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EluRyng Disease Interactions

There are 23 disease interactions with EluRyng (ethinyl estradiol / etonogestrel).

Major

Combined oral contraceptives (applies to EluRyng) smoking

Major Potential Hazard, Moderate plausibility.

Cigarette smoking increases the risk of serious cardiovascular events from estrogen-containing combination oral contraceptives (COC). This risk increases with age, particularly in females over 35 years of age, and with the number of cigarettes smoked. For this reason, COCs are contraindicated in females who are over 35 years of age and smoke.

References

  1. "Product Information. Ortho Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  2. "Product Information. Gianvi (drospirenone-ethinyl estradiol)." Teva Pharmaceuticals USA (2017):
  3. "Product Information. Alesse-28 (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Canada Inc (2017):
  4. "Product Information. Lo Loestrin Fe (ethinyl estradiol-norethindrone)." Warner Chilcott Laboratories (2017):
  5. "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma (2021):
View all 5 references
Major

Contraceptives (applies to EluRyng) abnormal genital bleeding

Major Potential Hazard, Moderate plausibility. Applicable conditions: Abnormal Uterine Bleeding

The use of contraceptives is contraindicated when there is an undiagnosed abnormal genital bleeding. Adequate diagnostic measures should be undertaken to rule out the presence of any malignancy.

References

  1. "Product Information. Micronor (norethindrone)." Ortho McNeil Pharmaceutical (2001):
  2. "Product Information. Implanon (etonogestrel)." Organon Pharmaceuticals (2006):
  3. "Product Information. Liletta (levonorgestrel)." Actavis Pharma, Inc. (2016):
Major

Estrogens (applies to EluRyng) abnormal vaginal bleeding

Major Potential Hazard, High plausibility. Applicable conditions: Abnormal Uterine Bleeding

The use of estrogens is contraindicated in patients with undiagnosed, abnormal vaginal bleeding. Prolonged (> 1 year), unopposed estrogen use (i.e. estrogen without concomitant progestin therapy) has been associated with a significant, dose-related risk of endometrial carcinoma. The risk may be offset substantially by the addition of a progestin but may not be completely abolished. Prior to initiating estrogen therapy, appropriate diagnostic tests should be performed in patients with abnormal vaginal bleeding to rule out endometrial malignancy. The same applies if recurrent or persistent bleeding develops during estrogen therapy.

References

  1. Collen J, Obrink A, Tjernberg B, Bunne G "Endometrial cancer and exogenous estrogens." Acta Obstet Gynecol Scand 58 (1979): 123
  2. Clarke EA, Osborn RW, Spengler RF, Newman AM, Woolever CA "Exogenous estrogens and endometrial cancer: a case-control study and assessment of potential biases." Am J Epidemiol 114 (1981): 497-506
  3. Buring JE, Ehrmann RL, Bain CJ "Conjugated estrogen use and risk of endometrial cancer." Am J Epidemiol 124 (1986): 434-41
  4. Adami HO, Pettersson B, Bergkvist L, Hoover R, Lindgren A, Persson I, Schairer C "Risk of endometrial cancer after treatment with oestrogens alone or in conjunction with progestogens: results of a prospective study." BMJ 298 (1989): 147-51
  5. Brown C, Burnett L, Garcia R, Davies JL, Antunes CM, Pokempner M, Rosenshein NB, Tonascia JA, Rutledge A, Strolley PD "Endometrial cancer and estrogen use. Report of a large case-control study." N Engl J Med 300 (1979): 9-13
  6. Finkle WD, Gordon J, Ziel HK, Reagan JW "Estrogen and endometrial carcinoma. An independent pathology review supporting original risk estimate." N Engl J Med 297 (1977): 570-1
  7. Helmrich SP, Stolley PD, Kelly JP, Lewis JL Jr, Rosenshein NB, Schottenfeld D, Kaufman DW, Knapp RC, Rosenberg L, Shapiro S "Risk of localized and widespread endometrial cancer in relation to recent and discontinued use of conjugated estrogens." N Engl J Med 313 (1985): 969-72
  8. Gray LA Sr, Christopherson WM, Hoover RN "Estrogens and endometrial carcinoma." Obstet Gynecol 49 (1977): 385-9
  9. Woodruff JD, Pickar JH "Incidence of endometrial hyperplasia in postmenopausal women taking conjugated estrogens (Premarin) with medroxyprogesterone acetate or conjugated estrogens alone." Am J Obstet Gynecol 170 (1994): 1213-23
  10. "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories (2001):
  11. "Product Information. Climara (estradiol)." Berlex Laboratories (2001):
  12. "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories (2001):
  13. "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  14. "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  15. The Writing Group for the PEPI Trial "Effects of hormone replacement therapy on endometrial histology in postmenopausal women." JAMA 275 (1996): 370-5
  16. "Product Information. Ortho Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  17. "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical (2001):
  18. "Product Information. Demulen (ethinyl estradiol-ethynodiol)." Searle, Skokie, IL.
  19. "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories (2001):
  20. "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical (2001):
  21. "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories (2001):
  22. "Product Information. Ortho Novum 1/50 (mestranol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  23. "Product Information. Emcyt (estramustine)." Pharmacia and Upjohn (2001):
  24. "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical (2001):
  25. "Product Information. Ortho Dienestrol Cream (dienestrol topical)" Ortho McNeil Pharmaceutical, Raritan, NJ.
  26. "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn (2001):
  27. "Product Information. Estinyl Tablets (ethinyl estradiol)" Schering Corporation, Kenilworth, NJ.
  28. "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc (2001):
  29. "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma (2021):
View all 29 references
Major

Estrogens (applies to EluRyng) carcinomas (estrogenic)

Major Potential Hazard, High plausibility. Applicable conditions: Neoplasia -- Estrogen Dependent

The use of estrogens is generally contraindicated in patients with known or suspected estrogen-dependent neoplasia such as breast and endometrial cancer, since it may stimulate tumor proliferation. High dosages of estrogens may be used for the palliative treatment of inoperable, metastatic breast cancer, but only in appropriately selected men and postmenopausal women.

