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NUVARING 0.120MG/0.015 MG PER 24 HOURS VAGINAL DELIVERY SYSTEM

Active substance(s): ETHINYLESTRADIOL / ETONOGESTREL

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Package leaflet: Information for the user



®

NuvaRing 0.120mg/0.015mg per 24hours, vaginal
delivery system



(etonogestrel/ethinylestradiol)
Important things to know about combined hormonal contraceptives
(CHCs):
 They are one of the most reliable reversible methods of contraception if
used correctly.
 They slightly increase the risk of having a blood clot in the veins and
arteries, especially in the first year or when restarting a combined
hormonal contraceptive following a break of 4 or more weeks.
 Please be alert and see your doctor if you think you may have
symptoms of a blood clot (see section 2 ‘Blood clots’).
The name of your medicine is NuvaRing 0.120mg/0.015mg per 24hours,
vaginal delivery system but will be referred to as NuvaRing throughout this
leaflet.
Read all of this leaflet carefully before you start using NuvaRing
because it contains important information for you.
 Keep this leaflet. You may need to read it again.
 If you have any further questions, ask your doctor or pharmacist.
 This medicine has been prescribed for you only. Do not pass it on to
others. It may harm them.
 If you get any side effects, talk to your doctor or pharmacist.
This includes any possible side effects not listed in this leaflet. See
section 4.
What is in this leaflet
1. What NuvaRing is and what it is used for
2. What you need to know before you use NuvaRing
2.1 When you should not use NuvaRing
2.2 Warnings and precautions
Blood clots
Cancer
2.3 Children and adolescents
2.4 Other medicines and NuvaRing
Laboratory tests
2.5 Pregnancy and breast-feeding
2.6 Driving and using machines
3. How to use NuvaRing?
3.1 How to insert and remove NuvaRing
3.2 Three weeks in, one week out
3.3 When to start with the first ring
3.4 What to do if…
Your ring is accidentally expelled from the vagina
Your ring has temporarily been out of the vagina
Your ring breaks
You have inserted more than one ring
You have forgotten to insert a new ring after the ring-free interval
You have forgotten to remove the ring
You have missed a menstrual period
You have unexpected bleeding
You want to change the first day of your menstrual period
You want to delay your menstrual period
3.5 When you want to stop using NuvaRing Possible side effects
5. How to store NuvaRing
6. Contents of the pack and other Information
What NuvaRing contains
What NuvaRing looks like and contents of the pack
Manufacturer

1. What NuvaRing is and what it is used for
NuvaRing is a contraceptive vaginal ring used to prevent pregnancy. Each
ring contains a small amount of two female sex hormones – etonogestrel
and ethinylestradiol. The ring slowly releases these hormones into the blood
circulation. Because of the low amount of hormones that is released,
NuvaRing is considered a low-dose hormonal contraceptive. Since
NuvaRing releases two different types of hormones it is a so-called
combined hormonal contraceptive.
4mm
54mm

NuvaRing works just like a combined contraceptive pill (the Pill) but instead
of taking a pill every day, the ring is used for 3 weeks in a row. NuvaRing
releases two female sex hormones that prevent the release of an egg cell
from the ovaries. If no egg cell is released you cannot become pregnant.

2. What you need to know before you use
NuvaRing
Package Leaflet: information for the User
General notes
Before you start using ®NuvaRing you should read the information on blood
NuvaRing
0.120mg/0.015mg
24hours,
vaginal
clots in section
2. It is particularly
important to read per
the symptoms
of a blood
clot – see section 2 ‘Blood clots’. delivery system
In this leaflet, several situations
are described where you should stop using
(etonogestrel/ethinylestradiol)
NuvaRing, or where NuvaRing may be less reliable. In such situations you
should not
have intercourse
you about
shouldcombined
take extra hormonal
non-hormonal
Important
things to or
know
contraceptives
contraceptive
precautions – such as using a condom or another barrier
(CHCs):
method. Do
notare
use
rhythm
temperature
methods. methods
These methods
can
They
one
of theormost
reliable reversible
of contraception
if
be unreliable
NuvaRing alters the monthly changes of the body
usedbecause
correctly.
temperature
and
of theincrease
cervical the
mucus.
 They
slightly
risk of having a blood clot in the veins and
arteries,
especially
in thecontraceptives,
first year or when
restarting
a combined
NuvaRing,
like other
hormonal
does
not protect
hormonal
contraceptive
break of 4transmitted
or more weeks.
against HIV
infection
(AIDS) or following
any othera sexually
disease.
 Please be alert and see your doctor if you think you may have
2.1 When you should not use NuvaRing
symptoms of a blood clot (see section 2 ’Blood clots’).
You should
not use
if youishave
any of® the
conditions listedper
below.
The name
ofNuvaRing
your medicine
NuvaRing
0.120mg/0.015mg
24hours,
If you do
have any
of the
conditions
listed
tell yourthroughout
doctor.
vaginal
delivery
system,
but will
be below,
referredyou
to must
as NuvaRing
Your doctor
will discuss with you what other form of birth control would be
this leaflet.
more appropriate.
Read
this ever
leaflet
carefully
you
start
using
 if you
haveall
(orofhave
had)
a bloodbefore
clot in a
blood
vessel
ofNuvaRing
your legs
because
it contains
important
information
for embolus,
you.
(deep
vein thrombosis,
DVT),
your lungs
(pulmonary
PE) or
Keep this leaflet. You may need to read it again.
other organs;
 know
If you you
havehave
any afurther
questions,
your
doctor
or pharmacist.
 if you
disorder
affectingask
your
blood
clotting
- for
instance,
C deficiency,
protein S deficiency,
antithrombin
– III
 Thisprotein
medicine
has been prescribed
for you only.
Do not pass
it on to
deficiency,
Factor
V harm
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or antiphospholipid antibodies;
others.
It may
them.
 if you
if youtalk
are to
offyour
yourdoctor
feet for
long time (see
 need
If youan
getoperation
any side or
effects,
orapharmacist.
sectionThis
‘Blood
clots’);
includes
any possible side effects not listed in this leaflet. See
section
4. had a heart attack, or a stroke;
 if you have
ever

