NuvaRing (generic: etonogestrel/ethinyl estradiol) is a prescription vaginal ring used to prevent pregnancy in women. NuvaRing contains two hormones which belong to a group of drugs called hormonal contraceptives. These hormones prevent pregnancy by stopping ovulation and by altering cervical mucus and the lining of the uterus.
This medication comes in the form of a vaginal ring that is inserted vaginally for three weeks, then removed for one week. This process is repeated each month.
Common side effects of NuvaRing include vaginal infections and irritation, vaginal secretion, headaches, and weight gain.
NuvaRing is a prescription medicine used to prevent pregnancy in women.
This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.
Risks and side effects of NuvaRing:
- Blood clots: The hormones in NuvaRing may cause changes in your blood clotting system which may allow your blood to clot more easily. If blood clots form in your legs, they can travel to the lungs and cause a sudden blockage of a vessel carrying blood to the lungs. Rarely, clots occur in the blood vessels of the eye and may cause blindness, double vision, or other vision problems. The risk of getting blood clots may be greater with the type of progestin in NuvaRing than with some other progestins in certain low-dose birth control pills. It is unknown if the risk of blood clots is different with NuvaRing use than with the use of certain birth control pills.
- Strokes and heart attacks: Hormonal contraceptive may increase your risk of strokes (blockage of blood flow to the brain) or heart attacks (blockage of blood flow to the heart). Any of these conditions can cause death or serious disability. Smoking greatly increases the risk of having strokes and heart attacks. Furthermore, smoking and the use of combination hormonal contraceptives, like NuvaRing, greatly increases the chances of developing and dying of heart disease. If you use combination hormonal contraceptives, including NuvaRing, you should not smoke.
- High blood pressure and heart disease: Combination hormonal contraceptives, including NuvaRing, can worsen conditions like high blood pressure, diabetes, and problems with cholesterol and triglycerides.
- Cancer of the reproductive organs and breast: Breast cancer has been diagnosed slightly more often in women who use the pill than in women of the same age who do not use the pill. This small increase in the number of breast cancer diagnoses gradually disappears during the 10 years after stopping use of the pill. It is not known whether the difference is caused by the pill. It may be that women taking the pill are examined more often, so that breast cancer is more likely to be detected. You should have regular breast examinations by a healthcare provider and examine your own breasts monthly. Tell your healthcare provider if you have a family history of breast cancer or if you have had breast nodules or an abnormal mammogram.
- Gallbladder disease: Combination hormonal contraceptive users may have a higher chance of having gallbladder disease.
- Liver tumors: In rare cases, combination hormonal contraceptives, like NuvaRing, can cause non-cancerous (benign) but dangerous liver tumors. These benign liver tumors can break and cause fatal internal bleeding. In addition, it is possible that women who use combination hormonal contraceptives, like NuvaRing, have a higher chance of getting liver cancer. However, liver cancers are extremely rare.
- Lipid metabolism and inflammation of the pancreas: In women with inherited defects of lipid metabolism, there have been reports of significant elevations of plasma triglycerides during estrogen therapy. This has led to pancreatitis in some cases.
The common side effects reported by NuvaRing users are:
- vaginal infections and irritation
- vaginal secretion
- weight gain
In addition to the risks and side effects listed above, users of combination hormonal contraceptives have reported the following side effects:
- change in appetite
- abdominal cramps and bloating
- breast tenderness or enlargement
- irregular vaginal bleeding or spotting
- changes in menstrual cycle
- temporary infertility after treatment
- fluid retention (edema)
- spotty darkening of the skin, particularly on the face
- weight changes
- intolerance to contact lenses
- loss of scalp hair
Call your healthcare provider right away if you get any of the symptoms listed below. They may be signs of a serious problem:
- sharp chest pain, coughing blood, or sudden shortness of breath (possible clot in the lung)
- pain in the calf (back of lower leg; possible clot in the leg)
- crushing chest pain or heaviness in the chest (possible heart attack)
- sudden severe headache or vomiting, dizziness or fainting, problems with vision or speech, weakness, or numbness in an arm or leg (possible stroke)
- sudden partial or complete loss of vision (possible clot in the eye)
- yellowing of the skin or whites of the eyes (jaundice), especially with fever, tiredness, loss of appetite, dark colored urine, or light colored bowel movements (possible liver problems)
- severe pain, swelling, or tenderness in the abdomen (gallbladder or liver problems)
- sudden fever (usually 102°F or more), vomiting, diarrhea, dizziness, fainting, or a sunburn-like rash on the face or body (very rarely, toxic shock syndrome)
- breast lumps (possible breast cancer or benign breast disease)
- irregular vaginal bleeding or spotting that happens in more than one menstrual cycle or lasts for more than a few days
- urgent, frequent, burning and/or painful urination, and cannot locate the ring in the vagina (rarely, accidental placement of NuvaRing into the urinary bladder)
- swelling (edema) of your fingers or ankles
- difficulty in sleeping, weakness, lack of energy, fatigue, or a change in mood (possible severe depression)
- The hormones in NuvaRing can interact with many other medicines and herbal supplements. Tell your doctor about any medicines you are taking, including prescription medicines, over-the-counter medicines, herbal remedies, and vitamins.