References

  1. Ewertz M "Oral contraceptives and breast cancer risk in Denmark." Eur J Cancer 28A (1992): 1176-81
  2. Collen J, Obrink A, Tjernberg B, Bunne G "Endometrial cancer and exogenous estrogens." Acta Obstet Gynecol Scand 58 (1979): 123
  3. Clarke EA, Palmer JR, Miller DR, Rosenberg L, Shapiro S "Breast cancer risk after estrogen replacement therapy: results from the Toronto Breast Cancer Study." Am J Epidemiol 134 (1991): 1386-95
  4. de Mouzon J, Stolley PD, Palmer JR, Zauber AG, Kaufman DW, Rosenberg L, Shapiro S, Warshauer ME "Estrogen replacement therapy and the risk of breast cancer: results from the case-control surveillance study." Am J Epidemiol 134 (1991): 1375-85
  5. Clarke EA, Osborn RW, Spengler RF, Newman AM, Woolever CA "Exogenous estrogens and endometrial cancer: a case-control study and assessment of potential biases." Am J Epidemiol 114 (1981): 497-506
  6. Buring JE, Ehrmann RL, Bain CJ "Conjugated estrogen use and risk of endometrial cancer." Am J Epidemiol 124 (1986): 434-41
  7. Adami HO, Pettersson B, Bergkvist L, Hoover R, Lindgren A, Persson I, Schairer C "Risk of endometrial cancer after treatment with oestrogens alone or in conjunction with progestogens: results of a prospective study." BMJ 298 (1989): 147-51
  8. Azevedo D, Milne K, Finkle WD, Glass A, Hoover R "Conjugated estrogens and breast cancer risk in women." J Natl Cancer Inst 67 (1981): 815-20
  9. Hutchinson WB, Thomas DB, Persing JP "Exogenous estrogens and other risk factors for breast cancer in women with benign breast diseases." J Natl Cancer Inst 69 (1982): 1017-25
  10. Brown C, Burnett L, Garcia R, Davies JL, Antunes CM, Pokempner M, Rosenshein NB, Tonascia JA, Rutledge A, Strolley PD "Endometrial cancer and estrogen use. Report of a large case-control study." N Engl J Med 300 (1979): 9-13
  11. Finkle WD, Gordon J, Ziel HK, Reagan JW "Estrogen and endometrial carcinoma. An independent pathology review supporting original risk estimate." N Engl J Med 297 (1977): 570-1
  12. Adami HO, Bergkvist L, Hoover R, Persson I, Schairer C "The risk of breast cancer after estrogen and estrogen-progestin replacement." N Engl J Med 321 (1989): 293-7
  13. Helmrich SP, Stolley PD, Kelly JP, Lewis JL Jr, Rosenshein NB, Schottenfeld D, Kaufman DW, Knapp RC, Rosenberg L, Shapiro S "Risk of localized and widespread endometrial cancer in relation to recent and discontinued use of conjugated estrogens." N Engl J Med 313 (1985): 969-72
  14. Gray LA Sr, Christopherson WM, Hoover RN "Estrogens and endometrial carcinoma." Obstet Gynecol 49 (1977): 385-9
  15. Delgado-Rodriguez M, Galvez-Vargas R, Martin-Moreno JM, Sillero-Arenas M "Oral contraceptives and cancer of the cervix uteri. A meta-analysis." Acta Obstet Gynecol Scand 71 (1992): 368-76
  16. Bueno-Cavanillas A, Delgado-Rodriguez M, Rodriguez-Contreras R, Galvez-Vargas R, Sillero-Arenas M "Patterns of research. Oral contraceptives and cervical cancer." Acta Obstet Gynecol Scand 70 (1991): 143-8
  17. Lund E "Oral contraceptives and breast cancer. A review with some comments on mathematical models." Acta Oncol 31 (1992): 183-6
  18. Kaufman DW, Miller DR, Stolley P, Rosenberg L, Shapiro S, Warshauer ME "Breast cancer before age 45 and oral contraceptive use: new findings." Am J Epidemiol 129 (1989): 269-80
  19. Clarke EA, Palmer JR, Rosenberg L, Shapiro S "A case-control study of the risk of breast cancer in relation to oral contraceptive use." Am J Epidemiol 136 (1992): 1437-44
  20. Schlesselman JJ "Oral contraceptives and breast cancer." Am J Obstet Gynecol 163 (1990): 1379-87
  21. Turnquest MA "Oral contraceptive use and incidence of cervical intraepithelial neoplasia." Am J Obstet Gynecol 168 (1993): 1895-6
  22. Kaunitz AM "Oral contraceptives and gynecologic cancer: an update for the 1990s." Am J Obstet Gynecol 167 (1992): 1171-6
  23. Romieu I, Speizer FE, Stampfer MJ, Willett WC, Colditz GA, Hennekens CH, Rosner B "Prospective study of oral contraceptive use and risk of breast cancer in women." J Natl Cancer Inst 81 (1989): 1313-21
  24. Olsson H, Moller TR, Ranstam J "Early oral contraceptive use and breast cancer among premenopausal women: final report from a study in southern Sweden." J Natl Cancer Inst 81 (1989): 1000-4
  25. Jones MW, Silverberg SG "Cervical adenocarcinoma in young women: possible relationship to microglandular hyperplasia and use of oral contraceptives." Obstet Gynecol 73 (1989): 984-9
  26. Murray PP, Stadel BV, Schlesselman JJ "Oral contraceptive use in women with a family history of breast cancer." Obstet Gynecol 73 (1989): 977-83
  27. Thomas DB "Oral contraceptives and breast cancer: review of the epidemiologic literature." Contraception 43 (1991): 597-642
  28. Brinton LA "Oral contraceptives and cervical neoplasia." Contraception 43 (1991): 581-95
  29. "Oral contraceptives and neoplasia. WHO Scientific Group." World Health Organ Tech Rep Ser 817 (1992): 1-46
  30. Woodruff JD, Pickar JH "Incidence of endometrial hyperplasia in postmenopausal women taking conjugated estrogens (Premarin) with medroxyprogesterone acetate or conjugated estrogens alone." Am J Obstet Gynecol 170 (1994): 1213-23
  31. Mishell DR "Contraception." N Engl J Med 320 (1989): 777-85
  32. "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories (2001):
  33. Amadori D, Filiberti R, Franceschi S, Conti E, Montella M, Lavecchia C, Parazzini F, Ferraroni M, Negri E, Talamini R, Veronesi A "Oral contraceptives and breast cancer: a cooperative italian study." Int J Cancer 60 (1995): 163-7
  34. Colditz GA, Hunter DJ, Hankinson SE, et al. "The use of estrogens and progestins and the risk of breast cancer in postmenopausal women." N Engl J Med 332 (1995): 1589-93
  35. Daling JR, Rossing MA, Stanford JL, Voigt LF, Habel LA, Weiss NS "Combined estrogen and progestin hormone replacement therapy in relation to risk of breast cancer in middle-aged women." JAMA 274 (1995): 137-42
  36. "Product Information. Climara (estradiol)." Berlex Laboratories (2001):
  37. "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories (2001):
  38. "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  39. "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  40. The Writing Group for the PEPI Trial "Effects of hormone replacement therapy on endometrial histology in postmenopausal women." JAMA 275 (1996): 370-5
  41. Painter R, Vessey MP, Carpenter LM, Zondervan KT "Oral contraceptives and cervical cancer - further findings from the oxford family planning association contraceptive study." Br J Cancer 73 (1996): 1291-7
  42. Franceschi S, Koetsawang S, Rachawat D, Calle EE, Chantarakul N, Coates RJ, Heath CW, Liff JM, Miraclemcmahill HL, Talamini R "Breast cancer and hormonal contraceptives: further results." Contraception 54 (suppl (1996): s1-106
  43. Rettig BA, Lemon HM "Cancers related to contraceptive use." Br J Cancer 74 (1996): 1509-10
  44. "Product Information. Ortho Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  45. "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical (2001):
  46. "Product Information. Demulen (ethinyl estradiol-ethynodiol)." Searle, Skokie, IL.
  47. "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories (2001):
  48. "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical (2001):
  49. "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories (2001):
  50. "Product Information. Ortho Novum 1/50 (mestranol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  51. "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical (2001):
  52. Greendale GA, Reboussin BA, Sie A, et al. "Effects of estrogen and estrogen-progestin on mammographic parenchymal density." Ann Intern Med 130 (1999): 262-9
  53. Gapstur SM, Morrow M, Sellers TA "Hormone replacement therapy and risk of breast cancer with a favorable histology: results of the Iowa women's health study." JAMA 281 (1999): 2091-7
  54. "Product Information. Ortho Dienestrol Cream (dienestrol topical)" Ortho McNeil Pharmaceutical, Raritan, NJ.
  55. "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn (2001):
  56. "Product Information. Estinyl Tablets (ethinyl estradiol)" Schering Corporation, Kenilworth, NJ.
  57. "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc (2001):
  58. "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma (2021):
View all 58 references
Major

Estrogens (applies to EluRyng) hypercalcemia in breast cancer

Major Potential Hazard, Moderate plausibility.

When treated with an estrogen, patients with breast cancer and bone metastases may develop severe hypercalcemia, in which case the drug should be stopped and measures be taken to reduce serum calcium levels.

References

  1. "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories (2001):
  2. "Product Information. Climara (estradiol)." Berlex Laboratories (2001):
  3. "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories (2001):
  4. "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  5. "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  6. "Product Information. Emcyt (estramustine)." Pharmacia and Upjohn (2001):
  7. "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical (2001):
  8. "Product Information. Ortho Dienestrol Cream (dienestrol topical)" Ortho McNeil Pharmaceutical, Raritan, NJ.
  9. "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn (2001):
  10. "Product Information. Estinyl Tablets (ethinyl estradiol)" Schering Corporation, Kenilworth, NJ.
  11. "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc (2001):
View all 11 references
Major

Estrogens (applies to EluRyng) hypertension

Major Potential Hazard, High plausibility.

The risk of myocardial infarction and strokes, including those associated with oral contraceptive use and some estrogen use, is increased in patients with hypertension. Moreover, estrogens (and progestogens) may elevate blood pressure and worsen the hypertension, thus compounding the risk. Clinically significant blood pressure increases have been reported during estrogen therapy, particularly in patients receiving high dosages or treated with oral contraceptive combinations having high progestational activity. These effects also increase with duration of therapy and patient age. Therapy with estrogens should be administered cautiously in patients with preexisting hypertension. Patients should be monitored for changes in cardiovascular status, and their antihypertensive regimen adjusted or estrogen therapy withdrawn as necessary. In patients requiring contraception, alternative methods should be considered for those who are hypertensive, over age 35, and smoke.

