Ethinyl Estradiol/Etonogestrel is a microdose hormonal vaginal ring. It is a well-known analog of NuvaRing. This device provides a high protection from unwanted pregnancy.
Indications for use
Mechanism of action
Ethinylestradiol / Etonogestrel is a combined hormonal contraceptive for intravaginal use. It contains etonogestrel, a progestogen, a derivative of 19-nortestosterone, and ethinyl estradiol, which is an estrogen. The main mechanism of contraceptive action is the inhibition of ovulation. The gestagen component (etonogestrel) inhibits the synthesis of LH and FSH by the pituitary gland and, thus, prevents the maturation of the follicle. Perl index, an indicator that reflects the frequency of pregnancy in 100 women during a year of contraception, when using this drug is 0.96. On the background of this drug application, the pain and intensity of menstrual bleeding decreases, the frequency of acyclic bleeding and the probability of the development of iron-deficiency conditions are reduced. In addition, there is evidence of a reduction in the risk of endometrial and ovarian cancer during the use of the drug.
Mode of application and dosage
Ethinyl Estradiol / Etonogestrel fixes into the vagina once every 4 weeks. The vaginal ring is for 3 weeks and then is removed on the same day of the week in which it was placed. After a week break, a new ring is introduced. Bleeding associated with the withdrawal of the drug usually begins 2-3 days after the removal and may not completely cease until the time when it is necessary to start using the next vaginal ring.
The patient can independently introduce this ring into the vagina. A woman should choose the most convenient position to insert a ring, for example, standing, lifting one leg, squatting, or lying down. It is necessary to squeeze the ring and hold in the vagina until the ring is comfortable. The exact position in the vagina doesn’t play the main role for the contraceptive effect.
After the introduction, the ring should be kept in the vagina continuously for 3 weeks. If it was accidentally removed (for example, when removing the tampon), the ring should be rinsed with warm water and immediately placed in the vagina.
- Venous or arterial thrombosis/thromboembolism (including in the medical history);
- Risk factors for thrombosis (including in the anamnesis);
- Migraine accompanied by focal neurological symptoms;
- Diabetic angiopathy;
- Pancreatitis (including in the medical history) in combination with a high degree of hypertriglyceridemia (concentration of LDL more than 500 mg / dL);
- Severe hepatic disease (before the normalization of function indicators);
- Hepatic tumors (benign or malignant, including in the medical history);
- Hormone-dependent malignant tumors (established or suspected, for example, tumors of genital organs or mammary glands);
- Vaginal bleeding of unknown genesis;
- Diagnosed or suspected pregnancy;
- Breastfeeding period;
- hypersensitivity to the drug components.
Etonogestrel and ethinyl estradiol vaginal rings can cause side effects. Tell your doctor if any of these symptoms are severe or do not disappear:
- swelling, redness, irritation, burning, itching, or vaginal infection;
- vaginal bleeding or spotting when this is not the time for your period;
- changes in appetite;
- weight gain or loss;
- abdominal pain;
- breasts disorders: increase in size, tenderness or discharge;
- growth of facial hair;
- hair loss;
- changes in sexual desire.
Some side effects can be severe. The following symptoms are rare, but if you experience any of them immediately consult a doctor:
- pain in the back of the lower leg;
- sudden chest pain;
- heaviness in the chest;
- coughing up to blood;
- sudden shortness of breath;
- sudden severe headache, vomiting, dizziness, or fainting;
- sudden speech problems;
- weakness or numbness of the arm or leg;
- sudden vision loss;
- double vision, visual impairment, or other changes in vision;
- bulging eyes;
- yellowing of the skin or eyes, especially if you also have fever, fatigue, loss of appetite, dark urine and/or light stools;
- depression, especially if you also have trouble sleeping, fatigue, loss of energy, or other mood changes;
- pain, tenderness, or swelling of the abdominal cavity;
- pain in the stomach that worsens after eating;
- swelling of the hands, feet, ankles, or lower limbs;
- painful, difficult, or frequent urination;
- brown spots on the skin, especially on the face;
The effectiveness of the drug may decrease in the case of simultaneous use of antiepileptic drugs (primidone, phenytoin, phenobarbital, carbamazepine, topiramate, felbamate), antituberculosis drugs (rifampicin), antimicrobial drugs (ampicillin, tetracycline), antifungal (griseofulvin), antiviral drugs (ritonavir) and drugs, containing St. John’s wort.
What if I miss a dose?
If you forgot to enter a new contraceptive ring 1 week after you removed the previous ring, you cannot be protected from pregnancy 100%. Make sure that you are not pregnant. If you are not pregnant, insert a new ring as soon as you remember and do not use a backup method of birth control until the new ring was in place for 7 consecutive days.
If you forgot to remove the ring for a while, but remember before, 1 week has passed, take off the ring as soon as you remember. Wait one week, and then set up a new ring.
If you forget to remove the ring and remember, after more than 1 week has passed, you cannot be protected from pregnancy. Make sure that you are not pregnant. If you are not pregnant, remove the ring as soon as you remember, wait 1 week and set up a new one. Use the backup method of birth control until the new ring was not in place for 7 consecutive days.
Ethinyl Estradiol / Etonogestrel and pregnancy
Ethinyl Estradiol / Etonogestrel is contraindicated during pregnancy, in the case of suspected pregnancy and lactation.
It is contraindicated during the period of breastfeeding. It is able to influence lactation, reduce the volume of breast milk and its composition. Small amounts of contraceptive steroids and/or their metabolites can be excreted with milk.