What is in this leaflet:
1. What NuvaRing is and what is it used for
2. What you need to know before you use NuvaRing









if you have (or have ever had) angina pectoris (a condition that causes
severe chest pain and may be a first sign of a heart attack) or transient
ischaemic attack (TIA – temporary stroke symptoms);
if you have any of the following diseases that may increase your risk of
a clot in the arteries:
- severe diabetes with blood vessel damage
- very high blood pressure
- a very high level of fat in the blood (cholesterol or triglycerides)
- a condition known as hyperhomocysteinaemia
if you have (or have ever had) a type of migraine called ‘migraine with
aura’;
if you have (had) inflammation of the pancreas (pancreatitis) associated
with high levels of fat in your blood.
if you have (had) severe liver disease and your liver is not yet working
normally.
if you have (had) a benign or malignant tumour in the liver.
if you have (had), or if you may have, cancer of the breast or the genital
organs.
if you have any unexplained vaginal bleeding.
if you are allergic to ethinylestradiol or etonogestrel, or any of the other
ingredients of this medicine (listed in section 6).

If any of these conditions appear for the first time while using NuvaRing,
remove the ring immediately and contact your doctor. In the meantime, use
non-hormonal contraceptive measures.
2.2 Warnings and precautions
When should you contact your doctor?
Seek urgent medical attention
- if you notice possible signs of a blood clot that may mean you are
suffering from a blood clot in the leg (i.e. deep vein thrombosis), a
blood clot in the lung (i.e. pulmonary embolism), a heart attack or a
stroke (see ‘Blood clots’ section below).
For a description of the symptoms of these serious side effects please go
to ‘How to recognise a blood clot’.
Tell your doctor if any of the following conditions apply to you.
If the condition develops, or gets worse while you are using NuvaRing, you
should also tell your doctor.
 if a close relative has or has ever had breast cancer;
 if you have epilepsy (see section 2.4 ‘Other medicines and NuvaRing’);
 if you have liver disease (for instance jaundice) or gallbladder disease
(for instance gallstones);
 if you have Crohn’s disease or ulcerative colitis (chronic inflammatory
bowel disease);
 if you have systemic lupus erythematosus (SLE - a disease affecting
your natural defence system);
 if you have haemolytic uraemic syndrome (HUS - a disorder of blood
clotting causing failure of the kidneys);
 if you have sickle cell anaemia (an inherited disease of the red blood
cells);
 if you have elevated levels of fat in the blood (hypertriglyceridaemia) or
a positive family history for this condition. Hypertriglyceridaemia has
been associated with an increased risk of developing pancreatitis
(inflammation of the pancreas);
 if you need an operation, or you are off your feet for a long time (see in
section 2 ‘Blood clots’);
 if you have just given birth you are at an increased risk of blood clots.
You should ask your doctor how soon after delivery you can start using
NuvaRing;
 if you have an inflammation in the veins under the skin (superficial
thrombophlebitis);
 if you have varicose veins;
 if you have a condition that occurred for the first time or worsened
during pregnancy or previous use of sex hormones (e.g. hearing loss,
porphyria [a disease of the blood], herpes gestationis [skin rash with
vesicles during pregnancy], Sydenham’s chorea [a disease of the
nerves in which sudden movements of the body occur], hereditary
angioedema [you should see your doctor immediately if you experience
symptoms of angioedema such as swollen face, tongue and/or throat
and/or difficulty swallowing or hives together with difficulty breathing];
 if you have (or have ever had) chloasma (yellowish-brown pigment
patches, so called ‘pregnancy patches’, particularly on the face). If so,
avoid too much exposure to the sun or ultraviolet light;
 if you have a medical condition that makes it difficult to use NuvaRing –
for example, if you are constipated, have a prolapse of the uterine cervix
or have pain during intercourse.
BLOOD CLOTS
Using a combined hormonal contraceptive such as NuvaRing increases
your risk of developing a blood clot compared with not using one. In rare
cases a blood clot can block blood vessels and cause serious problems.
Blood clots can develop
 in veins (referred to as a ‘venous thrombosis’, ‘venous
