Health Library

Etonogestrel/ethinyl estradiol (Into the vagina)

Ethinyl Estradiol (ETH-i-nil es-tra-DYE-ol), Etonogestrel (e-toe-noe-JES-trel)

Prevents pregnancy.

Brand Name(s):

EluRyng, EnilloRing, Haloette, NuvaRing

When This Medicine Should Not Be Used:

How to Use This Medicine:

Insert

• This medicine is in a ring that is put into your vagina. Your doctor or nurse will show you how to put in the ring. The ring should be left in place for 3 weeks. It will then be removed and another one will be inserted 1 week later. During the week without the ring, you will usually have your menstrual period.
• The first time you start using the ring, you should also use a second form of birth control during the first 7 days to avoid pregnancy. Do not use a diaphragm, because the ring may affect how the diaphragm fits.
• Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.
• Once the ring is in place, you should not be able to feel it. If you feel uncomfortable, the ring may not be inserted far enough. Gently push the ring farther into your vagina. If you feel pain, talk to your doctor.
• Check for the presence of the ring inside your vagina regularly (including before and after having sex).
• The ring may move down accidently. This can happen if you are having a bowel movement. Gently push the ring back into place. If the ring comes all the way out, rinse it with warm water and put it back in. Call your doctor if the ring comes out several times.
• Missed dose:
  • If NuvaRing® has slipped out and it has been out for less than 3 hours, rinse it in cool or lukewarm water and reinsert it. You should still be protected from pregnancy.
  • If NuvaRing® has been out of the vagina for more than 3 hours:
    • During Weeks 1 and 2: You may not be protected from pregnancy. Reinsert the ring as soon as you remember. Use another form of birth control (condoms or spermicide) until the ring has been in place for 7 days in a row.
    • During Week 3: Throw the NuvaRing® away, do not reinsert. Use another form of birth control (condoms or spermicide) until the new ring has been used for 7 days in a row, following these options. You may only choose option 2 if you used the ring for 7 days in a row prior to it falling out.
      • Option 1: Insert a new ring right away to start your next 21 day cycle. You may not have your regular period, but you may have spotting or vaginal bleeding.
      • Option 2: Insert a new ring no later than 7 days from the time the previous ring was removed. During this time, you may have your period.
  • If you leave the vaginal ring in place for more than 4 weeks, you may not be protected from pregnancy. Make sure that you are not pregnant before you insert a new ring. You must use an additional form of birth control (not a diaphragm) until the new ring has been in place for 7 days in a row.
  • If you forget to insert a new ring after the ring-free week, call your doctor for instructions.
• Store this medicine at room temperature, away from heat and direct light for up to 4 months. Place the used vaginal ring in the re-sealable foil pouch and throw it in the trash. Do not flush the ring down the toilet.

Drugs and Foods to Avoid:

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Do not use this medicine together with medicine to treat hepatitis C virus infection, including ombitasvir/paritaprevir/ritonavir, with or without dasabuvir.
• Some foods and medicines can affect how etonogestrel/ethinyl estradiol works. Tell your doctor if you are using any of the following:
  • Acetaminophen, aprepitant, ascorbic acid, atorvastatin, bosentan, clofibric acid, cyclosporine, efavirenz, etravirine, morphine, nevirapine, prednisolone, salicylic acid, St John's wort, temazepam, theophylline, tizanidine
  • Medicine for HIV/AIDS (including atazanavir/ritonavir, boceprevir, darunavir/ritonavir, fosamprenavir/ritonavir, indinavir, lopinavir/ritonavir, nelfinavir, ritonavir, telaprevir, tipranavir/ritonavir)
  • Medicine to treat an infection (including fluconazole, griseofulvin, itraconazole, ketoconazole, miconazole, rifabutin, rifampicin, voriconazole)
  • Medicine to treat seizures (including carbamazepine, felbamate, lamotrigine, oxcarbazepine, phenobarbital, phenytoin, rufinamide, topiramate)
  • Thyroid medicine
• Do not eat grapefruit or drink grapefruit juice while you are using this medicine.
• Ask your doctor before you use other products or medicines into your vagina. You may need to remove the ring first.

Warnings While Using This Medicine:

• It is not safe to take this medicine during pregnancy. It could harm an unborn baby. Tell your doctor right away if you become pregnant.
• Tell your doctor if you are breastfeeding, or if you recently had a baby, miscarriage, or abortion. Tell your doctor if you have kidney disease, cervical cancer, diabetes, epilepsy, migraines, heart or blood vessel disease, high cholesterol, high blood pressure, or a history of depression or chloasma (skin discoloration on the face). Tell your doctor if you smoke or if you are having a surgery that requires inactivity for a long time.
• This medicine may cause the following problems:
  • Increased risk of heart attack, stroke, or blood clots
  • Toxic shock syndrome
  • Liver problems
  • High blood pressure
  • Gallbladder disease
  • High cholesterol or fats in the blood
  • Increased risk of breast or cervical cancer
• This medicine may cause skin discoloration. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds.
• This medicine will not protect you from HIV/AIDS or other sexually transmitted diseases.
• You might have spotting or irregular bleeding when you first start using this medicine. You might have unplanned bleeding if you miss a dose or are late taking it. However, if you have heavy bleeding, call your doctor.
• Tell any doctor or dentist who treats you that you are using this medicine. You may need to stop using this medicine several days before you have surgery or medical tests.
• Tell any doctor or dentist who treats you that you are using this medicine. This medicine may affect certain medical test results.
• Your doctor will do lab tests at regular visits to check on the effects of this medicine. Keep all appointments.
• Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:

Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Blistering, peeling, red skin rash
• Breast lumps, tenderness, pain, swelling, or discharge
• Chest pain that may spread, trouble breathing, coughing up blood
• Dark urine or pale stools, loss of appetite, yellow skin or eyes
• Fast, slow, or pounding heartbeat
• Numbness or weakness on one side of your body, pain in your lower leg, sudden or severe headache, problems with vision, speech, or walking
• Redness, pain, itching, or burning sensation inside your vagina
• Sudden and severe stomach pain, nausea, vomiting, lightheadedness
• Sudden high fever, diarrhea, dizziness, fainting, muscle aches, sunburn-like rash
• Unusual or unexpected vaginal bleeding or heavy bleeding
• Vision loss, double vision

If you notice these less serious side effects, talk with your doctor:

• Darkened skin on your face
• Depression, mood changes
• Headaches

If you notice other side effects that you think are caused by this medicine, tell your doctor

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088

Last Updated: 9/6/2024