(120 mcg etonogestrel/15 mcg ethinylestradiol)
Consumer Medicine Information
Read all of this leaflet carefully before you start using NuvaRing because it contains
important information for you.
Keep this leaflet. You may need to read it again.
If you have any further questions, ask your doctor or pharmacist.
This medicine has been prescribed for you only. Do not pass it on to others.
If you get any side effects, talk to your doctor or pharmacist. This includes any
possible side effects not listed in this leaflet.
Read the leaflet also regularly if you are already using NuvaRing. This is important
because the information in the leaflet may change.
What NuvaRing contains:
Composition in Full
active substances: etonogestrel (11.7 mg) and ethinylestradiol (2.7 mg);
other substances: ethylene vinylacetate copolymer (a type of plastic that will not
dissolve in the body), magnesium stearate.
Etonogestrel and ethinylestradiol are released from the ring at a rate of 0.120 mg/day
and 0.015 mg/day respectively, each for 3 weeks.
1. WHAT NUVARING IS AND WHAT IT IS USED FOR
NuvaRing is a contraceptive vaginal ring used to prevent pregnancy. Each ring contains
a small amount of two female sex hormones - etonogestrel and ethinylestradiol. The
ring slowly releases these hormones into the blood circulation. Because of the low
amount of hormones that is released, NuvaRing is considered a low-dose hormonal contraceptive.
Since NuvaRing releases two different types of hormones it is a so-called combined
NuvaRing works just like a combined contraceptive pill (the Pill) but instead of taking
a pill every day, the ring is used for 3 weeks in a row. NuvaRing releases two female
sex hormones that prevent the release of an egg cell from the ovaries. If no egg is
released you cannot become pregnant. An advantage of NuvaRing is that you do not have
to remember to take a pill every day.
NuvaRing is very reliable, but as for all contraceptive methods, protection is never
100%. If NuvaRing is used according to the directions, your chance of getting pregnant
is less than 0.7% per year. For comparison purposes, if combined oral contraceptives
are used diligently, the chance of getting pregnant is expected to be about 0.1% and
if progestogen only pills ("mini pills") are used about 0.3%. Your chance of getting
pregnant increases if NuvaRing is not used exactly according to the directions.
2. WHAT YOU NEED TO KNOW BEFORE YOU USE NUVARING
In this leaflet, several situations are described where you should stop using NuvaRing,
or where NuvaRing may be less reliable. In such situations you should not have intercourse
or you should take extra non-hormonal contraceptive precautions such as using a male
condom or another barrier method. Do not use rhythm or temperature methods. These
methods can be unreliable because NuvaRing alters the monthly changes of the body
temperature and of the cervical mucous.
NuvaRing, like other hormonal contraceptives, does not protect against HIV infection
(AIDS) or any other sexually transmitted disease.
2.1 When you should not use NuvaRing
In some situations you should not use a combined hormonal contraceptive. Tell your
doctor if any of the following conditions apply to you. Your doctor may then advise
you to use a different (non-hormonal) method of birth control.
Do not use NuvaRing:
If you have, or have ever had a disorder affecting the blood vessels. In particular,
this applies to conditions relating to thrombosis. Thrombosis is the formation of
a blood clot. This may occur in the blood vessels of the legs (deep vein thrombosis),
the lungs (pulmonary embolism), the heart (heart attack), the brain (stroke), or other
parts of the body;
if you have ever had a heart attack, or a stroke, or if you have (or have ever had)
a condition that may be a first sign of a heart attack (such as angina pectoris, or
severe chest pain) or stroke (such as a transient ischaemic attack [a TIA - a slight
if you have a serious risk factor, or several risk factors for developing a blood
clot - see also in section 2.2 'Blood clots (Thrombosis)';
if you have a disorder affecting the blood clotting, for instance protein C deficiency;
if you have major surgery (e.g., an operation) and your ability to move around is
limited for a long period of time (see in section 2.2 'Blood clots (Thrombosis)').
if you have (had) a type of migraine called 'migraine with aura' Ask your doctor if
you are unsure;
if you have diabetes with damaged blood vessels;
if you have (had) an inflammation of the pancreas (pancreatitis) associated with high
levels of fat in your blood;
If you have jaundice (yellowing of the skin) or if you have or ever had severe liver
disease and your liver is not yet working normally;
if you have any unexplained vaginal bleeding;
if you are allergic to ethinylestradiol or etonogestrel, or any of the other ingredients
If you have or have had cancer of the breast or the genital organs;
If you have or have had a benign or malignant tumour in the liver;
If you are pregnant or think you might be pregnant.
