What is Nuvaring?

The NuvaRing vaginal ring contains a combination of ethinyl estradiol and etonogestrel are female hormones that prevent ovulation (the release of an egg from an ovary). The hormones in NuvaRing also causes changes in your cervical mucus and uterine lining, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus. The NuvaRing vaginal ring is used as contraception to prevent pregnancy.

Always read the patient information and instructions carefully before using this medication.

• This product is for vaginal use only. Before use, wash and dry your hands. Remove the ring from the reclosable foil pouch, keeping the pouch for later disposal of the used ring. Fold the ring in half and gently push it into your vagina as directed, until it feels comfortable. Although some women may be aware of the ring in the vagina, most women do not feel it once it is in place; it will not interfere with sexual intercourse (though your partner may be able to feel the ring). Unlike a diaphragm, the ring's exact position in the vagina does not affect how well it works. Once inserted, keep the ring in place for 3 weeks in a row.
• If this is the first time you are using the ring, use an additional form of non-hormonal birth control (such as condoms, spermicide) for the first 7 days to prevent pregnancy until the ring has enough time to work. Do not use a diaphragm, female condom, or cervical cap for additional birth control since the ring may interfere with proper placement. If you start using the ring on the first day of your period, you do not need to use back-up birth control the first week.
• After using the ring for 3 weeks, remove it on the same day of the week and about the same time that you placed it. Place the used ring back into the foil pouch and discard in the trash. Do not flush the used ring down a toilet. If you have pain/bleeding when trying to remove the ring, or if you cannot remove it, tell your doctor right away.
• Next, do not wear a ring for 1 week (7 days). You should have your period within 2 to 3 days after the ring is removed. After 1 ring-free week, insert a new ring on the same day of the week that you removed the old ring, whether or not you have your period. If you do not get your period, consult your doctor. Do not go longer than 7 days without a ring. Doing so will increase your risk of pregnancy.
• Regularly check that the ring is in your vagina, such as before and after sexual intercourse. The ring may accidentally fall out during sexual intercourse, during a bowel movement, or while removing a tampon. If this happens and the ring has been out of your vagina for less than 3 hours, rinse it with cool to lukewarm (not hot) water and re-insert the ring as soon as possible. If the ring has been out longer than 3 hours, you could become pregnant. Re-insert it or insert a new ring as directed and use an additional form of non-hormonal birth control (such as condoms, spermicide) for the next 7 days to prevent pregnancy. If you are not sure how long the ring has been out of your vagina, you may not be protected from pregnancy. Contact your doctor for a pregnancy test before inserting a new ring and using additional back-up birth control for 7 days.
• If you have left the ring in place longer than directed, up to an extra week (4 weeks total), you will still be protected from pregnancy. Remove the ring and insert a new ring after 1 ring-free week. However, if you have left the ring in place longer than 4 weeks, you may not be protected from pregnancy. Remove the ring and contact your doctor for a pregnancy test before inserting a new ring and using additional back-up birth control for 7 days.
• Rarely, the vaginal ring has broken at the weld joint after placement. This increases the chance of it slipping out of the vagina. If this happens, throw it away and use a new ring.

Make sure to tell your doctor and pharmacist:

• If you have any drug allergies.
• Which other prescription and non-prescription medications you currently take.
• Your medical history, especially of: blood clots (for example, in the legs, eyes, lungs), blood clotting disorders (such as protein C or protein S deficiency), high blood pressure, abnormal breast exam, cancer (especially endometrial or breast cancer), high cholesterol or triglyceride (blood fat) levels, depression, diabetes, family or personal history of a certain swelling disorder (angioedema), gallbladder problems, severe headaches/migraines, heart problems (such as heart valve disease, irregular heartbeat, previous heart attack), history of yellowing eyes/skin (jaundice) during pregnancy or while using hormonal birth control (such as pills, patch), liver disease (including tumors), stroke, swelling (edema), thyroid problems, vaginal conditions (such as unexplained vaginal bleeding, vaginal stenosis, prolapsed uterus).

Also be aware that:

• If you have diabetes, this medication may affect your blood sugar. Check your blood sugar regularly as directed and share the results with your doctor. Tell your doctor right away if you have symptoms of high blood sugar such as increased thirst/urination. Your doctor may need to adjust your diabetes medication, exercise program, or diet.
• Tell your doctor if you just had or will be having surgery or if you will be confined to a bed or chair for a long time (such as a long plane flight). These conditions increase your risk of getting blood clots, especially if you are using hormonal birth control. You may need to stop this medication for a time or take special precautions.
• Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).
• The hormones in this product may cause blotchy, dark areas on your face and skin (melasma). Sunlight may worsen this effect. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors.
• If you are nearsighted or wear contact lenses, you may develop vision problems or trouble wearing your contact lenses. Contact your eye doctor if these problems occur.
• This medication must not be used during pregnancy. If you become pregnant or think you may be pregnant, tell your doctor right away. If you have just given birth or had a pregnancy loss/abortion after the first 3 months, talk with your doctor about reliable forms of birth control, and find out when it is safe to start using birth control that contains a form of estrogen, such as this medication.
• The hormones in this product may decrease breast milk production. A small amount passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.

Common side-effects may include but are not limited to:

• Vaginal discomfort/irritation, nausea, vomiting, headache, bloating, breast tenderness, swelling of the ankles/feet (fluid retention), or weight change may occur. Vaginal bleeding between periods (spotting) may occur, especially during the first few months of use. If any of these effects persist or worsen, tell your doctor or pharmacist promptly. If you miss 2 periods in a row (or 1 period if the ring has not been used properly), talk to your doctor about a pregnancy test.

Contact your doctor if you experience any of the following side-effects:

• This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.
• Lumps in the breast, mental/mood changes (such as new/worsening depression), severe stomach/abdominal pain, unusual changes in vaginal bleeding (such as continuous spotting, sudden heavy bleeding, missed periods), dark urine, yellowing eyes/skin.
• Urgent/frequent/burning/painful urination and cannot find the ring in your vagina.
• Chest/jaw/left arm pain, confusion, sudden dizziness/fainting, pain/swelling/warmth in the groin/calf, slurred speech, sudden shortness of breath/rapid breathing, unusual headaches (including headaches with vision changes/lack of coordination, worsening of migraines, sudden/very severe headaches), unusual sweating, weakness on one side of the body, vision problems/changes (such as double vision, partial/complete blindness).
• Symptoms of toxic shock syndrome, including: sudden high fever, severe/sudden dizziness, fainting, unusual muscle pain, sunburn-like rash.
• Any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Q: What happens if I miss a dose?

A: If a NuvaRing falls out, rinse it with warm water and reinsert it. If the ring is lost or broken, insert a new ring and stay on the same schedule you started. Carefully follow the Patient Instructions about how to replace a ring that has been out of the vagina for more than 3 hours.

 Q: What should I avoid while using NuvaRing?

A: Do not smoke while using NuvaRing, especially if you are older than 35 years of age. Grapefruit and grapefruit juice may interact with ethinyl estradiol and etonogestrel and lead to unwanted side effects. Avoid the use of grapefruit products. This medicine will not protect you from sexually transmitted diseases--including HIV and AIDS. Using a condom is the only way to protect yourself from these diseases.