Ethinyl Estradiol and Etonogestrel

This information from Lexicomp^® explains what you need to know about this medication, including what it’s used for, how to take it, its side effects, and when to call your healthcare provider.

Brand Names: US

EluRyng; EnilloRing; Haloette; NuvaRing

Brand Names: Canada

Haloette; NuvaRing

What is this drug used for?

• It is used to prevent pregnancy. If your child has been given this drug for some other reason, talk with the doctor for more information.

What do I need to tell the doctor BEFORE my child takes this drug?

• If your child is allergic to this drug; any part of this drug; or any other drugs, foods, or substances. Tell the doctor about the allergy and what signs your child had.
• If your child has had any of these health problems: Blood clots, blood clotting problem, breast cancer or other cancer where hormones make it grow, diseased blood vessels in the brain or heart, heart valve problems, heart disease, a certain type of abnormal heartbeat (atrial fibrillation), chest pain caused by angina, heart attack, stroke, high blood pressure, liver tumor or other liver problems, severe headache or migraine, or diabetes.
• If your child has unexplained vaginal bleeding.
• If your child has taken ombitasvir, paritaprevir, and ritonavir (with or without dasabuvir) within the past 2 weeks.
• If your child has turned yellow while pregnant or with estrogen use like hormonal birth control.

If your child is pregnant:

• Do not give this drug to your child during pregnancy.

This is not a list of all drugs or health problems that interact with this drug.

Tell the doctor and pharmacist about all of your child’s drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe to give this drug with all of your child’s other drugs and health problems. Do not start, stop, or change the dose of any drug your child takes without checking with the doctor.

What are some things I need to know or do while my child takes this drug?

• Tell all of your child’s health care providers that your child is taking this drug. This includes your child’s doctors, nurses, pharmacists, and dentists. This drug may need to be stopped before certain types of surgery as the doctor has told you. If this drug is stopped, the doctor will tell you when to start giving this drug again after your child’s surgery or procedure.
• Be sure your child does not use a diaphragm, cervical cap, or female condom while using this ring.
• If your child has high blood sugar (diabetes), talk with the doctor. This drug can raise blood sugar.
• Check your child’s blood sugar as you have been told by the doctor.
• Have blood work checked as you have been told by the doctor. Talk with the doctor.
• High blood pressure has happened with drugs like this one. Have your child’s blood pressure checked as you have been told by the doctor.
• This drug may raise the chance of blood clots, a stroke, or a heart attack. Talk with the doctor.
• Talk with the doctor if your child will need to be still for long periods of time like long trips, bedrest after surgery, or illness. Not moving for long periods may raise the chance of blood clots.
• Be sure your child has regular breast exams and gynecology check-ups. Your child will also need to do breast self-exams as the doctor has told you.
• Certain drugs, herbal products, or health problems may cause hormone-based birth control to not work as well. Be sure the doctor knows about all of your child’s drugs and health problems. You will need to see if your child also needs to use a non-hormone form of birth control like condoms.
• If your child drinks grapefruit juice or eats grapefruit often, talk with your child’s doctor.
• This drug may affect certain lab tests. Tell all of your child’s health care providers and lab workers that your child takes this drug.
• This drug may cause dark patches of skin on your child’s face. Avoid lots of sun, sunlamps, and tanning beds. Use sunscreen and dress your child in clothing and eyewear that protects from the sun.
• This drug may cause high cholesterol and triglyceride levels. Talk with the doctor.
• This drug does not stop the spread of diseases like HIV or hepatitis that are passed through having sex. Be sure your child does not have any kind of sex without using a latex or polyurethane condom.
• Have your child check to see if this drug is in place as you have been told by the doctor or read the package insert. If your child cannot find the ring after putting it in or if your child is not able to take it out, call the doctor right away.
• Vaginal injury has happened with rings that have broken. If your child finds that the ring has broken, throw it away and have your child use a new ring. Call the doctor right away if your child has vaginal pain or bleeding that is not normal.
• The chance of getting cervical cancer may be higher in people who take hormone-based birth control. However, this may be due to other reasons. If you have questions, talk with the doctor.
• Some studies have shown the risk of breast cancer is raised when taking hormone-based birth control for a long time. However, other studies have not shown this risk. If you have questions, talk with the doctor.
• Do not use in children who have not had their first menstrual period.
• If your child has any signs of pregnancy or a positive pregnancy test, call the doctor right away.

If your child is breast-feeding a baby:

• Tell the doctor if your child is breast-feeding a baby. You will need to talk about any risks to the baby.

What are some side effects that I need to call my child’s doctor about right away?