If any of these conditions appear for the first time while using NuvaRing, remove
the ring immediately and contact your doctor. In the meantime, use non-hormonal contraceptive
Do not use NuvaRing if you have hepatitis C and are taking the combination drug regimen
ombitasvir/paritaprevir/ritonavir with or without dasabuvir (see in section 2.2 'Other
medicines and NuvaRing').
For possible signs of a blood clot see in section 2.2 'Blood Clots (Thrombosis)'.
2.2 Warnings and precautions
In some situations you need to take special care while using a combined hormonal contraceptive.
Talk to your doctor before using NuvaRing if any of the following conditions apply
to you. Also if the condition develops or gets worse while you are using NuvaRing
you must tell your doctor.
if you breast-feed a baby. The use of a hormonal contraceptive containing an estrogen
is generally not recommended until the nursing mother has completely weaned her child;
if you have diabetes;
if you are overweight;
if you have high blood pressure;
if you have a heart valve disorder or a certain heart rhythm disorder;
if you have an inflammation of your veins (superficial phlebitis);
if you have varicose veins;
if anyone in your immediate family has had a thrombosis, a heart attack or a stroke;
if you suffer from migraine;
if a close relative has or has ever had breast cancer;
if you have epilepsy (see in section 2.2 'Other Medicines and NuvaRing');
if you or someone in your immediate family has or had high blood levels of fatty substances
(cholesterol or triglycerides);
if you have liver disease (for instance jaundice) or gallbladder disease (for instance
if you have Crohn's disease or ulcerative colitis (chronic inflammatory bowel disease);
if you have SLE (systemic lupus erythematosus; a disease affecting your natural defence
if you have HUS (haemolytic uraemic syndrome; a disorder of blood clotting causing
failure of the kidneys);
if you have sickle cell anaemia (an inherited disease of the red blood cells);
if you have elevated levels of fat in the blood (hypertriglyceridemia) or a positive
family history for this condition. Hypertriglyceridemia has been associated with an
increased risk of developing pancreatitis (inflammation of the pancreas) in women
using hormonal contraceptives.
if you have an operation, or if your ability to move around is limited for a long
time (see in section 2.2 'Blood Clots (Thrombosis)';
if you have a condition that occurred for the first time or worsened during pregnancy
or previous use of sex hormones, e.g. hearing loss, porphyria (a disease of the blood),
herpes gestationis [skin rash with vesicles during pregnancy], Sydenham's chorea [a
disease of the nerves in which sudden movements of the body occur]); hereditary angioedema
[you should see your doctor immediately if you experience symptoms of angioedema such
as swollen face, tongue and/or throat and/or difficulty swallowing or hives, together
with difficulty breathing].
if you have (or have ever had) chloasma [yellowish-brown pigment patches, so called
'pregnancy patches', particularly on the face]; if so, avoid too much exposure to
the sun or ultraviolet light;
if you have a medical condition that makes it difficult to use NuvaRing - e.g. if
you are constipated, have a prolapse of the uterine cervix or have pain during intercourse;
if you have recently given birth you are at an increased risk of blood clots. You
should ask your doctor how soon after delivery you can start using NuvaRing (see in
section 2.2 'Blood clots (Thrombosis)');
if you have (or have ever had) an allergic reaction while using NuvaRing, including
swelling of the face, lips, tongue, and/or throat causing difficulty in breathing
or swallowing (angioedema and/or anaphylaxis);
if you have a history of toxic shock syndrome (TSS).
Even if none of the conditions listed above applies to you, it is sensible to see
your doctor regularly for a medical check-up, e.g. once every year.