thromboembolism’ or VTE)
 in the arteries (referred to as an ‘arterial thrombosis’, ‘arterial
thromboembolism’ or ATE).
Recovery
fromknow
blood
clots
is not
always affecting
complete.your
Rarely,
there
may–be
 if you
you
have
a disorder
blood
clotting
for
seriousinstance,
lasting effects
or,Cvery
rarely, they
may
fatal.
protein
deficiency,
protein
S be
deficiency,
antithrombin – III
deficiency,
Factor V Leiden
or antiphospholipid
It is important
to remember
that the
overall risk of aantibodies;
harmful blood clot
 ifNuvaRing
you need is
ansmall.
operation or if you are off your feet for a long time (see
due to
section ‘Blood clots’);
HOW TO RECOGNISE A BLOOD CLOT
 if you have ever had a heart attack, or a stroke;
Seek urgent medical attention if you notice any of the following signs or
 if you have (or have ever had) angina pectoris (a condition that causes
symptoms.
severe chest pain and may be a first sign of a heart attack) or transient
Are you
experiencing
signs?stroke symptoms);
What are you possibly
ischaemic
attackany
(TIAof–these
temporary
suffering
from? your risk
 if you have any of the following diseases that
may increase
of a clot in the arteries:
Deep vein thrombosis
 swelling of one leg or along a vein in the
- severe diabetes with blood vessel damage
leg or foot especially when accompanied
- very high blood pressure
by:
- a very high level of fat in the blood (cholesterol or triglycerides)
 -paina or
tenderness
in the
leg which
condition
known
as hyperhomocysteinaemia
may be felt only when standing or
 if you have (or have ever had) a type of migraine called ‘migraine with
walking
aura’;
 increased warmth in the affected leg
 if you have (had) inflammation of the pancreas (pancreatitis) associated
 with
change
in colour
ofinthe
skinblood.
on the
high levels
of fat
your
leg e.g. turning pale, red or blue
 if you have (had) severe liver disease and your liver is not yet working
Pulmonary embolism
 sudden
unexplained breathlessness or
normally.
breathing;
rapid
if you
have (had) a benign or malignant tumour in the liver.
 sudden
without
obvious
cause,cancer of the breast or the genital
if you cough
have (had),
or an
if you
may have,
which
may bring up blood;
organs.
 sharp
may increase
if youchest
havepain
any which
unexplained
vaginal bleeding.
with deep breathing;
 if you are allergic to ethinylestradiol or etonogestrel, or any of the other
 severe
light
headedness
or
dizziness;
ingredients of this medicine (listed in section 6).
 rapid or irregular heartbeat;
any ofpain
these
appear for the first time while using NuvaRing,
 Ifsevere
in conditions
your stomach;
remove the ring immediately and contact your doctor. In the meantime,
use non-hormonal contraceptive measures.

2.2 Warnings and precautions

If any of the above conditions change while you are using NuvaRing, for
example a close family member experiences a thrombosis for no known
reason, or you gain a lot of weight, tell your doctor.

If you are unsure, talk to a doctor as some of
these symptoms such as coughing or being
short of breath may be mistaken for a milder
condition such as a respiratory tract infection
(e.g. a ‘common cold’).

BLOOD CLOTS IN AN ARTERY

Symptoms most commonly occur in one eye:
 immediate loss of vision or
 painless blurring of vision which can
progress to loss of vision

Retinal vein thrombosis
(blood clot in the eye)



Heart attack














chest pain, discomfort, pressure,
heaviness
sensation of squeezing or fullness in the
chest, arm or below the breastbone;
fullness, indigestion or choking feeling;
upper body discomfort radiating to the
back, jaw, throat, arm and stomach;
sweating, nausea, vomiting or dizziness;
extreme weakness, anxiety, or shortness
of breath;
rapid or irregular heartbeats
sudden weakness or numbness of the
face, arm or leg, especially on one side
of the body;
sudden confusion, trouble speaking or
understanding;
sudden trouble seeing in one or both
eyes;
sudden trouble walking, dizziness, loss of
balance or coordination;
sudden, severe or prolonged headache
with no known cause;
loss of consciousness or fainting with or
without seizure.

Sometimes the symptoms of stroke can be
brief with an almost immediate and full
recovery, but you should still seek urgent
medical attention as you may be at risk of
another stroke.
 swelling and slight blue discolouration of
an extremity;
 severe pain in your stomach (acute
abdomen).

