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Ethinyl Estradiol / Segesterone Review

Ethinyl Estradiol / Segesterone is a birth control vaginal ring containing two female hormones: ethinyl estradiol and segesterone. This is a generic analog of Annovera vaginal ring.


Indications for use

Hormonal contraceptive. Ethinyl Estradiol / Segesterone is mainly intended to protect against unwanted pregnancy. This vaginal ring is often prescribed by doctors for endometriosis. It can also treat uterine fibroids when its size is small requiring no surgical intervention.

Mechanism of action

This contraceptive ring refers to hormonal contraceptives. The contraceptive effect is provided by ethinyl estradiol and segesterone. Thanks to the use of this vaginal ring, the menstrual cycle is adjusted. Pain during menstruation becomes less noticeable, the volume of secretions decreases.

Also, the possibility of iron deficiency anemia is reduced. The main advantage of the hormone-based contraceptive ring is that its use prevents:

  • ovarian cancer;
  • endometrium cancer;
  • ovarian cysts;
  • ectopic pregnancy;
  • inflammatory diseases of the genitals;
  • benign neoplasms in the mammary glands.

Mode of application and dose

Ethinyl Estradiol / Segesterone is applied intravaginally. The ring is inserted into the vagina and left for 3 weeks to achieve a contraceptive effect. Then the ring is removed from the vagina and a break for 7 days is followed. It is necessary to apply an additional barrier method of contraception during the first 7 days of the usage of this vaginal ring. The ring may fall out if inserted incorrectly or when the vaginal pack is removed. In this case, rinse the ring with warm water and reinsert it.


Ethinyl Estradiol / Segesterone vaginal ring should not be used when there are:

  • thrombosis/thromboembolism;
  • heart defects;
  • migraine;
  • pancreatitis;
  • diabetes mellitus affecting the vascular system;
  • hepatic ailments of a severe nature;
  • neoplasms in the liver are benign/malignant;
  • neoplasms in the reproductive system that depend on hormones;
  • the period of gestation;
  • intolerance to contraceptives.

Rarely and with caution, this vaginal ring is recommended in the following cases:

  • thrombosis in relatives;
  • serious operations in general and including legs;
  • obesity;
  • thrombophlebitis;
  • arterial hypertension;
  • smoking if you are over 40;
  • violations of fat metabolism in the body;
  • gallstone disease;
  • hemolytic uremic syndrome;
  • chorea;
  • otosclerosis with impaired auditory perception;
  • systemic lupus erythematosus;
  • angioneurotic edema;
  • Crohn’s syndrome;
  • ulcerative colitis;
  • sickle cell anemia;
  • porphyria;
  • chronic constipation;
  • hernia hernia;
  • hernia of the rectum;
  • uterine prolapse.

Side effects

  • The immune system: hypersensitivity.
  • Metabolism and nutrition: increased appetite, increased body weight.
  • The nervous system: headache, migraine, dizziness, hypesthesia, depression, decreased libido, mood changes, fatigue, irritability.
  • The urinary system: cervicitis, cystitis, urinary tract infections, dysuria, mandatory urination, pollakiuria, urinary tract urination, pollakiuria.
  • The digestive system: abdominal pain, nausea, bloating, diarrhea, vomiting, constipation.
  • The reproductive system: vaginal infection, engorgement and tenderness of the mammary glands, genital itching in women, painful menstrual bleeding, pain in the pelvic area, vaginal discharge, lack of menstrual bleeding, discomfort in the mammary glands, enlargement of the mammary glands, tightening of mammary glands, cervical polyps, spotting during intercourse, pain during intercourse, cervical ectropion, fibrocystic mastopathy, heavy menstrual bleeding, acyclic bleeding, discomfort in the pelvic area, premenstrual like syndrome, burning vaginal sensation, vaginal odor, vaginal pain, discomfort and dryness of the vulva.
  • The musculoskeletal system: backpain, muscle cramps, pain in the limbs.
  • The skin system: acne, alopecia, eczema, skin itching, rash, urticaria.
  • The side of the organ of vision: visual impairment.
  • The cardiovascular system: external thromboembolism, hot flashes, increased blood pressure.
  • Other: discomfort when using the vaginal ring, prolapse of the vaginal ring, malaise, swelling, foreign body sensation, difficulty using a contraceptive, vaginal ring rupture.


Hepatic metabolism: interactions with microsomal liver enzymes may occur. It can result in increased clearance of sex hormones. Possible interactions with phenytoin, barbiturates, primidone, carbamazepine, rifampicin have been established. Other possible interactions are combinations with oxcarbazepine, topiramate, felbamate, ritonavir, griseofulvin and drugs containing St. John’s wort (Hypericum perforatum).

Antibiotics: A decrease in the effectiveness of oral contraceptives containing ethinyl estradiol has been observed with concomitant use of antibiotics such as ampicillin and tetracyclines. The mechanism of this effect has not been studied. In a study of pharmacokinetic interactions, ingestion of amoxicillin (875 mg, 2 times a day) or doxycycline (200 mg per day, and then 100 mg per day) for 10 days during the use of the vaginal ring had little effect on pharmacokinetics.

Ethinyl Estradiol / Segesterone and pregnancy

The use of this vaginal ring during pregnancy is contraindicated. In case of pregnancy, the ring should be removed. Extensive epidemiological studies did not reveal an increased risk of congenital malformations in children born to women who took COCs before pregnancy, as well as teratogenic effects in cases when women took COCs in early pregnancy, knowing about it.

Breastfeeding period

The use of this vaginal birth control ring during breastfeeding is contraindicated. The drug composition can affect lactation, reduce the amount and change the composition of breast milk. Small amounts of contraceptive sex hormones and/or their metabolites may be excreted in milk, but evidence of their negative effects on children’s health has not been recorded.

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