References

  1. Leiman G "Depo-medroxyprogesterone acetate as a contraceptive agent: its effect on weight and blood pressure." Am J Obstet Gynecol 114 (1972): 97-102
  2. Williams RS "Benefits and risks of oral contraceptive use." Postgrad Med 92 (1992): 155-7
  3. Crane MG, Harris JJ "Estrogens and hypertension: effect of discontinuing estrogens on blood pressure, exchangeable sodium, and the renin-aldosterone system." Am J Med Sci 276 (1978): 33-55
  4. Crane MG, Winsor W 3d, Harris JJ "Hypertension, oral contraceptive agents, and conjugated estrogens." Ann Intern Med 74 (1971): 13-21
  5. Slone D, Stolley PD, Kaufman D, Miettinen OS, Rosenberg L, Shapiro S "Noncontraceptive estrogens and myocardial infarction in young women." JAMA 244 (1980): 339-42
  6. Rothman KJ, Dinan B, Jick H "Noncontraceptive estrogens and nonfatal myocardial infarction." JAMA 239 (1978): 1407-8
  7. Routledge DA, Wren BG "Blood pressure changes: oestrogens in climacteric women." Med J Aust 2 (1981): 528-31
  8. Lesko SM, Palmer JR, Rosenberg L, Shapiro S "Oral contraceptive use and the risk of myocardial infarction." Am J Epidemiol 131 (1990): 1009-16
  9. Mann J, Murphy M, Thorogood M, Vessey M "Fatal stroke and use of oral contraceptives: findings from a case- control study." Am J Epidemiol 136 (1992): 35-45
  10. Leaf DA, Neighbor WE, Scott CS, Bland D, Schaad D "Oral contraceptive use and coronary risk factors in women." Am J Med Sci 301 (1991): 365-8
  11. Thorneycroft IH "Oral contraceptives and myocardial infarction." Am J Obstet Gynecol 163 (1990): 1393-7
  12. Lidegaard O "Oral contraception and risk of a cerebral thromboembolic attack: results of a case-control study." BMJ 306 (1993): 956-63
  13. Derman RJ "Oral contraceptives and cardiovascular risk. Taking a safe course of action." Postgrad Med 88 (1990): 119-22
  14. Hannaford PC, Croft PR, Kay CR "Oral contraception and stroke. Evidence from the Royal College of General Practitioners' Oral Contraception Study." Stroke 25 (1994): 935-42
  15. Steinberg WM "Oral contraception: risks and benefits." Adv Contracept 5 (1989): 219-28
  16. Lee NC, Peterson HB "Long-term health risks and benefits of oral contraceptive use." Obstet Gynecol Clin North Am 17 (1990): 775-88
  17. Derman R "Oral contraceptives: a reassessment." Obstet Gynecol Surv 44 (1989): 662-8
  18. Belchetz PE "Hormonal treatment of postmenopausal women." N Engl J Med 330 (1994): 1062-71
  19. Stampfer MJ, Willett WC, Colditz GA, et al. "Postmenopausal estrogen and cardiovascular disease. Ten-year follow-up from the Nurses' Health Study." N Engl J Med 325 (1991): 756-62
  20. Barrett-Connor E, Bush TL "Estrogen and coronary heart disease in women." JAMA 265 (1991): 1861-7
  21. Barrett-Connor E, Criqui MH, Wingard DL "Postmenopausal estrogen use and heart disease risk factors in the 1980s. Rancho Bernardo, Calif, revisited." JAMA 261 (1989): 1095-2100
  22. Mishell DR "Contraception." N Engl J Med 320 (1989): 777-85
  23. "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories (2001):
  24. Freeman R, Schwartz J, Frishman W "Clinical pharmacology of estrogens: cardiovascular actions and cardioprotective benefits of replacement therapy in postmenopausal women." J Clin Pharmacol 35 (1995): 1-16
  25. The Writing Group for the PEPI Trial "Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women: the Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial." JAMA 273 (1995): 199-208
  26. "Product Information. Climara (estradiol)." Berlex Laboratories (2001):
  27. "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories (2001):
  28. "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  29. "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  30. Bonnar J, Norris LA "The effect of oestrogen dose and progestogen type on haemostatic changes in women taking low dose oral contraceptives." Br J Obstet Gynaecol 103 (1996): 261-7
  31. Cowchock FS, Levine AB, Mcgough B, Teppa J "Evaluation of the prethrombotic state in pregnancy and in women using oral contraceptives." Contraception 53 (1996): 255-7
  32. Sidney S, Bernstein A, Petitti DB, Quesenberry C, Wolf S, Ziel HK "Stroke in users of low-dose oral contraceptives." N Engl J Med 335 (1996): 8-15
  33. Speroff L "Oral contraceptives and venous thromboembolism." Int J Gynaecol Obstet 54 (1996): 45-50
  34. Artigas J, , Medina E, Meirik O, Zhong YH, Poulter NR, Shen H, Chang CL, Debertribeiro M, Farley TMM, Marmot MG, Zhang DW "Ischaemic stroke and combined oral contraceptives: results of an international, multicentre, case-control study." Lancet 348 (1996): 498-505
  35. Meirik O, Poulter NR, Chang CL, Farley TMM, Marmot MG "Haemorrhagic stroke, overall stroke risk, and combined oral contraceptives: results of an international, multicentre, case-control study." Lancet 348 (1996): 505-10
  36. Guillebaud J, Piegsa K "Oral contraceptives and the risk of DVT." Practitioner 240 (1996): 544
  37. Martinelli I, Mannucci PM, Rosendaal FR, Vandenbroucke JP "Oral contraceptives are a risk factor for cerebral vein thrombosis." Thromb Haemost 76 (1996): 477-8
  38. Meirik O, Poulter NR, Chang CL, Farley TMM, Marmot MG "Oral contraceptives and thrombotic diseases: impact of new epidemiological studies." Contraception 54 (1996): 193-5
  39. "Product Information. Ortho Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  40. "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical (2001):
  41. "Product Information. Demulen (ethinyl estradiol-ethynodiol)." Searle, Skokie, IL.
  42. "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories (2001):
  43. "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical (2001):
  44. "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories (2001):
  45. "Product Information. Ortho Novum 1/50 (mestranol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  46. Sidney S, Petitti DB, Quesenberry CP "Myocardial infarction and the use of estrogen and estrogen-progestogen in postmenopausal women." Ann Intern Med 127 (1997): 501-8
  47. "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical (2001):
  48. Thorogood M "Risk of stroke in users of oral contraceptives." JAMA 281 (1999): 1255-6
  49. "Product Information. Ortho Dienestrol Cream (dienestrol topical)" Ortho McNeil Pharmaceutical, Raritan, NJ.
  50. "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn (2001):
  51. "Product Information. Estinyl Tablets (ethinyl estradiol)" Schering Corporation, Kenilworth, NJ.
  52. "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc (2001):
  53. "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma (2021):
View all 53 references
Major

Estrogens (applies to EluRyng) thromboembolism/cardiovascular

Major Potential Hazard, Moderate plausibility. Applicable conditions: Migraine, History - Thrombotic/Thromboembolic Disorder, Cerebral Vascular Disorder, Thrombotic/Thromboembolic Disorder, Ischemic Heart Disease

The use of estrogens is considered by manufacturers and some authorities to be contraindicated in patients with active thrombotic or thromboembolic disorders. The use of estrogen-containing oral contraceptives is additionally deemed contraindicated in patients with a history of such disorders and/or current cerebrovascular or coronary artery disease. Females with a history of migraines with aura are at an increased risk for stroke and this stroke risk may be further increased in females who have migraines with aura with use of combination oral contraceptives. Hypercoagulability and changes in various clotting factors and blood components have been observed in women receiving estrogen therapy. Although the clinical significance of these effects is unknown, epidemiological data suggest it may be dose-dependent. The risk is probably slight with the use of newer, low-dose oral contraceptives in the absence of known risk factors (e.g., smoker, particularly over the age of 35; hypertension; hyperlipidemia; obesity; diabetes; age over 40). However, a much more significant risk has been reported with higher dosages, such as those used to treat prostate or metastatic breast cancer or those used in older formulations of birth control pills. Therapy with estrogens should be administered cautiously in the lowest effective dosage and only after careful consideration of risks and benefits. Estrogens should be avoided in patients with a history of thrombotic and thromboembolic disorders associated with estrogen use, except when used in the treatment of breast or prostatic malignancy.