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your child’s doctor or get medical help right away if your child has any of the following signs or symptoms that may be related to a very bad side effect:

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
• Signs of liver problems like dark urine, tiredness, decreased appetite, upset stomach or stomach pain, light-colored stools, throwing up, or yellow skin or eyes.
• Signs of high blood pressure like very bad headache or dizziness, passing out, or change in eyesight.
• Signs of gallbladder problems like pain in the upper right belly area, right shoulder area, or between the shoulder blades; yellow skin or eyes; fever with chills; bloating; or very upset stomach or throwing up.
• Weakness on 1 side of the body, trouble speaking or thinking, change in balance, drooping on one side of the face, or blurred eyesight.
• Depression or other mood changes.
• Eyesight changes or loss, bulging eyes, or change in how contact lenses feel.
• A lump in the breast, breast pain or soreness, or nipple discharge.
• Vaginal itching or discharge.
• Call the doctor right away if your child has signs of a blood clot like chest pain or pressure; coughing up blood; shortness of breath; swelling, warmth, numbness, change of color, or pain in a leg or arm; or trouble speaking or swallowing.
• Toxic shock syndrome (TSS) has happened in a few patients using vaginal rings. TSS is rare, but can be deadly. Tell the doctor right away if your child has diarrhea, dizziness or light-headedness, passing out, fever, muscle pain, upset stomach, throwing up, or a sunburn-like rash.

What are some other side effects of this drug?

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your child’s doctor or get medical help if any of these side effects or any other side effects bother your child or do not go away:

• Vaginal irritation.
• Weight gain.
• Headache.
• Upset stomach or throwing up.
• Tender breasts.
• Stomach pain.
• Pimples (acne).
• Lowered interest in sex.
• Period (menstrual) changes. These include spotting or bleeding between cycles.

These are not all of the side effects that may occur. If you have questions about side effects, call your child’s doctor. Call your child’s doctor for medical advice about side effects.

You may report side effects to your national health agency.

How is this drug best given?

Give this drug as ordered by your child’s doctor. Read all information given to you. Follow all instructions closely.

• Have your child wash and completely dry hands before touching this drug. Take the ring from the pouch. Keep the pouch to throw away the ring later.
• Put into the vagina and leave in place for 3 weeks.
• Take out ring at the start of the 4th week.
• Put in a new ring 7 days later.
• Put it in at the same time of day that the one before was taken out.
• Press sides of ring at the same time between thumb and index finger and put folded ring into the vagina.
• Perfect placement is not needed for the ring to work. The ring will not hurt.
• To take out, hook the index finger around the rim or hold rim between index finger and middle finger and pull out.
• Do not throw the vaginal ring in the toilet.
• After starting this drug, your child may need to use a non-hormone type of birth control like condoms to prevent pregnancy for some time. Have your child follow what the doctor has told you about using a non-hormone type of birth control.
• If your child misses 2 periods in a row, have your child take a pregnancy test before starting a new dosing cycle.
• If this drug has not been used the right way and 1 monthly period is missed, have your child take a pregnancy test.
• If the ring has been in for up to 1 extra week, it will still work. Have your child take the ring out and put in a new ring 7 days later. If the ring has been in for more than 4 weeks, the ring may not work. Talk with the doctor to make sure your child is not pregnant. Have your child use an extra kind of birth control like condoms until you know your child is not pregnant. If your child is not pregnant, have your child put in a new ring. Have your child keep using the extra kind of birth control for 7 days after putting in the ring.

What do I do if my child misses a dose?

• If the ring is out of the vagina for less than 3 hours, rinse it off with cool to lukewarm (not hot) water and have your child put it back in as soon as possible.
• If the ring is out of the vagina for more than 3 hours during weeks 1 and 2, have your child rinse it off with cool to lukewarm (not hot) water and put it back in as soon as possible. Have your child use an extra kind of birth control like condoms for 7 days after putting the ring back in.
• If the ring is out of the vagina for more than 3 hours during week 3, throw away the ring. Check the package insert or call the doctor to find out when to put in a new ring. Have your child use an extra kind of birth control like condoms for 7 days after putting in the ring.
• If the ring is out of the vagina for more than 1 week or you do not know how long, have your child take a pregnancy test before putting in a new ring. Have your child use an extra kind of birth control like condoms for 7 days after putting in the ring.

How do I store and/or throw out this drug?

• Store unused rings at room temperature. Be sure you know how long unused rings may be stored. Check with your pharmacist.
• Do not use if this drug is out of date.
• Protect from heat and light.
• Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
• Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.

General drug facts

• If your child’s symptoms or health problems do not get better or if they become worse, call your child’s doctor.
• Do not share your child’s drug with others and do not give anyone else’s drug to your child.
• Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your child’s doctor, nurse, pharmacist, or other health care provider.
• If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

Consumer Information Use and Disclaimer

This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider’s examination and assessment of a patient’s specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms.

Last Reviewed Date

2023-01-05

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