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Hormonal methods of Birth Control

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Hormonal methods of Birth Control

Birth control options

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Hormonal Methods - Contraception

Birth control preferences can evolve throughout life

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Hormonal Methods - Contraception

	Implant—The implant is a single, thin rod that is inserted under the skin of a women’s upper arm. The rod contains a progestin that is released into the body over 3 years. Typical use failure rate: 0.1%. 1
	Injection or “shot”—Women get shots of the hormone progestin in the buttocks or arm every three months. The shot can be self-injected or given by a health care provider. Typical use failure rate: 4%. 1
	Combined oral contraceptives—Also called “the pill,” combined oral contraceptives contain the hormones estrogen and progestin. It is prescribed by a doctor. A pill is taken at the same time each day. If you are older than 35 years and smoke, have a history of blood clots or breast cancer, your doctor may advise you not to take the pill. Typical use failure rate: 7%. 1 Progestin-only pill—Unlike the combined pill, the progestin-only pill (sometimes called the mini-pill) only has one hormone, progestin, instead of both estrogen and progestin. It is prescribed by a doctor. It is taken at the same time each day. It may be a good option for women who can’t take estrogen. Typical use failure rate: 7%. 1
	Patch—This skin patch is worn on the lower abdomen, buttocks, or upper body (but not on the breasts). This method is prescribed by a doctor. It releases hormones progestin and estrogen into the bloodstream. You put on a new patch once a week for three weeks. During the fourth week, you do not wear a patch, so you can have a menstrual period. Typical use failure rate: 7%. 1
	Hormonal vaginal contraceptive ring—The ring releases the hormones progestin and estrogen. You place the ring inside your vagina. You wear the ring for three weeks, take it out for the week you have your period, and then put in a new ring. Typical use failure rate: 7% 1

Source: Centers for Disease Control and Prevention (CDC)

Additional Materials (1)

Contraceptive Effectiveness

Source: Trussell J, Aiken ARA, Micks E, Guthrie KA. Efficacy, safety, and personal considerations. In: Hatcher RA, Nelson AL, Trussell J, Cwiak C, Cason P, Policar MS, Edelman A, Aiken ARA, Marrazzo J, Kowal D, eds. Contraceptive technology. 21st ed. New York, NY: Ayer Company Publishers, Inc., 2018.

Contraceptive Implant for Birth Control

extracted Implanon, a implant that works as a contraceptive for a long time

Image by Vera de Kok

Contraceptive Implant for Birth Control

The contraceptive implant is the most effective reversible contraception available.

The contraceptive implant is one small, thin, soft vinyl rod about the same length as a matchstick.The contraceptive implant contains the progestin hormone etonogestrel which prevents the release of an egg from the woman’s ovary. This hormone causes thickening of the natural mucus of the cervix and so closes the cervix making it difficult for sperm to pass.These actions prevent an egg from being fertilized by a sperm and prevent pregnancy. There may be other ways that this hormone works to prevent pregnancy that are not listed here.

The hormonal implant must be placed into the woman’s upper arm by a health care provider. A numbing shot is given and then the implant is inserted.This takes less than one minute.Once inserted, the contraceptive implant remains in place and works for 3 years.Removal takes a couple of minutes and a new implant may be provided at the same time.

The contraceptive implant is very safe for nearly all women. Serious side effects are very rare.The most common change women noticed when using this birth control method is irregular spotting or not having a menstrual period.

Advantages of contraceptive implants include:

It is the most effective reversible birth control method there is.
Very convenient for once the implant is in place.
Insertion and removal is quick and easy.
One rod provides contraception for 3 years.
It is very discreet and private.
It is safe for women who smoker and are older than age 35.
It is safe for women who cannot use estrogen.
It may reduce menstrual problems for some.
It may be inserted at any time during the menstrual cycle, but a back up method recommended unless inserted during menstrual cycle.
Once the implant is removed most women quickly return to fertility. Women, who wish to breastfeed generally can have the implant inserted after delivery or during thepostpartum period.

Possible disadvantages and side effects include:

There is no protection against sexually transmitted infections.
Irregular spotting, bleeding, or no period are all possible issues for some women.
Women can only get the implant from a health care professional.
Women with deep vein thrombosis or blood clots need to avoid this method.
Women who have breast cancer or a history of breast cancer need to avoid this method.
Women with severe liver disease need to avoid this method.

Possible health risks include:

Insertion problems, such as infection, are very rare, but possible.
There is possible interaction with some medicines so this should be discussed with your doctor.
Over a3 year time period some studies showa possible5.6lbs.weight gain. Whether the weight gain iscaused by theimplant isunknown.
Blood clots are a possible problem, however the risk may be less than with regular birth control pills containing estrogen.

Source: Alaska Department of Health

Additional Materials (1)

Implant that works as a contraceptive for a long time being removed

Vera de Kok/Wikimedia

Contraceptive Injection

Birth Control Injection

Image by TheVisualMD

Contraceptive Injection

This method is given as a shot (injection) every 3 months. If you want to get pregnant, you can stop using this at any time.

Progestin Shot/Injection (Depo-Provera)

What is it?

A shot of a progestin hormone, either in the muscle or under the skin.

How does it work?

The shot stops the ovaries from releasing eggs
It also thickens the cervical mucus, which keeps the sperm from getting to the egg.

How do I get it?

You need one shot every 3 months from a healthcare provider.

Chance of getting pregnant with typical use (Number of pregnancies expected per 100 women who use this method for one year)

Out of 100 women who use this method, including women who don’t get the shot on time, up to 6 may get pregnant.

Some Side Effects

Loss of bone density
Irregular bleeding or bleeding between periods
Headaches
Weight gain
Nervousness
Dizziness
Abdominal discomfort

Some Less Common Risks

Ectopic pregnancy
It is rare, but some women will have blood clots.

Does it protect me from sexually transmitted infections (STIs)? No.

Source: FDA Consumer Health Information

Additional Materials (1)

Injection for birth control (Depo-Provera® 150)

Ciell/Wikimedia

Hormonal Methods - Injection or “shot”

Hormonal Methods - Injection or “shot”

	Injection or “shot”—Women get shots of the hormone progestin in the buttocks or arm every three months. The shot can be self-injected or given by a health care provider. Typical use failure rate: 4%.

Source: Centers for Disease Control and Prevention (CDC)

Instructions on Depo Provera

An injection drug

Image by ©torange.biz

Instructions on Depo Provera

Depot Medroxyprogesterone Acetate (DMPA), referred to as Depo Provera, is a progestin contraceptive injected intramuscularly (within a muscle) or subcutaneously (beneath the skin) every 11 to 13 weeks. This method is 96% effective at preventing pregnancy in typical users and is 99% effective when used perfectly.

Women who use DMPA therapy may have the following:

Benefits

Less risk of endometrial/ovarian cancer
13 weeks of protection from one injection
No estrogen effects
Light or no menses (period), less anemia
Possible improvement of endometriosis
Minimal drug interactions
Fewer menstrual cramps
Fewer seizures for those with seizure disorders
Reduced risk of pelvic inflammatory disease and tubal pregnancy

Risks/Side Effects

You may experience the following while using DMPA:

Possible increase in depression or mood changes
Change in appetite, weight gain or loss
Rare allergic reaction
Return to fertility may be delayed
Hair loss or increased hair growth
Dizziness, weakness or fatigue
Menstrual cycle disturbances
Side effects not immediately reversible
Cardiovascular risk may be increased with prior history of cardiovascular disease
Headache
Hot flashes, decreased sex drive or vaginal dryness
Decreased bone density
Current research suggests that bone loss is substantially reversible upon discontinuation and that use should not be restricted in adults, in adolescents the risk may outweigh the possible safety concerns regarding bone mineral density. Talk with your provider to determine if you have other risks for bone loss and to ensure DMPA is a safe method for you.

Women who use DMPA Contraceptive Injections may lose significant bone mineral density. This bone loss is great the longer DMPA is used, and the bone density may not completely return to normal after DMPA is stopped. It is unknown if the use of DMPA during the teens or early 20s, when bone density is increasing, will reduce peak bone mass and increase the risk of thinning bones which could result in bones breaking in later life. DMPA should be used for longer than two years if other birth control methods are inadequate or unacceptable.

Alternatives

You have received information about other methods of birth control that are available. Emergency contraception is available for situations of suspected contraceptive failure and offers a second chance to avoid unintended pregnancy.

Instructions

You have received information about DMPA and how it works. This injection does not protect you against STIs or HIV.

Decision to Stop Using Injectable Contraception

You may stop using DMPA at any time. A woman is most likely to become pregnant if she or her partner does not use a method of birth control.

Questions

You may ask questions about DMPA at any time and contact the clinic with further questions.

Instructions for Using DMPA

The first injection during the first five days of a normal menstrual period

Within the first five days postpartum

Your provider may provide DMPA anytime in the cycle when known you are not pregnant.

Use a backup method of birth control for 7 days after your first injection.

Because of the rare possibility of an allergic reaction, some providers ask that women remain in the clinic for 20 minutes after having their DMPA injections.

Return to the clinic every 11 to 13 weeks for another injection. Mark your calendar for your next shot to be sure you are on time. Talk with your provider if you can’t receive your injection within this time frame.

Regular exercise, including weight-bearing exercises, adequate calcium and vitamin D intake, and smoking cessation is encouraged while using DMPA.

If you administer DMPA yourself, refer to the instructions for proper administration and storage.

Late for an injection:

If you are more than one week late for your injection, talk to your provider and visit your clinic as soon as possible. You may need a backup method until you get your injection and/or receive emergency contraception.

DMPA and menstrual changes:

Unpredictable bleeding and spotting during the first months of use is common. After the first few injections, you may have no period at all. This is not harmful and often viewed as an advantage of using DMPA.
If your pattern of bleeding is bothersome, contact your clinician.
When you discontinue taking DMPA, it may take a number of months for your periods to return to normal.

Discontinuing DMPA:

If you discontinue DMPA and do not want to become pregnant, use a new contraceptive less than 13 weeks from your last shot.

DMPA injections may keep you from getting pregnant for more than 14 weeks after your last shot. The average delay in fertility is 10 months from the last injection, however, it may persist up to 18 months. DMPA does not permanently decrease your fertility.

See your healthcare provider if you develop any of the following symptoms:

Repeated, very painful headaches
Heavy bleeding
Depression
Severe lower abdominal pain (maybe a sign of pregnancy)
Pus, prolonged pain or bleeding at injection site

Instructions for DMPA-SQ Self-Administration:

Wash your hands.
Remove the pre-filled syringe from box and shake for 1 minute.
Hold the syringe with the needle pointing up and tap the syringe to shake air bubbles to the top.
Gently push plunger of syringe until air bubbles come out (keep the cap on the needle).
Choose injection site (either abdomen or top of the thigh) and wipe it with an alcohol pad.
Take the cap off needle and hold the syringe in your dominant hand.
Grab the skin around the injection site with your non-dominant hand and insert the needle all the way at 45-degree angle.
Press the plunger of the syringe all the way and keep needle in place while counting to 5.
Remove the needle and dispose of it into a sharp’s container.
Apply pressure to the injection site, but don’t rub.
If all the medication is not injected, reinject the remaining medication at the site previously wiped with the alcohol pad.