- The blood levels of the hormones released by NuvaRing were increased when women used a vaginal medication (miconazole nitrate) for a yeast infection while NuvaRing was in place. The pregnancy protection of NuvaRing is not likely to be changed by use of these products. The blood levels of these hormones were not changed when women used vaginal, water-based spermicides (nonoxynol or N-9 products) along with NuvaRing.
- Certain drugs and herbal supplements may interact with combined hormonal contraceptives to make them less effective in preventing pregnancy or cause an increase in breakthrough bleeding
- Such drugs include rifampin, drugs used for epilepsy such as barbiturates (for example, phenobarbital), carbamazepine, and phenytoin, primidone, topiramate, phenylbutazone, modafinil, and some drugs used for HIV such as ritonavir. Pregnancies and breakthrough bleeding have been reported by users of combined hormonal contraceptives who also used the herbal supplement St. John's Wort.
- You may need to use a non-hormonal method of contraception during any cycle in which you take drugs that can make oral contraceptives less effective. Be sure to tell your doctor if you are taking or start taking any other medications, including non-prescription products or herbal products while using NuvaRing.
- While using NuvaRing, you should not rely upon a diaphragm when you need a back-up method of birth control because NuvaRing may interfere with the correct placement and position of a diaphragm.
- If you are scheduled for any laboratory tests, tell your doctor or doctor you are using NuvaRing. Contraceptive hormones may change certain blood tests results.
Cigarette smoking increases the risk of serious cardiovascular side effects when you use combination oral contraceptives. This risk increases even more if you are over age 35 and if you smoke 15 or more cigarettes a day. Women who use combination hormonal contraceptives, including NuvaRing, are strongly advised not to smoke.
Do not use NuvaRing if you have any of the following conditions:
- a history of heart attack or stroke
- a history of blood clots in your legs (thrombophlebitis), lungs (pulmonary embolism), or eyes
- a history of blood clots in the deep veins of your legs
- chest pain (angina pectoris)
- severe high blood pressure
- diabetes with complications of the kidneys, eyes, nerves, or blood vessels
- headaches with neurological symptoms
- known or suspected breast cancer or cancer of the lining of the uterus, cervix, or vagina (now or in the past)
- unexplained vaginal bleeding (until a diagnosis is reached by your healthcare provider)
- yellowing of the whites of the eyes or of the skin (jaundice) during pregnancy or during previous use of hormonal birth control of any kind (the pill, patch, vaginal ring, injection, or implant)
- liver tumor (benign or cancerous)
- heart valve or heart rhythm disorders that may be associated with formation of blood clots
- need for a long period of bed rest following major surgery
- known or suspected pregnancy
- active liver disease with abnormal liver function tests
- an allergy or hypersensitivity to any of the components of NuvaRing
NuvaRing does not protect against HIV infection (AIDS) and other sexually transmitted diseases.
Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of NuvaRing there are no specific foods that you must exclude from your diet when receiving NuvaRing.
Talk with your doctor about using NuvaRing if you:
- recently had a baby
- recently had a miscarriage or abortion
- are breast-feeding
- are taking other medications
In addition, talk to your doctor about using NuvaRing if you have any of the following conditions. Women with any of these conditions should be checked often by their doctor if they choose to use NuvaRing.
- a family history of breast cancer
- breast nodules, fibrocystic disease, an abnormal breast x-ray, or abnormal mammogram
- elevated cholesterol or triglycerides
- high blood pressure
- migraine or other headaches or epilepsy
- gallbladder, liver, heart, or kidney disease
- scanty or irregular menstrual periods
- plan to have major surgery (You may need to stop using NuvaRing for a while to reduce your chance of getting blood clots.)
