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Last reviewed on RxList: 5/17/2016
NuvaRing Patient Information Including Side Effects

Brand Names: NuvaRing

Generic Name: ethinyl estradiol and etonogestrel (vaginal ring) (Pronunciation: ETH in il es tra DYE ole and et oh noe JES trel)

What is ethinyl estradiol and etonogestrel (NuvaRing)?

Ethinyl estradiol and etonogestrel contains 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 vaginal ring is used as contraception to prevent pregnancy.

Ethinyl estradiol and etonogestrel may also be used for purposes not listed in this medication guide.

What are the possible side effects of this medication (NuvaRing)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using this medication and call your doctor at once if you have a serious side effect such as:

  • sudden numbness or weakness, especially on one side of the body;
  • sudden and severe headache, confusion, problems with vision, speech, or balance;
  • chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
  • sudden cough, wheezing, rapid breathing, coughing up blood;
  • pain, swelling, warmth, or redness in one or both legs;
  • a change in the pattern or severity of migraine headaches;
  • nausea, upper stomach pain, itching, 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, tired feeling, mood changes).

Less serious side effects may include:

  • mild nausea, vomiting, bloating, stomach cramps, changes in weight or appetite;
  • breast pain, tenderness, or swelling;
  • headache, nervousness, dizziness, tired feeling;
  • freckles or darkening of facial skin, increased hair growth, loss of scalp hair;
  • problems with contact lenses; or
  • vaginal itching or discharge, changes in your menstrual periods, decreased sex drive.

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.

What is the most important information I should know about this medication (NuvaRing)?

Do not use this medication if you are pregnant or if you have recently had a baby.

You should not use this medication if you have any of the following conditions: uncontrolled high blood pressure, heart disease, a blood-clotting disorder, circulation problems, diabetic problems with your eyes or kidneys, unusual vaginal bleeding, liver disease or liver cancer, severe migraine headaches, if you smoke and are over 35, or if you have ever had breast or uterine cancer, jaundice caused by birth control pills, a heart attack, a stroke, or a blood clot.

You may need to use back up birth control, such as condoms or a spermicide, when you first start using this medication or if you miss a dose. Avoid using a diaphragm with the ethinyl estradiol and etonogestrel vaginal ring. Follow your doctor's instructions.

Smoking can increase your risk of blood clots, stroke, or heart attack caused by this medication, especially if you are older than 35.

NuvaRing Patient Information including How Should I Take

What should I discuss with my healthcare provider before using this medication (NuvaRing)?

This medication can cause birth defects. Do not use if you are pregnant. Tell your doctor right away if you become pregnant, or if you miss two menstrual periods in a row. If you have recently had a baby, wait at least 4 weeks before using an ethinyl estradiol and etonogestrel vaginal ring.

You should not use this medication if you have:

  • untreated or uncontrolled high blood pressure;
  • heart disease, circulation problems, history of heart attack, stroke, or blood clot;
  • a history of hormone-related cancer such as breast or uterine cancer;
  • unusual vaginal bleeding that has not been checked by a doctor;
  • severe migraine headaches (with aura, numbness, weakness, or vision changes), especially if you are older than 35;
  • liver disease or liver cancer, a history of jaundice caused by pregnancy or birth control pills; or
  • if you smoke and are over 35 years old.

To make sure you can safely use a vaginal ring tell your doctor if you have any of these other conditions:

  • high blood pressure, varicose veins, high cholesterol or triglycerides, or if you are overweight;
  • a history of depression;
  • diabetes, underactive thyroid, gallbladder disease;
  • seizures or epilepsy;
  • tuberculosis;
  • a history of irregular menstrual cycles, toxic shock syndrome, or easy vaginal irritation;
  • prolapsed (dropped) uterus, bladder, or rectum;
  • severe constipation; or
  • a history of fibrocystic breast disease, lumps, nodules, or an abnormal mammogram.

The hormones in this medication can pass into breast milk and may harm a nursing baby. Ethinyl estradiol and etonogestrel may also slow breast milk production. Do not use if you are breast feeding a baby.

How should I use this medication (NuvaRing)?

Use exactly as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label. This medication comes with patient instructions for safe and effective use. Follow these directions carefully.

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. Avoid using a diaphragm. Follow your doctor's instructions.

The 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. 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.

If you need surgery or medical tests or if you will be on bed rest, you may need to stop using this medication for a short time. Any doctor or surgeon who treats you should know that you are using the vaginal ring.

Store unused vaginal rings at room temperature away from moisture, heat, and light. 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.

NuvaRing Patient Information including If I Miss a Dose

What happens if I miss a dose (NuvaRing)?

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.

What happens if I overdose (NuvaRing)?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include nausea, vomiting, and vaginal bleeding.

What should I avoid while using this medication (NuvaRing)?

Smoking can increase your risk of blood clots, stroke, or heart attack caused by this medication, especially if you are older than 35.

This medication 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.

What other drugs will affect ethinyl estradiol and etonogestrel (NuvaRing)?

Some drugs can make birth control less effective, which may result in pregnancy. Before using this medication, tell your doctor if you are using any of the following drugs:

  • bosentan (Tracleer);
  • an antibiotic or antifungal medication;
  • drugs to treat hepatitis C, HIV, or AIDS;
  • phenobarbital (Solfoton) and other barbiturates;
  • St. John's wort; or
  • seizure medications.

Tell your doctor about all other medicines you use, especially:

  • acetaminophen (Tylenol) or ascorbic acid (vitamin C);
  • atorvastatin (Lipitor, Caduet);
  • dantrolene (Dantrium);
  • vaginal miconazole (Monistat);
  • tizanidine (Zanaflex); or
  • tranexamic acid (Cyklokapron, Lysteda).

This list is not complete and other drugs may interact with ethinyl estradiol and etonogestrel. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

Your pharmacist can provide more information about ethinyl estradiol and etonogestrel.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

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