Blood clots (Thrombosis)
Blood clots in a vein
A blood clot in a vein (known as a 'venous thrombosis') can block the vein. This can
happen in veins in the leg, the lung (a lung embolus), or other organs.
Using combined hormonal contraceptives, including NuvaRing, increases a woman's risk
of developing a venous thrombosis compared with a woman not using any combined hormonal
contraceptive. The risk of developing a blood clot in a vein is highest during the
first year of using a combined hormonal contraceptive for the first time. The risk
is also higher if you restart using a combined hormonal contraceptive (the same product
or a different product) after a break of 4 weeks or more. The risk is not as high
as the risk of developing a blood clot during pregnancy. The risk of getting a blood
clot with NuvaRing is similar to the risk contraceptive pills.
If you use a combined hormonal contraceptive your risk of venous thrombosis increases
the older you are;
if one of your close relatives has had a blood clot in the leg, lung or other organ
at a young age;
if you are overweight;
if you must have an operation, or if your ability to move around is limited for a
long period of time because of any injury or illness, or you have your leg in a plaster
If this applies to you, it is important to tell your doctor that you are using NuvaRing,
as the treatment may have to be stopped. Your doctor may tell you to stop using your
hormonal contraception several weeks before surgery or while you are less mobile.
Your doctor will also tell you when you can start using NuvaRing again after you are
able to move around. See also section 2.1 'When should you not use NuvaRing'.
if you gave birth less than a few weeks ago.
Blood clots in an artery
A blood clot in an artery can cause serious problems. For example, a blood clot in
an artery in the heart causes a heart attack, or in the brain causes a stroke. Extremely
rarely blood clots can occur in the liver, gut, kidney or eye.
The use of a combined hormonal contraceptive has also been connected with an increased
risk of clots in the arteries. This risk increases further:
the older you are;
if you smoke.
When using a combined hormonal contraceptive like NuvaRing you are strongly advised
to stop smoking, especially if you are older than about 35 years;
if you are overweight;
if you have high blood pressure. If you develop high blood pressure while using NuvaRing,
you may be told to stop using it;
if a close relative has had a heart attack or stroke at a young age;
if you have a high level of fat in your blood (cholesterol or triglycerides);
if you have diabetes;
if you get migraine;
if you have a problem with your heart (valve disorder, disturbance of the rhythm).
Symptoms of blood clots
Remove NuvaRing and contact your doctor immediately if you notice possible signs of
a blood clot, such as:
unusual pain and/or swelling in one of your legs;
severe pain in the chest which may reach the left arm;
sudden cough without an obvious cause;
any unusual, severe or long-lasting headache or worsening of migraine;
partial or complete blindness or double vision;
difficulty in speaking or inability to speak;
giddiness or fainting;
weakness, strange feeling, or numbness in any part of your body.
Following a blood clot recovery is not always complete. Very occasionally serious
permanent disabilities may occur or the blood clot may even be fatal.
The information given below was obtained from studies of women who used combined oral
hormonal contraceptives, such as the combined pill, and from an additional study that
included both oral and non-oral hormonal contraceptives, such as NuvaRing.
In studies with the combined pill, breast cancer has been found slightly more often
in women using combined pills, but it is not known whether this is caused by the treatment.
For example, it may be that tumours are found more in women on combined pills because
they are examined by the doctor more often. The increased occurrence of breast cancer
becomes gradually less after stopping the combined pill, so that 10 years after stopping
the extra risk has gone.
In the additional study that included both oral and non-oral hormonal contraceptives,
such as NuvaRing, the occurrence of breast cancer was reported to increase the longer
the women used the contraceptive. The difference in the reported risk of breast cancer
between women who had never used the contraceptive and those who had used the contraceptive
was small: 13 additional cases of breast cancer per 100,000 women-years.
It is important to regularly check your breasts and you should contact your doctor
if you feel any lump. You should also tell your doctor if a close relative has, or
ever had breast cancer (see section 2.2 Warnings and precautions).