Stroke

Factors that increase your risk of a blood clot in an artery
It is important to note that the risk of a heart attack or stroke from using
NuvaRing is very small but can increase:
 with increasing age (beyond about 35 years);
 if you smoke. When using a combined hormonal contraceptive like
NuvaRing you are advised to stop smoking. If you are unable to stop
smoking and are older than 35 your doctor may advise you to use a
different type of contraceptive;
 if you are overweight;
 if you have high blood pressure;
 if a member of your immediate family has had a heart attack or stroke at
a young age (less than about 50). In this case you could also have a
higher risk of having a heart attack or stroke;
 if you, or someone in your immediate family, have a high level of fat in
the blood (cholesterol or triglycerides);
 if you get migraines, especially migraines with aura;
 if you have a problem with your heart (valve disorder, disturbance of the
rhythm called atrial fibrillation)
 if you have diabetes.
-

If you have more than one of these conditions or if any of them are
particularly severe, the risk of developing a blood clot may be increased
even more.
If any of the above conditions change while you are using NuvaRing, for
example, you start smoking, a close family member experiences a
thrombosis for no known reason, or you gain a lot of weight, tell your doctor.
Cancer
The information given below was obtained in studies with combined oral
contraceptives and it may also apply to NuvaRing. Information about vaginal
administration of contraceptive hormones (as in NuvaRing) is not available.
Blood clots blocking
other blood vessels

BLOOD CLOTS IN A VEIN
What can happen if a blood clot forms in a vein?
 The use of combined hormonal contraceptives has been connected with
an increase in the risk of blood clots in the vein (venous thrombosis).
However, these side effects are rare. Most frequently, they occur in the
first year of use of a combined hormonal contraceptive.

If a blood clot forms in a vein in the leg or foot it can cause a deep vein
thrombosis (DVT).
 If a blood clot travels from the leg and lodges in the lung it can cause a
pulmonary embolism.
 Very rarely a clot may form in a vein in another organ such as the eye
(retinal vein thrombosis).
When is the risk of developing a blood clot in a vein highest?
The risk of developing a blood clot in a vein is highest during the first year of
taking a combined hormonal contraceptive for the first time. The risk may
also be higher if you restart taking a combined hormonal contraceptive (the
same product or a different product) after a break of 4 weeks or more.
After the first year, the risk gets smaller but is always slightly higher than if
you were not using a combined hormonal contraceptive.
When you stop using NuvaRing your risk of a blood clot returns to normal
within a few weeks.
What is the risk of developing a blood clot?
The risk depends on your natural risk of VTE and the type of combined
hormonal contraceptive you are taking.
The overall risk of a blood clot in the leg or lung (DVT or PE) with NuvaRing
is small.
 Out of 10,000 women who are not using any combined hormonal
contraceptive and are not pregnant, about 2 will develop a blood clot in
a year.
 Out of 10,000 women who are using a combined hormonal
contraceptive that contains levonorgestrel, norethisterone, or
norgestimate, about 5-7 will develop a blood clot in a year.
 Out of 10,000 women who are using a combined hormonal
contraceptive that contains norelgestromin, or etonogestrel such as
NuvaRing, between about 6 and 12 women will develop a blood clot in a
year.
 The risk of having a blood clot will vary according to your personal
medical history (see ‘Factors that increase your risk of a blood clot’
below).

Women who are not using a combined
hormonal pill/patch/ring and are not pregnant
Women using a combined hormonal
contraceptive pill containing levonorgestrel,
norethisterone or norgestimate
Women using NuvaRing

What can happen if a blood clot forms in an artery?
Like a blood clot in a vein, a clot in an artery can cause serious problems.
For example, it can cause a heart attack or a stroke.

Risk of developing a
blood clot in a year
About 2 out of
10,000 women
About 5-7 out of
10,000 women
About 6-12 out of
10,000 women

Factors that increase your risk of a blood clot in a vein
The risk of a blood clot with NuvaRing is small but some conditions will
increase the risk. Your risk is higher:
2
 if you are very overweight (body mass index or BMI over 30kg/m );
 if one of your immediate family has had a blood clot in the leg, lung or
other organ at a young age (e.g. below the age of about 50). In this case
you could have a hereditary blood clotting disorder;
 if you need to have an operation, or if you are off your feet for a long
time because of an injury or illness, or you have your leg in a cast. The
use of NuvaRing may need to be stopped several weeks before surgery
or while you are less mobile. If you need to stop using NuvaRing ask
your doctor when you can start using it again.
 as you get older (particularly above about 35 years);
 if you gave birth less than a few weeks ago.
The risk of developing a blood clot increases the more conditions you have.
Air travel (>4 hours) may temporarily increase your risk of a blood clot,
particularly if you have some of the other factors listed.
It is important to tell your doctor if any of these conditions apply to you, even
if you are unsure. Your doctor may decide that NuvaRing needs to be
stopped.