Source: North Dakota Department of Health and Human Services

Medroxyprogesterone Injection

Medroxyprogesterone Injection

Also called: Depo-Provera®, Depo-SubQ Provera®, Depot Medroxyprogesterone Acetate, DMPA

Medroxyprogesterone is a progestin hormone birth control method that is given by injection (a shot) to prevent pregnancy. It is given either in the muscle or under the skin once every 3 months.

Medroxyprogesterone Injection

Also called: Depo-Provera®, Depo-SubQ Provera®, Depot Medroxyprogesterone Acetate, DMPA

Medroxyprogesterone is a progestin hormone birth control method that is given by injection (a shot) to prevent pregnancy. It is given either in the muscle or under the skin once every 3 months.

Medroxyprogesterone injection can cause serious side effects, including:
- Use of medroxyprogesterone injection may cause you to lose calcium stored in your bone and decrease your bone mass. The longer you use medroxyprogesterone injection, the greater your loss of calcium from your bones. Your bones may not recover completely when you stop using medroxyprogesterone injection.
- If you use medroxyprogesterone injection continuously for a long time (for more than 2 years), it may increase the risk of weak, porous bones (osteoporosis) that could increase the risk of broken bones, especially after menopause.
- You should not use medroxyprogesterone injection for more than two years unless you cannot use other birth control methods.
- It is not known if your risk of developing osteoporosis is greater if you are a teenager or young adult when you start to use medroxyprogesterone injection (see “What are the possible side effects of medroxyprogesterone?”).
Medroxyprogesterone is intended to prevent pregnancy. Medroxyprogesterone does not protect against HIV infection (AIDS) and other sexually transmitted diseases (STDs).
- Medroxyprogesterone is given by your healthcare provider as a shot into your muscle (intramuscular injection). The shot is given in your buttock or upper arm 1 time every 3 months. At the end of the 3 months, you will need to return to your healthcare provider for your next injection in order to continue your protection against pregnancy .
- To make sure that you are not pregnant before you take medroxyprogesterone, the first injection should be given only:
  during the first 5 days of a normal menstrual period, or
  within the first 5 days after giving birth, if you are not breastfeeding, or
  at the 6th week after giving birth, if you are feeding your baby only breastmilk.
- Medroxyprogesterone may be given at other times than those listed above, but you will likely need to have a pregnancy test first to show that you are not pregnant.
- During treatment with medroxyprogesterone, you should see your healthcare provider every year for a blood pressure check and other healthcare needs.
Do not use medroxyprogesterone if you:
- are pregnant or think you might be pregnant
- have bleeding from your vagina that has not been explained
- have breast cancer now or in the past, or think you have breast cancer
- have had a stroke
- ever had blood clots in your arms, legs or lungs
- have problems with your liver or liver disease
- are allergic to medroxyprogesterone acetate or any of the other ingredients in medroxyprogesterone injection. See the end of the leaflet that comes with your medicine for a complete list of ingredients.
Before taking medroxyprogesterone, tell your healthcare provider if you have:
- risk factors for weak bones (osteoporosis) such as bone disease, use alcohol or smoke regularly, anorexia nervosa, or a strong family history of osteoporosis
- irregular or lighter than usual menstrual periods
- breast cancer now or in the past, or think you have breast cancer
- a family history of breast cancer
- an abnormal mammogram (breast X-ray), lumps in your breasts, or bleeding from your nipples
- kidney problems
- high blood pressure
- had a stroke
- had blood clots in your arms, legs or lungs
- migraine headaches
- asthma
- epilepsy (convulsions or seizures)
- diabetes
- depression or a history of depression
- any other medical conditions
If you are breastfeeding or plan to breastfeed, medroxyprogesterone can pass into your breast milk. Talk to your healthcare provider about the best way to feed your baby if you take medroxyprogesterone.
Tell your healthcare provider about all of the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements.
Medroxyprogesterone and certain other medicines may affect each other, causing serious side effects. Sometimes the doses of other medicines may need to be changed while you are taking medroxyprogesterone.
Some medicines may make medroxyprogesterone less effective at preventing pregnancy, including those listed below.
Especially tell your healthcare provider if you take:
- medicine to help you sleep
- bosentan
- medicine for seizures
- griseofulvin
- an antibiotic
- medicine for HIV (AIDS)
- St. John’s wort
Know the medicines you take. Keep a list of your medicines with you to show your healthcare provider or pharmacist before you first start taking medroxyprogesterone or when you get a new medicine.
Follow your healthcare provider’s instructions about using a back-up method of birth control if you are taking medicines that may make medroxyprogesterone less effective.
Medroxyprogesterone can cause serious side effects, including:
- Effect on the bones: See “What is the most important information I should know about medroxyprogesterone?”
- Teenage years are the most important years to gain bone strength. The decrease in calcium in your bones is of most concern if you are a teenager or have the following problems:
  bone disease
  an eating disorder (anorexia nervosa)
  a strong family history of osteoporosis
  you take a drug that can lower the amount of calcium in your bones (drugs for epilepsy or steroid drugs)
  you drink a lot of alcohol (more than 2 drinks a day)
  you smoke
- Possible increased risk of breast cancer. Women who use medroxyprogesterone may have a slightly increased risk of breast cancer compared to non-users.
- blood clots in your arms, legs, lungs, and eyes
- stroke
- a pregnancy outside of your uterus (ectopic pregnancy). Ectopic pregnancy is a medical emergency that often requires surgery. Ectopic pregnancy can cause internal bleeding, infertility, and even death.
- allergic reactions. Severe allergic reactions have been reported in some women using medroxyprogesterone.
- loss of vision or other eye problems
- migraine headaches
- depression
- convulsions or seizures
- liver problems
Call your healthcare provider right away if you have:
- sharp chest pain, coughing up blood, or sudden shortness of breath (indicating a possible clot in the lung)
- sudden severe headache or vomiting, dizziness or fainting, problems with your eyesight or speech, weakness, or numbness in an arm or leg (indicating a possible stroke)
- severe pain or swelling in the calf (indicating a possible clot in the leg)
- sudden blindness, partial or complete (indicating a possible clot in the blood vessels of the eye)
- unusually heavy vaginal bleeding
- severe pain or tenderness in the lower abdominal area
- persistent pain, pus, or bleeding at the injection site
- yellowing of the eyes or skin
- hives
- difficulty breathing
- swelling of the face, mouth, tongue or neck
The most common side effects of medroxyprogesterone include:
- irregular vaginal bleeding, such as lighter or heavier menstrual bleeding, or continued spotting
- weight gain. You may experience weight gain while you are using medroxyprogesterone. About two-thirds of the women who used medroxyprogesterone in the clinical trials reported a weight gain of about 5 pounds during the first year of use. You may continue to gain weight after the first year. Women who used medroxyprogesterone for 2 years gained an average of 8 pounds over those 2 years.
- abdominal pain
- headache
- weakness
- tiredness
- nervousness
- dizziness
Tell your healthcare provider if you have any side effect that bothers you or does not go away.
These are not all the possible side effects of medroxyprogesterone. For more information, ask your healthcare provider or pharmacist.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
- Pregnancy. When you take medroxyprogesterone every 3 months, your chance of getting pregnant is very low. You could miss a period or have a light period and not be pregnant. If you miss 1 or 2 periods and think you might be pregnant, see your healthcare provider as soon as possible. You should not use medroxyprogesterone if you are pregnant. However, medroxyprogesterone taken by accident during pregnancy does not seem to cause birth defects.
- Nursing Mothers. Although medroxyprogesterone can be passed to the nursing baby in the breast milk, no harmful effects on babies have been found. Medroxyprogesterone does not stop the breasts from producing milk, so it can be used by nursing mothers. However, to minimize the amount of medroxyprogesterone that is passed to the baby in the first weeks after birth, you should wait until your baby is 6 weeks old before you start using medroxyprogesterone for birth control.
- Change in normal menstrual cycle. The side effect reported most frequently by women who use medroxyprogesterone for birth control is a change in their normal menstrual cycle. During the first year of using medroxyprogesterone, you might have one or more of the following changes:
  irregular or unpredictable bleeding or spotting
  an increase or decrease in menstrual bleeding
  no bleeding at all. In clinical studies of medroxyprogesterone, 55% of women reported no menstrual bleeding (amenorrhea) after one year of use and 68% of women reported no menstrual bleeding after two years of use.
- Missed period. During the time you are using medroxyprogesterone for birth control, you may skip a period, or your periods may stop completely. If you have been receiving your shot of medroxyprogesterone regularly every 3 months, then you are probably not pregnant. However, if you think that you may be pregnant, see your healthcare provider.
Unusually heavy or continuous bleeding is not a usual effect of medroxyprogesterone and if this happens you should see your healthcare provider right away.
With continued use of medroxyprogesterone, bleeding usually decreases and many women stop having periods completely. When you stop using medroxyprogesterone your menstrual period will usually, in time, return to its normal cycle.
1. LABEL: MEDROXYPROGESTERONE ACETATE- medroxyprogesterone acetate injection, suspension [accessed on Nov 14, 2018]
2. Medroxyprogesterone Injection. MedlinePlus/AHFS® Drug Information. [accessed on Oct 29, 2018]

These FAQs provide a summary of the most important information about Medroxyprogesterone Injection. If you would like more information or have any questions, talk to your healthcare provider.

Additional Materials (4)

Injection for birth control (Depo-Provera® 150)

Ciell/Wikimedia

Birth Control Injection

TheVisualMD

1:17

Depo-Provera Shot Side Effects, Schedule & More

Cleveland Clinic/YouTube

1:10

Depo-Provera, the Birth Control Shot, as a Form of Birth Control - Planned Parenthood

Planned Parenthood/YouTube

The Patch

Contraceptive Patch

Image by TheVisualMD

Birth Control Patch (Transdermal System)

Patch (transdermal system)

What is it?

A skin patch you can wear on the lower abdomen, buttocks, upper arm, or upper back

How do I use it?

You put on a new patch and take off the old patch once a week for 3 weeks (wear a patch for 21 consecutive days).
Do not put on a patch during the fourth week (the following 7 days). Your menstrual period should start during this patch-free week.
If the patch comes loose or falls off, you (or your partner) may need to use another non-hormonal contraceptive, like a condom and spermicide.

How do I get it?

You need a prescription from a health care provider.

Chance of getting pregnant with use (number of pregnancies expected per 100 women who use this method of contraception for one year)

Out of 100 women who use this contraceptive, about 7 may get pregnant.

Some side effects

Breast tenderness
Headache
Nausea, stomach pain
Skin irritation
Spotting or bleeding between periods

Some risks

It may expose you to higher levels of estrogen compared to most combined oral contraceptives.
There may be an increased risk of blood clots among women who use the patch as compared to women who use certain combination oral contraceptives.

Does it provide protection from sexually transmitted infections (STIs)?

No.

Source: FDA Consumer Health Information

Additional Materials (8)

1:09

Brook Contraception - Contraceptive Patch Animation

Onclick - Bespoke Digital Learning/YouTube

7:49

REAL FACTS about the birth control PATCH & How to use it CORRECTLY| As told by a Nurse Practitioner

The Lady's Guide/YouTube

3:17

What is the Contraceptive Patch?