In rare cases benign liver tumours and in even fewer cases, malignant liver tumours
have been reported in pill users. Contact your doctor if you have unusual severe abdominal
Chronic infection with Human Papilloma Virus (HPV) is the single most important risk
factor for cervical cancer. HPV is a sexually transmitted infection. In women who
use combined oral contraceptives for a long time the chance of getting cervical cancer
may be slightly higher. This finding may not be caused by the Pill itself but may
be related to sexual behaviour and other factors.
Other medicines and NuvaRing
Always tell the doctor who prescribes NuvaRing which medicines or herbal products
you are already using, including medicines obtained without a prescription. Also tell
any other doctor or dentist who prescribes another medicine (or the dispensing pharmacist)
that you use NuvaRing.
Some medicines may cause particular problems when you are using combined hormonal
contraceptives, such as NuvaRing.
There are medicines that can make NuvaRing less effective in preventing pregnancy,
or can cause unexpected bleeding. These include medicines used to treat:
epilepsy (e.g. primidone, phenytoin, phenobarbital, carbamazepine, oxcarbamazepine,
tuberculosis (e.g. rifampicin);
HIV infection (e.g. ritonavir, nelfinavir, nevirapine, efavirenz);
Hepatitis C virus infection (e.g. boceprevir, telaprevir)
other infectious diseases (e.g. griseofulvin).
high blood pressure in the blood vessels of the lungs (bosentan).
The herbal product St. John's wort may also stop NuvaRing from working properly. If
you want to use herbal products containing St. John's wort while you are already using
NuvaRing you should consult your doctor first.
If you are taking medicines or herbal products that might make NuvaRing less effective,
a barrier contraceptive method should also be used. Since the effect of another medicine
on NuvaRing may last up to 28 days after stopping the medicine, it is necessary to
use the additional barrier contraceptive method for that long. Note: Do not use NuvaRing
with a diaphragm, cervical cap, or a female condom.
NuvaRing may also interfere with the working of other medicines - such as ciclosporin
and the anti-epileptic lamotrigine.
Do not use NuvaRing if you have Hepatitis C and are taking the combination drug regimen
ombitasvir/paritaprevir/ritonavir with or without dasabuvir as this may cause increases
in liver function blood test results (increase in ALT liver enzyme). NuvaRing can
be restarted approximately 2 weeks after completion of treatment with the combination
drug regimen. See section 2.1 'When you should not use NuvaRing'.
You can use tampons while using NuvaRing. Insert NuvaRing before inserting a tampon.
You should be careful when removing a tampon to be sure that the ring is not accidentally
pulled out. If the ring does come out, simply rinse the ring in cool to lukewarm water
(do not use hot water) and immediately reinsert it.
Ring breakage has occurred when also using a vaginal product such as a lubricant or
treatment for infection (see section 3.4 'What to do if…Your ring breaks').
Using spermicides or vaginal yeast products will not reduce the contraceptive efficacy
If you are having any blood or urinary test, tell your health care professional that
you are using NuvaRing as it may affect the results of some tests.
NuvaRing must not be used by women, who are pregnant, or who think they may be pregnant.
If you get pregnant while using NuvaRing you should remove the ring and contact your
If you want to stop NuvaRing because you want to get pregnant, see section 3.4 'What
to do if…You want to stop using NuvaRing'.
NuvaRing is not usually recommended for use during breast-feeding. If you wish to
use NuvaRing while breastfeeding, please seek the advice of your doctor.
Driving and using machines
NuvaRing is unlikely to affect your ability to drive or use machines.
More about hormonal contraceptives
Combined hormonal contraceptives, like NuvaRing, may also have non-contraceptive health
benefits. Your periods may be lighter and shorter. As a result, the risk of anaemia
may be lower. Your period pains may become less severe or may completely disappear.
Your period may be more confined to the ring-free period when you use NuvaRing.
