Generic Name: ethinyl estradiol and etonogestrel (ETH in il es tra DYE ole and et oh noe JES trel)Brand Names: NuvaRing
Ethinyl estradiol and etonogestrel is a combination of female hormones that prevent ovulation (the release of an egg from an ovary). This medication also causes changes in your cervical mucus and uterine lining, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus.
Ethinyl estradiol and etonogestrel is used as contraception to prevent pregnancy.
Ethinyl estradiol and etonogestrel may also be used for other purposes not listed in this medication guide.What is the most important information I should know about ethinyl estradiol and etonogestrel?This medication can cause birth defects. Do not use if you are pregnant. Tell your doctor right away if you become pregnant. Do not use this medication if you have any of the following conditions: a history of stroke or blood clot, circulation problems (especially if caused by diabetes), a hormone-related cancer such as breast or uterine cancer, abnormal vaginal bleeding, liver disease or liver cancer, severe high blood pressure, migraine headaches, a heart valve disorder, or a history of jaundice caused by birth control pills.
You may need to use back-up birth control, such as condoms or a spermicide, when you first start using this medication. Avoid using a diaphragm with the ethinyl estradiol and etonogestrel vaginal ring. Follow your doctor's instructions.Taking hormones can increase your risk of blood clots, stroke, or heart attack, especially if you smoke and are older than 35. The ethinyl estradiol and etonogestrel vaginal ring will not prevent pregnancy if you wear it only during intercourse. You must wear the ring for 3 full weeks, followed by 1 full week without a ring. The timing of ring insertion and removal is very important for this medicine to be effective as a form of birth control.
Some drugs can make ethinyl estradiol and etonogestrel less effective, which may result in pregnancy. Tell your doctor about all the prescription and over-the-counter medications you use, including vitamins, minerals and herbal products. Do not start using a new medication without telling your doctor.What should I discuss with my healthcare provider before using ethinyl estradiol and etonogestrel?This medication can cause birth defects. Do not use if you are pregnant. Tell your doctor right away if you become pregnant. Do not use this medication if you are allergic to ethinyl estradiol or etonogestrel, or if you have:
a history of stroke or blood clot;
circulation problems (especially if caused by diabetes);
a hormone-related cancer such as breast or uterine cancer;
abnormal vaginal bleeding;
liver disease or liver cancer;
severe high blood pressure;
severe migraine headaches;
a heart valve disorder; or
a history of jaundice caused by birth control pills.
If you have any of these other conditions, you may need a dose adjustment or special tests to safely take ethinyl estradiol and etonogestrel.
high blood pressure, heart disease, congestive heart failure, angina (chest pain), or a history of heart attack;
high cholesterol or triglycerides;
a history of depression;
seizures or epilepsy;
a history of irregular menstrual cycles, toxic shock syndrome, or easy vaginal irritation;
prolapsed (dropped) uterus, bladder, or rectum;
a history of fibrocystic breast disease, lumps, nodules, or an abnormal mammogram;
severe constipation; or
Use this medication exactly as it was prescribed for you. Do not use the medication in larger amounts, or use it for longer than recommended by your doctor. Follow the directions on your prescription label.
This medication comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.
Your doctor will tell which day of your menstrual cycle to insert the first vaginal ring you use. During the first 7 days of using your first vaginal ring, you may need to use back-up birth control, such as condoms or a spermicide. Follow your doctor's instructions.
The ethinyl estradiol and etonogestrel vaginal ring should be left in place for 3 full weeks. Remove the ring after 3 weeks, on the same day of the week it was inserted at about the same time of day. Allow 1 full week to pass before inserting the new ring.
Your period should start during the week you do not wear a vaginal ring. Insert the new ring on the same day of the week it was inserted in the last cycle, even if your menstrual period has not ended yet.The ethinyl estradiol and etonogestrel vaginal ring will not prevent pregnancy if you wear it only during intercourse. You must wear the ring for 3 full weeks, followed by 1 full week without a ring. The timing of ring insertion and removal is very important for this medicine to be effective as a form of birth control.
