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Segesterone acetate and ethinyl estradiol (Vaginal)

se-JES-ter-one AS-e-tate, ETH-i-nil es-tra-DYE-ol

Vaginal route(Insert, Extended Release)

Warning: Cigarette Smoking and Serious Cardiovascular EventsFemales over 35 years old who smoke should not use segesterone acetate/ethinyl estradiol vaginal system. Cigarette smoking increases the risk of serious cardiovascular events from combination hormonal contraceptive (CHC) use .

Medically reviewed by Drugs.com. Last updated on Jan 30, 2019.

Commonly used brand name(s)

In the U.S.

  • Annovera

Pharmacologic Class: Segesterone

Uses for segesterone acetate and ethinyl estradiol

Segesterone acetate and ethinyl estradiol combination is used to prevent pregnancy. It is a flexible birth control vaginal system (in the shape of a ring) that contains two types of hormones, segesterone acetate and ethinyl estradiol. It works by stopping a woman's egg from fully developing each month. The egg can no longer accept a sperm and fertilization (pregnancy) is prevented.

No contraceptive method is 100 percent effective. Birth control methods such as having surgery to become sterile or not having sex are more effective than vaginal systems. Discuss your options for birth control with your doctor.

Segesterone acetate and ethinyl estradiol will not prevent HIV infection or other sexually transmitted diseases. It will not help as emergency contraception, such as after unprotected sexual contact.

Segesterone acetate and ethinyl estradiol is available only with your doctor's prescription.

Before using segesterone acetate and ethinyl estradiol

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For segesterone acetate and ethinyl estradiol, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to segesterone acetate and ethinyl estradiol or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies on the relationship of age to the effects of segesterone acetate and ethinyl estradiol combination have not been performed in the pediatric population. However, pediatric-specific problems that would limit the usefulness of segesterone acetate and ethinyl estradiol in teenagers are not expected. Segesterone acetate and ethinyl estradiol may be used for birth control in teenage females but should not be used before the start of menstruation.

Geriatric

Appropriate studies on the relationship of age to the effects of segesterone acetate and ethinyl estradiol combination have not been performed in the geriatric population. Segesterone acetate and ethinyl estradiol is not indicated for use in elderly women.

Interactions with medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking segesterone acetate and ethinyl estradiol, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using segesterone acetate and ethinyl estradiol with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Dasabuvir
  • Ombitasvir
  • Paritaprevir
  • Ritonavir
  • Tranexamic Acid

Using segesterone acetate and ethinyl estradiol with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Anagrelide
  • Aprepitant
  • Boceprevir
  • Bosentan
  • Bupropion
  • Carbamazepine
  • Ceritinib
  • Dabrafenib
  • Darunavir
  • Dexamethasone
  • Donepezil
  • Encorafenib
  • Enzalutamide
  • Fosaprepitant
  • Fosphenytoin
  • Glecaprevir
  • Griseofulvin
  • Isotretinoin
  • Ivosidenib
  • Lesinurad
  • Lixisenatide
  • Lumacaftor
  • Mitotane
  • Modafinil
  • Nafcillin
  • Nevirapine
  • Oxcarbazepine
  • Paclitaxel
  • Paclitaxel Protein-Bound
  • Phenobarbital
  • Phenytoin
  • Pibrentasvir
  • Piperaquine
  • Pitolisant
  • Prednisone
  • Primidone
  • Rifabutin
  • Rifampin
  • St John's Wort
  • Sugammadex
  • Theophylline
  • Tizanidine
  • Topiramate
  • Valproic Acid

