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Ethinyl Estradiol and Segesterone (Vaginal Ring)

Generic name: ethinyl estradiol and segesterone (vaginal ring) [ETH-in-il-es-tra-DYE-ole-and-se-JES-ter-one]

Brand name: Annovera
Vaginal Ring (0.013-0.15 mg/24 hour)
Drug class: contraceptives

What is Ethinyl Estradiol and Segesterone ?

Ethinyl estradiol vaginal system (ring) is contraceptive to prevent pregnancy. One vaginal band can be used for up to one year.This medication guide does not list all possible uses for estradiol, ethinyl, or segesterone.

Side effects of Ethinyl Estradiol and Segesterone

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

Segesterone and ethinyl estradiol can cause severe side effects. If you experience:

  • Very high blood pressure; severe headache; blurry vision or pounding in the neck and ears
  • Signs of blood clots: sudden numbness, weakness, or pain (especially in one leg), severe headaches, difficulty speaking or seeing, chest pain that stabs, shortness of breath, or pain or numbness on either side;
  • 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 a skin rash, nausea, and diarrhea.
  • New headaches or changes in migraine pattern or intensity;
  • Jaundice
  • Symptoms of depression include mood changes and thoughts about harming yourself.

Some of the common side effects associated with ethinyl estradiol or segesterone include:

  • Headache;
  • Nausea, vomiting, diarrhea, and stomach pain;
  • Vaginal itching or discharge
  • Breast tenderness, menstrual discomfort, and pain
  • Unusually irregular vaginal bleeding
  • Pain or burning after urinating;

There may be other side effects. For medical advice on side effects, call your doctor. Report side effects by calling the FDA at 1-800-FDA-1088.


This medicine should be avoided if: you are suffering from uncontrolled hypertension, heart disease, coronary artery diseases, decreased blood flow to the brain, undiagnosed bleeding in your vaginal area, liver disease or liver carcinoma, severe headaches; you take hepatitis C medications; you plan on having major surgery; you smoke; you're over 35 years old; you had a previous heart attack or stroke or a blood clot; or you suffer from cancer of the breast, uterus, or cerviDo not take this medication if you are over 35 and smoke.Avoid using the vaginal rings if you are pregnant or have just had a child.

Before you take this drug

This medicine should not be used if:

  • Uncontrolled high blood pressure (especially if there is also damage to your blood vessels);
  • Heart problems (coronary arterial disease, a disorder of the heart's rhythm, an abnormality in its valves, a previous history of a stroke or heart attack);
  • Reduced blood flow in your brain
  • An increased risk for blood clots as a result of a blood disorder or heart disease;
  • Diabetes (and have had diabetes for more than 20 years or are older than 35);
  • A health issue related to diabetes (vision issues, kidney damage, nerve problems, circulatory problems)
  • A history of cancers of the breast, uterus, or cervix, or of vaginal or ovarian origin;
  • Unusual vaginal bleeding not checked by your doctor
  • Migraines or headaches severe enough to cause vision problems;
  • Liver disease or liver carcinoma;
  • If you have taken any hepatitis C medication containing ombitasvir, paritaprevir, or ritonavir in the past 2 weeks.

Do not take this medication if your age is over 35 and you are a smoker. This medicine increases the risk of stroke or heart attack if it's taken by someone who smokes.

If you've ever:

  • High blood pressure or blood clots are signs of heart disease.
  • High cholesterol (or triglycerides, a type of fat found in the blood);
  • Jaundice or liver disease (yellowing skin or eyes)
  • Kidney disease
  • Gallbladder Disease
  • Depression, migraine headaches, or a seizure;
  • The toxic shock syndrome, or vaginal irritation, is a common symptom.
  • A family history of strokes or cancer
  • A breast lump, fibrocystic disease, or abnormal mammography
  • If you've recently experienced a miscarriage,

If you think that you might be pregnant or have missed your period, call your doctor.This medicine should not be used while breastfeeding.Women who have not had their period or no longer experience periods are not eligible to take ethinyl estradiol.

How to take  Ethinyl Estradiol or Segesterone?

Read all the instructions or guides that come with your medication and follow all the directions. Follow the directions on how to use your medicine. Please read and follow all instructions for use that come with the medicine.Wearing the vaginal rings around the clock for three full weeks (21 days) is required.Remove the ring after 21 days and wait seven full days to reinsert it. Keep to your plan of removing and inserting the ring.The ring should not be removed from the vagina for more than 2 hours in total during the wear time of 21 days.When a ring comes out of the ear, you can wash it in warm, soapy water and dry it off with a soft cloth. Then, you can re-insert the ring.It is possible that you will need to use a backup contraceptive for seven consecutive days (condoms, spermicide, or male condoms but not female condoms):

  • If the ring is removed from the vagina for more than 2 hours in total during the wear time of 21 days,
  • If the ring is out of vagina longer than seven days,
  • If you have recently given birth and are not experiencing periods yet,

You could have been bleeding. If the bleeding lasts more than seven days or is heavy, tell your doctor.You may have to temporarily stop taking ethinyl estradiol or segesterone if you are going through major surgery, bed rest for long periods of time, etc. You should let any doctor who treats you know you use the vaginal rings.Segesterone and ethinyl estradiol will not provide protection against sexually transmissible diseases, including HIV and AIDS. A condom will help you protect yourself from sexually transmitted diseases.When the ring has been removed from the vaginal area, clean it with mild soap, warm water, and pat-dry. Store in the provided case. Keep it at room temperature. Store away from sunlight, heat, and freezing. When not in use, follow the instructions to clean the vaginal rings.Dispose of used vaginal rings in their original pouch or case after 1 year.Keep them out of reach of children and animals.The ring should not be flushed down the toilet.

What happens if I miss the dose?

If you are unable to remove a vaginal band or you find yourself off track, call your doctor.

What happens if I overdose?

Overdoses of ethinyl estradiol or segesterone are not dangerous but can cause nausea and vaginal blood.

What should be avoided?

Do not leave the ring on for more than three weeks.Use a water-based vaginal lubricant, but not one that contains silicone or oil. Use a water-based vaginal product, but avoid any that contain silicone or oil.Dark patches of skin on your face may be caused by ethinyl estradiol or segesterone. Avoid tanning or sunlight. When you're outdoors, wear protective clothing and use sunblock with SPF 30 or greater.If you are taking ethinyl estradiol or segesterone along with other medications, it is important to not drink grapefruit juice. You can ask your pharmacist or doctor.

Interaction with other drug

Some medications can reduce the effectiveness of birth control, which could lead to pregnancy. If you are also taking any of these medicines, use a barrier birth control method (male condoms with spermicide but not female condoms) in conjunction with the vaginal rings.

  • Aprepitant, bosentan, St. John's wort;
  • Antifungal medicine;
  • Antiviral medication to treat HIV or hepatitis C;
  • Blood pressure medications
  • Seizure medicine;
  • Steroid medicine;
  • Thyroid medicine;
  • Tuberculosis Medicine

Use barrier contraception for at least 14 days following the last dose.Ethinyl estradiol or segesterone may affect the blood levels of drugs that you are taking, causing side effects to increase. If you combine certain drugs with grapefruit, they can have an effect on your blood level of ethinyl estradiol or segesterone. Inform your doctor of all the medicines you are taking, as well as any new ones. Many medications, both prescription and non-prescription, vitamins, and herbal products can interact with ethinyl estradiol or segesterone. This list does not include all interactions.