Lancashire & South Cumbria NHS Foundation Trust/YouTube

1:20

Birth Control Patch Safety & Effectiveness | Birth Control

Howcast/YouTube

1:03

Birth Control Patch Side Effects | Birth Control

Howcast/YouTube

2:52

Which Birth Control is Best For Me? Pros and Cons of the Patch - Pandia Health

Pandia Health/YouTube

1:01

Contraceptive Methods: The Patch

WSU Student Health Services/YouTube

2:34

Patch (Gynecology - Birth Control)

Med Twice/YouTube

Hormonal Methods - Patch

Birth Control Patch

Image by Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014"

Hormonal Methods - Patch

	Patch—This skin patch is worn on the lower abdomen, buttocks, or upper body (but not on the breasts). This method is prescribed by a doctor. It releases hormones progestin and estrogen into the bloodstream. You put on a new patch once a week for three weeks. During the fourth week, you do not wear a patch, so you can have a menstrual period. Typical use failure rate: 7%.

Source: Centers for Disease Control and Prevention (CDC)

Ortho Evra Contraceptive Patch

OrthoEvra contraceptive patch on white computer paper

Image by Keitei

Ortho Evra Contraceptive Patch

Ortho Evra® is a new form of contraception. Since Ortho Evra® works in the same way that birth control pills work, most of the advantages, risks, and side-effects are considered to be the same for both methods.

Ortho Evra® is a thin, beige, plastic patch that sticks to the skin. The sticky part of the patch contains the hormones norelgestromin and ethinyl estradiol, which are absorbed continuously through the skin and into the blood stream. These hormones are similar to those produced by a woman's body. They work to prevent pregnancy by keeping eggs from being released by the ovaries. Ortho Evra® is expected to be at least as effective as birth control pills. In early studies of this new contraceptive, the pregnancy rate of users was less than 1 per 100 women.

EFFECTIVENESS

99% with perfect use
Weight greater than 198 pounds may decrease effectiveness of the patch. A back-up method is encouraged if you weigh more than 198 pounds.

BENEFITS

Ortho Evra® is an effective method of birth control.
You do not need to remember to take the pill everyday. You only need to remember to apply a patch once a week for three out of four weeks.
When you decide that you no longer want to use contraception and you discontinue your use of the patch, your ability to become pregnant should return quickly.

Some non-contraceptive benefits include:

Predictable, regular menstrual cycles
Decreased menstrual cramps and blood loss
Less acne
Some protection from non-cancerous breast tumors and ovarian cysts
Some protection from ovarian and uterine lining cancer

RISKS

Risks for Ortho Evra® users are based on studies of women who use birth control pills. These include:

Blood clots
Stroke
Heart attack
Liver tumors

Women over the age of 35 years who smoke cigarettes should not use Ortho Evra®.

SIDE EFFECTS

Minor reactions from use of Ortho Evra® may include:

Breast discomfort
Headache
Skin irritation at the patch site
Nausea
Abdominal pain
Menstrual cramps

Regular physical examinations for routine health care are recommended. Condom use for the prevention of sexually transmitted infections is encouraged.

Source: Bay County, Michigan

Additional Materials (1)

Contraceptive Patch

TheVisualMD

Levonorgestrel and Ethinyl Estradiol Patch

Levonorgestrel and Ethinyl Estradiol Patch

Also called: Twirla®, Twirla Patch

Levonorgestrel and ethinyl estradiol (Twirla) patch is a combination hormonal contraceptive used to prevent pregnancy. It comes as a patch to be applied to the skin. The patch contains 2 hormones: a progestin (levonorgestrel) and an estrogen (ethinyl estradiol).

Levonorgestrel and Ethinyl Estradiol Patch

Also called: Twirla®, Twirla Patch

Levonorgestrel and ethinyl estradiol (Twirla) patch is a combination hormonal contraceptive used to prevent pregnancy. It comes as a patch to be applied to the skin. The patch contains 2 hormones: a progestin (levonorgestrel) and an estrogen (ethinyl estradiol).

- Do not use Twirla if you smoke cigarettes and are over 35 years old. Smoking increases your risk of serious cardiovascular side effects from combination hormonal contraceptives (CHCs), including death from heart attack, blood clots or stroke. This risk increases with age and the number of cigarettes you smoke.
- Do not use Twirla if your Body Mass Index (BMI) is 30 kg/m2 or more. If you do not know what your BMI is, please talk to your health care provider. Women with a BMI of 30 kg/m2 or more who use CHCs may have a higher risk for developing side effects like blood clots compared to women with a BMI lower than 30 kg/m2.
Hormonal birth control methods help to lower the chances of becoming pregnant when taken as directed. Twirla does not protect against HIV infection (AIDS) and other sexually transmitted infections (STIs).
Twirla is:
- a birth control patch for women with a BMI less than 30 kg/m2 who can become pregnant. It contains two female hormones, a progestin called levonorgestrel, and an estrogen called ethinyl estradiol. Birth control methods that have both an estrogen and a progestin are called combination hormonal contraceptives (CHCs).
Twirla is less effective in women with a BMI of 25 kg/m2 or more.
Do not use Twirla if you:
- smoke and are over 35 years old.
- have or have had blood clots in your arms, legs, eyes or lungs.
- have had a stroke.
- have had a heart attack.
- have certain heart valve problems or heart rhythm problems that can cause blood clots to form in the heart.
- have a problem that makes your blood clot more than normal that you were born with (inherited) or that has happened for other reasons such as medicines, surgery or injuries (acquired).
- have high blood pressure that is not controlled.
- have diabetes and you are over the age of 35, have high blood pressure or have kidney, eye, nerve, or blood vessel damage, or have had diabetes for more than 20 years.
- have had certain kinds of severe migraine headaches with aura, numbness, weakness or changes in vision, or have any migraine headaches if you are over age 35.
- have a BMI of 30 kg/m2 or more.
- have liver problems including liver tumors, hepatitis, cirrhosis, or liver disease.
- have unexplained vaginal bleeding.
- are pregnant or think you may be pregnant. However, Twirla is not known to cause birth defects when used by accident during pregnancy.
- have had breast cancer or any cancer that is sensitive to female hormones.
- are allergic to any of the ingredients in Twirla. See a complete list of ingredients at the end of this Patient Information leaflet. Symptoms of an allergic reaction you may include itching and irritation at the patch site.
- take any Hepatitis C drug combination containing ombitasvir, paritaprevir, ritonavir, with or without dasabuvir. This may increase levels of a liver enzyme called alanine aminotransferase (ALT) in the blood.
Twirla may not be a good choice for you if you have ever had jaundice (yellowing of the skin or eyes) caused by pregnancy (also called cholestasis of pregnancy) or related to previous use of hormonal birth control.
Tell your healthcare provider if you have ever had any of the above conditions. Your healthcare provider may recommend another method of birth control.
Before using Twirla, tell your healthcare provider about all of your medical conditions, including if you:
- are pregnant or think you are pregnant. Twirla is not for pregnant women. If you think you are pregnant, you should have a pregnancy test and know the results. Do not use Twirla if the test is positive and talk to your healthcare provider.
- are scheduled for surgery. Twirla may increase your risk of blood clots after surgery. You should stop using your Twirla patch at least 4 weeks before you have surgery and not restart it until at least 2 weeks after your surgery.
- have or have had gallblalier problems including yellowing of the skin or eyes during pregnancy.
- have high cholesterol that is not controlled.
- have or have had depression.
- have a history of hereditary angioedema.
- have had dark patches of skin on your forehead, cheeks, upper lip, and chin (chloasma).
- are breastfeeding or plan to breastfeed. CHC medicines that contain estrogen, like Twirla, may decrease the amount of milk you make. A small amount of hormones from the Twirla patch may pass into your breast milk. You may want to use another method of birth control until you are ready to stop breastfeeding.
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Some medicines and herbal products may make Twirla less effective or cause breakthrough bleeding, including, but not limited to:
- certain anti-seizure medicines (such as barbiturates, carbamazepine, felbamate, oxcarbazepine, phenytoin, rufinamide, or topiramate).
- medicine to treat chemotherapy-induced nausea and vomiting (aprepitant).
- medicine to treat high blood pressure in the vessels of the lung (bosentan).
- a certain medicine used to treat fungal infections (griseofulvin).
- certain combinations of HIV medicines (nelfinavir, ritonavir, darunavir/ritonavir, (fos)amprenavir/ritonavir, lopinavir/rotinavir, and tipranavir/ritonavir).
- certain non-nucleoside reverse transcriptase inhibitors (such as nevirapine and efavirenz).
- rifampin and rifabutin.
- certain hepatitis C (HCV) medicines (such as boceprevir, telaprevir).
- St. John’s wort.
- Use another birth control method (such as condoms and spermicide, or diaphragm and spermicide) when you take medicines that may make Twirla less effective and for 28 days after stopping the medicine.
- Some medicines and grapefruit juice may increase your level of the hormone ethinyl estradiol if used together, including:
  the pain reliever acetaminophen.
  ascorbic acid (vitamin C).
  certain medicines used to treat fungal infections (itraconazole, ketoconazole, voriconazole, and fluconazole).
  certain HIV medicines (atazanavir/ritonavir, indinavir).
  non-nucleoside reverse transcriptase inhibitors (such as etravirine).
  medicines to lower cholesterol (such as atorvastatin and rosuvastatin).
- Twirla may affect the way that lamotrigine, a medicine used to treat seizures, works and may increase the risk of seizures. Your healthcare provider may need to adjust the dose of lamotrigine while you are on Twirla.
- If you are scheduled for any laboratory tests, tell your healthcare provider that you are using Twirla. Certain blood tests may be affected by CHC methods.
- Women on thyroid replacement therapy may need increased doses of thyroid replacement medicine or corticosteroid replacement medicine may need increased doses of their thyroid hormone or cortisol medicines.
Ask your healthcare provider if you are not sure if you take any of the medicines listed above.
Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine. Talk to your healthcare provider before you start taking a new medicine.
- For detailed instructions, see the step-by-step instructions for using Twirla at the end of the Patient Information leaflet that comes with your medicine.
- Use Twirla exactly as your healthcare provider tells you to use it.
- Wear 1 Twirla patch at a time.
- Do not skip using any Twirla patches, even if you do not have sex often.
- Twirla is applied in a 4 week patch cycle. Each patch cycle includes 4 weeks (28 days). You will put on 1 patch every week for 3 weeks. You will not wear a patch during week 4. Each patch is worn for 7 days (1 week).
- Apply a new Twirla patch on the same day each week (this is called your Patch Change Day). For example, if you apply your first patch on a Monday, all of your Twirla patches should be applied on Monday.
- You will not wear a Twirla patch during week 4 (this is called your Patch Free Week). Make sure you remove the old patch from your body. Your period should begin during your Patch Free Week. After you have finished week 4, apply a new Twirla patch on the day after Week 4 ends. Repeat the patch cycle of 1 patch a week for 3 weeks followed by your Patch Free Week.
- Do not cut, damage or change the Twirla patch in any way. If the patch is cut, damaged or changed in any way, it may be less effective.
- Your Twirla patch should never be off more than 7 days in a row.If you ever go more than 7 days without a patch, you should use another non-hormonal back up birth control method.
- If you miss your Patch Change Day, put the patch on late or if it comes off of your skin before your Patch Change Day, you may or may not need to use another non-hormonal back up birth control method. See the detailed table in the Instructions for Use for more information.
- If you miss a period you might be pregnant. Some women miss their periods or have light periods on hormonal birth control methods even when they are not pregnant. Call your healthcare provider if you miss 1 period and have not used your Twirla patch every day or you miss 2 periods in row.
- Smoking
- The following can cause the patch to not stick the right way making Twirla less effective:
- Avoid using makeup, creams, lotions, oils, powders or any other products on the skin area where you put or plan to put the patch.
- Swimming or contact with water often or for long periods of time (30 minutes or more). Talk with your healthcare provider about the best method of birth control if you are a swimmer or you often come in contact with water for 30 minutes or more.
- Women who tend to get chloasma should avoid spending a long time in sunlight, tanning booths, and under sun lamps while using Twirla. Use sunscreen if you have to be in the sunlight.
Twirla may cause serious side effects, including:
- See “What is the most important information I should know about Twirla?”
- blood clots. Like pregnancy, hormonal birth control may increase the risk of serious blood clots (see following graph), especially in women who have other risk factors, such as smoking, high blood pressure, high levels of fat in the blood, diabetes, obesity, a family history of blood clots or are older than 35 years old. This increased risk is highest when you first start using hormonal birth control and when you restart the same or different hormonal birth control after not using it for a month or more. Some studies have reported that women who use levonorgestrel and ethinyl estradiol transdermal system have a higher risk of getting a blood clot. Talk to your healthcare provider about your risk of getting a blood clot before using Twirla or deciding which type of birth control is right for you.
  It is possible to die or be permanently disabled from a problem caused by a blood clot, such as a heart attack or a stroke. Some examples of serious blood clots are blood clots in the:
  legs (deep vein thrombosis)
  lungs (pulmonary embolus)
  eyes (loss of eyesight)
  heart (heart attack)
  brain (stroke)
  To put the risk of developing a blood clot into perspective: If 10,000 women who are not pregnant and do not use hormonal birth control are followed for one year, between 1 and 5 of these women will develop a blood clot. The figure below shows the likelihood of developing a serious blood clot for women who are not pregnant and do not use hormonal birth control, for women who use hormonal birth control, for pregnant women, and for women in the first 12 weeks after delivering a baby.
  Call your healthcare provider right away if you have:
  leg pain that does not go away
  sulien shortness of breath
  sulien changes to your vision or blindness
  severe pain or pressure in your chest
  sulien, severe headache unlike your usual headaches
  weakness or numbness in an arm or leg
  trouble speaking
- liver problems, including liver tumors.Stop using Twirla and tell your healthcare provider right away if you have yellowing of your skin or eyes (jaundice).
- high blood pressure.Your healthcare provider will check your blood pressure and may stop you from using Twirla if your blood pressure rises.
- gallblalier problems or worsening of a gallblalier problem you already have. You may have an increased risk of gallblalier problems with the use of Twirla especially if you have had gallblalier problems before or gallblalier problems when you were pregnant.
- headaches.Headaches can be a common but serious side effect. Tell your healthcare provider if you have new headaches that keep coming back, that do not go away, or are severe. Also tell your healthcare provider if your migraine headaches happen more often or are more severe than normal. Your healthcare provider may stop you from using Twirla.
- irregular or unusual vaginal bleeding and spotting between your menstrual periods or absence of menstrual periods (amenorrhea).This can happen especially during the first 3 months of using Twirla. You also may have no bleeding at all. Tell your healthcare provider if you miss 2 or more menstrual cycles. After you stop using Twirla, your periods may not happen as often or you may have no bleeding at all, especially if you had these types of menstrual cycles before taking Twirla.
- depression.
- swelling of your skin especially around your mouth, eyes, and in your throat (angioedema). Call your healthcare provider or get emergency medical care right away if you have a swollen face, lips, mouth, tongue or throat as this may lead to difficulty swallowing or breathing. Your risk of having angioedema is higher if you have a history of angioedema.
- dark patches of skin on your forehead, cheeks, upper lip, and chin (chloasma). Your risk of getting chloasma with the use of Twirla is higher if you had chloasma during pregnancy.
The most common side effects of Twirla include:
- skin reactions at the patch site such as bumps, redness or changes in color of your skin, bleeding itching, rash, dryness, pain and swelling.
- headache
- weight gain
- nausea
- menstrual cramps
These are not all the possible side effects of Twirla. Call your doctor for medical advice about side effects.
- Store at room temperature between 68°F to 77°F (20°C to 25°C).
- Store Twirla in the original unopened pouch it comes in. Apply Twirla immediately after taking it out from the pouch.
- Do not store Twirla in the refrigerator or freezer.
- Used Twirla patches may still have some active hormones. To throw away the Twirla patch, fold the sticky side of the patch together, and place this container in the trash. Do not flush used Twirla patches down the toilet.
Keep Twirla and all medicines out of the reach of children.
1. DailyMed - TWIRLA- levonorgestrel/ethinyl estradiol patch [accessed on Aug 17, 2023]

