NuvaRing Side Effects

Frequency not reported: Penile disorder, galactorrhea, uterine bleeding irregular

Possible Risks and Side Effects of NuvaRing

Like pregnancy, combination hormonal birth control methods increase the risk of serious blood clots (see graph below), especially in women who have other risk factors, such as smoking, obesity, or age greater than 35. This increased risk is highest when you first start using a combination hormonal birth control method or when you restart the same or different combination hormonal birth control method after not using it for a month or more. Talk with your health care provider about your risk of getting a blood clot before using NuvaRing or before deciding which type of birth control is right for you.

In some studies of women who used NuvaRing, the risk of getting a blood clot was similar to the risk in women who used combination birth control pills.

Other studies have reported that the risk of blood clots was higher for women who use combination birth control pills containing desogestrel (a progestin similar to the progestin in NuvaRing) than for women who use combination birth control pills that do not contain desogestrel.

It is possible to die or be permanently disabled from a problem caused by a blood clot, such as heart attack or stroke.

Some examples of serious blood clots are blood clots in the:

Americans see their primary care doctors less often than they did a decade ago. Adults under 65 made nearly 25% fewer visits to primary care providers in 2016 than they did in 2018, according to National Public Radio. In the same time period, the number of adults who went at least a year without visiting a primary care provider increased from 38% to 46%.

• Legs (deep vein thrombosis)
• Lungs (pulmonary embolus)
• Eyes (loss of eyesight)
• Heart (heart attack)
• Brain (stroke)

To put the risk of developing a blood clot into perspective: If 10,000 women who are not pregnant and do not use hormonal birth control are followed for 1 year, between 1 and 5 of these women will develop a blood clot. The figure below shows the likelihood of developing a serious blood clot for women who are not pregnant and do not use hormonal birth control, for women who use hormonal birth control, for pregnant women, and for women in the first 12 weeks after delivering a baby.

Likelihood of Developing a Serious Blood Clot (Venous Thromboembolism [VTE])

*CHC = combination hormonal contraception

**Pregnancy data based on actual duration of pregnancy in the reference studies. Based on a model assumption that pregnancy duration is nine months, the rate is 7 to 27 per 10,000 woman-years.

Call your health care provider right away if you have:

• Leg pain that does not go away
• Sudden shortness of breath
• Sudden blindness, partial or complete
• Severe pain or pressure in your chest
• Sudden, severe headache unlike your usual headaches
• Weakness or numbness in an arm or leg, or trouble speaking
• Yellowing of the skin or eyeballs

Other serious risks include:

• Toxic Shock Syndrome (TSS). Some of the symptoms are much the same as the flu, but they can become serious very quickly. Call your health care provider or get emergency treatment right away if you have the following symptoms:

• Sudden high fever
• Vomiting
• Diarrhea
• A sunburn-like rash
• Muscle aches
• Dizziness
• Fainting or feeling faint when standing up

• Allergic reaction, including hives, swelling of the face, lips, tongue, and/or throat causing difficulty in breathing or swallowing (anaphylaxis and/or angioedema)
• Liver problems, including liver tumors
• High blood pressure
• Gallbladder problems
• Accidental insertion into bladder
• Symptoms of a problem called angioedema if you already have a family history of angioedema

The most common side effects of NuvaRing are:

• Tissue irritation inside your vagina or on your cervix
• Headache (including migraine)
• Mood changes (including depression, especially if you had depression in the past). Call your health care provider immediately if you have any thoughts of harming yourself
• NuvaRing problems, including the ring slipping out or causing discomfort
• Nausea and vomiting
• Vaginal discharge
• Weight gain
• Vaginal discomfort
• Breast pain, discomfort, or tenderness
• Painful menstrual periods
• Abdominal pain
• Acne
• Less sexual desire

Some women have spotting or light bleeding during NuvaRing use. If these symptoms occur, do not stop using NuvaRing. The problem will usually go away. If it doesn’t go away, check with your health care provider.

Other side effects seen with NuvaRing include breast discharge; vaginal injury (including pain, discomfort, and bleeding) associated with broken rings; and penis discomfort of the partner (such as irritation, rash, itching).

