Insert 1 vaginal ring (delivering either 50 or 100 mcg per 24 hours) vaginally into the upper third of the vaginal vault; keep in place continuously for 3 months, then remove. If appropriate, insert a new ring. Use lowest effective dose. While Femring may be used to treat isolated genitourinary symptoms, consider other vaginal products of lower estradiol dosage first. Generally, when used in a postmenopausal woman with an intact uterus, a progestin should also be considered to reduce the risk of endometrial hyperplasia. Reevaluate every 3 to 6 months to determine if the dose and continued systemic hormone replacement is appropriate. The North American Menopause Society (NAMS) Guidelines support the initiation of hormone therapy around the time of menopause if no contraindications to use exist and use is acceptable to the individual patient, as hormone therapy is the most effective treatment for vasomotor and genitourinary symptoms and has been shown to prevent bone loss and fracture.