Sandrena Gel (℞)
0.1% (0.5mg) Gel
(℞) Prescription required. Product of UK/EU. Shipped from United Kingdom. Divigel is also marketed internationally under the name Sandrena Gel.
0.1% (0.25mg) Gel
(℞) Prescription required. Product of Canada. Shipped from Canada.
To comply with Canadian International Pharmacy Association regulations you are permitted to order a 3-month supply or the closest package size available based on your personal prescription. read more
(ess' troe jen)Estrogen increases the risk that you will develop endometrial cancer (cancer of the lining of the uterus [womb]). The longer you use estrogen, the greater the risk that you will develop endometrial cancer. If you have not had a hysterectomy (surgery to remove the uterus), you may be given another medication called a progestin to take with vaginal estrogen. This may decrease your risk of developing endometrial cancer but may increase your risk of developing certain other health problems, including breast cancer. Before you begin using vaginal estrogen, tell your doctor if you have or have ever had cancer and if you have unusual vaginal bleeding. Call your doctor immediately if you have abnormal or unusual vaginal bleeding during your treatment with vaginal estrogen. Your doctor will watch you closely to help ensure you do not develop endometrial cancer during or after your treatment. In a large study, women who took estrogen with progestins by mouth had a higher risk of heart attacks, strokes, blood clots in the lungs or legs, breast cancer, and dementia (loss of ability to think, learn, and understand). Women who use vaginal estrogen alone or with progestins may also have a higher risk of developing these conditions. Tell your doctor if you smoke or use tobacco, if you have had a heart attack or a stroke in the past year, and if you or anyone in your family has or has ever had blood clots or breast cancer. Also tell your doctor if you have or have ever had high blood pressure, high blood levels of cholesterol or fats, diabetes, heart disease, lupus (a condition in which the body attacks its own tissues causing damage and swelling), breast lumps, or an abnormal mammogram (x-ray of the breasts used to find breast cancer). The following symptoms can be signs of the serious health conditions listed above. Call your doctor immediately if you experience any of the following symptoms while you are using vaginal estrogen: sudden, severe headache; sudden, severe vomiting; speech problems; dizziness or faintness; sudden complete or partial loss of vision; double vision; weakness or numbness of an arm or a leg; crushing chest pain or chest heaviness; coughing up blood; sudden shortness of breath; difficulty thinking clearly, remembering, or learning new things; breast lumps or other breast changes; discharge from nipples; or pain, tenderness, or redness in one leg. You can take steps to decrease the risk that you will develop a serious health problem while you are using vaginal estrogen. Do not use vaginal estrogen alone or with a progestin to prevent heart disease, heart attacks, strokes, or dementia. Use the lowest dose of estrogen that controls your symptoms and only use vaginal estrogen as long as needed. Talk to your doctor every 3 to 6 months to decide if you should use a lower dose of estrogen or should stop using the medication. You should examine your breasts every month and have a mammogram and a breast exam performed by a doctor every year to help detect breast cancer as early as possible. Your doctor will tell you how to properly examine your breasts and whether you should have these exams more often than once a year because of your personal or family medical history. Tell your doctor if you are having surgery or will be on bed rest. Your doctor may tell you to stop using vaginal estrogen 4 to 6 weeks before the surgery or bed rest to decrease the risk that you will develop blood clots. Talk to your doctor regularly about the risks and benefits of using vaginal estrogen.
- Wash and dry your hands.
- Remove the vaginal ring from its pouch.
- Stand with one leg up on a chair, step or other object, squat, or lie down. Choose the position that is most comfortable for you.
- Hold the vaginal ring between your thumb and index finger and press the sides of the ring together. You may want to twist the ring into a figure-of-eight shape.
- Hold open the folds of skin around your vagina with your other hand.
- Place the tip of the ring into your vagina and then use your index finger to gently push the ring inside your vagina as far as you can.
- The vaginal ring does not have to be positioned a certain way inside your vagina, but it will be more comfortable and less likely to fall out when it is placed as far back in your vagina as possible. The ring cannot go past your cervix, so it will not go too far in your vagina or get lost when you push it in. If you feel discomfort, use your index finger to push the ring further into your vagina.
- Wash your hands again.
- Leave the ring in place for 3 months. The ring may fall out if you have not inserted it deeply in your vagina, if your vaginal muscles are weak, or if you are straining to have a bowel movement. If the ring falls out, wash it with warm water and replace it in your vagina following the directions above. If the ring falls out and is lost, insert a new ring and leave the new ring in place for up to 3 months. Call your doctor if your ring falls out often.
- You can leave the ring in place when you have sex. If you choose to remove it or if it falls out, wash it with warm water and replace it in your vagina as soon as possible.
- When you are ready to remove the ring, wash your hands and stand or lie in a comfortable position.
- Put a finger into your vagina and hook it through the ring. Gently pull downward and forward to remove the ring.
- Wrap the ring in a tissue or a piece of toilet paper and dispose of it safely, so that it is out of reach of children or pets. Do not flush the ring in a toilet.
- Wash your hands again.
- Tear off one applicator from the strip of applicators in your carton.
- Open the plastic wrap and remove the applicator.
- Stand with one leg up on a chair, step, or other object, or lie down. Choose the position that is most comfortable for you.