References

  1. Notelovitz M "Oral contraception and coagulation." Clin Obstet Gynecol 28 (1985): 73-83
  2. Meade TW "Oral contraceptives, clotting factors, and thrombosis." Am J Obstet Gynecol 142 (1982): 758-61
  3. Williams RS "Benefits and risks of oral contraceptive use." Postgrad Med 92 (1992): 155-7
  4. Slone D, Stolley PD, Kaufman D, Miettinen OS, Rosenberg L, Shapiro S "Noncontraceptive estrogens and myocardial infarction in young women." JAMA 244 (1980): 339-42
  5. Rothman KJ, Dinan B, Jick H "Noncontraceptive estrogens and nonfatal myocardial infarction." JAMA 239 (1978): 1407-8
  6. Nencioni T, Boschetti C, Bertolli V, Cortellaro M, Della Volpe A, Zanussi C "Short- and long-term effects of hormone replacement therapy (transdermal estradiol vs oral conjugated equine estrogens, combined with medroxyprogesterone acetate) on blood coagulation factors in postmenopausal women." Thromb Res 62 (1991): 1-8
  7. Lesko SM, Palmer JR, Rosenberg L, Shapiro S "Oral contraceptive use and the risk of myocardial infarction." Am J Epidemiol 131 (1990): 1009-16
  8. Mann J, Murphy M, Thorogood M, Vessey M "Fatal stroke and use of oral contraceptives: findings from a case- control study." Am J Epidemiol 136 (1992): 35-45
  9. Leaf DA, Neighbor WE, Scott CS, Bland D, Schaad D "Oral contraceptive use and coronary risk factors in women." Am J Med Sci 301 (1991): 365-8
  10. Thorneycroft IH "Oral contraceptives and myocardial infarction." Am J Obstet Gynecol 163 (1990): 1393-7
  11. Lidegaard O "Oral contraception and risk of a cerebral thromboembolic attack: results of a case-control study." BMJ 306 (1993): 956-63
  12. Derman RJ "Oral contraceptives and cardiovascular risk. Taking a safe course of action." Postgrad Med 88 (1990): 119-22
  13. Hannaford PC, Croft PR, Kay CR "Oral contraception and stroke. Evidence from the Royal College of General Practitioners' Oral Contraception Study." Stroke 25 (1994): 935-42
  14. Steinberg WM "Oral contraception: risks and benefits." Adv Contracept 5 (1989): 219-28
  15. Miwa LJ, Shaefer MS, Edmunds AL, Raynor SC "Idiopathic thromboembolism associated with triphasic oral contraceptives." DICP 23 (1989): 773-5
  16. Beaumont JL, Lemort N, Beaumont V "Oral contraceptives, sex steroid-induced antibodies and vascular thrombosis: results from 1318 cases." Eur Heart J 12 (1991): 1219-24
  17. Key JD, Everett L, Hammill WW "Pulmonary embolus in an adolescent on oral contraceptives." J Adolesc Health 13 (1992): 713-5
  18. Burkman RT Jr "Benefits and risk of oral contraceptives. A reassessment." J Reprod Med 36 (1991): 217-8
  19. Lee NC, Peterson HB "Long-term health risks and benefits of oral contraceptive use." Obstet Gynecol Clin North Am 17 (1990): 775-88
  20. Boston Collaborative Drug Surveilance Program "Surgically confirmed gallbladder disease, venous thromboembolism, and breast tumors in relation to postmenopausal estrogen therapy." N Engl J Med 290 (1974): 15-9
  21. Belchetz PE "Hormonal treatment of postmenopausal women." N Engl J Med 330 (1994): 1062-71
  22. Barrett-Connor E, Devor M, Renvall M, Feigal D, Ramsdell J "Estrogen replacement therapy and the risk of venous thrombosis." Am J Med 92 (1992): 275-81
  23. Barrett-Connor E, Bush TL "Estrogen and coronary heart disease in women." JAMA 265 (1991): 1861-7
  24. Grady D, Rubin SM, Petiti DB, et al. "Hormone therapy to prevent disease and prolong life in postmenopausal women." Ann Intern Med 117 (1992): 1016-36
  25. Barrett-Connor E, Criqui MH, Wingard DL "Postmenopausal estrogen use and heart disease risk factors in the 1980s. Rancho Bernardo, Calif, revisited." JAMA 261 (1989): 1095-2100
  26. Mishell DR "Contraception." N Engl J Med 320 (1989): 777-85
  27. "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories (2001):
  28. Freeman R, Schwartz J, Frishman W "Clinical pharmacology of estrogens: cardiovascular actions and cardioprotective benefits of replacement therapy in postmenopausal women." J Clin Pharmacol 35 (1995): 1-16
  29. Lidegaard O "Oral contraceptives, pregnancy and the risk of cerebral thromboembolism: the influence of diabetes, hypertension, migraine and previous thrombotic disease." Br J Obstet Gynaecol 102 (1995): 153-9
  30. The Writing Group for the PEPI Trial "Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women: the Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial." JAMA 273 (1995): 199-208
  31. "Product Information. Climara (estradiol)." Berlex Laboratories (2001):
  32. "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories (2001):
  33. "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  34. "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  35. Bonnar J, Norris LA "The effect of oestrogen dose and progestogen type on haemostatic changes in women taking low dose oral contraceptives." Br J Obstet Gynaecol 103 (1996): 261-7
  36. Cowchock FS, Levine AB, Mcgough B, Teppa J "Evaluation of the prethrombotic state in pregnancy and in women using oral contraceptives." Contraception 53 (1996): 255-7
  37. Sidney S, Bernstein A, Petitti DB, Quesenberry C, Wolf S, Ziel HK "Stroke in users of low-dose oral contraceptives." N Engl J Med 335 (1996): 8-15
  38. Speroff L "Oral contraceptives and venous thromboembolism." Int J Gynaecol Obstet 54 (1996): 45-50
  39. Artigas J, , Medina E, Meirik O, Zhong YH, Poulter NR, Shen H, Chang CL, Debertribeiro M, Farley TMM, Marmot MG, Zhang DW "Ischaemic stroke and combined oral contraceptives: results of an international, multicentre, case-control study." Lancet 348 (1996): 498-505
  40. Meirik O, Poulter NR, Chang CL, Farley TMM, Marmot MG "Haemorrhagic stroke, overall stroke risk, and combined oral contraceptives: results of an international, multicentre, case-control study." Lancet 348 (1996): 505-10
  41. Guillebaud J, Piegsa K "Oral contraceptives and the risk of DVT." Practitioner 240 (1996): 544
  42. Martinelli I, Mannucci PM, Rosendaal FR, Vandenbroucke JP "Oral contraceptives are a risk factor for cerebral vein thrombosis." Thromb Haemost 76 (1996): 477-8
  43. Meirik O, Poulter NR, Chang CL, Farley TMM, Marmot MG "Oral contraceptives and thrombotic diseases: impact of new epidemiological studies." Contraception 54 (1996): 193-5
  44. "Product Information. Ortho Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  45. "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical (2001):
  46. "Product Information. Demulen (ethinyl estradiol-ethynodiol)." Searle, Skokie, IL.
  47. "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories (2001):
  48. "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical (2001):
  49. "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories (2001):
  50. "Product Information. Ortho Novum 1/50 (mestranol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  51. Sidney S, Petitti DB, Quesenberry CP "Myocardial infarction and the use of estrogen and estrogen-progestogen in postmenopausal women." Ann Intern Med 127 (1997): 501-8
  52. Furberg C, Grady D, Herrington D, Vittinghoff E, Riggs B, Bush T, Hulley S "Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women." JAMA 280 (1998): 605-13
  53. "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical (2001):
  54. Petitti DB "Hormone replacement therapy and heart disease prevention: experimentation trumps observation." JAMA 280 (1998): 650-2
  55. Thorogood M "Risk of stroke in users of oral contraceptives." JAMA 281 (1999): 1255-6
  56. Karas RH, Mendelsohn ME "The protective effects of estrogen on the cardiovascular system." N Engl J Med 340 (1999): 1801-11
  57. "Product Information. Ortho Dienestrol Cream (dienestrol topical)" Ortho McNeil Pharmaceutical, Raritan, NJ.
  58. "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn (2001):
  59. "Product Information. Estinyl Tablets (ethinyl estradiol)" Schering Corporation, Kenilworth, NJ.
  60. "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc (2001):
  61. "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma (2021):
View all 61 references
Major

Estrogens/progestogens (applies to EluRyng) hepatic neoplasms

Major Potential Hazard, High plausibility. Applicable conditions: Hepatic Tumor, Hepatic Tumor

The use of oral contraceptives is contraindicated in patients with liver tumors. An increased risk of benign hepatic adenomas and hepatocellular carcinomas has been associated with long-term, oral estrogen- progestin contraceptive use of at least 4 years and 8 years, respectively. Although these tumors are rare and have not been reported with other types of estrogen or progestogen therapies, any preparation containing estrogens and/or progestogens should probably be avoided in patients with existing tumors of the liver. Hepatic hemangiomas and nodular hyperplasia of the liver have been reported with isolated estrogen therapy.