The ring does not need to be removed during sexual intercourse. Neither partner should be able to feel the ring when it is in place. If the ring is bothersome, you may remove it, rinse it with warm water, and reinsert it after intercourse. Do not leave the ring out for longer than 3 hours.
To dispose of a used vaginal ring, place it in the foil pouch it came in and throw it away where children and pets cannot get to it. Do not flush the ring down a toilet.
Have regular physical exams and self-examine your breasts for lumps on a monthly basis while using estradiol vaginal.Store this medication at room temperature away from moisture, heat, and light.
If the ring ever falls out during the 3-week wearing time, rinse it with warm water and reinsert it. If it slides down into the lower part of the vagina, use a finger to push it in farther. If the ring is lost, a new vaginal ring should be inserted as soon as possible and the schedule continued without change. Do not leave a ring out for longer than 3 hours.
During week 1 or 2 of wearing time: If a ring has been out of the vagina for more than 3 hours, you may not be protected from pregnancy. You must use a back-up birth control until the new or replaced ring has been in place for 7 days in a row.
During week 3 of wearing time: If a ring has been out of the vagina for more than 3 hours, you may either insert a new ring and start a new 3-week cycle, or you may wait 7 days (and have a menstrual period) before you insert a new ring. You must use back-up birth control until the new or replaced ring has been in place for 7 days in a row.
Avoid leaving the vaginal ring in place for longer than 3 weeks. Call your doctor if you get off the proper schedule for use and non-use of the vaginal ring. Do not wear more than one ring at a time.
Ethinyl estradiol and etonogestrel will not protect you from sexually transmitted diseases--including HIV and AIDS. Using a condom is the only way to protect yourself from these diseases.While using the ethinyl estradiol and etonogestrel vaginal ring, do not use a diaphragm as back-up birth control. The vaginal ring may interfere with the correct placement and position of the diaphragm
Vaginal lubricants, spermicides, and yeast infection treatments should not affect the vaginal ring. However, talk to your doctor before using other vaginal products while using the ethinyl estradiol and etonogestrel vaginal ring.
sudden numbness or weakness, especially on one side of the body;
sudden headache, confusion, pain behind the eyes, problems with vision, speech, or balance;
chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
a change in the pattern or severity of migraine headaches;
nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
swelling in your hands, ankles, or feet;
a breast lump; or
symptoms of depression (sleep problems, weakness, mood changes).
Less serious side effects may include:
mild nausea, vomiting, bloating, stomach cramps;
breast pain, tenderness, or swelling;
freckles or darkening of facial skin;
increased hair growth, loss of scalp hair;
changes in weight or appetite;
problems with contact lenses;
vaginal itching or discharge;
changes in your menstrual periods, decreased sex drive; or
headache, nervousness, dizziness, tired feeling.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Usual Adult Dose for Contraception:
Insert one vaginal ring in vagina and leave in place continuously for 3 weeks. Then, remove vaginal ring for a one-week break. A new vaginal ring is inserted one week after the last ring was removed.
Some drugs can make ethinyl estradiol and etonogestrel less effective, which may result in pregnancy. Before using this medication, tell your doctor if you are using any of the following drugs:
acetaminophen (Tylenol) or ascorbic acid (vitamin C);
griseofulvin (Grisactin, Grifulvin V, Fulvicin PG);
St. John's wort;
seizure medicines such as phenytoin (Dilantin), carbamazepine (Tegretol), felbamate (Felbatol), oxcarbazepine (Trileptal), topiramate (Topamax), or primidone (Mysoline);
a barbiturate such as amobarbital (Amytal), butabarbital (Butisol), mephobarbital (Mebaral), secobarbital (Seconal), or phenobarbital (Luminal, Solfoton); or
HIV medicines such as atazanavir (Reyataz), tipranavir (Aptivus), indinavir (Crixivan), saquinavir (Invirase), lopinavir/ritonavir (Kaletra), fosamprenavir (Lexiva), ritonavir (Norvir), or nelfinavir (Viracept).
This list is not complete and there may be other drugs that can interact with ethinyl estradiol and etonogestrel. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.