Nuvaring

What is this medication for?

Etonogestrel (progestin) and ethinyl estradiol (estrogen) belong to the class of medications called combination hormonal contraceptives. Etonogestrel - ethinyl estradiol is used to prevent pregnancy.

This medication prevents pregnancy mainly by stopping ovulation (the release of an egg by the ovaries). It also changes the mucus produced by the cervix, making it difficult for sperm to enter the uterus and changes the endometrium (lining of the uterus), making it more difficult for eggs to implant.

Your doctor may have suggested this medication for conditions other than those listed here. As well, some forms of this medication may not be used for all of the conditions discussed here. If you are not sure why you are using this medication, speak to your doctor. Do not stop using this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to use this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Nuvaring® is available as:

• ring (vaginal)
  • on average, each ring releases 0.12 mg etonorgestrel and 0.015 mg ethinyl estradiol per day

How should I use this medication?

The etonogestrel - ethinyl estradiol vaginal ring is inserted into the vagina and left in place for 3 weeks in a row. It is then removed for a one week break, during which a menstrual period usually occurs. A new ring is inserted one week after the last ring is removed. Ask your doctor about the best time to start using the etonogestrel - ethinyl estradiol vaginal ring.

Inserting the ring
To insert the ring yourself (as agreed upon by you and your doctor), choose the position that is most comfortable for you (standing with one leg up, squatting, or lying down).

1. Wash and dry your hands thoroughly.
2. Remove the ring from its foil pouch. (Keep the foil pouch for proper disposal of the ring after use.)
3. Hold the ring between your thumb and index finger and press the opposite sides of the ring together.
4. Gently push the compressed ring into your vagina.

The exact position of the ring is not important for it to work. When the ring is in place, most women do not feel it. If you feel uncomfortable, use your finger to gently push the ring further into your vagina. There is no danger of the ring being pushed too far up in the vagina or getting lost. The ring can only be inserted as far as the end of the vagina, where the cervix will block the ring from going any further.

Removing the ring
Remove the vaginal ring 3 weeks after insertion on the same day of the week as it was inserted and at about the same time. To remove the vaginal ring:

1. Wash and dry your hands thoroughly.
2. Hook your index finger under the forward rim or hold the rim between the index and middle finger, and pull the ring out.
3. Place the used ring in the foil pouch and properly dispose of it in a waste receptacle out of the reach of children and pets. Do not flush the ring down the toilet.

Your menstrual period will usually start 2 to 3 days after you remove the ring, and may not end before the new ring is inserted. For continuous protection against pregnancy, you must insert a new ring one week after one was removed, even if your menstrual period has not stopped.

If you have trouble removing the ring from the vagina, contact your health care provider.

If the ring slips out of the vagina and is replaced within 3 hours, you should still be protected from pregnancy. The ring can be rinsed with cool or lukewarm water and should be reinserted as soon as possible. If the ring is lost outside the vagina, insert a new ring and continue your regular schedule.

If the ring has been out of the vagina for more than 3 hours during the first or second week of ring use, there is a possibility that you could become pregnant. A barrier method of contraception such as condoms or spermicides must be used until the ring has been used continuously for 7 days.

If the ring is out of the vagina for more than 3 hours during the third week of ring use, discard the ring and either:

1. Insert a new ring immediately. Inserting a new ring will start the next 3-week use period. You may not experience withdrawal bleeding from the previous cycle, but may experience some breakthrough spotting or bleeding; or
2. Have withdrawal bleeding and insert a new ring no later than 7 days from the time the previous ring was removed. This option should only be chosen if the ring was used continuously for the preceding 7 days. A barrier method of contraception such as condoms or spermicides must be used until the ring has been used continuously for 7 days.

If the ring has been left in your vagina for an extra week or less (up to 4 weeks total), remove it, take a one-week break, and insert a new ring. If the ring has been left in place for more than 4 weeks total, there is a possibility that you may become pregnant. You must check that you are not pregnant and should use an extra method of birth control such as condoms or spermicides until a new ring has been in place for 7 days in a row.

If the ring slips out repeatedly, contact your doctor. Also, if the ring disconnects, causing the ring to change shape and straighten out, discard the ring and replace it with a new ring. Although the effectiveness of the ring is not affected when it is disconnected, it will be more likely to slip out.

While using this medication, you should be examined by your doctor at least once a year.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

It is important to use this medication exactly as prescribed by your doctor.

Store the ring for up to 4 months at room temperature (59-86°F), protect it from direct sunlight, and keep it out of the reach of children.

Who should NOT take this medication?

Do not use this medication if you:

• are allergic to etonogestrel, ethinyl estradiol, or any ingredients of the medication
• are a heavy smoker (at least 15 cigarettes a day) and are over 35 years old
• are pregnant or suspect you may be pregnant
• have diabetes with complications of the kidneys, eyes, nerves, or blood vessels
• have had recent major surgery with prolonged bed rest or immobility
• have headaches accompanied by certain nerve function problems (problems affecting a particular body area or function)
• have jaundice (yellowing of the skin or the whites of the eyes ) associated with pregnancy or with past use of hormonal contraceptives
• have liver tumors (noncancerous and cancerous) or active liver disease
• have or have ever had breast cancer or cancer of the endometrium (lining of the uterus)
• have or have had a stroke, heart attack, or coronary artery disease
• have or have had other types of cancers that need estrogen to grow
• have or have had thrombophlebitis or thromboembolic (blood clotting) disorders
• have or have had unusual vaginal bleeding that has not been evaluated by a doctor
• have severe hypertension (high blood pressure)
• have valvular heart disease with complications