References

  1. Tao LC "Oral contraceptive-associated liver cell adenoma and hepatocellular carcinoma." Cancer 68 (1991): 341-7
  2. "Depot-medroxyprogesterone acetate (DMPA) and risk of liver cancer. The WHO Collaborative Study of Neoplasia and Steroid Contraceptives." Int J Cancer 49 (1991): 182-5
  3. Conter RL, Longmire WP Jr "Recurrent hepatic hemangiomas. Possible association with estrogen therapy." Ann Surg 207 (1988): 115-9
  4. Aldinger K, Whalen G, Ben-Menachem Y "Focal nodular hyperplasia of the liver associated with high-dosage estrogens." Arch Intern Med 137 (1977): 357-9
  5. Palmer JR, Kaufman DW, Stolley P, Rosenberg L, Shapiro S, Warshauer ME "Oral contraceptive use and liver cancer." Am J Epidemiol 130 (1989): 878-82
  6. Mooney MJ, Carter PL, Hall RA, Nyreen MR "Hepatic adenoma presenting as a right lower quadrant mass." Am Surg 59 (1993): 229-31
  7. Bredfeldt JE, Black WC, Gyorffy EJ "Transformation of hepatic cell adenoma to hepatocellular carcinoma due to oral contraceptive use." Ann Intern Med 110 (1989): 489-90
  8. Franceschi S, Tavani A, Parazzini F, La Vecchia C, Negri E "Female hormone utilisation and risk of hepatocellular carcinoma." Br J Cancer 67 (1993): 635-7
  9. Anglade MC, Dhumeaux D, Zafrani ES, Mathieu D "Association of focal nodular hyperplasia and hepatic hemangioma." Gastroenterology 97 (1989): 154-7
  10. Le Bail B, Balabaud C, Saric J, Bioulac-Sage P, Deugnier Y, Jouhanole H, Pellegrin JL, Salame G "Liver adenomatosis with granulomas in two patients on long-term oral contraceptives." Am J Surg Pathol 16 (1992): 982-7
  11. "Oral contraceptives and neoplasia. WHO Scientific Group." World Health Organ Tech Rep Ser 817 (1992): 1-46
  12. Mishell DR "Contraception." N Engl J Med 320 (1989): 777-85
  13. "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories (2001):
  14. "Product Information. Climara (estradiol)." Berlex Laboratories (2001):
  15. "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories (2001):
  16. "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  17. "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  18. "Product Information. Ortho Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  19. "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical (2001):
  20. "Product Information. Demulen (ethinyl estradiol-ethynodiol)." Searle, Skokie, IL.
  21. "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories (2001):
  22. "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical (2001):
  23. "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories (2001):
  24. "Product Information. Ortho Novum 1/50 (mestranol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  25. "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical (2001):
  26. "Product Information. Ortho Dienestrol Cream (dienestrol topical)" Ortho McNeil Pharmaceutical, Raritan, NJ.
  27. "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn (2001):
  28. "Product Information. Estinyl Tablets (ethinyl estradiol)" Schering Corporation, Kenilworth, NJ.
  29. "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc (2001):
  30. "Product Information. Norplant System (levonorgestrel)." Wyeth-Ayerst Laboratories (2001):
  31. "Product Information. Micronor (norethindrone)." Ortho McNeil Pharmaceutical (2001):
  32. "Product Information. Ovrette (norgestrel)." Wyeth-Ayerst Laboratories (2001):
  33. "Product Information. Implanon (etonogestrel)." Organon Pharmaceuticals (2006):
  34. "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma (2021):
View all 34 references
Major

Progestogens (applies to EluRyng) breast malignancy

Major Potential Hazard, High plausibility. Applicable conditions: Breast Cancer

The use of progestogens is considered by manufacturers to be contraindicated in patients with existing or suspected malignancy of the breast. Some supportive data are available for medroxyprogesterone. Specifically, medroxyprogesterone treatment may be associated with breast cancer, primarily when the drug is administered intramuscularly. A pooled analysis of two case-control studies, one from the World Health Organization and the other from New Zealand, revealed a small overall relative risk of breast cancer in women who have ever used intramuscular medroxyprogesterone acetate. The relative risk was higher in the subgroup of women who had initiated therapy within the previous 5 years. Thus, an increased risk (approximately 2-fold) is associated with intramuscular medroxyprogesterone use in the first 5 years. A more recent U.S. study also found a statistically significant increase in breast cancer risk among recent users (defined as last use within the past five years) who used depo-medroxyprogesterone acetate for 12 months or longer.

References

  1. Michelson MJ, Layde PM, Potts M, Hatcher RA, Levenson AG, Liang AP, Shelton JD "Risk of breast, uterine corpus, and ovarian cancer in women receiving medroxyprogesterone injections." JAMA 249 (1983): 2909-12
  2. "Breast cancer, cervical cancer, and depot medroxyprogesterone acetate. WHO Collaborative Study of Neoplasia and Steroid Contraceptives" Lancet 2 (1984): 1207-8
  3. "Breast cancer and depot-medroxyprogesterone acetate: a multinational study. WHO Collaborative Study of Neoplasia and Steroid Contraceptives" Lancet 338 (1991): 833-8
  4. Jordan A "Toxicology of depot medroxyprogesterone acetate." Contraception 49 (1994): 189-201
  5. Chilvers C "Breast cancer and depot-medroxyprogesterone acetate - a review." Contraception 49 (1994): 211-22
  6. "Product Information. Depo-Provera (medroxyprogesterone)." Pharmacia and Upjohn (2001):
  7. "Product Information. Provera (medroxyprogesterone)." Pharmacia and Upjohn (2001):
  8. Meirik O, Paul C, Thomas DB, Noonan EA, Skegg DC, Spears GF "Depot medroxyprogesterone acetate and breast cancer." JAMA 273 (1995): 799-807
  9. "Product Information. Norplant System (levonorgestrel)." Wyeth-Ayerst Laboratories (2001):
  10. "Product Information. Micronor (norethindrone)." Ortho McNeil Pharmaceutical (2001):
  11. "Product Information. Ovrette (norgestrel)." Wyeth-Ayerst Laboratories (2001):
  12. "Product Information. Prometrium (progesterone)." Virtus Pharmaceuticals LLC (2001):
  13. "Product Information. Implanon (etonogestrel)." Organon Pharmaceuticals (2006):
View all 13 references
Major

Progestogens (applies to EluRyng) liver disease

Major Potential Hazard, Moderate plausibility.

The use of progestogens, in general, is contraindicated in patients with impaired hepatic function or liver disease. There are little or no data concerning the pharmacokinetic disposition of the different progestogens in patients with hepatic disease. However, most hormones, including progestational hormones, are known to be extensively metabolized by the liver. Medroxyprogesterone should not be used by women with significant liver disease and should be discontinued if jaundice or disturbances of liver function occur.

References

  1. Aakvaag A, Kvinnsland S, Lundgren S, Utaaker E "Pharmacokinetics and metabolism of medroxyprogesterone acetate in patients with advanced breast cancer." J Steroid Biochem 31 (1988): 437-41
  2. Sala G, Castegnaro E "Pharmacokinetics and metabolism of medroxyprogesterone acetate. Influence of the route of administration and of its physical state." Steroidologia 2 (1971): 13-26
  3. Kauppila A, Riippa P, Sundstrom H, Vihko R "Hepatic impairment during simultaneous administration of medroxyprogesterone acetate and tamoxifen in the treatment of endometrial and ovarian carcinoma." Anticancer Res 4 (1984): 109-12
  4. 3d Wiener I, Emory LE, Meyer WJ, Cole CM, Fagan CJ, Isenberg N, Thompson JC "Cholelithiasis associated with medroxyprogesterone acetate therapy in men." Res Commun Chem Pathol Pharmacol 75 (1992): 69-84
  5. Galand N, Hendeles SM, Schwers J "Metabolism of orally administered D-norgestrel in women." Acta Endocrinol (Copenh) 71 (1972): 557-68
  6. "Product Information. Depo-Provera (medroxyprogesterone)." Pharmacia and Upjohn (2001):
  7. "Product Information. Provera (medroxyprogesterone)." Pharmacia and Upjohn (2001):
  8. "Product Information. Norplant System (levonorgestrel)." Wyeth-Ayerst Laboratories (2001):
  9. "Product Information. Micronor (norethindrone)." Ortho McNeil Pharmaceutical (2001):
  10. "Product Information. Ovrette (norgestrel)." Wyeth-Ayerst Laboratories (2001):
  11. "Product Information. Prometrium (progesterone)." Virtus Pharmaceuticals LLC (2001):
  12. "Product Information. Implanon (etonogestrel)." Organon Pharmaceuticals (2006):
View all 12 references
Major

