13 mins read

Overview: Etonogestrel/ethinyl estradiol is a form of birth control that is used to prevent pregnancy. It works by slowly releasing hormones into the body through a ring that is inserted into the vagina. Common side effects include vaginal discomfort or discharge, headache, and changes in mood. Serious side effects are rare but can include blood clots and an increase in blood pressure. 

Uses

What is etonogestrel/ethinyl estradiol used for?

Etonogestrel/ethinyl estradiol is a form of hormonal birth control that is commonly used to prevent pregnancy.  

Etonogestrel/ethinyl estradiol may also be used for other conditions as determined by your health care provider.

How does etonogestrel/ethinyl estradiol work (mechanism of action)?

Etonogestrel/ethinyl estradiol contains two types of hormones, etonogestrel (a progestin) and ethinyl estradiol (an estrogen). It works by slowly releasing these hormones into the body through a ring that is inserted into the vagina. It prevents pregnancy by stopping the release of an egg from the ovaries (ovulation). It also works by thickening the mucus in your cervix to block sperm from reaching the uterus and by changing the lining of your uterus to make it less likely for a pregnancy to happen.

How is etonogestrel/ethinyl estradiol supplied (dosage forms)?

Brands and other names

  • EluRyng
  • EnilloRing
  • Haloette
  • NuvaRing

Dosage forms and strengths

  • 0.12 mg/0.015 mg per day vaginal ring

How should I store etonogestrel/ethinyl estradiol?

Store etonogestrel/ethinyl estradiol at room temperature between 68 F to 77 F (20 C to 25 C) for up to four months. It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Do not store at temperatures over 86 F (30 C) or in direct sunlight. Store in a cool, dry place. If you do not use the ring within four months at room temperature, throw it away.

Side Effects

What are the most common side effects of etonogestrel/ethinyl estradiol?

The most common side effects of etonogestrel/ethinyl estradiol are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Vaginal discomfort, inflammation, or discharge (vaginitis)
  • Headache or migraine (see below)
  • Changes in mood (see below)
  • Issues with the ring, such as discomfort or feeling it in the vagina or the ring coming out
  • Nausea or vomiting 
  • Weight gain
  • Breast pain, discomfort, or tenderness
  • Painful periods
  • Stomach pain
  • Acne
  • Decrease in sex drive

There may be other side effects of etonogestrel/ethinyl estradiol that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of etonogestrel/ethinyl estradiol?

While less common, the most serious side effects of etonogestrel/ethinyl estradiol are described below, along with what to do if they happen.

Severe Allergic Reactions. Etonogestrel/ethinyl estradiol may cause allergic reactions, which can be serious. Stop using etonogestrel/ethinyl estradiol and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Blood Clots. Etonogestrel/ethinyl estradiol may cause a blood clot in your arteries or veins and could cause a stroke, heart attack, or venous thromboembolism (VTE), including a blood clot in the lungs (pulmonary embolism), in the back of your eye (retinal vein occlusion), or in your legs or arms (deep venous thrombosis). Stop using etonogestrel/ethinyl estradiol and get emergency help if you have any of the following signs of a blood clot.

  • Chest pain or pressure
  • Fast or abnormal heartbeat
  • Trouble breathing
  • Pain in your back, jaw, throat, or arm
  • Sweating, upset stomach, vomiting, or dizziness
  • Sudden weakness on one side of your body
  • Sudden and severe headache
  • Slurred speech or trouble understanding speech
  • Pain, swelling, or tenderness in your arm or leg
  • Vision loss
  • Bulging eyes
  • Double vision

Changes in Menstrual Bleeding. Etonogestrel/ethinyl estradiol can cause irregular bleeding, spotting, or light bleeding between periods, especially during the first three months of use. For some people, periods may stop. Call your health care provider right away if you continue to have spotting or breakthrough bleeding between periods, or if you have spotting after having regular cycles while using etonogestrel/ethinyl estradiol. 

Increased Blood Pressure (Hypertension). Etonogestrel/ethinyl estradiol may increase your blood pressure or make it worse if you have a history of high blood pressure. Call your health care provider if your blood pressure increases while using this medicine.

If you measure your blood pressure and the top number (systolic) is 180 or higher or the bottom number (diastolic) is 120 or higher, get medical attention right away. Increases in blood pressure may not be noticeable, but look out for and tell your health care provider right away if you have any of the following symptoms of severely high blood pressure.

