Medication Guide App

Etonogestrel/ ethinyl estradiol ring

Generic Name: etonogestrel/ethinyl estradiol (e-TOE-noe-JES-trel/ETH-i-nil ES-tra-DYE-ol)
Brand Name: NuvaRing

Cigarette smoking while taking etonogestrel/ethinyl estradiol ring increases the risk of serious heart problems. The risk increases with age (older than 35 years old) and with the number of cigarettes smoked. Do not use etonogestrel/ethinyl estradiol ring if you smoke and are older than 35 years old.


Etonogestrel/ ethinyl estradiol ring is used for:

Preventing pregnancy. It may also be used for other conditions as determined by your doctor.

Etonogestrel/ethinyl estradiol ring is an estrogen/progestin combination. It works by preventing the release of eggs from the ovaries and thereby preventing pregnancy.

Do NOT use etonogestrel/ ethinyl estradiol ring if:

  • you are allergic to any ingredient in etonogestrel/ethinyl estradiol ring
  • you are pregnant or think you may be pregnant
  • you smoke and are older than 35 years old
  • you have heart valve problems or heart rhythm problems that could cause blood clots to form in the heart
  • you have or have had a history of blood clots (eg, in the lungs, legs, eyes), breast cancer, or any cancer that is sensitive to female hormones
  • you have ever had bleeding in the brain, stroke, heart attack, or other serious blood vessel problems
  • you have liver problems, uncontrolled high blood pressure, undiagnosed abnormal vaginal bleeding, or a condition that may increase your risk of blood clots
  • you have diabetes with kidney, eye, nerve, or blood vessel problems
  • you have certain kinds of headaches with aura, numbness, weakness, or changes in vision, or you have any migraine headaches and you are older than 35 years old

Contact your doctor or health care provider right away if any of these apply to you.

Slideshow: 2014 Update: First Time Brand-to-Generic Switches

Before using etonogestrel/ ethinyl estradiol ring:

Some medical conditions may interact with etonogestrel/ethinyl estradiol ring. Tell your health care provider if you have any medical conditions, especially if any of the following apply to you:

  • if you are pregnant, planning to become pregnant, or are breast-feeding
  • if you have recently had a baby, a miscarriage, or abortion
  • if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
  • if you have allergies to medicines, foods, or other substances
  • if you have a history of high blood pressure; high cholesterol or triglycerides levels; heart, liver, or kidney problems; pancreatitis; or gallbladder problems
  • if you have a history of breast nodules, fibrocystic disease of the breast, an abnormal breast x-ray or mammogram, or irregular or scanty menstrual periods
  • if you have diabetes, vision loss, a history of depression, migraines or other headaches, seizures, thyroid problems, or toxic shock syndrome (TSS)
  • if you smoke or are very overweight
  • if you have a condition called hereditary angioedema
  • if a member of your family has ever had a blood clot (eg, in the lung, leg), high triglycerides, or breast cancer
  • if you have a history of jaundice (yellowing of the eyes or skin) caused by pregnancy or estrogen use
  • if you will be confined to a bed or chair for an extended period of time (eg, because of surgery or a long airplane ride)

Some MEDICINES MAY INTERACT with etonogestrel/ethinyl estradiol ring. Tell your health care provider if you are taking any other medicines, especially any of the following:

  • Acetaminophen, azole antifungals (eg, ketoconazole), etravirine, HIV protease inhibitors (eg, indinavir), statins (eg, atorvastatin, rosuvastatin), or vitamin C because they may increase the risk of etonogestrel/ethinyl estradiol ring's side effects
  • Aprepitant, barbiturates (eg, phenobarbital), bosentan, carbamazepine, felbamate, griseofulvin, hydantoins (eg, phenytoin), nevirapine, oxcarbazepine, protease inhibitors (eg, boceprevir, ritonavir), rifamycins (eg, rifampin), rufinamide, St. John's wort, or topiramate because they may decrease etonogestrel/ethinyl estradiol ring's effectiveness. Use an extra form of birth control (eg, condoms) when you take medicines that may decrease etonogestrel/ethinyl estradiol ring's effectiveness.
  • Corticosteroids (eg, prednisone), cyclosporine, theophylline, tizanidine, and voriconazole because their side effects may be increased by etonogestrel/ethinyl estradiol ring
  • Lamotrigine or thyroid hormones (eg, levothyroxine) because their effectiveness may be decreased by etonogestrel/ethinyl estradiol ring

This may not be a complete list of all interactions that may occur. Ask your health care provider if etonogestrel/ethinyl estradiol ring may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use etonogestrel/ ethinyl estradiol ring:

Use etonogestrel/ethinyl estradiol ring as directed by your doctor. Check the label on the medicine for exact dosing instructions.