Progestogens (applies to EluRyng) thromboembolism

Major Potential Hazard, Moderate plausibility. Applicable conditions: Cerebral Vascular Disorder, Thrombotic/Thromboembolic Disorder, History - Thrombotic/Thromboembolic Disorder

The use of progestogens, in general, is considered by manufacturers to be contraindicated in patients with active thrombophlebitis, cerebrovascular disease, or a current or past history of thromboembolic disorders. While the role of progestogens in the development of thromboembolic events associated with hormonal therapy is often unclear and thought to be secondary to that of estrogens, it may not be insignificant. Medroxyprogesterone, a common progestational agent, has been shown to produce a hypercoagulable state in high dosages. Whether or not this effect contributes to the development of thrombotic events is unknown. However, thrombophlebitis and pulmonary embolism have been reported with megestrol, an antineoplastic and progestational agent. In addition, an increased risk of nonfatal venous thrombosis has been associated with oral contraceptive combinations containing desogestrel or gestodene relative to those that contain other progestins (e.g., levonorgestrel, norethindrone), suggesting some degree of hemostatic effect by progestogens.

References

  1. Astedt B, Jeppsson S, Pandolfi M "Fibrinolytic activity of veins during use of depot medroxyprogesterone acetate as a contraceptive." Fertil Steril 23 (1972): 489-92
  2. Imaoka S, Noguchi S, Iwanaga T, Miyauchi K, Inaji H, Koyama H, Yamamoto H "Changes in hematologic parameters during treatment with medroxyprogesterone acetate for breast cancer." Jpn J Cancer Res 82 (1991): 420-5
  3. Adachi I, Fukutomi T, Yamamoto H, Nanasawa T, Watanabe T "The induction of a hypercoagulable state by medroxyprogesterone acetate in breast cancer patients." Jpn J Surg 20 (1990): 665-70
  4. "Product Information. Depo-Provera (medroxyprogesterone)." Pharmacia and Upjohn (2001):
  5. "Product Information. Provera (medroxyprogesterone)." Pharmacia and Upjohn (2001):
  6. "Product Information. Ortho Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  7. "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical (2001):
  8. "Product Information. Demulen (ethinyl estradiol-ethynodiol)." Searle, Skokie, IL.
  9. "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories (2001):
  10. "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical (2001):
  11. "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories (2001):
  12. "Product Information. Megace (megestrol)." Bristol-Myers Squibb (2001):
  13. "Product Information. Norplant System (levonorgestrel)." Wyeth-Ayerst Laboratories (2001):
  14. "Product Information. Micronor (norethindrone)." Ortho McNeil Pharmaceutical (2001):
  15. "Product Information. Ovrette (norgestrel)." Wyeth-Ayerst Laboratories (2001):
  16. "Product Information. Prometrium (progesterone)." Virtus Pharmaceuticals LLC (2001):
  17. "Product Information. Implanon (etonogestrel)." Organon Pharmaceuticals (2006):
View all 17 references
Moderate

Estrogens (applies to EluRyng) angioedema

Moderate Potential Hazard, Moderate plausibility.

The use of exogenous estrogens may induce or exacerbate symptoms of angioedema, particularly in women with hereditary angioedema. Close monitoring is recommended when prescribing these agents to patients predisposed to angioedema.

References

  1. "Product Information. Ortho Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  2. "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical (2001):
  3. "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical (2001):
  4. "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories (2001):
  5. "Product Information. Ortho Novum 1/50 (mestranol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  6. "Product Information. Ortho Dienestrol Cream (dienestrol topical)" Ortho McNeil Pharmaceutical, Raritan, NJ.
  7. "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma (2021):
View all 7 references
Moderate

Estrogens (applies to EluRyng) gallbladder disease

Moderate Potential Hazard, Moderate plausibility.

A two- to four-fold increase in risk of gallbladder disease has been noted in women receiving postmenopausal estrogen therapy. The risk for gallbladder disease may be less for premenopausal women using oral contraceptives containing low-dose estrogens and/or progestins. Therapy with estrogens should be administered cautiously in patients with preexisting gallbladder disease.

References

  1. Boston Collaborative Drug Surveilance Program "Surgically confirmed gallbladder disease, venous thromboembolism, and breast tumors in relation to postmenopausal estrogen therapy." N Engl J Med 290 (1974): 15-9
  2. "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories (2001):
  3. "Product Information. Climara (estradiol)." Berlex Laboratories (2001):
  4. "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories (2001):
  5. "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  6. "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  7. "Product Information. Ortho Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  8. "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical (2001):
  9. "Product Information. Demulen (ethinyl estradiol-ethynodiol)." Searle, Skokie, IL.
  10. "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories (2001):
  11. "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical (2001):
  12. "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories (2001):
  13. "Product Information. Ortho Novum 1/50 (mestranol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  14. "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical (2001):
  15. "Product Information. Ortho Dienestrol Cream (dienestrol topical)" Ortho McNeil Pharmaceutical, Raritan, NJ.
  16. "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn (2001):
  17. "Product Information. Estinyl Tablets (ethinyl estradiol)" Schering Corporation, Kenilworth, NJ.
  18. "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc (2001):
  19. "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma (2021):
View all 19 references
Moderate

Estrogens (applies to EluRyng) hypercalcemia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Hyperparathyroidism, Renal Dysfunction

Estrogens influence the metabolism of calcium and phosphorus. Intestinal absorption and retention of calcium are increased, which may occasionally result in hypercalcemia. Therapy with estrogens should be administered cautiously in patients with preexisting hypercalcemia, renal dysfunction, or metabolic bone diseases that are associated with hypercalcemia.

References

  1. "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories (2001):
  2. "Product Information. Climara (estradiol)." Berlex Laboratories (2001):
  3. "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories (2001):
  4. "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  5. "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  6. "Product Information. Emcyt (estramustine)." Pharmacia and Upjohn (2001):
  7. "Product Information. Duavee (bazedoxifene-conjugated estrogens)." Pfizer U.S. Pharmaceuticals Group (2013):
View all 7 references
Moderate

Estrogens (applies to EluRyng) hyperlipidemia

Moderate Potential Hazard, Moderate plausibility.

Although estrogens have generally favorable effects on plasma lipids, including increases in HDL and decreases in total cholesterol and LDL, they have also been associated with significant elevations in triglyceride levels, particularly when high dosages are used. Severe hyperlipidemia is known to sometimes cause pancreatitis. Patients with preexisting hyperlipidemia may require closer monitoring during estrogen therapy, and adjustments made accordingly in their lipid-lowering regimen.

References

  1. Odell WD, Oill P, Molitch ME "Massive hyperlipemia during estrogen therapy." JAMA 227 (1974): 522-5
  2. Dain MP, Rouffy J, Janaud A, Upmalis D "A comparison study of lipid and androgen metabolism with triphasic oral contraceptive formulations containing norgestimate or levonorgestrel." Acta Obstet Gynecol Scand Suppl 156 (1992): 33-8
  3. Steinberg WM "Oral contraception: risks and benefits." Adv Contracept 5 (1989): 219-28
  4. Bell WR, Kwiterovich P, Burkman RT, Kimball AW, Zacur HA "Oral contraceptives and lipids and lipoproteins: Part I--Variations in mean levels by oral contraceptive type." Contraception 40 (1989): 553-61
  5. Derman R "Oral contraceptives: a reassessment." Obstet Gynecol Surv 44 (1989): 662-8
  6. Crook D, Godsland IF "Update on the metabolic effects of steroidal contraceptives and their relationship to cardiovascular disease risk." Am J Obstet Gynecol 170 (1994): 1528-36
  7. "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories (2001):
  8. "Product Information. Climara (estradiol)." Berlex Laboratories (2001):
  9. "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories (2001):
  10. "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  11. "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  12. "Product Information. Ortho Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  13. "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical (2001):
  14. "Product Information. Demulen (ethinyl estradiol-ethynodiol)." Searle, Skokie, IL.
  15. "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories (2001):
  16. "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical (2001):
  17. "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories (2001):
  18. "Product Information. Ortho Novum 1/50 (mestranol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  19. Furberg C, Grady D, Herrington D, Vittinghoff E, Riggs B, Bush T, Hulley S "Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women." JAMA 280 (1998): 605-13
  20. "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical (2001):
  21. "Product Information. Ortho Dienestrol Cream (dienestrol topical)" Ortho McNeil Pharmaceutical, Raritan, NJ.
  22. "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn (2001):
  23. "Product Information. Estinyl Tablets (ethinyl estradiol)" Schering Corporation, Kenilworth, NJ.
  24. "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc (2001):
  25. "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma (2021):
View all 25 references
Moderate

Estrogens (applies to EluRyng) liver disease

Moderate Potential Hazard, High plausibility.

