NuvaRing

Generic name: Etonogestrel, Ethinyl estradiol

What is NuvaRing?

NuvaRing is a flexible combined contraceptive vaginal ring. It is used to prevent pregnancy.

What is the most important information I should know about NuvaRing?

NuvaRing does not protect against HIV infection (AIDS) and other sexually transmitted diseases (STD's) such as chlamydia, genital herpes, genital warts, gonorrhea, hepatitis B, and syphilis.

To make sure NuvaRing works properly, you must follow a strict schedule for insertion and removal. Each ring should be inserted and left in place for exactly 3 weeks, then removed. Exactly 1 week after removal, a new ring should be inserted for the following 3 weeks. Always insert and remove NuvaRing on the same day of the week, at approximately the same time of day.

Cigarette smoking increases the risk of serious cardiovascular side effects when you use combination oral contraceptives. This risk increases even more if you are over age 35 and if you smoke 15 or more cigarettes a day. Women who use combination hormonal contraceptives, including NuvaRing, are strongly advised not to smoke.

Do not breastfeed while using NuvaRing. Some of the medicine may pass through the milk to the baby and could cause yellowing of the skin (jaundice) and breast enlargement in your baby. NuvaRing could also decrease the amount and quality of your breast milk.

Who should not take NuvaRing?

Do not use NuvaRing if you have any of the following conditions: pregnancy or suspected pregnancy; a history of blood clots in your legs (thrombophlebitis), lungs (pulmonary embolism), or eyes; chest pain (angina pectoris); a history of heart attack or stroke; severe high blood pressure; diabetes with complications of the kidneys, eyes, nerves or blood vessels; headaches with neurological symptoms; known or suspected breast cancer or cancer of the lining of the uterus, cervix or vagina (now or in the past); unexplained vaginal bleeding (until a diagnosis is reached by your doctor); yellowing of the whites of the eyes or of the skin (jaundice) during pregnancy or during past use of birth control medications of any kind; liver tumors or active liver disease; heart valve or heart rhythm disorders associated with blood clots formation; need for a long period of bed rest following major surgery; an allergic reaction to any of the components of NuvaRing.

What should I tell my doctor before I take the first dose of NuvaRing?

Tell your doctor about all prescription, over-the-counter, and herbal medications you are taking before beginning treatment with NuvaRing. Also, talk to your doctor about your complete medical history, especially if you have any of the following conditions: a family history of breast cancer, breast nodules, fibrocystic disease, an abnormal breast x-ray, or abnormal mammogram, diabetes (high blood sugar), high blood pressure, high cholesterol or triglycerides, headaches or epilepsy (seizures), mental depression, gallbladder, liver, heart or kidney disease, scanty or irregular menstrual periods, major surgery (You may need to stop using NuvaRing for a while to reduce your chance of getting blood clots), any condition that makes the vagina get irritated easily, prolapsed (dropped) uterus, dropped bladder (cystocele), or rectal prolapse (rectocele), severe constipation, and history of toxic shock syndrome.

What is the usual dosage?

The information below is based on the dosage guidelines your doctor uses. Depending on your condition and medical history, your doctor may prescribe a different regimen. Do not change the dosage or stop taking your medication without your doctor's approval.

Adults: NuvaRing is inserted in the vagina once a month. It stays in the vagina continuously for three weeks. It must be removed exactly 21 days after insertion. A new ring is inserted precisely 7 days later.

The time to start use of NuvaRing depends on your previous contraceptive program:

If you did not use a hormonal contraceptive in the past month

Count the first day of your menstrual period as day 1. Insert the first ring between day 1 and day 5 of the cycle, even if you are still bleeding on day 5. During the first cycle, use an extra method of birth control such as male condoms or spermicide for the first 7 days of ring use.

If you are switching from a combination birth control pill

Insert NuvaRing any time during the first 7 days after the last tablet and no later than the day you would have started a new pill cycle. No extra birth control method is needed.

If you are switching from a progestin-only contraceptive

When you are switching from a progestin-only contraceptive, use an extra method of birth control, such as male condoms or spermicide, for the first 7 days after inserting NuvaRing.

If you are switching from the "mini-pill," you can start using NuvaRing on any day of the month. Do not skip days between your last pill and first day of NuvaRing use.

If you are switching from a progestin implant (Norplant), start using NuvaRing on the same day you have your implant removed.