  • Sudden severe headache
  • Chest pain
  • Dizziness or confusion
  • Trouble breathing
  • Nausea or vomiting
  • Blurry or other changes to vision
  • Anxiety
  • Buzzing in the ears
  • Nosebleed
  • Feeling of skipped heartbeats

Toxic Shock Syndrome. Etonogestrel/ethinyl estradiol may cause toxic shock syndrome (TSS), which is a sudden, potentially deadly condition caused when an overgrowth of bacteria releases toxins into your bloodstream. Stop using etonogestrel/ethinyl estradiol and get emergency care right away if you have any of the following symptoms of TSS.

  • Sudden high fever
  • Vomiting or diarrhea
  • Dizziness or fainting
  • A sunburn-like rash, especially on the palms of the hands and bottoms of the feet
  • Muscle aches
  • Low blood pressure (hypotension)
  • Red eyes, mouth, and throat
  • Confusion
  • Seizures

Gallbladder Problems. Using etonogestrel/ethinyl estradiol may increase the risk of gallbladder problems, including cholecystitis and cholelithiasis (also known as gallstones). Call your health care provider right away if you have any of the following symptoms.

  • Your skin or the whites of your eyes turning yellowish in color (also called jaundice)
  • Fever
  • Pain in your upper stomach area
  • Stool (poop) that is clay-colored

Headache or Migraine. Etonogestrel/ethinyl estradiol may cause headaches or migraine. Call your health care provider right away if you develop new headaches or migraine attacks that keep coming back, do not go away, or cause you a lot of pain.

Changes in Mood. Etonogestrel/ethinyl estradiol may cause changes in mood, including depression, anxiety, or mood swings. Call your health care provider right away if you have new or worsening depression, other unusual changes in mood or behavior, or have any thoughts of harming yourself. 

Liver Problems. Etonogestrel/ethinyl estradiol may cause changes to your liver function, including an increase in your liver enzymes or possibly liver tumors. Call your health care provider if you have any of the following symptoms of liver problems.

  • Nausea or vomiting
  • Stomach or belly pain
  • Fever
  • Weakness or unusual tiredness
  • Itching
  • Loss of appetite
  • Light-colored poop
  • Dark-colored urine (pee)

Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Warnings & Precautions

Who should not use etonogestrel/ethinyl estradiol?

Allergies to Ingredients. People who are allergic to any of the following should not use etonogestrel/ethinyl estradiol.

  • Etonogestrel
  • Ethinyl estradiol 
  • EluRyng
  • EnilloRing
  • Haloette
  • NuvaRing
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific etonogestrel/ethinyl estradiol products they stock.

Smoking. Etonogestrel/ethinyl estradiol should not be used if you smoke and are over age 35, as this can increase your chances of having a heart attack, stroke, or blood clots.

Blood Clots. Etonogestrel/ethinyl estradiol should not be used if you have or have had blood clots, including a blood clot in the lungs (pulmonary embolism) or deep vein thrombosis (DVT). This medicine should also not be used if you have a condition that makes your blood more prone to getting blood clots (thrombophilia). Etonogestrel/ethinyl estradiol can increase the risk of developing a blood clot that could be dangerous or even deadly.

Heart Attack or Stroke. Etonogestrel/ethinyl estradiol should not be used if you have had a stroke or heart attack. Etonogestrel/ethinyl estradiol can increase the risk of having a heart attack or stroke that could be dangerous or even deadly.

Blood Vessel Problems. Etonogestrel/ethinyl estradiol should not be used if you have or have had a history of plaque buildup in your blood vessels (coronary artery disease) or if you have or have had a condition that affects blood flow to your brain (cerebrovascular disease). Etonogestrel/ethinyl estradiol could increase your chances of having a heart attack, stroke, or blood clots. 

Heart Problems. Etonogestrel/ethinyl estradiol should not be used if you have heart rhythm problems (such as atrial fibrillation) or heart valve problems, as this may increase your chances of having a blood clot.

Increased Blood Pressure (Hypertension). Etonogestrel/ethinyl estradiol should not be used if you have high blood pressure that is not managed or high blood pressure with a condition that affects your blood vessels (vascular disease). Etonogestrel/ethinyl estradiol could increase your chances of having a heart attack, stroke, or blood clots.

Diabetes. Etonogestrel/ethinyl estradiol should not be used if you have diabetes with kidney, eye, nerve, or blood vessel damage. This can increase your chance of having a heart attack, stroke, or blood clots.

Headaches or Migraine. Etonogestrel/ethinyl estradiol should not be used if you have migraine with vision or hearing changes, muscle weakness, tingling, or trouble speaking (known as migraine with aura) or certain other types of headaches. This can increase your risk of having a stroke. Etonogestrel/ethinyl estradiol also should not be used if you are over age 35 and have any type of migraine headaches (with or without aura).

