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Ethinyl estradiol and etonogestrel (vaginal ring)

Generic name: ethinyl estradiol and etonogestrel (vaginal ring) [ETH-in-il-es-tra-DYE-ole-and-et-oh-no-JES-trel]

Brand names: NuvaRing, EluDing, Haloette, and Enilloring
Vaginal Ring (0.015-0.12 mg/24 hour)
Drug class: contraceptives

What are Ethinyl Estradiol and Etonogestrel?

Ethinyl estradiol, etonogestrel, and vaginal rings are used to avoid pregnancy.

This medication guide does not list all possible uses of etonogestrel, estradiol, or ethinyl.

Side effects of Ethinyl Estradiol and Etonogestrel

If you experience any of the following symptoms of an allergy reaction, seek immediate medical attention: difficulty breathing, hives, swelling in your lips, face, throat, or tongue.

The side effects of this medicine can be serious. If you experience:

  • Signs of a Stroke: sudden numbness (especially on one side), severe headache; slurred or shaky speech.
  • Signs of a blood clot include sudden vision loss, chest pain that stabs, shortness of breath, blood in the cough, or pain or heat in both legs.
  • Heart attack symptoms: chest pain, pressure or pain in your shoulder or jaw, nausea, and sweating.
  • The symptoms of toxic shock syndrome include sudden fever and body aches. Other symptoms are skin rash, nausea, diarrhea, or feeling lightheaded.
  • Symptoms of depression: mood changes, self-harming thoughts;
  • Jaundice is an eye and skin disease characterized by yellowing of both.

Some of the common side effects associated with ethinyl esteradiol or etonogestrel include:

  • Headache, changes in mood, and decreased sexual drive
  • Pain in the cervix or irritation of your vaginal area
  • Menstrual cramps or breast tenderness
  • Nausea, vomiting, and stomach pain;
  • Acne or weight gain?

There may be other side effects. For medical advice on side effects, call your doctor.Call the FDA's Safe Health Hotline at 1-800-FDA-1088 if you experience adverse side effects.

Similar/related drugs

Norethindrone, Levonorgestrel, Medroxyprogesterone, Depo-Provera, Provera, and Nexplanon


Avoid using the vaginal rings if you are pregnant or have just had a child.This medicine should not be used if: you are suffering from uncontrolled hypertension; you suffer from heart disease; you have coronary artery problems; you experience circulation issues (especially with type 2 diabetes); you have undiagnosed bleeding in the vaginal area; you have liver disease or cancer; you plan to have a major operation; you smoke; you're over 35; you had a previous heart attack or stroke; or if cancer has affected your breasts, uterus, cervical, or vagina.Smoking increases your chances of having a stroke or a heart attack.

Before you take this drug

If you are:

  • Untreated high blood pressure or hypertension
  • Heart disease (coronary arterial disease, heart valve disorders, strokes, blood clots, and history of heart attacks);
  • An increased risk for blood clots as a result of a blood disorder or heart disease;
  • Circulatory problems, especially if they are caused by diabetes
  • A history of cancers of the breast, uterus, or cervix, or of vaginal or ovarian origin;
  • Unusual vaginal bleeding not checked by your doctor
  • Severe migraine headaches, especially in older people over 35.
  • Liver disease, or cancer of the liver;
  • If you are aged over 35 and smoke, smoking could pose significant health risks.
  • If you take any hepatitis C medication containing ombitasvir, paritaprevir, or ritonavir (Technivie).

If you are over 35 and smoke, it is not recommended that you use the vaginal rings.If you're pregnant or have missed two periods, remove the vaginal rings and consult your doctor.

If you've ever:

  • If you have heart disease, blood clots, or high blood pressure,
  • High cholesterol (or triglycerides, a type of fat found in the blood);
  • Liver or kidney disease
  • Depression
  • Gallbladder disease, diabetes
  • A seizure or migraine headaches;
  • You may experience irregular periods, toxic shock syndrome, or vaginal irritation.
  • The yellowing of the skin is caused by pregnancy or contraceptive pills.
  • A family history of breast cancer
  • If you've recently experienced a miscarriage,

This medicine may increase the risk of a stroke or heart attack. The risk of blood clots, stroke, and heart attack is greatest during the first year you use the vaginal rings or when inserting a new one after four weeks without wearing a ring.It is not recommended that you breastfeed if using an ethinyl estradiol or etonogestrel vaginal band.

