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All about: Etonogestrel and Ethinyl estradiol vaginal ring

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Generic name: Etonogestrel and Ethinyl estradiol vaginal ring
Brand names: NuvaRing

Why is Etonogestrel and Ethinyl estradiol vaginal ring prescribed?

NuvaRing is a contraceptive device. Like oral contraceptives ("The Pill"), it prevents pregnancy by providing a steady level of the female hormones estrogen and progestin. This eliminates the hormonal surge that ordinarily triggers the release of an egg. Hormonal contraceptives such as NuvaRing are extremely reliable when used exactly as directed.

Most important fact about Etonogestrel and Ethinyl estradiol vaginal ring

To make sure NuvaRing works properly, you must follow a strict schedule for insertion and removal. Each ring should be inserted and left in place for exactly 3 weeks, then removed. Exactly 1 week after removal, a new ring should be inserted for the following 3 weeks. Always insert and remove NuvaRing on the same day of the week, at approximately the same time of day.

How should you take Etonogestrel and Ethinyl estradiol vaginal ring?

Wash and dry your hands and remove NuvaRing from its foil pouch. Choose the position that is most comfortable for you, such as lying down, squatting, or standing with one leg up. Hold NuvaRing between your thumb and index finger and press the opposite sides of the ring together. Gently push the folded ring into your vagina. The exact position of the ring is not important for it to work. If you feel discomfort, use your finger to gently push NuvaRing further into the vagina. Most women do not feel the ring once it is in place, although some are aware of it.

Leave the ring in place for exactly 3 weeks, then remove it. Hook your index finger under the forward rim or hold the rim between your index finger and middle finger and pull the ring out. Place the used ring in the foil pouch it came in and dispose of it in the garbage, away from children and pets. Do not discard in the toilet.

Your menstrual period will usually start 2 to 3 days after the ring is removed and may not have finished before it's time to insert the next ring. For continued pregnancy protection, you need to insert the new ring exactly 1 week after the old one was removed, even if your period has not stopped.

--If you miss a dose...

If NuvaRing slips out, you'll still be protected against pregnancy provided the ring is replaced within 3 hours. You can use the old ring (after rinsing it with cool or lukewarm water) or insert a new ring. Remove the ring according to your original schedule.

If you're unable to replace the ring within 3 hours, insert it as soon as possible and use an additional method of birth control for 7 days.

If you forget and leave the ring in place for an extra week, remove it, take a one-week break, and reinsert a new one on day 7. If you leave the ring in place for more than 4 weeks you may not be adequately protected against pregnancy.

If you miss a menstrual period, you should check to be sure you are not pregnant if any of the following circumstances apply:

--If NuvaRing was out of the vagina for more than 3 hours during the 3 weeks of ring use

--If you waited longer than 1 week to insert a new ring after removing the old one

--If you followed the instructions but miss 2 periods in a row

--If you have left NuvaRing in place for longer than 4 weeks.

--Storage instructions...

Store at room temperature and avoid sunlight. Discard unused rings after the expiration date marked on the label.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue using NuvaRing.

  • More common side effects may include:
    Abdominal cramps, allergic rash, bloating, blood clots, breakthrough bleeding and spotting, breast secretions, change in menstrual flow, changes in the breast such as tenderness or enlargement, dark pigmentation of the skin, decreased milk production in nursing mothers, depression, emotional instability, gallbladder disease, headaches, heart attack, high blood pressure, intolerance to contact lenses, liver disease, liver tumors, migraine headaches, missed periods, nausea, problems with the ring, sinus inflammation, stroke, swelling, temporary infertility after discontinuing NuvaRing, upper respiratory tract infections, vaginal inflammation or discharge, vision problems, vomiting, weight gain or loss, yeast infections, yellow tint to the skin

Why should Etonogestrel and Ethinyl estradiol vaginal ring not be prescribed?

Do not use NuvaRing if you have any of the following conditions:

A clotting disorder (past or present)
A tendency for strokes or mini-strokes (past or present)
Heart disease (past or present)
A heart valve disorder
Severe high blood pressure
Diabetes with impaired circulation
Certain types of headaches
Breast cancer (past or present)
Endometrial cancer or any other estrogen-dependent cancer
Unexplained vaginal bleeding
Liver disease or liver tumors
Jaundice during pregnancy or from prior hormonal contraceptive use
Smoking 15 or more cigarettes per day past age 35
Planned surgery that will keep you immobilized
Allergy to any component of NuvaRing

Special warnings about Etonogestrel and Ethinyl estradiol vaginal ring

Hormonal contraceptives pose a slightly increased risk of blood clots and related disorders such as phlebitis, heart disease, heart attack, vision loss, and stroke. Smoking and advancing age increase this risk.