Furthermore, the following serious disorders have been reported to occur less frequently
in users of hormonal contraceptives with 50 micrograms of ethinylestradiol ('high-dosed'
pills) than in non-users. This may also be the case for NuvaRing but this has not
Cancer of the endometrium (the lining of the womb)
Cancer of the ovaries
Benign breast disease
Pelvic infections (pelvic inflammatory disease or PID)
Ectopic pregnancy (pregnancy in which the embryo implants outside of the uterus)
3. HOW TO USE NUVARING?
You can insert and remove NuvaRing yourself. Your doctor will tell you when to start
using NuvaRing for the first time. The vaginal ring must be inserted on the correct
day in your monthly cycle (see section 3.3 'When to start with the first ring') and
left in place for 3 consecutive weeks. Regularly check that NuvaRing is still in your
vagina (for example, before and after intercourse) to ensure that you are protected
from pregnancy. After the third week, you take NuvaRing out and have a one week break.
You will usually have your monthly period during this ring-free interval.
While using NuvaRing, you should not use certain female barrier contraceptive methods
such as a vaginal diaphragm, cervical cap, or female condom as your back-up method
of birth control because NuvaRing may interfere with the correct placement and position
of a diaphragm, cervical cap, or female condom.
3.1 How to insert and remove NuvaRing
1. Before inserting the ring, check it is not out of date (see section 6 'How to store
2. Wash your hands before inserting or removing the ring.
3. See Figures 1 - 5 below for details
Figure 1: Take NuvaRing out of the sachet.
Figure 2: Hold the ring between your thumb and index finger, press the opposite sites
together. Compress the ring.
Figure 3: Choose a comfortable position to insert the ring, like standing with one
leg up, squatting, or lying down.
Figure 4a: Insert the ring into the vagina with one hand, if necessary the labia may
be spread with the other.
Figure 4b: Push the ring into the vagina until the ring feels comfortable. When NuvaRing
is in place you should not feel anything. If you feel uncomfortable, gently change
the position of the NuvaRing (e.g, push the ring a bit further into the vagina) until
it is comfortable. The exact position of the ring inside the vagina is not important.
Figure 4c: Leave the ring in place for 3 weeks.
Figure 5: After 3 weeks, remove NuvaRing from the vagina. NuvaRing can be removed
by hooking the index finger under the ring or by grasping the ring between the index
and middle finger and pulling it out.
4. Dispose of the used ring with the normal household waste, preferably inside the resealable
sachet. Do not flush NuvaRing down the toilet.
3.2 Three weeks in, one week out
1. Starting with the day you put it in, the vaginal ring must be left in place without
interruption for 3 weeks.
2. After 3 weeks you remove the ring on the same day of the week and at approximately
the same time as it was put in. For example, if you put NuvaRing in on a Wednesday
at about 22.00 h, you should remove the ring 3 weeks later, on Wednesday, at about
3. After you have removed the ring, you do not use a ring for 1 week. During this week
a vaginal bleed should occur. Usually this starts 2-3 days after removal of NuvaRing.
4. Start a new ring exactly after the 1 week interval (again on the same day of the week
and approximately the same time), even if you have not stopped bleeding. If the new
ring is inserted more than 3 hours too late, the protection from pregnancy may be
reduced. Follow the instructions in section 3.4 'What to do if…You have forgotten
to insert a new ring after the ring-free interval'.
If you use NuvaRing as described above, your vaginal bleed will take place every month
on roughly the same days.
3.3 When to start with the first ring
You have not used a hormonal contraceptive during the last month.
Insert the first NuvaRing on the first day of your natural cycle (i.e. the first day
of your menstrual period). NuvaRing starts working straight away. You don't need to
take any other contraceptive precautions.
You can also start NuvaRing between day 2 and day 5 of your cycle, but if you have
sexual intercourse during the first 7 days of NuvaRing use make sure that you also
use an additional contraceptive method (such as a male condom). You only have to follow
this advice when you use NuvaRing for the first time.
You have used a combined Pill during the last month.
Start using NuvaRing at the latest the day following the tablet-free period of your
present Pill. If your Pill pack also contains inactive tablets, start NuvaRing at
the latest on the day after the last inactive tablet. If you are not sure which tablet
this is, ask your doctor or pharmacist. Never extend the hormone-free interval of
your current Pill pack beyond its recommended length.