Estrogens are primarily metabolized by the liver. Patients with impaired hepatic function may be at increased risk for adverse effects associated with estrogen administration due to decreased drug clearance. Therapy with estrogens should be administered cautiously in patients with liver disease. In addition, clinicians should be aware that estrogen therapy may affect liver function tests. Increased sulfobromophthalein retention has been reported with the use of estrogen-containing oral contraceptives and may be expected with larger doses of estrogens.

References

  1. Bhavnani BR, Cecutti A "Pharmacokinetics of 17 beta-dihydroequilin sulfate and 17 beta- dihydroequilin in normal postmenopausal women." J Clin Endocrinol Metab 78 (1994): 197-204
  2. Adlercrueuta H "Hepatic metabolism of estrogens in health and disease." N Engl J Med 290 (1974): 1081-3
  3. Goldzieher JW "Pharmacology of contraceptive steroids: a brief review." Am J Obstet Gynecol 160 (1989): 1260-4
  4. al-Yacoub G, Fuhrmeister A, Kuhnz W "Pharmacokinetics of levonorgestrel and ethinylestradiol in 9 women who received a low-dose oral contraceptive over a treatment period of 3 months and the same contraceptive formulation." Contraception 46 (1992): 455-69
  5. "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories (2001):
  6. "Product Information. Climara (estradiol)." Berlex Laboratories (2001):
  7. "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories (2001):
  8. "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  9. "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  10. "Product Information. Ortho Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  11. "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical (2001):
  12. "Product Information. Demulen (ethinyl estradiol-ethynodiol)." Searle, Skokie, IL.
  13. "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories (2001):
  14. "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical (2001):
  15. "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories (2001):
  16. "Product Information. Ortho Novum 1/50 (mestranol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  17. "Product Information. Emcyt (estramustine)." Pharmacia and Upjohn (2001):
  18. "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical (2001):
  19. "Product Information. Ortho Dienestrol Cream (dienestrol topical)" Ortho McNeil Pharmaceutical, Raritan, NJ.
  20. "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn (2001):
  21. "Product Information. Estinyl Tablets (ethinyl estradiol)" Schering Corporation, Kenilworth, NJ.
  22. "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc (2001):
  23. "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma (2021):
View all 23 references
Moderate

Estrogens (applies to EluRyng) melasma

Moderate Potential Hazard, Moderate plausibility.

The use of exogenous estrogens may occasionally cause chloasma, especially in women with a history of chloasma gravidarum. Women with a tendency to chloasma should avoid exposure to the sun or ultraviolet radiation while taking combination oral contraceptives.

References

  1. "Product Information. Ortho Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  2. "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical (2001):
  3. "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical (2001):
  4. "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories (2001):
  5. "Product Information. Ortho Novum 1/50 (mestranol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  6. "Product Information. Ortho Dienestrol Cream (dienestrol topical)" Ortho McNeil Pharmaceutical, Raritan, NJ.
  7. "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma (2021):
View all 7 references
Moderate

Estrogens/progestogens (applies to EluRyng) depression

Moderate Potential Hazard, Moderate plausibility.

The use of oral contraceptives has been associated with an increased incidence of depression. It is uncertain whether this effect is related to the estrogenic or the progestogenic component of the contraceptive, although excess progesterone activity is associated with depression. Patients with a history of depression receiving estrogen and/or progestogen therapy should be followed closely. The manufacturer of medroxyprogesterone recommends monitoring patients who have a history of depression and to not re- administer medroxyprogesterone if depression recurs.

References

  1. "Product Information. Depo-Provera (medroxyprogesterone)." Pharmacia and Upjohn (2001):
  2. "Product Information. Provera (medroxyprogesterone)." Pharmacia and Upjohn (2001):
  3. "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories (2001):
  4. "Product Information. Climara (estradiol)." Berlex Laboratories (2001):
  5. "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories (2001):
  6. "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  7. "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  8. "Product Information. Ortho Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  9. "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical (2001):
  10. "Product Information. Demulen (ethinyl estradiol-ethynodiol)." Searle, Skokie, IL.
  11. "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories (2001):
  12. "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical (2001):
  13. "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories (2001):
  14. "Product Information. Ortho Novum 1/50 (mestranol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  15. "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical (2001):
  16. "Product Information. Ortho Dienestrol Cream (dienestrol topical)" Ortho McNeil Pharmaceutical, Raritan, NJ.
  17. "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn (2001):
  18. "Product Information. Estinyl Tablets (ethinyl estradiol)" Schering Corporation, Kenilworth, NJ.
  19. "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc (2001):
  20. "Product Information. Norplant System (levonorgestrel)." Wyeth-Ayerst Laboratories (2001):
  21. "Product Information. Micronor (norethindrone)." Ortho McNeil Pharmaceutical (2001):
  22. "Product Information. Ovrette (norgestrel)." Wyeth-Ayerst Laboratories (2001):
  23. "Product Information. Implanon (etonogestrel)." Organon Pharmaceuticals (2006):
  24. "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma (2021):
View all 24 references
Moderate

Estrogens/progestogens (applies to EluRyng) fluid retention

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Migraine, Asthma, Seizures, Congestive Heart Failure, Renal Dysfunction, Congestive Heart Failure, Migraine, Asthma, Seizures, Renal Dysfunction, Hypertension

Estrogens and progestogens may cause fluid retention, particularly when given in high dosages or for prolonged periods. Therapy with these agents should be administered cautiously in patients who have preexisting problems with excess fluid. In addition, patients with conditions that may be adversely affected by fluid accumulation, such as asthma, epilepsy, migraine, and cardiovascular or renal dysfunction, should be observed for exacerbation of their condition during estrogen and/or progestogen therapy.

References

  1. Leiman G "Depo-medroxyprogesterone acetate as a contraceptive agent: its effect on weight and blood pressure." Am J Obstet Gynecol 114 (1972): 97-102
  2. "Product Information. Depo-Provera (medroxyprogesterone)." Pharmacia and Upjohn (2001):
  3. "Product Information. Provera (medroxyprogesterone)." Pharmacia and Upjohn (2001):
  4. "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories (2001):
  5. "Product Information. Climara (estradiol)." Berlex Laboratories (2001):
  6. "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories (2001):
  7. "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  8. "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  9. "Product Information. Ortho Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  10. "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical (2001):
  11. "Product Information. Demulen (ethinyl estradiol-ethynodiol)." Searle, Skokie, IL.
  12. "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories (2001):
  13. "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical (2001):
  14. "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories (2001):
  15. "Product Information. Ortho Novum 1/50 (mestranol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  16. "Product Information. Emcyt (estramustine)." Pharmacia and Upjohn (2001):
  17. "Product Information. Megace (megestrol)." Bristol-Myers Squibb (2001):
  18. "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical (2001):
  19. "Product Information. Ortho Dienestrol Cream (dienestrol topical)" Ortho McNeil Pharmaceutical, Raritan, NJ.
  20. "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn (2001):
  21. "Product Information. Estinyl Tablets (ethinyl estradiol)" Schering Corporation, Kenilworth, NJ.
  22. "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc (2001):
  23. "Product Information. Norplant System (levonorgestrel)." Wyeth-Ayerst Laboratories (2001):
  24. "Product Information. Micronor (norethindrone)." Ortho McNeil Pharmaceutical (2001):
  25. "Product Information. Ovrette (norgestrel)." Wyeth-Ayerst Laboratories (2001):
  26. "Product Information. Prometrium (progesterone)." Virtus Pharmaceuticals LLC (2001):
  27. "Product Information. Implanon (etonogestrel)." Organon Pharmaceuticals (2006):
View all 27 references
Moderate

Estrogens/progestogens (applies to EluRyng) glucose intolerance

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Diabetes Mellitus

Impaired glucose tolerance has been observed in some patients administered oral contraceptives and appears to be related primarily to the estrogen dose. However, progestogens can increase insulin secretion and produce insulin resistance to varying degrees, depending on the agent. Patients with diabetes mellitus should be monitored more closely during therapy with estrogens and/or progestogens, and adjustments made accordingly in their antidiabetic regimen.