Breast cancer has been found slightly more often in women using combined
pills, but it is not known whether this is caused by the treatment. For
example, it may be that tumours are found more in women on combined
pills because they are examined by the doctor more often. The increased
occurrence of breast cancer becomes gradually less after stopping the
combined pill.
It is important to regularly check your breasts and you should contact your
doctor if you feel any lump. You should also tell your doctor if a close
relative has, or ever had breast cancer (see section 2.2 ‘Warnings and
precautions’).
In rare cases, benign liver tumours, and in even fewer cases malignant liver
tumours have been reported in pill users. Contact your doctor if you have
unusual severe abdominal pain.
For users of the combined Pill it has been reported that cancer of the
endometrium (the lining of the womb) and cancer of the ovaries occur less
frequently. This may also be the case for NuvaRing but this has not been
confirmed.
2.3 Children and adolescents
The safety and efficacy of NuvaRing in adolescents under the age of 18
have not been studied.
2.4 Other medicines and NuvaRing
Always tell your doctor which medicines or herbal products you are already
using. Also tell any other doctor or dentist (or pharmacist) who prescribes
another medicine that you use NuvaRing. They can tell you if you need to
take additional contraceptive precautions (for example, condoms), and if so,
for how long, or, whether the use of another medicine you need must be
changed.
Some medicines
 can have an influence on the blood levels of NuvaRing
 can make it less effective in preventing pregnancy
 can cause unexpected bleeding.
These include medicines used for the treatment of:
 epilepsy (e.g. primidone, phenytoin, barbiturates, carbamazepine,
oxcarbazepine, topiramate, felbamate);
 tuberculosis (e.g. rifampicin);
 HIV infection (e.g. ritonavir, nelfinavir, nevirapine, efavirenz);
 Hepatitis C virus (HCV) infection (e.g. boceprevir, telaprevir);
 other infectious diseases (e.g. griseofulvin);
 high blood pressure in the blood vessels of the lungs (bosentan);
 depressive moods (the herbal remedy St. John’s wort (Hypericum
perforatum)).
If you are taking medicines or herbal products that might make NuvaRing
less effective, a barrier contraceptive method should also be used. Since the
effect of another medicine on NuvaRing may last up to 28 days after
stopping the medicine, it is necessary to use the additional barrier
contraceptive method for that long. Note: Do not use NuvaRing with a
female condom.
NuvaRing may influence the effect of other medicines, e.g.
 medicines containing ciclosporin
 the anti-epileptic lamotrigine (this could lead to an increased
frequency of seizures)
Ask your doctor or pharmacist for advice before taking any medicine.
You can use tampons while using NuvaRing. Insert NuvaRing before
inserting a tampon. You should be careful when removing a tampon to be
sure that the ring is not accidentally pulled out. If the ring does come out,
simply rinse the ring in cool to lukewarm water and immediately reinsert it.
Using spermicides or vaginal yeast products will not reduce the
contraceptive efficacy of NuvaRing.
Laboratory tests
If you are having any blood or urinary test, tell your health care professional
that you are using NuvaRing as it may affect the results of some tests.
2.5 Pregnancy and breast-feeding
NuvaRing must not be used by women who are pregnant, or who think they
may be pregnant. If you get pregnant while using NuvaRing you should
remove the ring and contact your doctor.
If you want to stop NuvaRing because you want to get pregnant, see section
3.5 ‘When you want to stop using NuvaRing’.
NuvaRing is not usually recommended for use during breast-feeding.
If you wish to use NuvaRing while breast-feeding, please seek the advice of
your doctor.
2.6 Driving and using machines
NuvaRing is unlikely to affect your ability to drive or use machines.

3. How to use NuvaRing



You have used a combined Pill during the last month
Start using NuvaRing at the latest the day following the tablet-free
period of your present Pill. If your Pill pack also contains inactive tablets,
start NuvaRing at the latest on the day after the last inactive tablet. If
you are not sure which tablet this is, ask your doctor or pharmacist.
Never extend the hormone-free interval of your current Pill pack beyond
its recommended length. If you have used the Pill consistently and
correctly and if you are sure that you are not pregnant, you can also
stop taking the Pill on any day of your current Pill pack and start using
NuvaRing immediately.



You have used a transdermal patch during the last month
Start using NuvaRing at the latest the day following your usual patchfree break. Never extend the patch-free break beyond its recommended
length.
If you have used the patch consistently and correctly and if you are sure
that you are not pregnant, you can also stop using the patch on any day
and start using NuvaRing immediately.



You have used a minipill (progestagen-only pill) during the last month.
You can stop taking the minipill any day and start NuvaRing the next
day, at the same time you would normally have taken your pill. But
make sure you also use an additional contraceptive method (such as a
condom) for the first 7 days of ring use.



You have used an injectable or implant or a progestagen-releasing IUD
during the last month.
Start using NuvaRing when your next injection is due or on the day that
your implant or your progestagen-releasing IUD is removed. But make
sure you also use an additional contraceptive method (such as a
condom) for the first 7 days of ring use.



After having a baby.
If you have just had a baby, your doctor may tell you to wait until after
your first normal period before you start using NuvaRing. Sometimes it
is possible to start sooner. Your doctor will advise you. If you are breastfeeding and want to use NuvaRing, you should discuss this first with
your doctor.



After a miscarriage or an abortion.
Your doctor will advise you.