If you have used the Pill consistently and correctly and if you are sure that you
are not pregnant, you can also stop taking the Pill on any day of your current Pill
pack and start using NuvaRing immediately.
You have used a transdermal patch during the last month.
Start using NuvaRing at the latest the day following your usual patch-free break.
Never extend the patch-free break beyond its recommended length.
If you have used the patch consistently and correctly and if you are sure that you
are not pregnant, you can also stop using the patch on any day and start using NuvaRing
You have used a minipill (progestagen-only pill) during the last month.
You can stop taking the minipill any day and start NuvaRing the next day, at the same
time you would have normally taken your pill. But make sure you also use an additional
contraceptive method (such as a male condom) for the first 7 days of ring use.
You have used an injectable or an implant or a progestagen-releasing intrauterine
device (IUD) during the last month.
Start using NuvaRing when your next injection is due or on the day that your implant
or your progestagen-releasing IUD is removed. But make sure you also use an additional
contraceptive method (such as a male condom) for the first 7 days of ring use.
After having a baby.
If you have just had a baby, your doctor may tell you to wait until after your first
normal period before you start using NuvaRing. Sometimes it is possible to start sooner.
Your doctor will advise you. If you are breast-feeding and want to use NuvaRing, you
should discuss this first with your doctor.
After a miscarriage or an abortion.
Your doctor will advise you.
When you have had irregular cycles or no bleeding
Your doctor will advise you.
3.4 What to do if…
You ring is accidentally expelled from the vagina
NuvaRing may accidentally be expelled from the vagina for example, if it has not been
inserted properly, while removing a tampon, during sexual intercourse, during constipation,
or if you have a prolapse of the womb. Therefore, it is a good habit to regularly
check whether the ring is still in your vagina (for example, before and after intercourse).
Your ring has temporarily been out of the vagina
NuvaRing might still protect you from getting pregnant depending on how long it has
been out of your vagina.
If the ring has been out of your vagina for:
Less than 3 hours,
it will still protect you from pregnancy. You should rinse the ring with cold to lukewarm
water (do not use hot water) and put the ring back in as soon as possible but only
if the ring has been out of the vagina for less than 3 hours.
More than 3 hours during the 1st and 2nd week,
it may not protect you from pregnancy. You should rinse the ring with cold to lukewarm
water (do not use hot water) and put the ring back in the vagina as soon as you remember,
and leave the ring in place without interruption for at least 7 days. Use a male condom
if you have sexual intercourse during these 7 days. If you are in your 1st week, and you had sexual intercourse during the past 7 days, there is a possibility
you may be pregnant. In that case contact your doctor.
More than 3 hours in the 3rd week,
it may not protect you from pregnancy. You should discard that ring and choose between
one of the following two options:
1. Insert a new ring immediately:
This will start the next 3-week use period. You may not have your period, but breakthrough
bleeding and spotting may occur.
2. Do not insert the ring again.
Have your period first and insert a new ring no later than 7 days from the time the
previous ring was removed or fell out. You should only choose this option if you have
used NuvaRing continuously during the previous 7 days.
An unknown amount of time,
you may not be protected from pregnancy. Perform a pregnancy test and consult your
doctor prior to inserting a new ring.
Your ring breaks
Very rarely NuvaRing may break. A broken ring is unlikely to cause an overdose because
the ring will not release a higher amount of contraceptive hormones.Vaginal injury
associated with ring breakage has been reported.
If NuvaRing breaks, expulsion of the ring is likely to occur (see section 3.4 'What
to do if…Your ring has temporarily been out of the vagina'). Therefore, if you notice
that your NuvaRing has broken, discard that ring and replace it with a new ring as
soon as possible.
You have inserted more than one ring/Overdose
There have been no reports of serious harmful effects due to an overdose of the hormones
in NuvaRing. If you have accidentally inserted more than one ring, you may feel sick
(nausea), or have vomiting or vaginal bleeding. Remove excess rings and contact your
doctor if these symptoms persist.