Using segesterone acetate and ethinyl estradiol with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Alprazolam
  • Amprenavir
  • Atazanavir
  • Bacampicillin
  • Betamethasone
  • Bexarotene
  • Colesevelam
  • Cyclosporine
  • Efavirenz
  • Eslicarbazepine Acetate
  • Etoricoxib
  • Fosamprenavir
  • Ginseng
  • Lamotrigine
  • Levothyroxine
  • Licorice
  • Mycophenolate Mofetil
  • Mycophenolic Acid
  • Nelfinavir
  • Parecoxib
  • Prednisolone
  • Rifapentine
  • Roflumilast
  • Rufinamide
  • Selegiline
  • Telaprevir
  • Tipranavir
  • Troglitazone
  • Troleandomycin
  • Valdecoxib
  • Voriconazole
  • Warfarin

Interactions with food/tobacco/alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using segesterone acetate and ethinyl estradiol with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use segesterone acetate and ethinyl estradiol, or give you special instructions about the use of food, alcohol, or tobacco.

  • Caffeine

Other medical problems

The presence of other medical problems may affect the use of segesterone acetate and ethinyl estradiol. Make sure you tell your doctor if you have any other medical problems, especially:

  • Abnormal or unusual vaginal bleeding or
  • Blood clots (eg, deep vein thrombosis, pulmonary embolism), or history of or
  • Blood disorder (eg, hypercoagulopathy), acquired or inherited or
  • Breast cancer, or history of or
  • Diabetes with kidney, eye, nerve, or blood vessel damage or
  • Heart attack, history of or
  • Heart or blood vessel disease (eg, coronary artery disease, heart valve problems), or history of or
  • Hypertension (high blood pressure), uncontrolled or
  • Jaundice during pregnancy or from using hormonal therapy in the past or
  • Liver disease (eg, cirrhosis, hepatitis), including tumors or cancer or
  • Major surgery in near future, with prolonged periods of immobilization or
  • Migraine headache or
  • Stroke, history of or
  • Tumors (estrogen-dependent), known or suspected—Should not be used in patients with these conditions.
  • Angioedema (swelling of the face, tongue, or throat), inherited or
  • Chloasma gravidarum (skin disorder during pregnancy), history of or
  • Cholestasis (bile problem) during pregnancy, history of or
  • Cervical cancer or
  • Depression, history of or
  • Gallbladder disease or
  • Hypertension (high blood pressure) or
  • Toxic shock syndrome, history of or
  • Vaginal or cervical erosion or ulcers—Use with caution. May make these conditions worse.
  • Diabetes or
  • Hyperlipidemia (high cholesterol or fats in the blood), or family history of or
  • Kidney disease or
  • Obesity, or history of—Use with caution. These conditions may increase the risk for more serious side effects.

Proper use of segesterone acetate and ethinyl estradiol

Use segesterone acetate and ethinyl estradiol exactly as directed by your doctor. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered. To do so may cause unwanted side effects.

Segesterone acetate and ethinyl estradiol is to be used only in the vagina. This combination medicine is contained in a vaginal system that is placed into your vagina. The vaginal system will slowly release small amounts of the medicine for your body to absorb.

Segesterone acetate and ethinyl estradiol comes with a patient information leaflet and patient instructions. Read and follow these instructions carefully. Ask your doctor if you have any questions.

Segesterone acetate and ethinyl estradiol is used in a 4 week cycle for 13 cycles (1 year). You may start using the vaginal system between the second and fifth day of your menstrual period, keeping it in place for 3 weeks.

Once the vaginal system is in place inside your vagina, you should not be able to feel it. If you feel uncomfortable, it may not be inserted far enough. Gently push the vaginal system farther into your vagina. If you feel pain, talk to your doctor.

The vaginal system may move down accidently. This can happen if you remove a tampon, during sex, or strain to have a bowel movement. Gently push it back into place. If the vaginal system comes all the way out, wash it with mild soap and warm water, pat it dry with a clean cloth towel or paper towel, and put it back inside. Call your doctor if the vaginal system comes out several times.

Remove the vaginal system after 3 weeks on the same day of the week and time it was inserted. During the 1-week break, you will usually have your menstrual period. Wash the vaginal system with mild soap and warm water, pat it dry with a clean cloth towel or paper towel, and keep it inside the case that comes with it. Reinsert it after a week.