These FAQs provide a summary of the most important information about Levonorgestrel and Ethinyl Estradiol Patch. The drug should not be used for a condition other than that for which it is prescribed. Do not give it to other people, even if they have the same symptoms that you have. It may harm them. If you would like more information or have any questions, talk to your healthcare provider.

Additional Materials (5)

Birth Control Chart

Document by U.S. FDA

Female Pelvis with Contraceptive Patch on Skin

Female Pelvis with Contraceptive Patch on Skin: Three-dimensional visualization reconstructed from scanned human data. Anteriolateral view of female pelvis and reproductive organs, showing proper placement of a contraceptive patch on the abdomen. A contraceptive patch is a female hormonal contraceptive that is affixed to the skin; it releases hormones that stop the ovary from releasing an egg, so that pregnancy does not occur. It also causes the cervical mucous to thicken, making it more difficult for sperm to enter the uterus, and changes the lining of the uterus, preventing implantation of a fertilized egg. The contraceptive patch is only available with a prescription. When used correctly, it has a failure rate of 1 - 2%. It offers no protection against STDs.

Image by TheVisualMD

Birth Control Patch

An Ortho Evra birth control patch with the plastic backing still on.

Image by James Heilman, MD

Contraceptive Patch

Anteriolateral view of a contraceptive patch. A contraceptive patch is a female hormonal contraceptive that is affixed to the skin; it releases hormones that stop the ovary from releasing an egg, so that pregnancy does not occur. It also causes the cervical mucous to thicken, making it more difficult for sperm to enter the uterus, and changes the lining of the uterus, preventing implantation of a fertilized egg. The contraceptive patch is only available with a prescription. When used correctly, it has a failure rate of 1 - 2%. It offers no protection against STDs.

Image by TheVisualMD

Female Pelvis with Contraceptive Patch on Skin

Three-dimensional visualization reconstructed from scanned human data. Anteriolateral view of female pelvis and reproductive organs, showing proper placement of a contraceptive patch on the abdomen. A contraceptive patch is a female hormonal contraceptive that is affixed to the skin; it releases hormones that stop the ovary from releasing an egg, so that pregnancy does not occur. It also causes the cervical mucous to thicken, making it more difficult for sperm to enter the uterus, and changes the lining of the uterus, preventing implantation of a fertilized egg. The contraceptive patch is only available with a prescription. When used correctly, it has a failure rate of 1 - 2%. It offers no protection against STDs.

Image by TheVisualMD

Birth Control Chart

U.S. FDA

Female Pelvis with Contraceptive Patch on Skin

TheVisualMD

Birth Control Patch

James Heilman, MD

Contraceptive Patch

TheVisualMD

Female Pelvis with Contraceptive Patch on Skin

TheVisualMD

Norelgestromin and Ethinyl Estradiol Patch

Norelgestromin and Ethinyl Estradiol Patch

Also called: Xulane®, Zafemy®, Xulane Patch, Zafemy Patch

Norelgestromin and ethinyl estradiol (Xulane, Zafemy) patch is a combination hormonal contraceptive used to prevent pregnancy. It comes as a patch to be applied to the skin. The patch contains 2 hormones: a progestin (norelgestromin) and an estrogen (ethinyl estradiol).

Norelgestromin and Ethinyl Estradiol Patch

Also called: Xulane®, Zafemy®, Xulane Patch, Zafemy Patch

Norelgestromin and ethinyl estradiol (Xulane, Zafemy) patch is a combination hormonal contraceptive used to prevent pregnancy. It comes as a patch to be applied to the skin. The patch contains 2 hormones: a progestin (norelgestromin) and an estrogen (ethinyl estradiol).