References

  1. Abdel-Sayed WS, Haiba NA, Said SA, el-Habashy MA, Darwish EA, Nayel SE "Clinical evaluation of two monthly injectable contraceptives and their effects on some metabolic parameters." Contraception 39 (1989): 619-32
  2. Nitichai Y, Tangkeo P, Wongsrichanalai C, Virutamasen P, Rienprayoon D "Metabolic effects of depot-medroxyprogesterone acetate in long-term users: a cross-sectional study." Int J Gynaecol Obstet 24 (1986): 291-6
  3. Who Task Force on Long-acting Agents for Fertility Regulation "Metabolic side-effects of injectable depot-medroxyprogesterone acetate, 150 mg three-monthly, in undernourished lactating women." Bull World Health Organ 64 (1986): 587-94
  4. Holmes DL, Marshall G, Garg SK, Chase HP, Hoops SL, Jackson WE "Oral contraceptives and renal and retinal complications in young women with insulin-dependent diabetes mellitus." JAMA 271 (1994): 1099-102
  5. Hannaford PC, Kay CR "Oral contraceptives and diabetes mellitus." BMJ 299 (1989): 1315-6
  6. Stubblefield PG "Choosing the best oral contraceptive." Clin Obstet Gynecol 32 (1989): 316-28
  7. Spellacy WN, Ellingson AB, Tsibris JC "The effects of two triphasic oral contraceptives on carbohydrate metabolism in women during 1 year of use." Fertil Steril 51 (1989): 71-4
  8. Steinberg WM "Oral contraception: risks and benefits." Adv Contracept 5 (1989): 219-28
  9. Derman R "Oral contraceptives: a reassessment." Obstet Gynecol Surv 44 (1989): 662-8
  10. Luciano AA, Halvorson CV, Nulsen JC, De Souza MJ, Schoenfeld MJ, Roy MP "Evaluation of low-dose estrogen and progestin therapy in postmenopausal women." J Reprod Med 38 (1993): 207-14
  11. Kaunitz AM "Long-acting injectable contraception with depot medroxyprogesterone acetate." Am J Obstet Gynecol 170 (1994): 1543-9
  12. Belchetz PE "Hormonal treatment of postmenopausal women." N Engl J Med 330 (1994): 1062-71
  13. "Product Information. Ortho-Novum (oral contraceptive combination pill)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  14. "Product Information. Ortho Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  15. "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical (2001):
  16. "Product Information. Demulen (ethinyl estradiol-ethynodiol)." Searle, Skokie, IL.
  17. "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories (2001):
  18. "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical (2001):
  19. "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories (2001):
  20. "Product Information. Ortho Novum 1/50 (mestranol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  21. "Product Information. Norplant System (levonorgestrel)." Wyeth-Ayerst Laboratories (2001):
  22. "Product Information. Micronor (norethindrone)." Ortho McNeil Pharmaceutical (2001):
  23. "Product Information. Ovrette (norgestrel)." Wyeth-Ayerst Laboratories (2001):
  24. "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma (2021):
View all 24 references
Moderate

Estrogens/progestogens (applies to EluRyng) retinal thrombosis

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Visual Defect/Disturbance, Visual Defect/Disturbance

Estrogens and progestogens may cause retinal thrombosis. Oral contraceptives should be discontinued if there is unexplained partial or complete loss of vision; onset of proptosis or diplopia; papilledema; or retinal vascular lesions. Therapy with these agents should be administered cautiously in patients who have preexisting ocular problems and appropriate diagnostic and therapeutic measures should be instituted. Contact lens wearers who develop visual changes or changes in lens tolerance should be assessed by an ophthalmologist.

References

  1. "Product Information. Ortho-Novum (oral contraceptive combination pill)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  2. "Product Information. Ortho Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  3. "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical (2001):
  4. "Product Information. Demulen (ethinyl estradiol-ethynodiol)." Searle, Skokie, IL.
  5. "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories (2001):
  6. "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical (2001):
  7. "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories (2001):
  8. "Product Information. Ortho Novum 1/50 (mestranol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  9. "Product Information. Norplant System (levonorgestrel)." Wyeth-Ayerst Laboratories (2001):
  10. "Product Information. Micronor (norethindrone)." Ortho McNeil Pharmaceutical (2001):
  11. "Product Information. Ovrette (norgestrel)." Wyeth-Ayerst Laboratories (2001):
  12. "Product Information. Prometrium (progesterone)." Virtus Pharmaceuticals LLC (2001):
  13. "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma (2021):
View all 13 references
Moderate

Estrogens/progestogens (applies to EluRyng) thyroid function tests

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Thyroid Disease

When administering estrogen and/or progestogen therapy in patients with thyroid disorders, clinicians should be aware that these hormones may affect thyroid function tests. Changes have mostly been reported with the use of combination oral contraceptives. Specifically, thyroid-binding globulin (TBG) may be increased, resulting in elevated circulating total thyroid hormone, as measured by PBI (protein-bound iodine), T4 by column or radioimmunoassay, or T3 by radioimmunoassay. Free T3 resin uptake may be decreased. On the contrary, a decrease in TBG and, consequently, thyroxine concentration, has been reported by the manufacturers of the progestin-only (norethindrone) oral contraceptives.

References

  1. "Product Information. Depo-Provera (medroxyprogesterone)." Pharmacia and Upjohn (2001):
  2. "Product Information. Provera (medroxyprogesterone)." Pharmacia and Upjohn (2001):
  3. "Product Information. Premarin (conjugated estrogens)." Wyeth-Ayerst Laboratories (2001):
  4. "Product Information. Deltasone (prednisone)." Pharmacia and Upjohn (2001):
  5. "Product Information. Climara (estradiol)." Berlex Laboratories (2001):
  6. "Product Information. Estrace (estradiol)." Warner Chilcott Laboratories (2001):
  7. "Product Information. Estraderm (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  8. "Product Information. Vivelle (estradiol)." Ciba-Geigy Pharmaceuticals (2001):
  9. "Product Information. Ortho Novum 10/11 (ethinyl estradiol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  10. "Product Information. Ortho-Cept (desogestrel-ethinyl estradiol)." Ortho McNeil Pharmaceutical (2001):
  11. "Product Information. Demulen (ethinyl estradiol-ethynodiol)." Searle, Skokie, IL.
  12. "Product Information. Triphasil (ethinyl estradiol-levonorgestrel)." Wyeth-Ayerst Laboratories (2001):
  13. "Product Information. Ortho-Cyclen (ethinyl estradiol-norgestimate)." Ortho McNeil Pharmaceutical (2001):
  14. "Product Information. Lo/Ovral (ethinyl estradiol-norgestrel)." Wyeth-Ayerst Laboratories (2001):
  15. "Product Information. Ortho Novum 1/50 (mestranol-norethindrone)." Ortho Pharmaceutical Corporation, Raritan, NJ.
  16. "Product Information. Emcyt (estramustine)." Pharmacia and Upjohn (2001):
  17. "Product Information. Ortho-Est (estropipate)." Ortho McNeil Pharmaceutical (2001):
  18. "Product Information. Ortho Dienestrol Cream (dienestrol topical)" Ortho McNeil Pharmaceutical, Raritan, NJ.
  19. "Product Information. Ogen (estropipate topical)." Pharmacia and Upjohn (2001):
  20. "Product Information. Estinyl Tablets (ethinyl estradiol)" Schering Corporation, Kenilworth, NJ.
  21. "Product Information. Estratab (esterified estrogens)." Solvay Pharmaceuticals Inc (2001):
  22. "Product Information. Norplant System (levonorgestrel)." Wyeth-Ayerst Laboratories (2001):
  23. "Product Information. Micronor (norethindrone)." Ortho McNeil Pharmaceutical (2001):
  24. "Product Information. Ovrette (norgestrel)." Wyeth-Ayerst Laboratories (2001):
  25. "Product Information. Nextstellis (drospirenone-estetrol)." Mayne Pharma (2021):
View all 25 references
Moderate

Etonogestrel (applies to EluRyng) gallbladder disease

Moderate Potential Hazard, Moderate plausibility.

Etonogestrel might increase the risk of gallbladder disease. Caution and monitoring of symptoms is suggested in patients with history or active gallbladder disease.

References

  1. "Product Information. Implanon (etonogestrel)." Organon Pharmaceuticals (2006):

EluRyng drug interactions

There are 433 drug interactions with EluRyng (ethinyl estradiol / etonogestrel).

EluRyng alcohol/food interactions

There are 6 alcohol/food interactions with EluRyng (ethinyl estradiol / etonogestrel).

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

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