  • An extra patient leaflet is available with etonogestrel/ethinyl estradiol ring. Talk to your pharmacist if you have questions about this information.
  • Wash and dry your hands before removing the ring from the pouch. The ring becomes slippery when wet, so make sure your hands are dry.
  • To insert the ring, choose a comfortable position, such as lying down, squatting, or standing with one leg up. Hold the ring between your thumb and index finger and press the opposite sides of the ring together. Gently insert and push the folded ring into the vagina as far as comfortably possible. The exact position of the ring in the vagina is not important for it to work.
  • Rarely, some women have inserted the ring into the bladder by mistake. Do not insert the ring into your bladder. Insert the ring into the vagina.
  • You may not feel the ring once it is in place. If you feel discomfort, the ring is probably not inserted far enough in your vagina. Use your finger to gently push the ring further into your vagina. There is no danger in the ring being pushed too far up the vagina or getting lost. It can be inserted only as far as the end of the vagina. The cervix will block it from going any further.
  • The ring should not interfere with sexual intercourse.
  • Some women have experienced moving or gliding of the ring within the vagina due to bowel movements, straining, constipation, or coughing. If this occurs, push it back into place with your finger.
  • After insertion, the ring should be left in place for 3 weeks (21 days) and then removed. It should be removed at about the same time and on the same day of the week that it was inserted. To remove the ring, wash and dry your hands thoroughly. Find a comfortable position, either standing, squatting, or lying down. Loop your finger through the ring and gently pull it out. Discard the used ring in the trash container. Do not flush it down the toilet.
  • After removing the ring, wait 7 days and then insert a new ring. The new ring should be inserted at about the same time and on the same day of the week as it was inserted in the last cycle.
  • If the ring is removed or falls out of the vagina and remains out for less than 3 hours, rinse the ring with lukewarm water and reinsert it. No other contraceptive measures are necessary.
  • If the ring is removed or falls out of the vagina and remains out for more than 3 hours, follow the instructions for use that came with etonogestrel/ethinyl estradiol ring or call your doctor if you are not sure what to do. In this case, you may not be adequately protected from pregnancy. You must use an additional form of birth control (eg, male condoms, spermicide) until the ring has been in place for 7 days in a row.
  • If the ring is removed or falls out and is lost, or if the ring becomes disconnected at the joint, you must insert a new ring and use it on the same schedule as you would have used the lost or disconnected ring.
  • If you miss inserting the new ring on the scheduled day, insert it as soon as you remember. You must use a backup form of birth control until the new ring has been in place for 7 days. If you are not sure what to do if you miss inserting the new ring on the scheduled day, use an extra form of birth control (eg, condoms) and talk with your doctor.

Ask your health care provider any questions you may have about how to use etonogestrel/ethinyl estradiol ring.

Important safety information:

  • If you miss your period, call your doctor immediately. A missed period may indicate that you are pregnant.
  • Tell your doctor or dentist that you take etonogestrel/ethinyl estradiol ring before you receive any medical or dental care, emergency care, or surgery. Etonogestrel/ethinyl estradiol ring should be discontinued at least 4 weeks before and through 2 weeks after surgery or any time you will be confined to a chair or bed for a long period of time (eg, a long plane flight). Talk to your doctor about the safe use of etonogestrel/ethinyl estradiol ring if any of these conditions apply to you.
  • Etonogestrel/ethinyl estradiol ring may cause dark skin patches on your face (melasma). Exposure to the sun may make these patches darker. Ask your doctor whether you should use sunscreen or wear protective clothing when your skin is exposed to the sun, sunlamps, or tanning booths.
  • Bleeding or spotting may occur while taking etonogestrel/ethinyl estradiol ring. Do not stop taking etonogestrel/ethinyl estradiol ring if this occurs. If bleeding or spotting continues for more than 7 days or is heavy, contact your doctor.
  • Etonogestrel/ethinyl estradiol ring may increase the risk of stroke, heart attack, blood clots, high blood pressure, or similar problems. The risk may be greater if you smoke.
  • Some women have rarely placed etonogestrel/ethinyl estradiol ring into the bladder by mistake. Contact your doctor right away if you develop persistent bladder problems (eg, difficult or painful urination) and you can not locate the ring in your vagina.
  • If you wear contact lenses and you develop problems with them or with your vision, contact your doctor.
  • Use of etonogestrel/ethinyl estradiol ring will not prevent the spread of sexually transmitted diseases (STDs).
  • Grapefruit and grapefruit juice may increase the risk of side effects from etonogestrel/ethinyl estradiol ring. Talk with your doctor before including grapefruit or grapefruit juice in your diet while taking etonogestrel/ethinyl estradiol ring.
  • Diabetes patients - Etonogestrel/ethinyl estradiol ring may affect your blood sugar. Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine.
  • Etonogestrel/ethinyl estradiol ring may interfere with certain lab tests. Be sure your doctor and lab personnel know you are using etonogestrel/ethinyl estradiol ring.
  • Lab tests, including mammograms, Pap smear, and blood pressure, may be performed while you use etonogestrel/ethinyl estradiol ring. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
  • You should perform monthly breast self-exams and receive yearly breast exams from your doctor while you are taking etonogestrel/ethinyl estradiol ring. Talk with your doctor if you are unsure how to properly perform a breast self-exam. Report any lumps to your doctor right away.
  • Etonogestrel/ethinyl estradiol ring is not approved for use in CHILDREN who have not had their first menstrual period.
  • PREGNANCY and BREAST-FEEDING: Do not use etonogestrel/ethinyl estradiol ring if you are pregnant. If you think you may be pregnant, contact your doctor right away. Continue to use another method of birth control (such as condoms). Etonogestrel/ethinyl estradiol ring is found in breast milk. Do not breast-feed while taking etonogestrel/ethinyl estradiol ring. Do not take etonogestrel/ethinyl estradiol ring soon after delivery of a baby even if you are not breast-feeding. You should wait 4 weeks after delivery if you are not breast-feeding or 4 weeks after a second trimester abortion.

Possible side effects of etonogestrel/ ethinyl estradiol ring:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Acne; breast tenderness or pain; decreased sexual desire; headache; mild hair loss; nausea; stomach cramps, bloating, or pain; vaginal spotting or breakthrough bleeding; vomiting; weight gain.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); absent menstrual period; breast discharge; breast lumps; bulging eyes; calf or leg pain, swelling, or tenderness; change in the amount of urine produced; chest pain or heaviness; confusion; coughing up blood; dark urine; fainting; mental or mood changes (eg, depression); migraines; numbness of an arm or leg; one-sided weakness; pale stools; persistent, severe, or recurring headache or dizziness; persistent vaginal spotting; severe pain or tenderness in the stomach; shortness of breath; slurred speech; sudden, severe headache or vomiting; swelling of the fingers, hands, legs, or ankles; symptoms of toxic shock syndrome (eg, diarrhea, dizziness, muscle aches, sudden fever, sunburn-like rash on the face or body, vomiting); unusual or severe vaginal bleeding; unusual tiredness or weakness; vaginal irritation, discharge, or change in secretions; vision changes (eg, double vision, sudden vision loss); yellowing of the skin or eyes (with or without fever).

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately.

Proper storage of etonogestrel/ethinyl estradiol ring:

Store etonogestrel/ethinyl estradiol ring at room temperature, between 68 and 77 degrees F (20 and 25 degrees C) for up to 4 months. Throw away etonogestrel/ethinyl estradiol ring if the expiration date on the label has passed. Store away from heat, moisture, and light. Do not store in the bathroom. Keep etonogestrel/ethinyl estradiol ring out of the reach of children and away from pets.

General information:

  • If you have any questions about etonogestrel/ethinyl estradiol ring, please talk with your doctor, pharmacist, or other health care provider.
  • Etonogestrel/ethinyl estradiol ring is to be used only by the patient for whom it is prescribed. Do not share it with other people.
  • If your symptoms do not improve or if they become worse, check with your doctor.
  • Check with your pharmacist about how to dispose of unused medicine.

This information should not be used to decide whether or not to take etonogestrel/ethinyl estradiol ring or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about etonogestrel/ethinyl estradiol ring. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to etonogestrel/ethinyl estradiol ring. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your health care provider for complete information about the risks and benefits of using etonogestrel/ethinyl estradiol ring.

Issue Date: July 2, 2014
Database Edition 14.3.1.001
Copyright © 2014 Wolters Kluwer Health, Inc.

Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using this medicine.

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