You can insert and remove NuvaRing yourself. Your doctor will tell you
when to start using NuvaRing for the first time. The vaginal ring must be put
in on the correct day in your monthly cycle (see section 3.3 ‘When to start
with the first ring’) and left in place for 3 weeks in a row. It is a good habit to
regularly check whether the ring is still in your vagina. After the third week,
you take NuvaRing out and have a one week break. You will usually have
your monthly period during this ring-free interval.
3.1 How to insert and remove NuvaRing
1. Before inserting the ring, check that it is not out of date (see section 5
‘How to store NuvaRing’).
2. Wash your hands before inserting or removing the ring.
3. Choose the position for inserting that is most comfortable to you, like
standing with one leg up, squatting, or lying down.
4. Remove NuvaRing from its sachet.
5. Hold the ring between your thumb and index finger, press the opposite
sides together and insert the ring into the vagina (see Figures 1– 4).
Alternatively, you may choose to use the NuvaRing Applicator (not
included with NuvaRing) to help you insert the ring. The NuvaRing
Applicator may not be available in all countries. When NuvaRing is in
place you should not feel anything. If you feel uncomfortable, gently
push NuvaRing a bit farther into the vagina. The exact position of the
ring inside the vagina is not important.
6. After 3 weeks you remove NuvaRing from the vagina. You can do this
by hooking your index finger under the front rim of the ring or by
grasping the rim and pulling it out (see Figure 5). If you locate the ring in
your vagina, but are unable to remove it, you should contact your
doctor.
7. Dispose of the used ring with the normal household waste, preferably
inside the reclosable sachet. Do not flush NuvaRing down the toilet.

3.4 What to do if….
Your ring is accidentally expelled from the vagina
NuvaRing may accidentally be expelled from the vagina – for example, if it
has not been inserted properly, while removing a tampon, during sexual
intercourse, during constipation, or if you have a prolapse of the womb.
Therefore, you should regularly check whether the ring is still in your vagina.

Figure 1
Take NuvaRing out of the
sachet

If the ring is out for less than 3 hours it will still protect you from pregnancy.
You can rinse the ring with cold to lukewarm water (do not use hot water)
and put it back in. If the ring is out for more than 3 hours, it may not protect
you from pregnancy, see the advice in section 3.4 ‘What to do if… Your ring
has temporarily been out of the vagina’.

Figure 2
Compress the ring

Figure 4A

Figure 3
Choose a comfortable position to insert
the ring

Figure 4B
Insert the ring into the vagina with one
hand (Figure 4A), if necessary the labia
may be spread with the other. Push the
ring into the vagina until the ring feels
comfortable (Figure 4B). Leave the ring
in place for 3 weeks (Figure 4C).

Figure 4C
Figure 5
NuvaRing can be removed by hooking
the index finger under the ring or by
grasping the ring between the index and
middle finger and pulling it out.

3.2 Three weeks in, one week out
1. Starting with the day you put it in, the vaginal ring must be left in place
without interruption for 3 weeks.
2. After 3 weeks you remove the ring on the same day of the week and at
approximately the same time as it was put in. For example, if you put
NuvaRing in on a Wednesday at about 22.00 h, you should remove the
ring 3 weeks later, on Wednesday, at about 22.00 h.
3. After you have removed the ring, you do not use a ring for 1 week.
During this week a vaginal bleed should occur. Usually this starts 2–3
days after removal of NuvaRing.
4. Start a new ring exactly after the 1 week interval (again on the same day
of the week and approximately the same time), even if you have not
stopped bleeding.
If the new ring is inserted more than 3 hours too late, the protection from
pregnancy may be reduced. Follow the instructions in section 3.4 ‘What
to do if…You have forgotten to insert a new ring after the ring-free
interval’.
If you use NuvaRing as described above, your vaginal bleed will take place
every month on roughly the same days.
3.3 When to start with the first ring
 You have not used a hormonal contraceptive during the last month
Insert the first NuvaRing on the first day of your natural cycle (i.e. the
first day of your menstrual period). NuvaRing starts working straight
away. You don’t need to take any other contraceptive precautions. You
can also start NuvaRing between day 2 and day 5 of your cycle, but if
you have sexual intercourse during the first 7 days of NuvaRing use
make sure that you also use an additional contraceptive method (such
as a condom). You only have to follow this advice when you use
NuvaRing for the first time.

