ETHINYL ESTRADIOL

COMMON BRAND NAME(S): Nuvaring

GENERIC NAME(S): ETONOGESTREL/ETHINYL ESTRADIOL

This product is a vaginal ring used to prevent pregnancy. It contains progestin (etonogestrel) and estrogen (ethinyl estradiol) that prevents the release of an egg (ovulation) during your menstrual cycle. It also makes vaginal fluid thicker to help prevent sperm from reaching an egg (fertilization) and changes the lining of the uterus (womb) to prevent attachment of a fertilized egg.

Using this product does not protect you or your partner against sexually transmitted diseases (such as HIV, gonorrhea, chlamydia).

How to use etonogestrel-ethinyl estradiol vaginal

Read the Patient Information Leaflet provided by your pharmacist before you start using this product and each time you get a refill. The leaflet contains very important information on how to properly use and dispose of the vaginal ring. If you have any questions, ask your doctor or pharmacist.

This product is for vaginal use only. Before use, wash and dry your hands. Remove the ring from the reclosable foil pouch, keeping the pouch for later disposal of the used ring. Fold the ring in half and gently push it into your vagina as directed, until it feels comfortable. Although some women may be aware of the ring in the vagina, most women do not feel it once it is in place; it will not interfere with sexual intercourse (though your partner may be able to feel the ring). Unlike a diaphragm, the ring’s exact position in the vagina does not affect how well it works. Once inserted, keep the ring in place for 3 weeks in a row.

If this is the first time you are using the ring, use an additional form of non-hormonal birth control (such as condoms, spermicide) for the first 7 days to prevent pregnancy until the ring has enough time to work. Do not use a diaphragm or cervical cap for additional birth control since the ring may interfere with proper placement. If you start using the ring on the first day of your period, you do not need to use back-up birth control the first week.

After using the ring for 3 weeks, remove it on the same day of the week and about the same time that you placed it. Place the used ring back into the foil pouch and discard in the trash. Do not flush the used ring down a toilet. If you have pain/bleeding when trying to remove the ring, or if you cannot remove it, tell your doctor right away.

Next, do not wear a ring for 1 week (7 days). You should have your period within 2 to 3 days after the ring is removed. After 1 ring-free week, insert a new ring on the same day of the week that you removed the old ring, whether or not you have your period. If you do not get your period, consult your doctor. Do not go longer than 7 days without a ring. Doing so will increase your risk of pregnancy.

The vaginal ring may accidentally fall out during sexual intercourse, during a bowel movement, or while removing a tampon. If this happens, rinse it with cool to lukewarm (not hot) water and re-insert the ring as soon as possible. If the ring has been out longer than 3 hours, or if you are not sure how long it has been out, you could become pregnant. Re-insert it or insert a new ring as directed and use an additional form of non-hormonal birth control (such as condoms, spermicide) for the next 7 days to prevent pregnancy.

If you have left the ring in place longer than directed, up to an extra week (4 weeks total), you will still be protected from pregnancy. Remove the ring and insert a new ring after 1 ring-free week. However, if you have left the ring in place longer than 4 weeks, you may not be protected from pregnancy. Remove the ring and contact your doctor for a pregnancy test before inserting a new ring and using additional back-up birth control for 7 days.

Rarely, the vaginal ring has broken at the weld joint after placement. This increases the chance of it slipping out of the vagina. If this happens, throw it away and use a new ring.

Ask your doctor or pharmacist about how to switch from other forms of hormonal birth control (such as birth control pills) to this product. If any information is unclear, consult the Patient Information Leaflet or your doctor or pharmacist.

Do not use this medication if you smoke cigarettes/use tobacco and are over 35 years old.

Tell your doctor or pharmacist promptly if any of these effects persist or worsen:

  • Vaginal discomfort/irritation
  • Nausea
  • Vomiting
  • Headache
  • Bloating
  • breast tenderness
  • swelling of the ankles/feet (fluid retention)
  • weight change
  • Vaginal bleeding between periods (spotting)

Tell your doctor right away if you have any serious side effects, including:

  • lumps in the breast
  • mental/mood changes (such as new/worsening depression)
  • severe stomach/abdominal pain
  • unusual changes in vaginal bleeding (such as continuous spotting, sudden heavy bleeding, missed periods)
  • dark urine
  • yellowing eyes/skin

Very rarely, the ring has been accidentally placed into the bladder.

This medication may rarely cause serious (sometimes fatal) problems from blood clots (such as deep vein thrombosis, heart attack, pulmonary embolism, stroke).

Rarely, a very serious (possibly fatal) bacterial infection (toxic shock syndrome-TSS) has occurred in women using vaginal rings.

A very serious allergic reaction to this drug is rare.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

Interactions

Some products that may interact with this drug include:

  • aromatase inhibitors (such as anastrozole, exemestane)
  • ospemifene
  • tamoxifen
  • tizanidine
  • tranexamic acid
  • a certain combination product used to treat chronic hepatitic C (ombitasvir, paritaprevir, ritonavir, dasabuvir)

Some drugs may cause hormonal birth control to work less well. Examples include:

  • Griseofulvin
  • Modafinil
  • rifamycins (such as rifampin, rifabutin)
  • John’s wort
  • drugs used to treat seizures (such as barbiturates, carbamazepine, felbamate, phenytoin, primidone, topiramate)
  • HIV drugs (such as nelfinavir, nevirapine, ritonavir)

Tell your doctor when you start any new drug, and discuss if you should use additional reliable birth control. Also tell your doctor if you have any new spotting or breakthrough bleeding, because these may be signs that your birth control is not working well.

This medication may interfere with certain laboratory tests (such as blood clotting factors, thyroid), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this medication.

Overdose

This product may be harmful if swallowed. Overdose with this product is highly unlikely. Do not use more than one ring at a time. If swallowing or overdose is suspected, remove the ring if possible and contact a poison control center or emergency room immediately.

Notes

Do not share this medication with others.

Keep all regular medical and laboratory appointments. You should have regular complete physical exams which include laboratory and medical tests (such as blood pressure, breast exam, pelvic exam, Pap smear) to monitor your progress and check for side effects. Follow your doctor’s instructions for examining your breasts, and report any lumps right away. Consult your doctor for more details.

Missed Dose

Refer to the product package information for instructions. You may need to use back-up birth control (such as condoms, spermicide) to prevent pregnancy. Ask your doctor or pharmacist if you have any questions.

If you have trouble remembering to remove and reinsert the ring as directed, or if it falls out repeatedly, contact your doctor to discuss switching to another form of birth control.

Storage

Different brands of this product have different storage needs. Check the product package for instructions on how to store your brand, or ask your pharmacist. Do not use after 4 months or after the expiration date, whichever comes first. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. (See also How to Use section.)

 

Brands

(Gracial) Aspen

Related Articles

ZADAXIN

Zadaxin is a synthetic 28-amino acid peptide with numerous biological properties that are mostly focused on enhancing the immune response. [...]

YEASTAZOL

Yeastazol is an imidazole derivative used topically as an antifungal drug. This drug works by inhibiting the formation of ergosterol, [...]

XAMBREX

Xambrex's active ingredient, Xambrex hydrochloride, has been shown to increase secretions from the respiratory tract. It makes more surfactant in [...]