If you are switching from an injectable contraceptive (Depo-Provera), start using NuvaRing on the day when your next injection is due.

If you are switching from a progestin intra-uterine device (IUD), start using NuvaRing on the same day you have your IUD removed.

Following a first trimester abortion or miscarriage

If you start using NuvaRing within 5 days after a complete first trimester abortion or miscarriage, you do not need to use an extra method of contraception. If more than 5 days have passed, proceed as you would if you had not used a hormonal contraceptive for the past month.

Following a second trimester abortion or miscarriage

You may start using NuvaRing 4 weeks after a complete second trimester abortion or miscarriage.

Following delivery

If you choose not to breastfeed your child, you may start using NuvaRing 4 weeks after a complete delivery. It is recommended to use an extra form of contraception such a male condoms or spermicide for the first 7 days. If you choose to breastfeed your child, do not use NuvaRing. Instead, use other forms of contraception until the child is weaned.

How should I take NuvaRing?

Wash and dry your hands and remove NuvaRing from its foil pouch. Choose the position that is most comfortable for you, such as lying down, squatting, or standing with one leg up. Hold NuvaRing between your thumb and index finger and press the opposite sides of the ring together. Gently push the folded ring into your vagina. The exact position of the ring is not important for it to work. If you feel discomfort, use your finger to gently push NuvaRing further into the vagina. Most women do not feel the ring once it is in place, although some are aware of it.

Leave the ring in place for exactly 3 weeks, and then remove it. Hook your index finger under the forward rim or hold the rim between your index finger and middle finger and pull the ring out. Place the used ring in the foil pouch it came in and dispose of it in the garbage, away from children and pets. Do not discard in the toilet.

Your menstrual period will usually start 2 to 3 days after the ring is removed and may not have finished before it's time to insert the next ring. For continued pregnancy protection, you need to insert the new ring exactly 1 week after the old one was removed, even if your period has not stopped.

What should I avoid while taking NuvaRing?

Do not smoke or breastfeed while using NuvaRing.

What are possible food and drug interactions associated with NuvaRing?

If NuvaRing is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining NuvaRing with any of the following: acetaminophen, antibiotics such as ampicillin and tetracycline, anticonvulsants, antifungals, atorvastatin, clofibrate, cyclosporine, HIV drugs known as protease inhibitors, morphine, phenylbutazone, prednisolone, rifadin, St. John's wort, temazepam, theophylline, and vitamin C.

What are the possible side effects of NuvaRing?

Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking this drug.

Side effects may include: abdominal cramps, allergic rash, bloating, blood clots, breakthrough bleeding and spotting, breast secretions, change in menstrual flow, changes in the breast such as tenderness or enlargement, dark pigmentation of the skin, decreased milk production in nursing mothers, depression, emotional instability, gallbladder disease, headaches, heart attack, high blood pressure, intolerance to contact lenses, liver disease, liver tumors, migraine headaches, missed periods, nausea, problems with the ring, sinus inflammation, stroke, swelling, temporary infertility after discontinuing NuvaRing, upper respiratory tract infections, vaginal inflammation or discharge, vision problems, vomiting, weight gain or loss, yeast infections, yellow tint to the skin

Can I receive NuvaRing if I am pregnant or breastfeeding?

NuvaRing should not be used during pregnancy or while nursing.

What should I do if I miss a dose of NuvaRing?

If NuvaRing slips out, you'll still be protected against pregnancy provided the ring is replaced within 3 hours. You can use the old ring (after rinsing it with cool or lukewarm water) or insert a new ring. Remove the ring according to your original schedule.

If you're unable to replace the ring within 3 hours, insert it as soon as possible and use an additional method of birth control for 7 days.

If you forget and leave the ring in place for an extra week, remove it, take a one-week break, and reinsert a new one on day 7. If you leave the ring in place for more than 4 weeks you may not be adequately protected against pregnancy.

If you miss a menstrual period, you should check to be sure you are not pregnant if any of the following circumstances apply: if NuvaRing was out of the vagina for more than 3 hours during the 3 weeks of ring use; if you waited longer than 1 week to insert a new ring after removing the old one; if you followed the instructions but miss 2 periods in a row; or if you have left NuvaRing in place for longer than 4 weeks.

How should I store NuvaRing?

Store NuvaRing at room temperature. Avoid direct sunlight or storing above 86°F (30°C).