Your ring has temporarily been out of the vagina
When it is in the vagina, NuvaRing slowly releases hormones into the body
to prevent pregnancy. If the ring has been out of the vagina for more than
3 hours, it may not protect you from pregnancy. So, the ring must not be
outside the vagina for longer than 3 hours in every twenty-four hour period.
 If the ring has been out of the vagina for less than 3 hours, it will still
protect you from pregnancy. You should put the ring back in as soon as
possible but at the latest within 3 hours.
 If the ring has been out of the vagina, or you suspect that the ring has
st
nd
been out of the vagina, for more than 3 hours during the 1 and 2
week, it may not protect you from pregnancy. Put the ring back in the
vagina as soon as you remember, and leave the ring in place without
interruption for at least 7 days. Use a condom if you have sexual
st
intercourse during these 7 days. If you are in your 1 week, and you had
sexual intercourse during the past 7 days, there is a possibility you may
be pregnant. In that case contact your doctor.
 If the ring has been out of the vagina, or you suspect that the ring has
rd
been out of the vagina, for more than 3 hours in the 3 week it may
not protect you from pregnancy. You should discard that ring and
choose between one of the following two options:
1 - Insert a new ring immediately
This will start the next three-week use period. You may not have your
period, but breakthrough bleeding and spotting may occur.
2 - Do not insert the ring again. Have your period first and insert a new
ring no later than 7 days from the time the previous ring was removed or
fell out.
You should only chose this option if you have used NuvaRing
continuously during the previous 7 days.
Your ring breaks
Very rarely NuvaRing may break. If you notice that your NuvaRing has
broken, discard it and start with a new ring as soon as possible. Use extra
contraceptive precautions (e.g. a condom) during the next 7 days. If you had
sexual intercourse before you noticed the ring breakage, please contact
your doctor.
You have inserted more than one ring
There have been no reports of serious harmful effects due to an overdose of
the hormones in NuvaRing. If you have accidentally inserted more than one
ring, you may feel sick (nausea) or have vomiting or vaginal bleeding.
Remove excess rings and contact your doctor if these symptoms persist.
You have forgotten to insert a new ring after the ring-free interval
If your ring-free interval was longer than 7 days, put a new ring as soon
as you remember. Use extra contraceptive precautions (such as a condom)
if you have sexual intercourse during the next 7 days. If you had sexual
intercourse in the ring-free interval, there is a possibility you may be
pregnant. In that case contact your doctor immediately. The longer the ringfree interval, the higher the risk that you have become pregnant.
You have forgotten to remove the ring
 If your ring has been left in place for between 3 and 4 weeks, it will still
protect you from pregnancy. Have your regular ring-free interval of one
week and subsequently insert a new ring.
 If your ring has been left in place for more than 4 weeks there is a
possibility of becoming pregnant. Contact your doctor before you start
with a new ring.
You have missed a menstrual period
 You have followed the instructions for NuvaRing
If you have missed a menstrual period but you followed the instructions
for NuvaRing, and have not used other medicines, it is very unlikely that
you are pregnant. Continue to use NuvaRing as usual. If you miss your
menstrual period twice in a row, however, you may be pregnant. Tell
your doctor immediately. Do not start the next NuvaRing until your
doctor has checked you are not pregnant.



If you have not followed the instructions for NuvaRing
If you have missed a menstrual period and you did not follow the
instructions, and you do not have your expected period in the first
normal ring-free interval, you may be pregnant. Contact your doctor
before you start with a new NuvaRing.

You have unexpected bleeding
While using NuvaRing, some women have unexpected vaginal bleeding
between menstrual periods. You may need to use sanitary protection. In any
case, leave the ring in the vagina and continue to use the ring as normal. If
the irregular bleeding continues, becomes heavy or starts again, tell your
doctor.
You want to change the first day of your menstrual period.
If you follow the instructions for NuvaRing, your menstrual period
(withdrawal bleed) will begin in the ring-free interval. If you want to change
the day it starts, you can make the ring-free interval shorter (but never
longer!).
For example, if your period usually begins on a Friday, you can change this
to a Tuesday (3 days earlier) from next month onwards. Simply insert your
next ring 3 days earlier than usual.
If you make your ring-free interval very short (for example, 3 days or less),
you may not have your usual bleeding. You may have spotting (drops or
flecks of blood) or breakthrough bleeding while using the next ring.
If you are not sure how to proceed, contact your doctor for advice.
You want to delay your menstrual period
Although it is not the recommended regimen, delay of your menstrual period
(withdrawal bleed) is possible by inserting a new ring immediately after
removing the current ring, with no ring-free interval between rings.
You can leave the new ring inserted for up to a maximum of 3 weeks.
You may experience spotting (drops or flecks of blood) or breakthrough
bleeding while using this new ring. When you want your period to begin, just
remove the ring. Have your regular ring free interval of one week and
subsequently insert a new ring.
You can ask your doctor for advice before deciding to delay your menstrual
period.
3.5 When you want to stop using NuvaRing
You can stop using NuvaRing any time you want.
If you do not want to become pregnant, ask your doctor about other
methods of birth control.
If you stop using NuvaRing because you want to get pregnant, you should
wait until you have had a natural period before trying to conceive. This helps
you calculate when the baby will be due.

4. Possible side effects
Like all medicines, NuvaRing can cause side effects, although not
everybody gets them. If you get any side effect, particularly if severe or
persistent, or have any change to your health that you think may be due to
NuvaRing, please talk to your doctor.

Not known (cannot be estimated from the available data)
 chloasma (yellowish-brown pigmentation patches on the skin,
particularly of the face)
 penis discomfort of the partner (such as irritation, rash, itching)
Breast cancer and liver tumours have been reported in users of combined
hormonal contraceptives. For more information, see section 2.2 Warnings
and precautions, Cancer.
Reporting of side effects
If you get any side effects, talk to your doctor, pharmacist or nurse. This
includes any possible side effects not listed in this leaflet. You can also
report any side effects directly via the Yellow Card Scheme at:
www.mhra.gov.uk/yellowcard.
By reporting side effects, you can help provide more information on the
safety of this medicine.