While using segesterone acetate and ethinyl estradiol, you may need to use an additional form of birth control method (eg, condom, spermicide) during the first 7 days to prevent pregnancy, especially if you have an irregular menstrual cycle or if you start using this vaginal system more than 5 days from your last menstrual bleeding.

If you need to remove the vaginal system, hook your finger through it and pull it out.

If you are switching from a combination hormonal method (eg, pills, patch) to Annovera™, start using segesterone acetate and ethinyl estradiol on any day. Do not use segesterone acetate and ethinyl estradiol after more than 7 hormone-free days.

If you are switching from a progestin-only method (eg, progestin-only implant, injection, intrauterine system, pill) to Annovera™, start using it on the day after you used your last progestin-only pill, or on the day your implant or IUD is removed, or on the day you would have your next injection. You must also use an additional barrier method of birth control (eg, male condom with spermicide) for the first 7 days.

Do not eat grapefruit or drink grapefruit juice while you are using segesterone acetate and ethinyl estradiol. Grapefruit and grapefruit juice may change the amount of segesterone acetate and ethinyl estradiol that is absorbed in the body.

Do not use segesterone acetate and ethinyl estradiol together with oil-based vaginal creams, gels, lubricants, or suppositories. Ask your doctor before you use other products or medicines into your vagina.

Dosing

The dose of segesterone acetate and ethinyl estradiol will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of segesterone acetate and ethinyl estradiol. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For vaginal dosage form (vaginal system):
    • For contraception (to prevent pregnancy):
      • Adults—One vaginal system inserted into the vagina for 21 days (3 weeks), followed by a 1 week vaginal system-free interval. It is then reinserted 1 week after.
      • Children—Use and dose must be determined by your doctor.

Missed dose

Call your doctor or pharmacist for instructions.

If the vaginal system has slipped out and it has been out for 2 hours or less, wash it with mild soap and warm water, pat it dry with a clean cloth towel or paper towel, and reinsert it. You should still be protected from pregnancy. If the vaginal system has been out for more than 2 hours (including multiple removals), use an additional form of birth control (including condoms or spermicide) until the vaginal system has been in the vagina for 7 days in a row.

If you forget to reinsert the vaginal system after the vaginal system-free week, use an additional form of birth control (including condoms or spermicide) until the vaginal system has been in the vagina for 7 days in a row.

If you leave the vaginal system inside the vagina for more than 21 days, remove it for 7 days and then reinsert it for 21 days to go back to the regular schedule.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Do not use the vaginal system for more than 13 cycles (1 year). Place the used vaginal system inside the case that comes with it. Throw it in the trash. Do not flush the vaginal system down the toilet.

Precautions while using segesterone acetate and ethinyl estradiol

It is very important that your doctor check your progress at regular annual visits to make sure segesterone acetate and ethinyl estradiol is working properly. Blood tests may be needed to check for unwanted effects. Your doctor may also want to check your blood pressure while using segesterone acetate and ethinyl estradiol.

Although you are using segesterone acetate and ethinyl estradiol to prevent pregnancy, you should know that using segesterone acetate and ethinyl estradiol while you are pregnant could harm your unborn baby. If you think you have become pregnant while using segesterone acetate and ethinyl estradiol, tell your doctor right away. You may start using segesterone acetate and ethinyl estradiol 4 weeks after giving birth and if you are not breastfeeding.

Vaginal bleeding of various amounts may occur between your regular menstrual periods during the first month of use. This is sometimes called spotting when lighter, or breakthrough bleeding when heavier.

  • If this should occur, continue using Annovera™.
  • The bleeding usually stops within 1 week. Check with your doctor if the bleeding continues for more than 1 week.
  • If the bleeding continues after you have been taking hormonal contraceptives on schedule, check with your doctor.