- Hold the applicator in one hand with a finger on the end of the plunger.
- Use the other hand to gently guide the applicator into the vaginal opening. If the tablet falls out of the applicator, do not try to replace it. Dispose of that applicator and tablet and use a fresh applicator.
- Insert the applicator into your vagina as far as is comfortable. Do not force the applicator into your vagina or insert more than half of the applicator into your vagina.
- Gently press the plunger until you hear a click.
- Remove the empty applicator from your vagina and dispose of it as you would a plastic tampon applicator. Do not save or reuse the applicator.
- Wash and dry your hands before handling the vaginal insert.
- Push one vaginal insert through the foil of the blister package.
- Hold the vaginal insert with the larger end between your fingers.
- Select the best insertion position for vaginal insertion either lying down or standing,
- With the smaller end up, put the insert about 2 inches into your vagina using your finger.
- Remove the cap from the tube of cream.
- Screw the nozzle end of the applicator onto the open end of the tube.
- Gently squeeze the tube from the bottom to fill the applicator with the amount of cream that your doctor has told you to use. Look at the markings on the side of the applicator to help measure your dose.
- Unscrew the applicator from the tube.
- Lie on your back and pull your knees up toward your chest.
- Gently insert the applicator into your vagina and press the plunger downward to release the cream.
- Remove the applicator from your vagina.
- To clean the applicator, pull the plunger to remove it from the barrel. Wash the applicator and plunger with mild soap and warm water. Do not use hot water or boil the applicator.
Before using vaginal estrogen,
- tell your doctor and pharmacist if you are allergic to vaginal estrogen, any other estrogen products, any other medications, or any of the ingredients in the type of vaginal estrogen you plan to use. Ask your pharmacist or check the manufacturer's patient information for a list of the ingredients.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements, you are taking or plan to take. Be sure to mention any of the following: amiodarone (Pacerone); certain antifungals such as itraconazole (Sporanox) and ketoconazole; aprepitant (Emend); carbamazepine (Carbatrol, Epitol, Tegretol); cimetidine (Tagamet); clarithromycin (Biaxin); cyclosporine (Neoral, Sandimmune); dexamethasone (Decadron, Dexpak); diltiazem (Cardizem, Dilacor, Tiazac, others); erythromycin (E.E.S, Erythrocin); fluoxetine (Prozac, Sarafem); fluvoxamine (Luvox); griseofulvin (Fulvicin, Grifulvin, Gris-PEG); lovastatin (Altocor, Mevacor); medications for human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) such as atazanavir (Reyataz), delavirdine (Rescriptor), efavirenz (Sustiva), indinavir (Crixivan), lopinavir (in Kaletra), nelfinavir (Viracept), nevirapine (Viramune), ritonavir (Norvir, in Kaletra), and saquinavir (Fortovase, Invirase); medications for thyroid disease; other medications that are used vaginally; nefazodone; phenobarbital; phenytoin (Dilantin, Phenytek); rifabutin (Mycobutin); rifampin (Rifadin, Rimactane, in Rifamate);sertraline (Zoloft); troleandomycin (TAO); verapamil (Calan, Covera, Isoptin, Verelan); and zafirlukast (Accolate). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor what herbal products you are taking, especially St. John's wort.
- tell your doctor if you have liver disease or a blood disorder such as protein C deficiency, protein S deficiency, or an antithrombin deficiency that may increase your risk of developing abnormal blood clots. Your doctor will probably tell you not to use estrogen vaginal products.
- tell your doctor if you have or have ever had yellowing of the skin or eyes during pregnancy or during your treatment with an estrogen product, endometriosis (a condition in which the type of tissue that lines the uterus [womb] grows in other areas of the body), uterine fibroids (growths in the uterus that are not cancer), asthma, migraine headaches, seizures, porphyria (condition in which abnormal substances build up in the blood and cause problems with the skin or nervous system), very high or very low levels of calcium in your blood, or thyroid, kidney, gallbladder, or pancreatic disease. If you will be using the vaginal ring, also tell your doctor if you have a vaginal infection; any condition that makes your vagina more likely to become irritated; a narrow vagina; or a condition where the rectum, bladder, or uterus has bulged or dropped into the vagina.
- tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while using vaginal estrogen, call your doctor immediately.
- you should know that the manufacturer of one brand of estrogen vaginal cream states that use of the cream may weaken latex or rubber birth control devices such as condoms or diaphragms. These devices may not be effective if you use them during your treatment with estrogen vaginal cream. Talk to your doctor about methods of birth control that will work for you.
- breast pain or tenderness
- difficulty falling asleep or staying asleep
- changes in sexual desire
- hair loss
- unwanted hair growth
- spotty darkening of the skin on the face
- sudden feelings of heat or sweating
- difficulty wearing contact lenses
- leg cramps
- swelling, redness, burning, itching, or irritation of the vagina
- vaginal discharge
- painful or difficult urination
- back pain
- cold symptoms
- flu symptoms
- bulging eyes
- pain, swelling, or tenderness in the stomach
- loss of appetite
- yellowing of the skin or eyes
- joint pain
- movements that are difficult to control
- rash or blisters
- swelling of the eyes, face, tongue, throat, hands, arms, feet, ankles, or lower legs
- difficulty breathing or swallowing