other actions might be helpful. 


Although Estring can seem like a convenient solution to vaginal dryness and urinary issues after menopause, there are several risk factors attached to local estrogen therapy. A higher chance of uterine cancer, strokes, blood clots, and dementia are the most common known side effects, for instance.

On the other hand, natural remedies for vaginal dryness and other menopause symptoms include vaginal dilators, physical therapy, organic vaginal moisturizers, and chasteberry supplements.   


Estring – Why Estring -

Mayo Clinic – Vaginal Atrophy: Symptoms & Causes -

National Library of Medicine - Menopause: What are the benefits and risks of long-term hormone therapy? -

National Library of Medicine - The Women's Health Initiative Memory Study: findings and implications for treatment -

National Library of Medicine - Hormonal Changes During Menopause and the Impact on Fluid Regulation -