Do not use segesterone acetate and ethinyl estradiol together with medicine to treat hepatitis C virus infection, including ombitasvir/paritaprevir/ritonavir, with or without dasabuvir (Technivie®, Viekira Pak®).

Do not use segesterone acetate and ethinyl estradiol if you smoke cigarettes or if you are over 35 years of age If you smoke while using Annovera™, you increase your risk of having a blood clot, heart attack, or stroke. Your risk is even higher if you are over age 35, if you have diabetes, high blood pressure, high cholesterol, or if you are overweight. Talk with your doctor about ways to stop smoking. Keep your diabetes under control. Ask your doctor about diet and exercise to control your weight and blood cholesterol level.

Using segesterone acetate and ethinyl estradiol may increase your risk of having blood clotting problems. Check with your doctor right away if you have pain in the chest, groin, or legs, especially the calves, difficulty with breathing, a sudden, severe headache, slurred speech, a sudden, unexplained shortness of breath, a sudden loss of coordination, or vision changes while using segesterone acetate and ethinyl estradiol.

Check with your doctor immediately if blurred vision, difficulty in reading, or any other change in vision occurs during or after treatment. Your doctor may want an eye doctor (ophthalmologist) to check your eyes.

Check with your doctor right away if you have pain or tenderness in the upper stomach, dark urine, pale stools, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.

Your blood pressure might get too high while you are using segesterone acetate and ethinyl estradiol. This may cause headaches, dizziness, or blurred vision. You might need to measure your blood pressure at home. If you think your blood pressure is too high, call your doctor right away.

Segesterone acetate and ethinyl estradiol may increase your risk of having gallbladder disease. Check with your doctor if you start to have stomach pains, nausea, and vomiting.

Using segesterone acetate and ethinyl estradiol may increase your risk of cervical cancer. Talk with your doctor about this risk. Check with your doctor immediately if you experience abnormal vaginal bleeding.

Segesterone acetate and ethinyl estradiol may cause skin discoloration. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds.

Toxic shock syndrome (TSS) may occur while using segesterone acetate and ethinyl estradiol. Call your doctor right away if you have any of the following symptoms: sudden high fever, diarrhea, dizziness, fainting, vomiting, muscle aches, or a sunburn-like rash.

Check with your doctor before refilling an old prescription, especially after a pregnancy. You will need another physical examination and your doctor may change your prescription.

Make sure any doctor or dentist who treats you knows that you are using segesterone acetate and ethinyl estradiol. The results of some medical tests may be affected by segesterone acetate and ethinyl estradiol. You may also need to stop using segesterone acetate and ethinyl estradiol at least 4 weeks before and 2 weeks after having major surgery.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.

Segesterone acetate and ethinyl estradiol side effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

  • Bladder pain
  • bloody or cloudy urine
  • chills
  • difficult, burning, or painful urination
  • fever
  • frequent or painful urination
  • headache, severe and throbbing
  • itching of the vagina or outside the genitals
  • lower back or side pain
  • pain during sexual intercourse
  • stomach pain
  • thick, white curd-like vaginal discharge without odor or with mild odor
  • upper or lower abdominal pain

Less common

  • Anxiety
  • back pain
  • chest pain
  • confusion
  • cough
  • dizziness or lightheadedness
  • expulsion of tissue with clots from your vagina
  • fainting
  • fast heartbeat
  • hives, itching, skin rash
  • hoarseness
  • irritation
  • joint pain, stiffness or swelling
  • mental depression
  • mood or other mental changes
  • numbness of the hands
  • pain, redness, or swelling in the arm or leg
  • redness of the skin
  • severe stomach pain
  • swelling of the eyelids, face, lips, hands, or feet
  • tightness in the chest
  • troubled breathing or swallowing

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  • Cramps
  • diarrhea
  • heavy bleeding
  • nausea
  • normal menstrual bleeding occurring earlier, possibly lasting longer than expected
  • vomiting

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Related questions

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Consumer resources

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