Less common side effects seen with combination hormonal birth control include:

• Blotchy darkening of your skin, especially on your face
• High blood sugar, especially in women who already have diabetes
• High fat (cholesterol, triglycerides) levels in the blood

There have been reports of the ring becoming stuck to the vaginal tissue and having to be removed by a healthcare provider. Call your healthcare provider if you are unable to remove your NuvaRing.

Tell your health care provider about any side effect that bothers you or that does not go away. These are not all the possible side effects of NuvaRing. For more information, ask your health care provider or pharmacist. Call your health care provider for medical advice about side effects. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Who Should Not Use NuvaRing

Do not use NuvaRing if you:

• Smoke and are over 35 years old
• Have or have had blood clots in your arms, legs, eyes, or lungs
• Have an inherited problem with your blood that makes it clot more than normal
• Have had a stroke
• Have had a heart attack
• Have certain heart valve problems or heart rhythm problems that can cause blood clots to form in the heart
• Have high blood pressure that medicine can’t control
• Have diabetes with kidney, eye, nerve, or blood vessel damage
• Have certain kinds of severe migraine headaches with aura, numbness, weakness, or changes in vision, or have any migraine headaches if you are over age 35
• Take any Hepatitis C drug combination containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir. This may increase levels of the liver enzyme “alanine aminotransferase” (ALT) in the blood
• Have unexplained vaginal bleeding
• Are pregnant or think you may be pregnant. NuvaRing is not for pregnant women
• Have or have had breast cancer or any cancer that is sensitive to female hormones

• Are allergic to etonogestrel, ethinyl estradiol, or any of the ingredients in NuvaRing. See the list of ingredients in NuvaRing in the Patient Information.

Hormonal birth control methods may not be a good choice for you if you have ever had jaundice (yellowing of the skin or eyes) caused by pregnancy or related to previous use of hormonal birth control.

Tell your health care provider if you have ever had any of the conditions listed above. Your health care provider can suggest another method of birth control.

NuvaRing Side Effects

Medically reviewed by Drugs.com. Last updated on Nov 29, 2022.

Note: This document contains side effect information about ethinyl estradiol / etonogestrel. Some dosage forms listed on this page may not apply to the brand name NuvaRing.

Applies to ethinyl estradiol / etonogestrel: vaginal insert extended release.

Warning

Vaginal route (Insert, Extended Release)

Women over 35 years old who smoke should not use etonogestrel/ethinyl estradiol vaginal ring. Cigarette smoking increases the risk of serious cardiovascular events from combination hormonal contraceptive use.

Serious side effects of NuvaRing

Along with its needed effects, ethinyl estradiol/etonogestrel may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking ethinyl estradiol / etonogestrel:

Incidence not known

• Blurred vision
• changes in skin color
• chest pain or discomfort
• confusion
• constipation
• diarrhea
• dizziness
• gaseous stomach pain
• headache
• inability to speak
• nausea
• nervousness
• numbness of the hands
• pain in the chest, groin, or legs, especially calves of the legs
• pain or discomfort in the arms, jaw, back, or neck
• pounding in the ears
• prominent superficial veins over the affected area with tenderness and warmth
• recurrent fever
• seizures
• severe headache of sudden onset
• slow or fast heartbeat
• stomach fullness
• stomach pain or tenderness usually after eating a meal
• sudden loss of coordination
• sudden onset of slurred speech
• sudden vision changes
• sudden and severe weakness in the arm or leg on one side
• sweating
• swelling of the foot or leg on one side of the body
• temporary blindness
• vomiting with or without blood
• yellow eyes or skin

Get emergency help immediately if any of the following symptoms of overdose occur while taking ethinyl estradiol / etonogestrel:

Symptoms of overdose

• Menstrual changes
• nausea
• vaginal bleeding

Other side effects of NuvaRing

Some side effects of ethinyl estradiol / etonogestrel may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

• Cough
• fever
• itching of the vagina or genital area
• pain during sexual intercourse
• pain or tenderness around the eyes and cheekbones
• sore throat
• stuffy or runny nose
• thick, white vaginal discharge with or without a mild odor
• tightness of the chest
• weight gain

Less common

• Crying
• depersonalization
• false or unusual sense of well-being
• hoarseness
• mental depression
• paranoia
• quick to react or overreact emotionally
• rapidly changing moods, mild feeling of sadness or discouragement that come and go

Incidence not known

• Absent, missed, or irregular menstrual periods
• bloody vaginal discharge
• brown, blotchy spots on exposed skin
• chills
• clay-colored stools
• contact lens intolerance
• dark urine
• decreased amount or quality of milk
• dry mouth
• dry skin
• fruit-like or unpleasant breath odor
• increased hunger
• increased thirst
• increased urination
• loss of appetite
• medium to heavy, irregular vaginal bleeding between regular monthly periods, which may require the use of a pad or a tampon
• rash
• soreness, swelling, or discharge from the breast or breasts
• trouble getting pregnant
• unexplained weight loss
• unusual tiredness or weakness

For Healthcare Professionals

Applies to ethinyl estradiol / etonogestrel: vaginal ring.