Certain Cancers. Etonogestrel/ethinyl estradiol should not be used if you have or have had breast cancer or any cancer that is sensitive to hormones, which could get worse if you use etonogestrel/ethinyl estradiol.

Liver Problems. Etonogestrel/ethinyl estradiol should not be used if you have liver disease or a liver tumor. Tell your health care provider if you have any liver problems.

Unusual Vaginal Bleeding. Etonogestrel/ethinyl estradiol should not be used if you have bleeding from the uterus or vagina that is not part of your menstrual cycle or is abnormal.

Pregnancy. Do not use etonogestrel/ethinyl estradiol if you are pregnant. If you become pregnant, contact your health care provider right away. See the Pregnancy section for more details.

Drug Interactions. Etonogestrel/ethinyl estradiol should not be used while you are using certain other medicines. Before using etonogestrel/ethinyl estradiol, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

What should I know about etonogestrel/ethinyl estradiol before using it?

Do not use etonogestrel/ethinyl estradiol unless it has been prescribed to you by a health care provider. Use it as prescribed.

Do not share etonogestrel/ethinyl estradiol with other people, even if they have the same condition as you. It may harm them.

Keep etonogestrel/ethinyl estradiol out of the reach of children.

Etonogestrel/ethinyl estradiol does not protect you from HIV, AIDS, or other sexually transmitted diseases (STDs). 

Expect to start etonogestrel/ethinyl estradiol during a specific time of your menstrual period. The timing will determine whether and for how long you need to use backup birth control (such as condoms or spermicide) after starting etonogestrel/ethinyl estradiol. Ask your health care provider if you are not sure how or when to start etonogestrel/ethinyl estradiol.

Follow the “Instructions for Use” that come with your etonogestrel/ethinyl estradiol. One etonogestrel/ethinyl estradiol ring should be placed in the vagina and left in place for 21 days (three weeks) straight. It should then be removed for seven days to allow for a week-free interval. A new ring should be inserted one week after the last one was removed.

Consider using a calendar or app to mark the day you insert etonogestrel/ethinyl estradiol, when you remove it, and when to insert the new one. Accidentally leaving etonogestrel/ethinyl estradiol in for longer than 28 days can increase your risk of pregnancy. Using more than one ring at a time can increase your risk of nausea, vomiting, bleeding, and other side effects.

Check that etonogestrel/ethinyl estradiol is in place on a regular basis by feeling for the ring inside the vagina. Ask your health care provider if you have questions about how to do this.

Etonogestrel/ethinyl estradiol could accidentally come out when removing a tampon, having sex, or straining during a bowel movement. Take care to avoid accidentally removing the ring. If etonogestrel/ethinyl estradiol comes out, clean the ring and reinsert it as soon as possible. 

Check with your pharmacist or other health care provider before using products that are placed inside the vagina, such as a diaphragm, female condom, suppositories, creams, or lubricants. Some products could cause problems with etonogestrel/ethinyl estradiol, or vice versa.

Throw away etonogestrel/ethinyl estradiol after using it for three weeks. Put the ring into its foil pouch (sachet) and throw it away in a trash can that is out of the reach of children and pets. Do not flush etonogestrel/ethinyl estradiol down the toilet.

Some people may feel discomfort or pain if the etonogestrel/ethinyl estradiol ring becomes displaced or breaks. Tell your health care provider right away if you have vaginal pain, discomfort, or bleeding, or if you are unable to remove the ring. 

Etonogestrel/ethinyl estradiol may affect your blood sugar or cholesterol levels. Make sure to keep all follow-up appointments, including for blood work and blood pressure checks, with your health care provider. 

Etonogestrel/ethinyl estradiol may affect the results of some laboratory tests. Tell all of your health care providers about all the medicines you take, and talk with your health care provider if you have any concerns. 

Etonogestrel/ethinyl estradiol is a combination birth control vaginal ring that contains two hormones. Certain cancers, including breast cancer and cervical cancer, are types of cancers that may be sensitive to hormones. Make sure to keep all appointments with your health care provider.

What should I tell my health care provider before using etonogestrel/ethinyl estradiol?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if etonogestrel/ethinyl estradiol is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your health care provider if you have any of the following.