The estrogen in hormonal contraceptives also appears to cause a slight increase in the risk of breast cancer while the contraceptives are in use. This increase subsides after the contraceptives are stopped.

The risk of developing dangerous liver tumors also goes up very slightly. If you develop signs of liver problems, such as yellowing of the skin or whites of the eyes, you should stop using NuvaRing. Hormonal contraceptives can also hasten the development of gallbladder disease in susceptible women.

If you have diabetes, hormonal contraceptives may worsen the problem. In a few women, they cause an increase in triglyceride (blood fat) levels as well.

Especially in older women, hormonal contraceptives may foster an increase in blood pressure. If you already suffer from high blood pressure or kidney disease, it's best to avoid these drugs. If you do decide to use them and sustain an increase in blood pressure, you'll have to discontinue their use.

Similarly, if NuvaRing triggers migraine headaches or makes them worse, you'll need to stop using this product.

Hormonal contraceptives sometimes leave the user depressed. If you've suffered from depression in the past, use NuvaRing with caution. If you become depressed, alert your doctor immediately; you may need to discontinue use of NuvaRing.

Remember that NuvaRing, like other forms of hormonal contraception, does not protect against HIV infection (AIDS) and other sexually transmitted diseases.

Possible food and drug interactions when taking Etonogestrel and Ethinyl estradiol vaginal ring

If NuvaRing is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining NuvaRing with the following:

Acetaminophen (Tylenol)
Antibiotics such as ampicillin and tetracycline
Anticonvulsants such as Dilantin, Phenobarbital, Tegretol, Trileptal, Topamax, Felbatol
Antifungals such as Gris-PEG, Nizoral, Sporanox
Atorvastatin (Lipitor)
Clofibrate (Atromid-S)
Cyclosporine (Neoral, Sandimmune)
HIV drugs classified as protease inhibitors (Agenerase, Crixivan, Fortovase, Invirase, Kaletra, Norvir, Viracept)
Morphine (Astramorph, Kadian, MS Contin)
Prednisolone (Prelone)
Rifadin (rifampin)
St. John's wort
Theophylline (Theo-Dur)
Vitamin C

Special information if you are pregnant or breastfeeding

NuvaRing should not be used during pregnancy or while nursing.

Recommended dosage


NuvaRing is inserted in the vagina once a month. It stays in the vagina continuously for three weeks. It must be removed exactly 21 days after insertion. A new ring is inserted precisely 7 days later.

The time to start use of NuvaRing depends on your previous contraceptive program:

If you did not use a hormonal contraceptive in the past month

Count the first day of your menstrual period as day 1. Insert the first ring between day 1 and day 5 of the cycle, even if you are still bleeding on day 5. During the first cycle, use an extra method of birth control such as male condoms or spermicide for the first 7 days of ring use.

If you are switching from a combination birth control pill

Insert NuvaRing any time during the first 7 days after the last tablet and no later than the day you would have started a new pill cycle. No extra birth control method is needed.

If you are switching from a progestin-only contraceptive

When you are switching from a progestin-only contraceptive, use an extra method of birth control, such as male condoms or spermicide, for the first 7 days after inserting NuvaRing.

  • If you are switching from the "mini-pill," you can start using NuvaRing on any day of the month. Do not skip days between your last pill and first day of NuvaRing use.
  • If you are switching from a progestin implant (Norplant), start using NuvaRing on the same day you have your implant removed.
  • If you are switching from an injectable contraceptive (Depo-Provera), start using NuvaRing on the day when your next injection is due.
  • If you are switching from a progestin-containing IUD, start using NuvaRing on the same day you have your IUD removed.

Following a first trimester abortion or miscarriage

If you start using NuvaRing within 5 days after a complete first trimester abortion or miscarriage, you do not need to use an extra method of contraception. If more than 5 days have passed, proceed as you would if you had not used a hormonal contraceptive for the past month.


Given the design of NuvaRing, it is unlikely that overdosage will occur. Symptoms of overdose with other hormonal contraceptives include nausea, vomiting, vaginal bleeding, and other menstrual irregularities.

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