You have forgotten to insert a new ring after the ring-free interval
If your ring-free interval was longer than 7 days, put a new ring in as soon as you
remember. Use extra contraceptive precautions (such as a male condom) if you have
sexual intercourse during the next 7 days. If you had sexual intercourse in the ring-free
interval, there is a possibility you may be pregnant. In that case contact your doctor
immediately. The longer the ring-free interval, the higher the risk that you have
You have forgotten to remove the ring
If your ring has been left in place for between 3 and 4 weeks, it will still protect
you from pregnancy. Have your regular ring-free interval of one week and subsequently
insert a new ring.
If your ring has been left in place for more than 4 weeks there is a possibility of
becoming pregnant. Contact your doctor before you start with a new ring.
You have missed a menstrual period
You have followed the instructions for NuvaRing
If you have missed a menstrual period but you followed the instructions for NuvaRing,
and have not used other medicines it is very unlikely that you are pregnant. Continue
to use NuvaRing as usual. If you miss your menstrual period twice in a row, however,
you may be pregnant. Tell your doctor immediately. Do not start the next NuvaRing
until your doctor has checked you are not pregnant.
If you have not followed the instructions for NuvaRing
If you have missed a menstrual period and you did not follow the instructions, and
you do not have your expected period in the first normal ring-free interval, you may
be pregnant. Contact your doctor before you start with a new NuvaRing.
You have unexpected bleeding
While using NuvaRing, some women have unexpected vaginal bleeding between menstrual
periods. You may need to use sanitary protection. In any case, leave the ring in the
vagina and continue to use the ring as normal. If the irregular bleeding continues
becomes heavy or starts again, tell your doctor.
You want to change the first day of your menstrual period
If you follow the instructions for NuvaRing, your menstrual period (withdrawal bleed)
will begin in the ring-free interval. If you want to change the day it starts, you
can make the ring-free interval shorter (but never longer!). For example, if your
ring-free interval begins on a Friday, you can change this to a Tuesday (3 days earlier).
Simply insert your next ring 3 days earlier than usual.
If you make your ring-free interval very short (e.g. 3 days or less), you may not
have your usual bleeding. You may have spotting (drops or flecks of blood) or breakthrough
bleeding while using the next ring.
You want to delay your menstrual period
Delay of your menstrual period (withdrawal bleed) is possible by inserting a new ring
immediately after removing the current ring, with no ring-free interval between rings.
You can leave the new ring inserted for up to a maximum of 3 weeks. You may experience
spotting (drops or flecks of blood) or breakthrough bleeding while using this new
ring. When you want your period to begin, just remove the ring. Have your regular
ring-free interval of one week and subsequently insert a new ring.
You want to stop using NuvaRing
You can stop using NuvaRing any time you want.
If you do not want to become pregnant, ask your doctor about other methods of birth
If you stop using NuvaRing because you want to get pregnant, you should wait until
you have had a natural period before trying to conceive. This helps you calculate
when the baby will be due.
4. WHEN SHOULD YOU CONTACT YOUR DOCTOR
When you are using NuvaRing, your doctor may tell you to return for regular check-ups.
In general, you should have a check-up every year
Contact your doctor as soon as possible if:
You notice any changes in your own health, especially involving any of the items mentioned
in this leaflet (see also section 2.1 'When you should not use NuvaRing' and section
2.2 'Warnings and precautions'.
Your ability to move around is limited for a long period of time or you are to have
surgery. Tell your doctor at least four weeks in advance (see also section 2.2 'Blood
You feel a lump in your breast. This symptom may indicate breast cancer (see also
section 2.2 'Cancer').
You experience an allergic reaction, including hives, swelling of the face, lips,
tongue, and/or throat causing difficulty in breathing or swallowing (angioedema and/or
You have severe pain in your abdomen.
You have unusual, heavy vaginal bleeding. This symptom may indicate cervical cancer.
You are going to use other medications (see also in section 2.2 'Other medicines and
The ring was out of the vagina for longer than 3 hours in the first week of use and
you had intercourse in the 7 days before.
You have forgotten to insert a new ring after the ring-free interval of 7 days.
You left NuvaRing in place for more than 4 weeks. Do not start the next ring until
your doctor tells you.
You missed your period twice in a row or suspect you are pregnant. Do not start the
next ring until your doctor tells you.