- any condition that makes the vagina get irritated easily
- prolapsed (dropped) uterus, dropped bladder (cystocele), or rectal prolapse (rectocele)
- severe constipation
- history of toxic shock syndrome
NuvaRing should not be used during pregnancy. Call your doctor right away if you become pregnant while using NuvaRing.
Do not breastfeed while using NuvaRing. Some of the medicine may pass through the milk to the baby and could cause yellowing of the skin (jaundice) and breast enlargement in your baby. NuvaRing could also decrease the amount and quality of your breast milk.
For the best protection from pregnancy, use NuvaRing exactly as directed. Insert one NuvaRing in the vagina and keep it in place for three weeks in a row. Remove it for a one-week break and then insert a new ring. During the one-week break, you will usually have your menstrual period. Your healthcare provider should examine you at least once a year to see if there are any signs of side effects of NuvaRing use.
Follow the instructions in one of the sections below to find out when to start using NuvaRing:
- If you did not use a hormonal contraceptive in the preceding cycle:
- Insert NuvaRing on the first day of your cycle, (i.e., the first day of menstrual bleeding). NuvaRing will work immediately, it is not necessary to use an additional contraceptive method. You may also start on days 2–5 of your cycle, but in this case make sure you also use an extra method of birth control (barrier method), such as male condoms or spermicide for the first seven days of NuvaRing use in the first cycle.
- If you are changing from a combined hormonal contraceptive pill or patch (containing both progestin and estrogen):
- Switch from your previous combined hormonal contraceptive on any day, but at the latest on the day following the usual hormone-free interval by inserting NuvaRing. If you have been using your hormonal contraceptive method consistently and correctly, no extra birth control method should be needed.
- If you are changing from a progestagen-only method (minipill, implant or injection) or from a progestagen-releasing intrauterine system (IUS):
- You may switch on any day from a minipill. You should switch from an implant or the IUS on the day of its removal and from an injectable on the day when the next injection would be due. In all of these cases, you should use an extra method of birth control, such as a male condom or spermicide, for the first seven days of ring use.
- Following first trimester abortion or miscarriage:
- If you start using NuvaRing within five days after a complete first trimester abortion or miscarriage, you do not need to use an extra method of contraception.
- If NuvaRing is not started within five days after a first trimester abortion or miscarriage, begin NuvaRing at the time of your next menstrual period. Counting the first day of your menstrual period as "Day 1", insert NuvaRing on or before Day 5 of the cycle, even if you have not finished bleeding. During this first cycle, use an extra method of birth control, such as male condoms or spermicide, for the first seven days of ring use.
When to insert a new ring:
- After no more than a one-week ring-free break, insert a new ring on the same day of the week as it was removed in the last cycle. If the ring-free interval has been extended beyond one week, the possibility of pregnancy should be considered, and an extra method of birth control, such as male condoms or spermicide, MUST be used until NuvaRing has been used continuously for seven days.
If NuvaRing slips out:
- NuvaRing can accidentally slip out of the vagina while removing a tampon, during intercourse, or straining during a bowel movement. If NuvaRing slips out of the vagina and it has been out for less than three hours, you should still be protected from pregnancy. NuvaRing can be rinsed with cool to lukewarm (not hot) water and reinserted as soon as possible, and at the latest within three hours of removal or expulsion (slipping out).
You must check to be sure that you are not pregnant if: 1. you miss a period and NuvaRing was out of the vagina for more than three hours during the three weeks of ring use 2. you miss a period and waited longer than one week to insert a new ring 3. you have followed the instructions and you miss two periods in a row 4. you have left NuvaRing in place for longer than four weeks
Use of tampons will not reduce the contraceptive efficacy of NuvaRing. Insert NuvaRing before inserting a tampon. You should pay particular attention when removing a tampon to be sure that the ring is not accidentally pulled out. If this should occur, simply rinse the ring in cool to lukewarm (not hot) water and immediately reinsert it.
Use of spermicides or vaginal yeast products will not reduce the contraceptive efficacy of NuvaRing.