  • Diabetes
  • High blood pressure
  • High cholesterol or triglycerides
  • Headaches or migraine
  • Gallbladder, kidney, or liver problems
  • Personal or family history of heart disease, blood clots, or stroke
  • Depression 
  • Seizures
  • Skin issues, such as dark patches on your cheeks, forehead, upper lip, and chin, sometimes called the “pregnancy mask” (chloasma)
  • A condition called hereditary angioedema
  • Recently had a baby, miscarriage, or abortion
  • Breast problems, including cysts or nodules or a family history of breast cancer
  • Any condition that makes your vagina become irritated easily
  • History of toxic shock syndrome with use of tampons
  • Family history of breast cancer
  • Irregular or light periods

Upcoming Surgery or Bed Rest. You may be at increased risk for some side effects of etonogestrel/ethinyl estradiol  if you do not move around normally for an extended period of time. Tell your health care provider if you have any upcoming surgeries or need to be on bed rest. Your health care provider can tell you if or when you need to stop using etonogestrel/ethinyl estradiol.

Smoking. Smoking can increase your risk of getting heart disease, which increases your risk of having a heart attack, stroke, or blood clots. Tell your health care provider if you smoke before starting etonogestrel/ethinyl estradiol. 

Pregnancy. Etonogestrel/ethinyl estradiol should not be used during pregnancy. Tell your health care provider if you are or plan to become pregnant. If you become pregnant, stop using etonogestrel/ethinyl estradiol right away and contact your health care provider.

Breastfeeding. Etonogestrel/ethinyl estradiol can pass into breast milk and may reduce milk production. Tell your health care provider if you are breastfeeding or plan to breastfeed. Your health care provider will advise you if you should stop breastfeeding or stop etonogestrel/ethinyl estradiol.

Interactions

Does etonogestrel/ethinyl estradiol interact with foods or drinks?

Eating grapefruit or drinking grapefruit juice while using etonogestrel/ethinyl estradiol can increase the levels of the medicine in your body and increase the risk of side effects. Talk to your health care provider if you eat grapefruit or drink grapefruit juice.

There are no known interactions between etonogestrel/ethinyl estradiol and alcohol.

Does etonogestrel/ethinyl estradiol interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using etonogestrel/ethinyl estradiol.

  • Aprepitant, which is a medicine used to prevent nausea and vomiting caused by chemotherapy 
  • A barbiturate, such as phenobarbital, butalbital, or primidone, which is a medicine that may be used to treat insomnia, migraine, or seizures
  • Bosentan, which is a medicine used to treat a condition called pulmonary arterial hypertension (PAH)
  • Any medicine that may be used to treat seizures, such as carbamazepine (Carbatrol, Tegretol, and others), phenytoin (Dilantin, Phenytek, and others), felbamate, lamotrigine, oxcarbazepine (Trileptal, Oxtellar XR), or topiramate (Topamax, Trokendi XR, Qudexy XR)
  • Fluconazole (Diflucan), griseofulvin, itraconazole (Sporanox, Tolsura), ketoconazole, or voriconazole (Vfend), which are used for fungal infections
  • Clarithromycin or erythromycin (Ery-Tab and others), which are used for bacterial infections
  • Diltiazem (Cardizem CD and others), which is a medicine used for high blood pressure and other conditions
  • Vaginal miconazole, which is a medicine commonly used for vaginal yeast infections
  • Rifampin (Rifadin), which is a medicine commonly used to treat an infection called tuberculosis or rifabutin (Mycobutin), which is a medicine used to prevent mycobacterium avium complex infection
  • St. John’s wort, which is a supplement that may be used for depression
  • A medicine for HIV, AIDS, or hepatitis C
  • Cyclosporine (Gengraf, Neoral, Sandimmune, and others), which is a medicine that suppresses your immune system
  • Atorvastatin (Lipitor and others) or rosuvastatin (Crestor), which lower cholesterol
  • A thyroid medicine, such as levothyroxine, which is used to raise thyroid hormone levels 
  • Prednisolone, which is a medicine for certain inflammatory conditions
  • Acetaminophen (Tylenol), which is a medicine used for pain or fever
  • Morphine, which is a medicine used for certain types of pain
  • A vitamin C supplement  
  • Temazepam, which is a medicine used for anxiety
  • Theophylline ( Elixophyllin, Theo-24), which is a medicine for asthma or certain other breathing problems
  • Tizanidine (Zanaflex), which is a muscle relaxant

Many other medicines may alter the blood levels of etonogestrel/ethinyl estradiol, and vice versa. Tell your health care provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with etonogestrel/ethinyl estradiol. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much etonogestrel/ethinyl estradiol?

If you or someone else has used too much etonogestrel/ethinyl estradiol, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of etonogestrel/ethinyl estradiol?

Etonogestrel/ethinyl estradiol may not prevent pregnancy if you forget to reinsert a new ring after the week-free interval. It may also not prevent pregnancy if the ring is out of the vagina for more than three hours during the 21 days when it should be in the vagina. In these cases, avoid sexual intercourse or use backup birth control (such as condoms or spermicide) until you talk with your health care provider.

Look up another drug