Do not use norelgestromin/ethinyl estradiol patch if you smoke cigarettes and are over 35 years old. Smoking increases your risk of serious cardiovascular side effects from hormonal birth control methods, including death from heart attack, blood clots or stroke. This risk increases with age and the number of cigarettes you smoke.
Do not use norelgestromin/ethinyl estradiol patch if you have an increased risk for blood clots.
Do not use norelgestromin/ethinyl estradiol patch if your Body Mass Index (BMI) is 30 kg/m2 or more. Women with a BMI of 30 kg/m2 or more who use norelgestromin/ethinyl estradiol patch may be at a higher risk for developing blood clots compared to women with a BMI lower than 30 kg/m2.
Hormonal birth control methods help to lower the chances of becoming pregnant. They do not protect against HIV infection (AIDS) and other sexually transmitted infections.
Do not use norelgestromin/ethinyl estradiol patch if you:
- smoke and are over 35 years old
- have or have had blood clots in your arms, legs, eyes or lungs
- have an inherited problem that makes your blood clot more than normal
- have had a stroke
- have had a heart attack
- have certain heart valve problems or heart rhythm problems that can cause blood clots to form in the heart
- have high blood pressure that medicine cannot control
- have diabetes with kidney, eye, nerve, or blood vessel damage
- have had certain kinds of severe migraine headaches with aura, numbness, weakness or changes in vision, or have any migraine headaches if you are over age 35
- have a BMI of 30 or more
- have liver disease, including liver tumors, take any Hepatitis C drug combination containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir. This may increase levels of the liver enzyme “alanine aminotransferase” (ALT) in the blood.
- have unexplained vaginal bleeding
- are pregnant or think you may be pregnant. However, norelgestromin/ethinyl estradiol patch is not known to cause birth defects when used by accident during pregnancy.
- have had breast cancer or any cancer that is sensitive to female hormones
Hormonal birth control methods may not be a good choice for you if you have ever had jaundice (yellowing of the skin or eyes) caused by pregnancy or related to previous use of hormonal birth control.
Tell your healthcare provider if you have ever had any of the above conditions. Your healthcare provider may recommend another method of birth control.
Before you use norelgestromin/ethinyl estradiol patch, tell your healthcare provider:
- about all your medical conditions
- if you are pregnant or think you are pregnant
- if you are scheduled for surgery. norelgestromin/ethinyl estradiol patch may increase your risk of blood clots after surgery. You should stop using your norelgestromin/ethinyl estradiol patch at least 4 weeks before you have surgery and not restart it until at least 2 weeks after your surgery.
- if you are scheduled for any laboratory tests. Certain blood tests may be affected by hormonal birth control methods.
- are breastfeeding or plan to breastfeed. Hormonal birth control methods that contain estrogen, like norelgestromin/ethinyl estradiol patch, may decrease the amount of milk you make. A small amount of hormones from the norelgestromin/ethinyl estradiol patch may pass into your breast milk. Consider another method of birth control until you are ready to stop breastfeeding.
Tell your healthcare provider about all medicines and herbal products that you take.
Some medicines and herbal products may make hormonal birth control less effective, including, but not limited to:
- certain seizure medicines (carbamazepine, felbamate, oxcarbazepine, phenytoin, rufinamide, and topiramate)
- aprepitant
- barbiturates
- bosentan
- griseofulvin
- certain combinations of HIV medicines (nelfinavir, ritonavir, ritonavir-boosted protease inhibitors)
- certain non-nucleoside reverse transcriptase inhibitors (nevirapine)
- rifampin and rifabutin
- St. John’s wort
Use another birth control method (such as a condom and spermicide or diaphragm and spermicide) when you take medicines that may make the norelgestromin/ethinyl estradiol patch less effective.
Some medicines and grapefruit juice may increase your level of the hormone ethinyl estradiol if used together, including:
- acetaminophen
- ascorbic acid
- medicines that affect how your liver breaks down other medicines (itraconazole, ketoconazole, voriconazole, and fluconazole)
- certain HIV medicines (atazanavir, indinavir)
- atorvastatin
- rosuvastatin
- etravirine
Hormonal birth control methods may interact with lamotrigine, an anti-seizure medicine used for epilepsy. This may increase the risk of seizures, so your healthcare provider may need to adjust the dose of lamotrigine.
Women on thyroid replacement therapy may need increased doses of thyroid hormone.
Know the medicines you take. Keep a list of them to show your doctor and pharmacist when you get a new medicine.
- For detailed instructions, see the step-by-step instructions for using the norelgestromin/ethinyl estradiol patch at the end of the Patient Information leaflet that comes with your medicine.
- Use the norelgestromin/ethinyl estradiol patch exactly as your healthcare provider tells you to use it.
- Wear 1 norelgestromin/ethinyl estradiol patch at a time. Make sure you remove your old patch before applying your new patch.
- Do not skip using any norelgestromin/ethinyl estradiol patches, even if you do not have sex often.
- The norelgestromin/ethinyl estradiol patch should never be off for more than 7 days in a row. If your patch is off for more than 7 days in a row and you have sex during this time, you could become pregnant.
- If you miss a period you might be pregnant. Some women miss their periods or have light periods on hormonal birth control methods even when they are not pregnant. Call your healthcare provider if you miss 1 period and have not used your norelgestromin/ethinyl estradiol patch every day or you miss 2 periods in a row.
See "What is the most important information I should know about norelgestromin/ethinyl estradiol patch?"
Norelgestromin/ethinyl estradiol patch may cause serious side effects, including:
- blood clots. Like pregnancy, hormonal birth control methods increase the risk of serious blood clots (see following graph), especially in women who have other risk factors, such as smoking, high blood pressure, high levels of fat in the blood, diabetes, obesity, a family history of blood clots, or age greater than 35. This increased risk is highest when you first start using hormonal birth control and when you restart the same or different hormonal birth control after not using it for a month or more. Some studies have reported that women who use norelgestromin/ethinyl estradiol patch have a higher risk of getting a blood clot. Talk with your healthcare provider about your risk of getting a blood clot before using norelgestromin/ethinyl estradiol patch or deciding which type of birth control is right for you.
It is possible to die or be permanently disabled from a problem caused by a blood clot, such as a heart attack or a stroke. Some examples of serious blood clots are blood clots in the:
- legs (deep vein thrombosis)
- lungs (pulmonary embolus)
- eyes (loss of eyesight)
- heart (heart attack)
- brain (stroke)
To put the risk of developing a blood clot into perspective: If 10,000 women who are not pregnant and do not use hormonal birth control are followed for one year, between 1 and 5 of these women will develop a blood clot. The figure below shows the likelihood of developing a serious blood clot for women who are not pregnant and do not use hormonal birth control, for women who use hormonal birth control, for pregnant women, and for women in the first 12 weeks after delivering a baby.
Call your healthcare provider right away if you have:
- leg pain that will not go away
- sulien shortness of breath
- sulien blindness, partial or complete
- severe pain or pressure in your chest
- sulien, severe headache unlike your usual headaches
- weakness or numbness in an arm or leg, or trouble speaking
- yellowing of the skin or eyeballs
Other serious risks include
- liver problems including liver tumors
- gallblalier disease
- high blood pressure
The most common side effects of norelgestromin/ethinyl estradiol patch are:
- breast symptoms (discomfort, swelling, or pain)
- nausea
- headache
- skin irritation, redness, pain, swelling, itching or rash at the patch application site
- stomach pain
- pain during menstruation
- vaginal bleeding and menstrual disorders, such as spotting or bleeding between periods
- mood, affect and anxiety disorders
Some women have spotting or light bleeding, breast tenderness, or feel sick to their stomach during norelgestromin/ethinyl estradiol patch use. If these symptoms occur, do not stop using the norelgestromin/ethinyl estradiol patch. The problem will usually go away. If it doesn't go away, check with your healthcare provider.
Less common side effects are:
- acne
- less sexual desire
- bloating or fluid retention
- blotchy darkening of your skin, especially your face
- high blood sugar, especially in women with diabetes
- high fat (cholesterol, triglycerides) levels in the blood
- depression, especially if you have had depression in the past. Call your healthcare provider immediately if you have any thoughts of harming yourself.
- problems tolerating contact lenses
- weight gain
Tell your healthcare provider about any side effect that bothers you or that does not go away.
These are not all the possible side effects of norelgestromin/ethinyl estradiol patch. For more information, ask your healthcare provider or pharmacist.
Call your healthcare provider for medical advice about side effects.
- Store at room temperature between 59°F to 86°F (15°C to 30°C).
- Do not store norelgestromin/ethinyl estradiol patches outside of their pouches. Apply immediately upon removal from the protective pouch.
- Do not store in the refrigerator or freezer.
- Used norelgestromin/ethinyl estradiol patches still contain some active hormones. To throw away the norelgestromin/ethinyl estradiol patch, fold the sticky side of the patch together, place it in a sturdy child-proof container, and place this container in the trash. Do not flush used norelgestromin/ethinyl estradiol patches down the toilet.
- Return unused, unneeded, or expired patches to your pharmacist.
Keep norelgestromin/ethinyl estradiol patch and all medicines out of the reach of children.
1. ZAFEMY® (za feʹ my) (norelgestromin and ethinyl estradiol transdermal system) [accessed on Oct 04, 2023]
2. XULANE (norelgestromin and ethinyl estradiol) patch [accessed on Oct 04, 2023]
3. Estrogen and Progestin (Transdermal Patch Contraceptives) [accessed on Oct 04, 2023]

These FAQs provide a summary of the most important information about Norelgestromin and Ethinyl Estradiol Patch. The drug should not be used for a condition other than that for which it is prescribed. Do not give it to other people, even if they have the same symptoms that you have. It may harm them. If you would like more information or have any questions, talk to your healthcare provider.

Additional Materials (3)

Birth Control Patch

James Heilman, MD

1:03

Birth Control Patch Side Effects | Birth Control

Howcast/YouTube

2:52

Which Birth Control is Best For Me? Pros and Cons of the Patch - Pandia Health

Pandia Health/YouTube

Oral Contraceptive

Birth Control Pill

Image by TheVisualMD

About Oral Contraceptives

Oral contraceptives, also known as “birth-control pills” or “the pill”, are taken to prevent pregnancy, and when taken correctly, have a failure rate of less than 1% per year when used without missing any pills. The typical failure rate of large numbers of pill users is less than 3% per year when women who miss pills are included. For most women oral contraceptives are also free of serious or unpleasant side effects. However, forgetting to take pills considerably increases the chances of pregnancy.

For the majority of women, oral contraceptives can be taken safely. But there are some women who are at high risk of developing certain serious diseases that can be life-threatening or may cause temporary or permanent disability or death. The risks associated with taking oral contraceptives increase significantly if you:

smoke
have high blood pressure, diabetes, high cholesterol
have or have had clotting disorders, heart attack, stroke, angina pectoris, cancer of the breast or sex organs, jaundice, or malignant or benign liver tumors

You should not take the pill if you suspect you are pregnant or have unexplained vaginal bleeding.

Cigarette smoking increases the risk of serious cardiovascular side effects from oral contraceptive use. This risk increases with age and with the amount of smoking (15 or more cigarettes per day has been associated with a significantly increased risk) and is quite marked in women over 35 years of age. Women who use oral contraceptives should not smoke.

Most side effects of the pill are not serious. The most common such effects are nausea, vomiting, bleeding between menstrual periods, weight gain, breast tenderness, and difficulty wearing contact lenses. These side effects, especially nausea and vomiting, may subside within the first three months of use.

The serious side effects of the pill occur very infrequently, especially if you are in good health and do not smoke. However, you should know that the following medical conditions have been associated with or made worse by the pill:

Blood clots in the legs (thrombophlebitis), lungs (pulmonary embolism), stoppage or rupture of a blood vessel in the brain (stroke), blockage of blood vessels in the heart (heart attack and angina pectoris) or other organs of the body. As mentioned above, smoking increases the risk of heart attacks and strokes and subsequent serious medical consequences.
Liver tumors, which may rupture and cause severe bleeding. A possible but not definite association has been found with the pill and liver cancer. However, liver cancers are extremely rare. The chance of developing liver cancer from using the pill is thus even rarer.
High blood pressure, although blood pressure usually returns to normal when the pill is stopped.

The symptoms associated with these serious side effects are discussed in the detailed leaflet given to you with your supply of pills. Notify your doctor or health-care provider if you notice any unusual physical disturbances while taking the pill. In addition, drugs such as rifampin, as well as some anticonvulsants and some antibiotics, may decrease oral contraceptive effectiveness.

Studies to date of women taking the pill have not shown an increase in the incidence of cancer of the breast or cervix. There is, however, insufficient evidence to rule out the possibility that pills may cause such cancers. Taking the pill provides some important noncontraceptive benefits. These include less painful menstruation, less menstrual blood loss and anemia, fewer pelvic infections, and fewer cancers of the ovary and the lining of the uterus.

Be sure to discuss any medical condition you may have with your healthcare provider. Your health-care provider will take a medical and family history before prescribing oral contraceptives and will examine you. The physical examination may be delayed to another time if you request it and the health-care provider believes that it is appropriate to postpone it. You should be re-examined at least once a year while taking oral contraceptives. The detailed patient information leaflet gives you further information which you should read and discuss with your health-care provider.

Oral contraceptives are intended to prevent pregnancy. It does not protect against transmission of HIV (AIDS) and other sexually transmitted diseases such as chlamydia, genital herpes, genital warts, gonorrhea, hepatitis B, and syphilis.

Source: FDA Medication Guide for Oral Contraceptives

Additional Materials (15)

Birth Control Chart

Document by U.S. FDA

Doctor Answers Commonly Searched Questions About Birth Control

Video by As/Is/YouTube

Contraceptive implant video

Video by Herefordshire & Worcestershire Health and Care NHS/YouTube

Emergency Contraceptive Pills: How They Work, Safety and Side Effects

Video by Drugs.com/YouTube

Emergency Contraceptive Pills: The Basics of How to Use

Video by Drugs.com/YouTube

Birth Control Pills | Contraceptive Pills Guide | MINI PILL (2019)

Video by AbrahamThePharmacist/YouTube

Progestin Only Contraceptive Pills (POPs)

Video by UW - Department of Family Medicine and Community Health/YouTube

Understanding blood clots – The oral contraceptive pill and risk of blood clots

Video by Thrombosis UK/YouTube

Side Effects of The Pill | Birth Control

Video by Howcast/YouTube

Birth Control Pills as a Form of Birth Control - Planned Parenthood

Video by Planned Parenthood/YouTube

How to Pick Best Birth Control Pill for You | Birth Control

Video by Howcast/YouTube

Birth control pills - how to use for IVF!