General

Adverse reactions leading to study discontinuation occurred in 13% of the women during clinical trials. The most common adverse reactions leading to discontinuation were device-related events (2.7%), mood changes (1.7%), headache/migraine (1.5%), and vaginal symptoms (1.2%). [Ref]

Genitourinary

Very common (10% or more): Vaginitis (13.8%)

Common (1% to 10%): Vaginal discharge, vaginal discomfort, breast pain/discomfort/tenderness, dysmenorrhea, genital pruritus, vaginal discomfort, pelvic pain, leucorrhoea, vaginal infection

Uncommon (0.1% to 1%): Dysuria, micturition urgency, pollakiuria, urinary tract infection, amenorrhea, breast enlargement, breast mass, cervical polyp, cervicitis, coital bleeding, coital discomfort, dyspareunia, ectropion of cervix, fibrocystic breast disease, menorrhagia, metrorrhagia, pelvic discomfort, premenstrual syndrome, uterine spasm, vaginal burning sensation, vaginal odor, vaginal pain, vulvovaginal discomfort, vulvovaginal dryness

Frequency not reported: Penile disorder, galactorrhea, uterine bleeding irregular

Postmarketing reports: Local reaction to penis, vaginal injury (including associated pain, discomfort, and bleeding) associated with ring breakage [Ref]

Cardiovascular

Uncommon (0.1% to 1%): Blood pressure increased, hot flush

Postmarketing reports: Arterial event, myocardial infarction, varicose vein aggravated [Ref]

In studies that were required or sponsored by regulatory agencies, this combined hormonal combination vaginal ring showed a VTE risk similar to combined oral contraceptive use (8.3 per 10,000 women-years versus 9.2 per 10,000 women-years). [Ref]

Hypersensitivity

Local

Common (1% to 10%): Medical device discomfort, discomfort/foreign body sensation [Ref]

Gastrointestinal

Uncommon (0.1% to 1%): Abdominal distention, constipation, abdomen enlarged [Ref]

Oncologic

Uncommon (0.1% to 1%): Breast fibroadenosis

Frequency not reported: Hormone dependent tumors, liver tumor [Ref]

Respiratory

Dermatologic

Common (1% to 10%): Acne

Uncommon (0.1% to 1%): Pruritus, rash, alopecia, eczema

Frequency not reported: Urticaria, chloasma

Postmarketing reports: Angioedema [Ref]

Hepatic

Ocular

Uncommon (0.1% to 1%): Visual disturbance [Ref]

Immunologic

Common (1% to 10%): Allergic reaction

Frequency not reported: Hypersensitivity

Postmarketing reports: Anaphylaxis [Ref]

Musculoskeletal

Common (1% to 10%): Back pain

Uncommon (0.1% to 1%): Muscle spasm, pain in extremity [Ref]

Metabolic

Uncommon (0.1% to 1%): Appetite increased [Ref]

Psychiatric

Common (1% to 10%): Mood changed/altered, depression, mood swings, affect lability, libido decreased

Uncommon (0.1% to 1%): Anxiety, irritability [Ref]

Other

Common (1% to 10%): Expulsion of contraceptive device, device-related event, weight increased, fatigue, fever, influenza-like symptoms

Uncommon (0.1% to 1%): Device breakage, device complication, cervicitis, herpes simplex, malaise, edema [Ref]

Nervous system

Very common (10% or more): Headache/migraine (11.2%)

Uncommon (0.1% to 1%): Dizziness, hypoesthesia

Renal

Frequently asked questions

• Vaginal bleeding while Nuvaring is still inserted?
• Would it be a problem if the Nuvaring was stored at room temperature?
• How long do antibiotics affect birth control?
• What is the name of the generic NuvaRing?

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