There have been reported cases of NuvaRing disconnecting at the weld joint causing the ring to change shape and straighten out. This is not expected to affect the contraceptive effectiveness of NuvaRing. If NuvaRing disconnects, expulsion (slipping out) is more likely to occur. If you discover the ring has disconnected, you should discard the ring and replace it with a new ring.
To achieve maximum contraceptive effectiveness, NuvaRing must be used as directed. One NuvaRing is inserted in the vagina. The ring is to remain in place continuously for three weeks. It is removed for a one-week break, during which a withdrawal bleed usually occurs. A new ring is inserted one week after the last ring was removed.
Deviations from the Recommended Regimen:
To prevent loss of contraceptive efficacy, women should not deviate from the recommended regimen. NuvaRing should be left in the vagina for a continuous period of three weeks.
Inadvertent removal, expulsion, or prolonged ring-free interval:
If the ring is accidentally expelled and is left outside of the vagina for less than three hours contraceptive efficacy is not reduced. NuvaRing can be rinsed with cool to lukewarm (not hot) water and reinserted as soon as possible, but at the latest within three hours. If NuvaRing is lost, a new vaginal ring should be inserted and the regimen should be continued without alteration.
If NuvaRing is out of the vagina for more than three continuous hours:
During Weeks 1 and 2:
If NuvaRing has been out of the vagina for more than three continuous hours during the 1st or 2nd week of use, contraceptive efficacy may be reduced. The woman should reinsert the ring as soon as she remembers. A barrier method such as condoms or spermicides must be used until the ring has been used continuously for seven days.
During Week 3:
If NuvaRing has been out of the vagina for more than three continuous hours during the 3rd week of the three-week use period, the woman should discard that ring. One of the following two options should be chosen:
- Insert a new ring immediately. Inserting a new ring will start the next three-week use period. The woman may not experience a withdrawal bleed from her previous cycle. However, breakthrough spotting or bleeding may occur.
- Have a withdrawal bleeding and insert a new ring no later than seven days (7×24 hours) from the time the previous ring was removed or expelled. This option should only be chosen if the ring was used continuously for the preceding seven days.
A barrier method such as condoms or spermicides must be used until the new ring has been used continuously for seven days.
If NuvaRing is out of the vagina for more than one week:
If the ring-free interval has been extended beyond one week, the possibility of pregnancy should be considered, and an additional method of contraception, such as male condoms or spermicide, MUST be used until NuvaRing has been used continuously for seven days.
If NuvaRing has been left in place for up to one extra week (i.e., up to four weeks total), the woman will remain protected. NuvaRing should be removed and the woman should insert a new ring after a one-week ring-free interval. If NuvaRing has been left in place for longer than four weeks, pregnancy should be ruled out, and an additional method of contraception, such as male condoms or spermicide, MUST be used until a new NuvaRing has been used continuously for seven days.
In the event of a missed menstrual period:
- If the woman has not adhered to the prescribed regimen (NuvaRing has been out of the vagina for more than three hours or the preceding ring-free interval was extended beyond one week) the possibility of pregnancy should be considered at the time of the first missed period and NuvaRing use should be discontinued if pregnancy is confirmed.
- If the woman has adhered to the prescribed regimen and misses two consecutive periods, pregnancy should be ruled out.
- If the woman has retained one NuvaRing for longer than four weeks, pregnancy should be ruled out.
NuvaRing is unlikely to cause an overdose because the ring holding the medicine releases a steady amount of contraceptive hormones. Do not use more than one ring at a time. Overdose of combination hormonal contraceptives may cause nausea, vomiting, or vaginal bleeding.
Each NuvaRing (etonogestrel/ethinyl estradiol vaginal ring) is individually packaged in a reclosable aluminum laminate sachet consisting of three layers, from outside to inside: polyester, aluminum foil, and low-density polyethylene. The ring should be replaced in this reclosable sachet after use for convenient disposal.
- Store NuvaRing at room temperature, 25°C (77°F). Temperatures can be from 59–86°F (15–30°C). Avoid direct sunlight or storing above 86°F (30°C).
- Place the used ring in the reclosable foil pouch and properly dispose of it in a waste receptacle out of the reach of children and pets.
Cigarette smoking increases the risk of serious cardiovascular side effects from combination oral contraceptive use. This risk increases with age and with heavy smoking (15 or more cigarettes per day) and is quite marked in women over 35 years of age. Women who use combination hormonal contraceptives, including NuvaRing, should be strongly advised not to smoke.
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