Estrogen and Progestin (Vaginal Ring Contraceptives)

Cigarette smoking increases the risk of serious side effects from estrogen and progestin vaginal ring, including heart attacks, blood clots, and strokes. This risk is higher for women over 35 years of age and heavy smokers (15 or more cigarettes per day). If you use estrogen and progestin, you should not smoke.

🔔 Why is this medication prescribed?

Estrogen and progestin vaginal ring contraceptives are used to prevent pregnancy. Estrogen (ethinyl estradiol) and progestin (etonogestrel or segesterone) are two female sex hormones. Estrogen and progestin are in a class of medications called combination hormonal contraceptives (birth control medications). Combinations of estrogen and progestin work by preventing ovulation (the release of eggs from the ovaries). They also change the lining of the uterus (womb) to prevent pregnancy from developing and change the mucus at the cervix (opening of the uterus) to prevent sperm (male reproductive cells) from entering. Contraceptive vaginal rings are a very effective method of birth control, but they do not prevent the spread of human immunodeficiency virus (HIV, the virus that causes acquired immunodeficiency syndrome [AIDS]) and other sexually transmitted diseases.

🔔 How should this medicine be used?

Estrogen and progestin vaginal ring contraceptives come as a flexible ring to place in the vagina. The estrogen and progestin vaginal ring contraceptives are usually placed in the vagina and left in place for 3 weeks. After 3 weeks using the vaginal ring, remove the ring for a 1-week break. After using the Annovera ® vaginal ring for 3 weeks, clean it with mild soap and warm water, pat it dry with a clean cloth or paper towel, and then place it in the provided case during the 1 week break. After using the NuvaRing ® vaginal ring for 3 weeks, you may dispose of it and insert a new vaginal ring after the 1 week break. Be sure to insert your vaginal ring at the end of the 1-week break on the same day and at the same time that you usually insert or remove the ring, even if you have not stopped bleeding. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use the contraceptive ring exactly as directed. Never use more than one contraceptive ring at a time and always insert and remove the ring according to the schedule your doctor gives you.

Contraceptive vaginal rings come in different brands. Different brands of contraceptive rings contain slightly different medications or doses, are used in slightly different ways, and have different risks and benefits. Be sure that you know which brand of contraceptive vaginal ring you are using and exactly how you should use it. Ask your doctor or pharmacist for a copy of the manufacturer’s information for the patient and read it carefully.

Your doctor will tell you when you should insert your first contraceptive vaginal ring. This depends on whether you were using another type of birth control in the past month, were not using birth control, or have recently given birth or had an abortion or miscarriage. In some cases, you may need to use an additional method of birth control for the first 7 days that you use the contraceptive ring. Your doctor will tell you whether you need to use backup birth control and will help you choose a method, such as male condoms and/or spermicides. You should not use a diaphragm, cervical cap, or a female condom when a contraceptive ring is in place.

If you are using the NuvaRing ® vaginal ring, insert a new ring after the 1-week break; repeat the cycle of 3 weeks of use with a 1-week break, using a new vaginal ring for each cycle.

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If you are using the Annovera ® vaginal ring, re-insert the clean vaginal ring after the 1-week break; repeat the cycle of 3 weeks of use with a 1-week break for up to 13 cycles.

The contraceptive ring will usually stay in your vagina until you remove it. It may sometimes slip out when you are removing a tampon, during intercourse, or having a bowel movement. Call your doctor if your contraceptive ring slips out often.

If your NuvaRing ® contraceptive ring slips out, you should rinse it with cool or lukewarm (not hot) water and try to replace it within 3 hours. However, if your NuvaRing ® contraceptive ring slips out and it is broken, discard it and replace it with a new vaginal ring. If your ring falls out and gets lost, you should replace it with a new ring and remove the new ring at the same time you were scheduled to remove the ring that was lost. If you do not replace your NuvaRing ® vaginal ring within the appropriate time, you must use a non-hormonal backup method of birth control (e.g., condoms with spermicide) until you have had the ring in place for 7 days in a row.

If your Annovera ® contraceptive vaginal ring falls out, wash it with mild soap and warm water, rinse and pat dry with a clean cloth towel or paper towel, and try to replace it within 2 hours. If your vaginal ring is out of place for more than a total of 2 hours over the cycle of 3 weeks that the vaginal ring is to be inserted (e.g., from falling out one time or several times), you must use a non-hormonal backup method of birth control (e.g., condoms with spermicide) until you have had the ring in place for 7 days in a row.

Regularly check for the presence of the vaginal ring in the vagina before and after intercourse.

Contraceptive vaginal rings will work only as long as they are used regularly. Do not stop using contraceptive vaginal rings without talking to your doctor.