Video by Vitalab Fertility Clinic - Sandton and Umhlanga/YouTube

How to Stop Your Period with Birth Control | Birth Control

Video by Howcast/YouTube

Let’s Actually Talk About Birth Control

Video by As/Is/YouTube

Model of a contraceptive pill

Model of a contraceptive pill

Image by Wellcome Trust

Birth Control Chart

U.S. FDA

7:18

Doctor Answers Commonly Searched Questions About Birth Control

As/Is/YouTube

3:23

Contraceptive implant video

Herefordshire & Worcestershire Health and Care NHS/YouTube

4:08

Emergency Contraceptive Pills: How They Work, Safety and Side Effects

Drugs.com/YouTube

4:30

Emergency Contraceptive Pills: The Basics of How to Use

Drugs.com/YouTube

5:59

Birth Control Pills | Contraceptive Pills Guide | MINI PILL (2019)

AbrahamThePharmacist/YouTube

3:22

Progestin Only Contraceptive Pills (POPs)

UW - Department of Family Medicine and Community Health/YouTube

2:42

Understanding blood clots – The oral contraceptive pill and risk of blood clots

Thrombosis UK/YouTube

1:25

Side Effects of The Pill | Birth Control

Howcast/YouTube

1:30

Birth Control Pills as a Form of Birth Control - Planned Parenthood

Planned Parenthood/YouTube

1:42

How to Pick Best Birth Control Pill for You | Birth Control

Howcast/YouTube

2:16

Birth control pills - how to use for IVF!

Vitalab Fertility Clinic - Sandton and Umhlanga/YouTube

1:24

How to Stop Your Period with Birth Control | Birth Control

Howcast/YouTube

4:50

Let’s Actually Talk About Birth Control

As/Is/YouTube

Model of a contraceptive pill

Wellcome Trust

Intrauterine Contraception -

Copper and Hormonal IUD

Image by alanagkelly

Intrauterine Contraception -

	Levonorgestrel intrauterine system (LNG IUD)—The LNG IUD is a small T-shaped device like the Copper T IUD. It is placed inside the uterus by a doctor. It releases a small amount of progestin each day to keep you from getting pregnant. The LNG IUD stays in your uterus for up to 3 to 8 years, depending on the device. Typical use failure rate: 0.1-0.4%.

Source: Centers for Disease Control and Prevention (CDC)

Additional Materials (1)

Mirena IntraUterine System - Intrauterine system (IUS) with progestogen

Hic et nunc/Wikimedia

Vaginal Ring

Hormone Replacement Therapy Vaginal Ring

Image by TheVisualMD

Vaginal Contraceptive Ring or Vaginal Contraceptive System

Vaginal Contraceptive Ring or Vaginal Contraceptive System

What is it?

A flexible ring that is about 2 inches across

How do I use it?

You put the ring into your vagina.
Keep the ring in your vagina for 3 weeks and then take it out for 1 week. Your menstrual period should start during this ring-free week.
There are different types of rings. Certain types can be reused for multiple cycles.
If the ring falls out and stays out for more than 2 or 3 hours (depending on type of ring), place the ring back in your vagina and you (or your partner) should use another non-hormonal contraceptive, like a condom and spermicide, until the ring has been in place for 7 days in a row.

How do I get it?

You need a prescription from a health care provider.

Chance of getting pregnant with use (number of pregnancies expected per 100 women who use this method of contraception for one year)

Out of 100 women who use this contraceptive, about 7 may get pregnant.

Some side effects and risks

Breast tenderness
Headache
Mood changes
Nausea
Vaginal discharge, discomfort in the vagina, and mild irritation

Some less common risks

It is not common, but some women who use the ring develop high blood pressure.
It is rare, but some women will have blood clots, heart attacks, or strokes.

Does it provide protection from sexually transmitted infections (STIs)?

No.

Source: Food and Drug Administration (FDA)

Instructions on Contraceptive Vaginal Ring

A medical illustration depicting the application of a vaginal ring.

Image by BruceBlaus

Instructions on Contraceptive Vaginal Ring

Information for Contraceptive Vaginal Ring

The contraceptive ring contains both estrogen and progestin. The contraceptive ring is 98 percent to 99 percent effective when used correctly.

BENEFITS:

Fewer menstrual cramps and bleeding
Improvement in acne
Regular periods
Weight neutral
Less pain at ovulation
Reduced PMS symptoms

DECREASED RISK OF:

Ovarian or Endometrial cancer
Benign breast tumors or ovarian cysts
Ectopic pregnancy
Anemia

RISKS/SIDE EFFECTS:

Vaginal infections and irritation
Vaginal discharge/discomfort
Mood changes/depression (NuvaRing)
Spotting between periods
Nausea/Vomiting
Breast tenderness
Headaches
Decreased milk supply (if breastfeeding)
Worse acne (NuvaRing)
Change in libido

Cigarette smoking increases the risk of serious cardiovascular side effects from combination oral contraceptive use. This risk increases with age and with heavy smoking (15 or more cigarettes per day) and is quite marked in women over 35 years of age. Women who use combination hormonal contraceptives, including NuvaRing, should be strongly advised not to smoke.

To decrease your chances of serious problems, you need to go to an emergency room, doctor, or clinic if you have any of the following symptoms:

A Abdominal pain (severe)

C Chest pain or shortness of breath

H Headaches (severe)

E Eye problems (blurred vision, flashing lights, or blindness)

S Severe leg pain (calf or thigh)

ALTERNATIVES: You have received written information about the other methods of birth control. For situations of suspected contraception failure, emergency contraception is available and offers a second chance to reduce the risk of unintended pregnancy.

INSTRUCTIONS: You have received information about the vaginal ring and how to use it. The vaginal ring does not protect against STIs (sexually transmitted infections) and HIV.

DECISION TO STOP USING: You may stop using the vaginal ring at any time. A woman is most likely to become pregnant if she or her partner does not use a method of birth control.

QUESTIONS: You may ask questions about the ring at any time and may contact the clinic with further questions.

Instructions for Contraceptive Vaginal Ring

Before the use of either vaginal ring and during the use of ANNOVERA, store unused vaginal rings at room temperature and out of direct sunlight.

After use, do not flush vaginal rings down the toilet. One ANNOVERA vaginal ring is designed to be used for one year and should be stored in the provided case in between insertions.

Speak to your medical provider about the proper timing of initial insertion/use and if you will need to use a backup method for 7 days.

No special accuracy is required for ring placement; absorption is fine anywhere in the vagina.

With clean hands, press the sides of the ring together between the thumb and the first (index) finger.

Press and hold the sides of the vaginal ring together for easier insertion into the vagina.

Choose a position that is comfortable to you for insertion. Helpful positions to ease insertion may include squatting or standing with one leg up.

Gently insert the folded vaginal ring into the vagina and use your index finger to push the ring in as far as it goes. When properly inserted, the ring should be entirely in the vagina and behind the pelvic bone.

The date and time of insertion should be noted so that the ring can be removed 21 days later at about the same time

When it is due for removal, wash and dry your hands and choose the position that is most comfortable for you. Place one finger into the vagina to hook the vaginal ring and then gently pull downward to remove it. The used vaginal ring should be disposed of in the trash; do not flush in the toilet.

NUVARING: The vaginal ring is inserted into the vagina, left in place for 3 weeks (21 days), and then removed for a “ring-free” week (7 days). At the end of the “ring-free” week, a woman inserts a new vaginal ring. Speak to your medical provider about insertion and removal timing to determine if “continuous cycling” is right for you. If you leave the ring in your vagina longer than 4 weeks, remove the ring, contact your medical provider for further direction, and check if you are pregnant.

NUVARING: Ring removal during intercourse is not recommended; however, women who want to remove it during intercourse may do so without having to use a backup method as long as it is not removed for longer than three hours. If the vaginal ring is out of your body for more than three hours during the 3-week period, contact your medical provider for direction.

NUVARING: Ring breakage has occurred when using a vaginal lubricant or treatment for infection. Talk to your medical provider about vaginal products and Nuvaring before use.

ANNOVERA: The vaginal ring is inserted into the vagina, left in place for 3 weeks (21 days), and then removed for a “ring-free” week (7 days). At the end of the “ring-free” week, a woman inserts her same vaginal ring as used before. One vaginal ring is used for one year (13 cycles). See proper cleaning instructions below.

ANNOVERA: Ring removal during intercourse is not recommended; however, women who want to remove it during intercourse may do so without having to use a backup method as long as it is not removed for longer than two hours. If the vaginal ring is out of your body for more than two hours during the 3-week period, contact your medical provider for direction.

ANNOVERA: Do not use any vaginal lubricants that have silicone or oil in them. Water-based lubricants are ok to use.

ANNOVERA Cleaning Instructions: Wash the vaginal ring with mild soap and lukewarm water, pat it dry, and store in the case provided. At the end of the ring-free interval, the vaginal system should be cleaned prior to being placed back in the vagina for another 21 continuous days (3 weeks).

Why is my vaginal ring uncomfortable?
Although some women may be aware of the vaginal ring in the vagina, most women do not feel it once it is in place. If you feel discomfort, the vaginal ring is probably not inserted back far enough in the vagina. Remove and reattempt insertion to ensure the vaginal ring is pushed into the vagina far enough. Use your finger to push the vaginal ring further into your vagina gently There is no danger of the vaginal ring being pushed too far up in the vagina or getting lost. The vaginal ring can be inserted only as far as the end of the vagina, where the cervix (the narrow, lower end of the uterus) will block the vaginal ring from going any further. Your medical provider can ensure proper placement before leaving the clinic if you desire.

Source: North Dakota Department of Health and Human Services

Estradiol Vaginal Ring

Estradiol Vaginal Ring

Also called: Estring®

Estring (estradiol vaginal ring) is a prescription vaginal ring that provides a low, continuous dose of estrogen for 90 days to help relieve vaginal dryness and inflammation due to menopause.

Estradiol Vaginal Ring

Also called: Estring®

Estring (estradiol vaginal ring) is a prescription vaginal ring that provides a low, continuous dose of estrogen for 90 days to help relieve vaginal dryness and inflammation due to menopause.

