Ethinyl Estradiol / Etonogestrel Dosage

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Usual Adult Dose for:

Additional dosage information:

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.

Dose Adjustments

For patients without use of hormonal contraception in the previous month - The vaginal ring should be inserted on or prior to Day 5 of the menstrual cycle (start of bleeding is counted as Day 1) even if bleeding has not stopped. During the first cycle, the manufacturer recommends the use of an additional method of contraception (condoms or spermicides) for a minimum of 7 days of continuous ring use.

For patients switching from a combination oral contraceptive - The vaginal ring may be inserted anytime within seven days after the last combined oral contraceptive tablet (estrogen plus progestin) and no later than the fist day of the new cycle of pills would have been started. No additional method of contraception is needed.

For patients switching from a progestin-only method - Depending on the progestin-only method used, the new ring should be inserted as follows:On the same day as removal of a progestin-containing IUD, or contraceptive implant; on the day when the next contraceptive injection would be due; and any day of the month when switching from a progestin-only pill to the use of the vaginal ring (do allow any days in between). During the first cycle, the manufacturer recommends the use of an additional method of contraception (condoms or spermicides) for a minimum of 7 days of continuous ring use.

For patients following complete first trimester abortion - The new vaginal ring may be inserted within the first five days following a complete first trimester abortion and there is not need for and additional method of contraception. If the first five days have passed, the patient should follow the instructions for "No preceding hormonal contraceptive use in the past month". In the meantime she should be advised to use a non-hormonal contraceptive method.

For patients following delivery or second trimester abortion - The new ring may be inserted 4 weeks postpartum in women who elect not to breast-feed. Similarly after a second trimester abortion.

In the case of inadvertent removal, expulsion, or prolonged ring-free interval - If at any time during the 3 week use period the vaginal ring is out, it can be rinsed in cool to lukewarm water and re-inserted as soon as possible, at the latest within 3 hours. If the ring is out of the vagina for longer than 3 hours, an additional method of contraception (condoms or spermicide) must be used until the vaginal ring has been used continuously for 7 days. If the ring-free interval has been extended beyond one week, the possibility of pregnancy should be considered, and an additional method of contraception (condoms or spermicide) must be used until the vaginal ring has been used continuously for 7 days.

Precautions

Cigarette smoking increases the risk of serious cardiovascular side effects from combination oral contraceptive use. The 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 the ethinyl estradiol-etonogestrel vaginal ring, should be strongly advised no to smoke.

Ethinyl estradiol-etonogestrel vaginal ring should not be used if you are pregnant or suspect a pregnancy, if you have or had in the past blood clots in your legs (thrombosis), lungs (pulmonary embolism), or eyes, chest pain (angina pectoris), heart attack or stroke, severe high blood pressure, diabetes with complications of the kidney, eyes, nerves, or blood vessels, headaches with neurologic symptoms, known or suspected breast cancer or cancer of the lining of the uterus, cervix or vagina, unexplained vaginal bleeding, liver tumors or active liver disease, yellowing of the whites of the eyes or of the skin (jaundice) during pregnancy or during past use of oral combination contraceptives (birth control pills), disease of the heart valve with complications.

An increased risk of thromboembolic and thrombotic disease associated with the use of oral contraceptives is well established. Patients using combination hormonal contraceptives are at increased risk for deep vein thrombosis and pulmonary embolism. Combination hormonal contraceptives, including ethinyl estradiol-etonogestrel vaginal ring, should be discontinued at least 4 weeks prior to and for 2 weeks after elective surgery of a type associated with an increase in risk of thromboembolism and during and following prolonged immobilization.

Ectopic as well as intrauterine pregnancy may occur in contraceptive failure.

Pregnancy should be ruled out in the event of amenorrhea, or if patient presents with abnormal or severe bleeding while on the ethinyl estradiol-etonogestrel vaginal ring.

Combination hormonal contraceptives, such as ethinyl estradiol-etonogestrel vaginal ring, may worsen existing gallbladder disease and may accelerate the development of this disease in previously asymptomatic women. Women with a history of combination hormonal contraceptive-related cholestasis are more likely to have the condition recur with subsequent combination hormonal contraceptive use.

Ethinyl estradiol-etonogestrel does not protect patient from sexually transmitted diseases or HIV infection (AIDS).

Combination hormonal contraceptives have the following effects on certain endocrine and liver function tests and blood components: increase prothrombin and factors VII, VIII, IX, and X; decreases antithrombin 3, increases norepinephrine-induced platelet aggregability, triglycerides and lipoproteins may be increased, glucose tolerance may be decreased, depress serum folate levels, increase in sex hormone-binding proteins, increase in thyroid binding globulin leading to increased circulating total thyroid hormone (free T4 concentration is not altered).

The manufacturer recommends that women be monitored closely if they are being treated or have a history of hyperlipidemias, diabetes (including prediabetes), fluid retention disorders, depression , breast cancer in family, or notice visual changes or decreased contact lens tolerance.

Other Comments

Ethinyl estradiol-etonogestrel vaginal ring should not be used to induce withdrawal bleeding as a test for pregnancy or during pregnancy to treat threatened or habitual abortion.

Patients should be advised not to discard ring in the toilet.

Withdrawal bleeding usually starts on the second or third day after removal of the ring, and it may not be finished before the next ring must be inserted (a week after the previous one removed).

In the event of a missed menstrual period, pregnancy should be rules out.

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