5. How to store NuvaRing
Keep out of the sight and reach of children.
Store in the original package in order to protect from light and moisture.
Do not store above 30°C.
Do not use NuvaRing if it was dispensed to you more than 4 months ago, or
if the expiry date has passed.
Do not use ring after the expiry date which is stated on the carton and
sachet labels after ‘Exp’. The expiry date refers to the last day of that month.
If you discover that a child has been exposed to the hormones from the
medicine, ask your doctor for advice.
Do not use ring if you notice a colour change in the ring or any visible signs
of deterioration.
Dispose of the used ring with the normal household waste, preferably inside
the re-closable sachet. Do not flush NuvaRing down the toilet. As with other
medicines, do not throw away any unused or outdated rings via wastewater
or household waste. Ask your pharmacist how to throw away any unused
rings no longer required. These measures will help protect the environment.

6. Contents of the pack and other information
What NuvaRing contains
The active ingredients in NuvaRing are etonogestrel and ethinylestradiol.
Each ring contains 11.7mg etonogestrel and 2.7mg ethinylestradiol.
The other ingredients are: ethylene vinylacetate copolymer (a type of plastic
that will not dissolve in the body) and magnesium stearate.
Etonogestrel and ethinylestradiol are released from the ring at a rate of
0.120mg/day and 0.015mg/day, each for 3 weeks.
What NuvaRing looks like and the contents of the pack
NuvaRing is a flexible, transparent, colourless to almost colourless ring,
54mm wide.
Each ring is packed in a reclosable foil sachet.
The sachet is packed in a cardboard box together with this package leaflet.
Nuvaring is available in packs containing 1 or 3 vaginal rings, each enclosed
separately in sealed sachets.

An increased risk of blood clots in your veins (venous thromboembolism
(VTE)) or blood clots in your arteries (arterial thromboembolism (ATE)) is
present for all women taking combined hormonal contraceptives. For more
detailed information on the different risks from taking combined hormonal
contraceptives, please see section 2,’What you need to know before you
use NuvaRing’.

Manufactured by: NV Organon, PO Box 20, 5340 BH Oss, Holland.
OR
Organon Ireland Ltd., Drynam Road Swords, Co. Dublin, Ireland.

If you are allergic to one of the ingredients of NuvaRing (hypersensitivity)
you may experience the following symptoms (frequency unknown):
angioedema [swollen face, tongue and/or throat and/or difficulty swallowing]
or hives together with difficulty breathing. If this happens, remove NuvaRing
and contact your doctor immediately.

NuvaRing 0.120mg/0.015mg per 24hours, vaginal delivery system
PL 18799/2599
POM
Leaflet date: 20.04.2017

Users of NuvaRing have reported the following side effects.
Common: may affect up to 1 in 10 women
 abdominal pain, feeling sick (nausea)
 yeast infection of the vagina (such as ‘thrush’); discomfort in the vagina
due to the ring; genital itching; secretion from the vagina
 headache or migraine; depressive moods; lower sex drive
 breast pain; pelvic pain; painful menstrual periods
 acne
 weight gain
 the ring falling out
Uncommon: may affect up to 1 in 100 women
 disturbed vision; dizziness
 swollen abdomen; vomiting, diarrhoea or constipation
 feeling tired, unwell or irritable; mood changes; mood swings
 extra fluid in the body (oedema)
 bladder or urinary tract infection
 difficulty or pain when passing urine; strong desire or need to pass
urine; passing urine more often
 problems during intercourse, including pain, bleeding or partner feeling
the ring
 increased blood pressure
 increased appetite
 back pain; muscle spasms; pain in legs or arms
 less sensitive skin
 sore or larger breasts; fibrocystic breast disease (cysts in the breasts
which may become swollen or painful)
 inflammation of the cervix; cervical polyps (growths in the cervix); rolling
outward of the margin of the cervix (ectropion)
 changes to menstrual periods (e.g. periods can be heavy, long, irregular
or stop altogether); pelvic discomfort; premenstrual syndrome; spasm of
the uterus
 vaginal infection (fungal and bacterial); burning feeling, smell, pain,
discomfort or dryness in the vagina or vulva
 hair loss, eczema, itching, rash or hot flushes
 ring breakage
Rare: may affect up to 1 in 1,000 women
 harmful blood clots in a vein or artery, for example:
o in a leg or foot (i.e. DVT)
o in a lung (i.e. PE)
o heart attack
o stroke
o mini-stroke or temporary stroke-like symptoms, known as a transient
ischaemic attack (TIA)
o blood clots in the liver, stomach/intestine, kidneys or eye.
The chance of having a blood clot may be higher if you have any other
conditions that increase this risk. (See section 2 for more information on the
conditions that increase risk for blood clots and the symptoms of a blood
clot).
 breast discharge

Procured from within the EU and repacked by the Product Licence
holder: B&S Healthcare, Unit 4, Bradfield Road, Ruislip, Middlesex,
HA4 0NU, UK.
®

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Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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