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What should I discuss with my healthcare provider before using ethinyl estradiol and etonogestrel (NuvaRing)?

Do not use this medication if you are allergic to ethinyl estradiol or etonogestrel, or if you have:

• a history of stroke or blood clot;
• circulation problems (especially if caused by diabetes);
• a hormone-related cancer such as breast or uterine cancer;
• abnormal vaginal bleeding;
• liver disease or liver cancer;
• severe high blood pressure;
• severe migraine headaches;
• a heart valve disorder; or
• a history of jaundice caused by birth control pills.

If you have any of these other conditions, you may need a dose adjustment or special tests:

• high blood pressure, heart disease, congestive heart failure, angina (chest pain), or a history of heart attack;
• high cholesterol or triglycerides;
• kidney disease;
• a history of depression;
• gallbladder disease;
• diabetes;
• seizures or epilepsy;
• a history of irregular menstrual cycles, toxic shock syndrome, or easy vaginal irritation;
• prolapsed (dropped) uterus, bladder, or rectum;
• a history of fibrocystic breast disease, lumps, nodules, or an abnormal mammogram;
• severe constipation; or
• migraine headaches.

The hormones in birth control pills can pass into breast milk and may harm a nursing baby. This medication may also slow breast milk production. Do not use if you are breast-feeding a baby.

How should I use ethinyl estradiol and etonogestrel (NuvaRing)?

Use exactly as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

This medication comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

Your doctor will tell which day of your menstrual cycle to insert the first vaginal ring you use. During the first 7 days of using your first vaginal ring, you may need to use back-up birth control, such as condoms or a spermicide. Follow your doctor's instructions.

The ethinyl estradiol and etonogestrel vaginal ring should be left in place for 3 full weeks. Remove the ring after 3 weeks, on the same day of the week it was inserted at about the same time of day. Allow 1 full week to pass before inserting the new ring.

Your period should start during the week you do not wear a vaginal ring. Insert the new ring on the same day of the week it was inserted in the last cycle, even if your menstrual period has not ended yet.

The ethinyl estradiol and etonogestrel vaginal ring will not prevent pregnancy if you wear it only during intercourse. You must wear the ring for 3 full weeks, followed by 1 full week without a ring. The timing of ring insertion and removal is very important for this medicine to be effective as a form of birth control.

The ring does not need to be removed during sexual intercourse. Neither partner should be able to feel the ring when it is in place. If the ring is bothersome, you may remove it, rinse it with warm water, and reinsert it after intercourse. Do not leave the ring out for longer than 3 hours.

To dispose of a used vaginal ring, place it 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.

Have regular physical exams and self-examine your breasts for lumps on a monthly basis while using estradiol vaginal.

Store unused vaginal rings at room temperature away from moisture, heat, and light.

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