Estrogens increase the chance of getting cancer of the uterus.
Report any unusual vaginal bleeding right away while you are using Estring. Vaginal bleeding after menopause may be a warning sign of cancer of the uterine (womb). Your healthcare provider should check any unusual vaginal bleeding to find out the cause.
Do not use estrogens with or without progestins to prevent heart disease, heart attacks, strokes, or dementia.
Using estrogens with or without progestins may increase your chance of getting heart attacks, strokes, breast cancer, and blood clots. Using estrogens with or without progestins may increase your risk of dementia, based on a study of women age 65 years or older.
You and your healthcare provider should talk regularly about whether you still need treatment with Estring.
Do not start using Estring if you:
- Have unusual vaginal bleeding
- Currently have or have had certain cancers. Estrogens may increase the chance of getting certain types of cancers, including cancer of the breast or uterus. If you have or had cancer, talk with your healthcare provider about whether you should use Estring.
- Had a stroke or heart attack in the past year
- Currently have or have had blood clots
- Currently have or have had liver problems
- Are allergic to any of the ingredients in Estring
- Think you may be pregnant
Tell your healthcare provider:
- If you are breastfeeding. The hormone in Estring can pass into your breast milk.
- About all of your medical problems. Your healthcare provider may need to check you more carefully if you have certain conditions, such as asthma (wheezing), epilepsy (seizures), migraine, endometriosis, lupus, or problems with your heart, liver, thyroid, kidneys, or have high calcium levels in your blood.
- About all the medicines you take. This includes prescription and nonprescription medicines, vitamins, and herbal supplements. Some medicines may affect how Estring works. Estring may also affect how your other medicines work.
- If you are going to have surgery or will be on bed rest. You may need to stop taking estrogens.
Side effects are grouped by how serious they are and how often they happen when you are treated.
Serious but less common side effects include:
- Breast cancer
- Cancer of the uterus
- Stroke
- Heart attack
- Blood clots
- Dementia
- Gallbladder disease
- Ovarian cancer
- High blood pressure
- Liver problems
- High blood sugar
- Enlargement of benign tumors of the uterus ("fibroids")
Some of the warning signs of these serious side effects include:
- Breast lumps
- Unusual vaginal bleeding
- Dizziness and faintness
- Changes in speech
- Severe headaches
- Chest pain
- Shortness of breath
- Pains in your legs
- Changes in vision
- Vomiting
- Yellowing of the skin, eyes or nail beds
Call your healthcare provider right away if you get any of these warning signs, or any other unusual symptom that concerns you.
Less serious but common side effects include:
- Headache
- Breast pain
- Irregular vaginal bleeding or spotting
- Stomach/abdominal cramps, bloating
- Nausea and vomiting
- Hair loss
- Fluid retention
- Vaginal yeast infection
These are not all the possible side effects of estrogens. For more information, ask your healthcare provider or pharmacist.
- Follow carefully the instructions for use.
- Talk with your healthcare provider regularly about whether you should continue using Estring.
- See your healthcare provider right away if you get vaginal bleeding while using Estring.
- If you have fever, nausea, vomiting, diarrhea, muscle pain, dizziness, faintness, or a sunburn-like rash on face and body, remove Estring and contact your healthcare provider.
- Contact your healthcare provider if you have difficulty removing the vaginal ring.
- Have a breast exam and mammogram (breast X-ray) every year unless your healthcare provider tells you something else. If members of your family have had breast cancer or if you have ever had breast lumps or an abnormal mammogram, you may need to have breast examinations more often.
- If you have high blood pressure, high cholesterol (fat in the blood), diabetes, are overweight, or if you use tobacco, you may have higher chances for getting heart disease. Ask your healthcare provider for ways to lower your chances for getting heart disease.
1. ESTRING (ESTRADIOL) RING [accessed on Jul 29, 2019]

These FAQs provide a summary of the most important information about Estradiol Vaginal Ring. If you would like more information or have any questions, talk to your healthcare provider.

Ethinyl Estradiol and Etonogestrel Vaginal Ring

Ethinyl Estradiol and Etonogestrel Vaginal Ring

Also called: NuvaRing®

NuvaRing is a hormonal birth control (contraceptive) device for women. It consists of a vaginal ring and two hormones (ethinyl estradiol and etonogestrel).

Ethinyl Estradiol and Etonogestrel Vaginal Ring

Also called: NuvaRing®

NuvaRing is a hormonal birth control (contraceptive) device for women. It consists of a vaginal ring and two hormones (ethinyl estradiol and etonogestrel).

Do not use NuvaRing if you smoke cigarettes and are over 35 years old. Smoking increases your risk of serious cardiovascular side effects (heart and blood vessel problems) from combination hormonal contraceptives (CHCs), including death from heart attack, blood clots or stroke. This risk increases with age and the number of cigarettes you smoke.
Hormonal birth control methods help to lower the chances of becoming pregnant. They do not protect against HIV infection (AIDS) and other sexually transmitted infections.
Do not use NuvaRing if you:
- smoke and are over 35 years old
- have or have had blood clots in your arms, legs, eyes, or lungs
- have an inherited problem with your blood that makes it clot more than normal
- have had a stroke
- have had a heart attack
- have certain heart valve problems or heart rhythm problems that can cause blood clots to form in the heart
- have high blood pressure that medicine can't control
- have diabetes with kidney, eye, nerve, or blood vessel damage
- have certain kinds of severe migraine headaches with aura, numbness, weakness, or changes in vision, or have any migraine headaches if you are over age 35
- have liver disease, including liver tumors
- take any Hepatitis C drug combination containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir. This may increase levels of the liver enzyme "alanine aminotransferase" (ALT) in the blood
- have unexplained vaginal bleeding
- are pregnant or think you may be pregnant. NuvaRing is not for pregnant women.
- have or have had breast cancer or any cancer that is sensitive to female hormones
- are allergic to etonogestrel, ethinyl estradiol or any of the ingredients in NuvaRing. See the list of ingredients in NuvaRing at the end of this leaflet.
Hormonal birth control methods may not be a good choice for you if you have ever had jaundice (yellowing of the skin or eyes) caused by pregnancy or related to previous use of hormonal birth control.
Tell your healthcare provider if you have ever had any of the conditions listed above. Your healthcare provider can suggest another method of birth control.
Before you use NuvaRing tell your healthcare provider if you:
- have any medical conditions
- smoke
- are pregnant or think you are pregnant
- recently had a baby
- recently had a miscarriage or abortion
- have a family history of breast cancer
- have or have had breast nodules, fibrocystic disease, an abnormal breast x-ray, or abnormal mammogram
- use tampons and have a history of toxic shock syndrome
- have been diagnosed with depression
- have had liver problems including jaundice during pregnancy
- have or have had elevated cholesterol or triglycerides
- have or have had gallbladder, liver, heart, or kidney disease
- have diabetes
- have a history of jaundice (yellowing of the skin or eyes) caused by pregnancy (also called cholestasis of pregnancy)
- have a history of scanty or irregular menstrual periods
- have any condition that makes the vagina become irritated easily
- have or have had high blood pressure
- have or have had migraines or other headaches or seizures
- are scheduled for surgery. NuvaRing may increase your risk of blood clots after surgery. You should stop using NuvaRing at least 4 weeks before you have surgery and not restart it until at least 2 weeks after your surgery.
- are scheduled for any laboratory tests. Certain blood tests may be affected by hormonal birth control methods.
- are breastfeeding or plan to breastfeed. Hormonal birth control methods that contain estrogen, like NuvaRing, may decrease the amount of milk you make. A small amount of hormones from NuvaRing may pass into your breast milk. Consider another non-hormonal method of birth control until you are ready to stop breastfeeding.
- have (or have ever had) an allergic reaction while using NuvaRing, including hives, swelling of the face, lips, tongue, and/or throat causing difficulty in breathing or swallowing (anaphylaxis and/or angioedema).
Tell your healthcare provider about all medicines and herbal products you take, including prescription and over-the-counter medicines, vitamins and herbal supplements.
Some medicines and herbal products may make hormonal birth control less effective, including, but not limited to:
- certain anti-seizure medicines (such as barbiturates, carbamazepine, felbamate, oxcarbazepine, phenytoin, rufinamide and topiramate)
- medicine to treat fungal infections (griseofulvin)
- certain combinations of HIV medicines, (such as nelfinavir, ritonavir, darunavir/ritonavir, (fos)amprenavir/ritonavir, lopinavir/ritonavir, and tipranavir/ritonavir)
- certain hepatitis C (HCV) medicines (such as boceprevir and telaprevir)
- non-nucleoside reverse transcriptase inhibitors (such as efavirenz and nevirapine)
- medicine to treat tuberculosis (such as rifampicin and rifabutin)
- medicine to treat high blood pressure in the vessels of the lung (bosentan)
- medicine to treat chemotherapy-induced nausea and vomiting (aprepitant)
- St John's wort
Use an additional barrier contraceptive method (such as a male condom with spermicide) when you take medicines that may make NuvaRing less effective. 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 to help prevent you from becoming pregnant. 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.
Some medicines and grapefruit juice may increase the level of ethinyl estradiol in your blood if used together, including:
- the pain reliever acetaminophen
- ascorbic acid (vitamin C)
- medicines that affect how your liver breaks down other medicines (such as itraconazole, ketoconazole, voriconazole, fluconazole, clarithromycin, erythromycin, and diltiazem)
- certain HIV medicines (atazanavir/ritonavir and indinavir)
- non-nucleoside reverse transcriptase inhibitors (such as etravirine)
- medicines to lower cholesterol such as atorvastatin and rosuvastatin
Hormonal birth control methods may interact with lamotrigine, a medicine used for seizures. This may increase the risk of seizures, so your healthcare provider may need to adjust your dose of lamotrigine.
Women on thyroid replacement therapy may need increased doses of thyroid hormone.
Ask your healthcare provider if you are not sure if you take any of the medicines listed above. Know the medicines you take. Keep a list of them to show your doctor and pharmacist when you get a new medicine.
- Read the Instructions for Use at the end of this Patient Information that comes with your NuvaRing for information about the right way to use NuvaRing.
- Use NuvaRing exactly as your healthcare provider tells you to use it.
- NuvaRing is used in a 4-week cycle.
- 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.
- Ring breakage has occurred when also using a vaginal product such as a lubricant or treatment for infection. Use of spermicides or vaginal yeast products will not make NuvaRing less effective at preventing pregnancy.
- Use of tampons will not make NuvaRing less effective or stop NuvaRing from working.
- If NuvaRing has been left inside your vagina for more than 4 weeks (28 days), you may not be protected from pregnancy and you should see your healthcare provider to be sure you are not pregnant. Until you know the results of your pregnancy test, you should use an extra method of birth control, such as male condoms with spermicide, until the new NuvaRing has been in place for 7 days in a row.
- Do not use more than 1 NuvaRing at a time. Too much hormonal birth control medicine in your body may cause nausea, vomiting, or vaginal bleeding.
Your healthcare provider should examine you at least 1 time a year to see if you have any signs of side effects from using NuvaRing.
Some women miss periods on hormonal birth control, even when they are not pregnant. Consider the possibility that you may be pregnant if:
1. you miss a period and NuvaRing was out of the vagina for more than 3 hours during the 3 weeks (21 days) of ring use
2. you miss a period and waited longer than 1 week to insert a new ring
3. you have followed the instructions and you miss 2 periods in a row
4. you have left NuvaRing in place for longer than 4 weeks (28 days)
See "What is the most important information I should know about NuvaRing?"
NuvaRing may cause serious side effects, including:
Blood clots. Like pregnancy, combination hormonal birth control methods increase the risk of serious blood clots, especially in women who have other risk factors, such as smoking, obesity, or age greater than 35. This increased risk is highest when you first start using a combination hormonal birth control method or when you restart the same or different combination hormonal birth control method after not using it for a month or more. Talk with your healthcare provider about your risk of getting a blood clot before using NuvaRing or before deciding which type of birth control is right for you.
In some studies of women who used NuvaRing, the risk of getting a blood clot was similar to the risk in women who used combination birth control pills.
Other studies have reported that the risk of blood clots was higher for women who use combination birth control pills containing desogestrel (a progestin similar to the progestin in NuvaRing) than for women who use combination birth control pills that do not contain desogestrel.
It is possible to die or be permanently disabled from a problem caused by a blood clot, such as heart attack or stroke. Some examples of serious blood clots are blood clots in the:
To put the risk of developing a blood clot into perspective: If 10,000 women who are not pregnant and do not use hormonal birth control are followed for one year, between 1 and 5 of these women will develop a blood clot. The figure below shows the likelihood of developing a serious blood clot for women who are not pregnant and do not use hormonal birth control, for women who use hormonal birth control, for pregnant women, and for women in the first 12 weeks after delivering a baby.
Call your healthcare provider right away if you have:
- legs (deep vein thrombosis)
- lungs (pulmonary embolus)
- eyes (loss of eyesight)
- heart (heart attack)
- brain (stroke)
- leg pain that does not go away
- sudden shortness of breath
- sudden blindness, partial or complete
- severe pain or pressure in your chest
- sudden, severe headache unlike your usual headaches
- weakness or numbness in an arm or leg, or trouble speaking
- yellowing of the skin or eyeballs
Other serious risks include:
- Toxic Shock Syndrome (TSS). Some of the symptoms are much the same as the flu, but they can become serious very quickly. Call your healthcare provider or get emergency treatment right away if you have the following symptoms:
  sudden high fever
  vomiting
  diarrhea
  a sunburn-like rash
  muscle aches
  dizziness
  fainting or feeling faint when standing up
- allergic reaction, including hives, swelling of the face, lips, tongue, and/or throat causing difficulty in breathing or swallowing (anaphylaxis and/or angioedema)
- liver problems, including liver tumors
- high blood pressure
- gallbladder problems
- accidental insertion into bladder
- symptoms of a problem called angioedema if you already have a family history of angioedema
The most common side effects of NuvaRing are:
- tissue irritation inside your vagina or on your cervix
- headache (including migraine)
- mood changes (including depression, especially if you had depression in the past). Call your healthcare provider immediately if you have any thoughts of harming yourself.
- NuvaRing problems, including the ring slipping out or causing discomfort
- nausea and vomiting
- vaginal discharge
- weight gain
- vaginal discomfort
- breast pain, discomfort, or tenderness
- painful menstrual periods
- abdominal pain
- acne
- less sexual desire
Some women have spotting or light bleeding during NuvaRing use. If these symptoms occur, do not stop using NuvaRing. The problem will usually go away. If it doesn't go away, check with your healthcare provider.
Other side effects seen with NuvaRing include breast discharge; vaginal injury (including pain, discomfort, and bleeding) associated with broken rings; and penis discomfort of the partner (such as irritation, rash, itching).
Less common side effects seen with combination hormonal birth control include:
- Blotchy darkening of your skin, especially on your face
- High blood sugar, especially in women who already have diabetes
- High fat (cholesterol, triglycerides) levels in the blood
There have been reports of the ring becoming stuck to the vaginal tissue and having to be removed by a healthcare provider. Call your healthcare provider if you are unable to remove your NuvaRing.
Tell your healthcare provider about any side effect that bothers you or that does not go away. These are not all the possible side effects of NuvaRing. For more information, ask your healthcare provider or pharmacist. Call your healthcare provider for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
- Store NuvaRing at room temperature between 68°F to 77°F (20°C to 25°C).
- Store NuvaRing at room temperature for up to 4 months after you receive it. Throw NuvaRing away if the expiration date on the label has passed.
- Do not store NuvaRing above 86°F (30°C).
- Avoid direct sunlight.
- Place the used NuvaRing in the re-closable foil pouch and properly throw it away in your household trash out of the reach of children and pets. Do not flush your used NuvaRing down the toilet.
Keep NuvaRing and all medicines out of the reach of children.
1. NuvaRing® (etonogestrel/ethinyl estradiol vaginal ring) [accessed on Jul 28, 2019]
2. Ethinyl Estradiol and Etonogestrel Vaginal Ring. MedlinePlus/AHFS® Drug Information. [accessed on Oct 29, 2018]