You have an urgent frequent burning, and/or painful urination, and cannot locate the
ring in the vagina. These symptoms may indicate accidental placement of NuvaRing into
the urinary bladder.
If you locate the ring in your vagina, but are unable to remove it.
Remove NuvaRing and contact your doctor immediately if you notice possible signs of
a blood clot. The symptoms are described in section 2.2 'Blood clots (Thrombosis)
5. POSSIBLE SIDE EFFECTS
Like all medicines, NuvaRing can cause side effects, although not everybody gets them.
Serious reactions seen with NuvaRing, as well as the related symptoms, are described
in sections 2.2 'Blood clots (Thrombosis) ' and 'Cancer'. Please read these sections
for additional information and consult your doctor if you suffer from any of these
conditions or symptoms.
Users of NuvaRing have reported the following Common (affecting more than 1 in 100,
but less than 1 in 10 women); and Uncommon (affecting more than 1 in 1000, but less
than 1 in 100 women) side effects:
abdominal pain, feeling sick (nausea)
yeast infection of the vagina (such as 'thrush'); discomfort in the vagina due to
the ring; genital itching; secretion from the vagina
headache or migraine; depressive moods; lower sex drive
breast pain; painful menstrual periods
the ring falling out
disturbed vision; dizziness
swollen abdomen; vomiting, diarrhoea or constipation
feeling tired, unwell or irritable; mood changes
extra fluid in the body (oedema)
bladder or urinary tract infection
difficulty or pain when passing urine; strong desire or need to pass urine; passing
urine more often
problems during intercourse, including pain, bleeding or partner feeling the ring
increased blood pressure
back pain; muscle spasms; pain on legs or arms
less sensitive skin
sore or larger breasts; fibrocystic breast disease (cysts in the breasts which may
become swollen or painful)
inflammation of the cervix; cervical polyps (growth in the cervix); rolling outward
of the margin of the cervix (ectropion)
genital secretion; changes to menstrual periods (e.g. periods can be heavy, long,
irregular or stop altogether); pelvic discomfort; premenstrual syndrome; spasm of
vaginal infection; burning feeling, smell, pain, discomfort or dryness in the vagina
hair loss, eczema, itching, rash or hot flushes
Rare side effects
(affecting more than 1 in 10 000, but less than 1 in 1000 women)
blood clot in a vein
blood clot in an artery.
The following rare side effects have been reported in users of NuvaRing, but the frequency
cannot be estimated from the available data: allergic reactions (hypersensitivity),
including hives, swelling of the face, lips, tongue, and/or throat causing difficulty
in breathing or swallowing (angioedema and/or anaphylaxis); vaginal injury associated
with ring breakage; breast discharge; and penis discomfort of the partner (such as
irritation, rash, itching).
If you get any side effects, talk to your doctor or pharmacist. This includes any
side effects not listed in this leaflet.
6. PHARMACEUTICAL PARTICULARS OF NUVARING
Store your NuvaRing in the original sachet below 30°C.
Protect from light and freezing.
Do not use a NuvaRing if it was dispensed to you more than 4 months ago. The dispensing
date is shown on the carton and sachet.
Do not use NuvaRing after the expiry date which is shown on the carton and sachet.
Do not use NuvaRing if you notice a colour change in the ring or any visible signs
Keep NuvaRing out of the reach and sight of children.
If you discover that a child has been exposed to the hormones from NuvaRing, ask your
doctor for advice.
What NuvaRing looks like and contents of the pack
NuvaRing is flexible, transparent, colourless to almost colourless and 54 mm wide.
Each ring is packed in a resealable sachet that is made of aluminium foil. The sachet
is packed in a cardboard box together with this package leaflet. Each box contains
1 or 3 rings.
IF YOU HAVE ANY FURTHER QUESTIONS, PLEASE CONSULT YOUR DOCTOR OR PHARMACIST.
Merck Sharp & Dohme (Australia) Pty Limited
Level 1, Building A, 26 Talavera Road,
Macquarie Park NSW 2113
Date of Preparation
AUST R 96229