Skip to Content

Ethinyl estradiol and etonogestrel (vaginal ring)

Generic Name: ethinyl estradiol and etonogestrel (vaginal ring) (ETH in il es tra DYE ole and et oh noe JES trel)
Brand Name: NuvaRing

Medically reviewed on Sep 14, 2018

What is ethinyl estradiol and etonogestrel?

The ethinyl estradiol and etonogestrel vaginal ring contains female hormones that prevent ovulation (the release of an egg from an ovary). ethinyl estradiol and etonogestrel also causes changes in your cervical mucus and uterine lining, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus.

Ethinyl estradiol and etonogestrel vaginal ring is used as contraception to prevent pregnancy.

Ethinyl estradiol and etonogestrel may also be used for purposes not listed in this medication guide.

Important Information

Do not use the vaginal ring if you are pregnant or if you have recently had a baby.

You should not use this medicine if you have: uncontrolled high blood pressure, heart disease, coronary artery disease, circulation problems (especially with diabetes), undiagnosed vaginal bleeding, liver disease or liver cancer, severe migraine headaches, if you also take certain hepatitis C medication, if you will have major surgery, if you smoke and are over 35, or if you have ever had a heart attack, a stroke, a blood clot, jaundice caused by pregnancy or birth control pills, or cancer of the breast, uterus/cervix, or vagina.

Smoking can greatly increase your risk of blood clots, stroke, or heart attack. You should not use the vaginal ring if you smoke and are older than 35 years of age.

Before taking this medicine

Using this medicine can increase your risk of blood clots, stroke, or heart attack. You are even more at risk if you have high blood pressure, diabetes, high cholesterol, or if you are overweight. Your risk of stroke or blood clot is highest during your first year of using the vaginal ring, or when you insert a new ring after not wearing one for 4 weeks or longer.

Smoking can greatly increase your risk of blood clots, stroke, or heart attack. Your risk increases the older you are and the more you smoke. You should not use the vaginal ring if you smoke and are older than 35 years of age.

Do not use a vaginal ring if you are pregnant, or if you had a baby within the past 4 weeks. Remove the vaginal ring and call your doctor if you become pregnant, or if you miss two menstrual periods in a row.

You should not use the vaginal ring if you have:

  • untreated or uncontrolled high blood pressure;

  • heart disease (coronary artery disease, a heart valve disorder, history of heart attack, stroke, or blood clot);

  • an increased risk of having blood clots due to a heart problem or a hereditary blood disorder;

  • circulation problems (especially if caused by diabetes);

  • a history of hormone-related cancer, or cancer of the breast, uterus/cervix, or vagina;

  • unusual vaginal bleeding that has not been checked by a doctor;

  • severe migraine headaches (with aura, numbness, weakness, or vision changes), especially if you are older than 35;

  • liver disease or liver cancer;

  • if you smoke and are over 35 years old; or

  • if you take any hepatitis C medication containing ombitasvir/paritaprevir/ritonavir (Technivie).

To make sure the vaginal ring is safe for you, tell your doctor if you have ever had:

The hormones in this medicine can slow breast milk production. Do not use if you are breast feeding a baby.

How should I use ethinyl estradiol and etonogestrel?

Follow all directions on your prescription label. Do not wear more than one ring at a time. Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.

Your doctor will tell you which day to insert the first vaginal ring you use. During the first 7 days, you may need to use back-up birth control (condoms or spermicide, but not a diaphragm or female condom).

The vaginal ring will not prevent pregnancy if you wear it only during intercourse. You must wear the ring around-the-clock for 3 full weeks (21 days).

After 21 days, remove the ring and wait 7 full days before inserting a new ring. Avoid leaving the vaginal ring in place for longer than 3 weeks. Call your doctor if you get off schedule.

The ring should stay in place during sexual intercourse. You may remove the ring, rinse it with warm water, and reinsert it after intercourse. Do not leave the ring out for longer than 3 hours.

You may have breakthrough bleeding. Tell your doctor if this bleeding continues or is very heavy.

If you need major surgery or will be on long-term bed rest, you may need to stop using this medicine for a short time. Any doctor or surgeon who treats you should know that you are using the vaginal ring.

Store unused vaginal rings at room temperature for up to 4 months. Protect from heat and light. Dispose of a used vaginal ring in the foil pouch it came in and throw it away where children and pets cannot get to it. Do not flush the ring down a toilet.

What happens if I miss a dose?

If a ring falls out, rinse it with warm water and reinsert it. If the ring is lost or broken, insert a new ring and stay on the same schedule you started. Carefully follow the Patient Instructions about how to replace a ring that has been out of the vagina for more than 3 hours.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include nausea, vomiting, and vaginal bleeding.

What should I avoid while using ethinyl estradiol and etonogestrel?

Do not smoke while using the vaginal ring, especially if you are older than 35 years of age.

Grapefruit and grapefruit juice may interact with ethinyl estradiol and lead to unwanted side effects. Discuss the use of grapefruit products with your doctor.

This medicine will not protect you from sexually transmitted diseases--including HIV and AIDS. Using a condom is the only way to protect yourself from these diseases.

ethinyl estradiol and etonogestrel side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using this medicine and call your doctor at once if you have:

  • signs of a stroke--sudden numbness or weakness (especially on one side of the body), sudden severe headache, slurred speech, problems with vision or balance;

  • signs of a blood clot--sudden vision loss, stabbing chest pain, feeling short of breath, coughing up blood, pain or warmth in one or both legs;

  • heart attack symptoms--chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating;

  • toxic shock syndrome--sudden fever, body aches, skin rash, vomiting, diarrhea, and feeling dizzy or light-headed;

  • symptoms of depression--mood changes, thoughts about hurting yourself; or

  • liver problems--loss of appetite, upper stomach pain, tiredness, dark urine, jaundice (yellowing of the skin or eyes).

Common side effects may include:

  • headache, mood changes, decreased sex drive;

  • vaginal irritation or discharge, pain in your cervix;

  • menstrual cramps, breast pain or tenderness;

  • nausea, vomiting, stomach pain;

  • acne or weight gain.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Ethinyl estradiol and etonogestrel dosing information

Usual Adult Dose for Contraception:

Insert 1 ring into the vagina and leave in place continuously for 3 weeks, then remove for 1 week and insert a new ring 1 week after the last ring was removed

Comments: During the 1 week ring-free period, withdrawal bleeding usually occurs.

Use: For females of reproductive age to prevent pregnancy

Usual Pediatric Dose for Contraception:

Insert 1 ring into the vagina and leave in place continuously for 3 weeks, then remove for 1 week and insert a new ring 1 week after the last ring was removed

Comments: During the 1 week ring-free period, withdrawal bleeding usually occurs.

Use: For females of reproductive age to prevent pregnancy

What other drugs will affect ethinyl estradiol and etonogestrel?

Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective.

Some drugs can make birth control less effective, which may result in pregnancy. Use a barrier form of birth control (a male condom with spermicide, but not a diaphragm or female condom) with the vaginal ring if you also use any of the following medicines:

Keep using the barrier birth control for at least 28 days after your last dose of any of these medicines.

This list is not complete and many other drugs can interact with ethinyl estradiol and etonogestrel. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any you start or stop using.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

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

Hide