How to take Ethinyl Estradiol and Etonogestrel?

Read all the instructions or guides that come with your medication and follow all the directions. Follow the directions on your prescription label.Please read and follow all instructions for use that come with your medication. If you do not understand the instructions, seek clarification from either your pharmacist or physician.If you only wear it during sexual activity, the vaginal rings will not work. It is necessary to wear your ring 24 hours a day for three weeks. Wear only one vaginal ring.You may have to use a backup contraceptive for 7 days following the insertion of your vaginal rings (condoms, spermicide, but not female condoms, diaphragms, or a male condom).Remove the ring after 21 days and wait seven full days to insert a replacement. Do not leave the ring on for more than three weeks. If you are unable to remove the vaginal rings on time, call your doctor.

You could have been bleeding. If the bleeding persists or becomes very heavy, tell your doctor.You may have to temporarily stop taking this medication if you are going through major surgery or if you will be bed-ridden for an extended period of time. You should let any doctor who treats you know that you use vaginal rings.Storing vaginal rings unworn at room temperature is safe for 4 months. Keep away from light and heat. Throw away the used vaginal rings in their foil pouches.Children and pets won't be able to reach them.The ring should not be flushed down the toilet.

Details on dosage

Adult dose for contraception:

Place 1 ring in the vagina for 3 consecutive weeks. Remove for 1 week, and then insert another ring one week later.
In general, bleeding occurs on the second or third day after removal.
Reinsertion must occur exactly one week after removal, on the exact same day.
Women of reproductive age can use it to avoid pregnancy.

The usual pediatric dose for contraception is:

Postpubertal adolescents:

Place 1 ring in the vagina for 3 consecutive weeks. Remove for 1 week, and then insert another ring one week later.
In general, bleeding occurs on the second or third day after removal.
Reinsertion must occur exactly one week after removal, on the exact same day.
Women of reproductive age can use it to avoid pregnancy.

What happens if I miss the dose?

Rinse the ring with warm water if it falls out, and then reinsert. Insert a replacement ring if the original is broken or lost. Continue to follow the schedule. Follow the instructions provided by the patient to ensure that the ring is replaced if it has been removed from the vagina for more than three hours.

What happens if I overdose?

A combined overdose of etonogestrel and ethinyl estradiol should not be harmful, although it may result in nausea or bleeding. Overdoses are not caused by a broken vaginal band.

What should be avoided?

Don't smoke when using the vaginal rings, particularly if you are more than 35 years old.Grapefruit can cause unwanted side effects when combined with ethinyl estradiol or etonogestrel. Use grapefruit-based products as little as possible.The medicine does not provide protection against sexually transmissible diseases, including HIV or Aids. The only way to prevent these diseases is by using a condom.

Interaction with other drug

It is sometimes not safe to take certain drugs at the same time. Some medications can cause side effects that increase or decrease the effectiveness of another drug you are taking.Some medications can reduce the effectiveness of birth control, resulting in pregnancy. If you are also taking any of these medicines, use a barrier birth control method (male condoms with spermicide but no diaphragms or female condoms) in conjunction with the vaginal rings.

  • Aprepitant, bosentan, griseofulvin, and St. John's wort;
  • Efavirenz, nevirapine;
  • Antiviral medicine to treat hepatitis C or HIV/AIDS: nelfinavir, ritonavir, darunavir/ritonavir, (fos)amprenavir/ritonavir, lopinavir/ritonavir, tipranavir/ritonavir, boceprevir, telaprevir;
  • Tuberculosis medicine—rifabutin, rifampin,
  • Seizure medicine: carbamazepine, felbamate, oxcarbazepine, phenobarbital, phenytoin, rufinamide, and topiramate.

Use barrier contraception for at least 14 days following the last dose.The list of drugs that can affect ethinyl estradiol or etonogestrel is far from complete. These include prescription, over-the-counter, vitamin, and herb products. This list does not cover all possible drug interactions.