These FAQs provide a summary of the most important information about Ethinyl Estradiol and Etonogestrel Vaginal Ring. The drug should not be used for a condition other than that for which it is prescribed. Do not give it to other people, even if they have the same symptoms that you have. It may harm them. If you would like more information or have any questions, talk to your healthcare provider.

Estradiol Acetate Vaginal Ring

Estradiol Acetate Vaginal Ring

Also called: Femring®

Femring is a prescription vaginal ring that contains estradiol (an estrogen hormone). It is used to relieve hot flashes and vaginal dryness that occurs in some women during menopause.

Estradiol Acetate Vaginal Ring

Also called: Femring®

Femring is a prescription vaginal ring that contains estradiol (an estrogen hormone). It is used to relieve hot flashes and vaginal dryness that occurs in some women during menopause.

- Using estrogen-alone may increase your chance of getting cancer of the uterus (womb). Report any unusual vaginal bleeding right away while you are using Femring. Vaginal bleeding after menopause may be a warning sign of cancer of the uterus (womb). Your healthcare provider should check any unusual vaginal bleeding to find out the cause.
- Do not use estrogen-alone to prevent heart disease, heart attacks, strokes or dementia (decline in brain function).
- Using estrogen-alone may increase your chances of getting strokes or blood clots.
- Using estrogen-alone may increase your chance of getting dementia, based on a study of women 65 years of age or older.
- Do not use estrogens with progestins to prevent heart disease, heart attacks, strokes or dementia.
- Using estrogens with progestins may increase your chances of getting heart attacks, strokes, breast cancer, or blood clots.
- Using estrogens with progestins may increase your chance of getting dementia, based on a study of women 65 years of age or older.
- You and your healthcare provider should talk regularly about whether you still need treatment with Femring.
Femring is used after menopause to:
- reduce moderate to severe hot flashes
  Estrogens are hormones made by a woman’s ovaries. The ovaries normally stop making estrogens when a woman is between 45 and 55 years old. This drop in body estrogen levels causes the “change of life” or menopause, the end of monthly menstrual periods. Sometimes both ovaries are removed during an operation before natural menopause takes place. The sudden drop in estrogen levels causes “surgical menopause”.
  When estrogen levels begin dropping, some women get very uncomfortable symptoms, such as feelings of warmth in the face, neck, and chest, or sudden intense episodes of heat and sweating (“hot flashes” or “hot flushes”). In some women the symptoms are mild, and they will not need to take estrogens. In other women, symptoms can be more severe.
- treat moderate to severe menopausal changes in and around the vagina
  You and your healthcare provider should talk regularly about whether you still need treatment with Femring to control these problems. If you use Femring only to treat your menopausal changes in and around your vagina, talk with your healthcare provider about whether a topical vaginal product would be better for you.
You and your healthcare provider should talk regularly about whether you still need treatment with Femring.
Do not start using Femring if you:
- have unusual vaginal bleeding
  Vaginal bleeding after menopause may be a warning sign of cancer of the uterus (womb). Your healthcare provider should check any unusual vaginal bleeding to find out the cause.
- currently have or have had certain cancers
  Estrogens may increase the chances of getting certain types of cancers, including cancer of the breast and uterus. If you have or have had cancer, talk with your healthcare provider about whether you should use Femring.
- had a stroke or heart attack
- currently have or have had blood clots
- currently have or have had liver problems
- have been diagnosed with a bleeding disorder
- are allergic to Femring or any of its ingredients
  See the list of ingredients in Femring at the end of this leaflet.
- think you may be pregnant
  Femring is not for pregnant women. If you think you may be pregnant, you should have a pregnancy test and know the results. Do not use Femring if the test is positive and talk to your healthcare provider.
Before you use Femring, tell your healthcare provider if you:
- have any unusual vaginal bleeding
  Vaginal bleeding after menopause may be a warning sign of cancer of the uterus (womb). Your healthcare provider should check any unusual vaginal bleeding to find out the cause.
- have any problems with your vagina or cervix (lower end of your womb)
  Your healthcare provider may need to check you more carefully if your cervix, bladder, or rectum have fallen out of their normal position and into the vagina or through the opening of the vagina. This may make it more difficult for you to keep Femring in place in your vagina.
- have any other medical conditions
  Your healthcare provider may need to check you more carefully if you have certain conditions such as asthma (wheezing), epilepsy (seizures), diabetes, migraine, endometriosis, lupus, angioedema (swelling of face and tongue) or problems with your heart, liver, thyroid, kidneys, or have high calcium levels in your blood.
- are going to have surgery or will be on bed rest
  Your healthcare provider will let you know if you need to stop using Femring.
- are breastfeeding
  The hormones in Femring can pass into your breast milk.
Tell your healthcare provider about all the medicines you take, including prescription and nonprescription medicines, vitamins and herbal supplements. Some medicines may affect how Femring works. Femring may also affect how your other medicines work. Keep a list of your medicines and show it to your healthcare provider and pharmacist when you get a new medicine.
For detailed instructions, see the step-by-step instructions for using Femring at the end of the Patient Information that comes with your medicine.
- Use Femring exactly as your healthcare provider tells you to use it.
- Femring is inserted into your vagina by you.
- Femring should stay in your vagina for 90 days.
- After 90 days Femring should be removed. If you and your healthcare provider decide you should continue using Femring, a new Femring can be inserted.
- You and your healthcare provider should talk regularly (every 3 to 6 months) about the dose of medicine you are using and whether you still need treatment with Femring.
- toxic shock syndrome (TSS)
  Toxic shock syndrome is a rare but serious illness caused by a bacterial infection that may cause death. Remove your Femring immediately and call your healthcare provider right away if you have any of the following symptoms:
  ° fever
  ° nausea or vomiting
  ° diarrhea
  ° muscle pain
  ° dizziness
  ° feel faint
  ° a sunburn rash on your face or body
- attachment to your vaginal wall
  Contact your healthcare provider right away if you have difficulty removing Femring.
- accidental placement in your bladder
Side effects are grouped by how serious they are and how often they happen when you are treated.
Serious, but less common side effects include:
- heart attack
- stroke
- blood clots
- dementia
- breast cancer
- cancer of the lining of the uterus (womb)
- cancer of the ovary
- high blood pressure
- high blood sugar
- gallbladder disease
- liver problems
- changes in your thyroid hormone levels
- enlargement of benign tumors of the uterus (“fibroids”)
Call your healthcare provider right away if you get any of the following warning signs, or any other unusual symptoms that concern you:
- new breast lumps
- unusual vaginal bleeding
- changes in vision or speech
- sudden new severe headaches
- severe pains in your chest or legs with or without shortness of breath, weakness and fatigue
Less serious, but common side effects include:
- headache
- breast tenderness or pain
- irregular vaginal bleeding or spotting
- stomach or abdominal cramps, bloating
- nausea and vomiting
- hair loss
- fluid retention
- vaginal yeast infection
- reactions from inserting Femring such as burning, irritation, and itching
These are not all the possible side effects of Femring. For more information, ask your healthcare provider or pharmacist. Tell your healthcare provider if you have any side effects that bother you or does not go away.
- Talk with your healthcare provider regularly about whether you should continue using Femring.
- If you have a uterus, talk with your healthcare provider about whether the addition of a progestin is right for you. The addition of a progestin is generally recommended for a woman with a uterus to reduce the chance of getting cancer of the uterus (womb). See your healthcare provider right away if you develop vaginal bleeding while using Femring.
- Have a pelvic exam, breast exam and mammogram (breast x-ray) every year unless your healthcare provider tells you something else.
- If members of your family have had breast cancer or if you have ever had breast lumps or an abnormal mammogram (breast x-ray), you may need to have breast exams more often.
- If you have high blood pressure, high cholesterol (fat in the blood), diabetes, are overweight, or if you use tobacco, you may have a higher chance for getting heart disease.
  Ask your healthcare provider for ways of lowering your chances for getting heart disease.
- Store at room temperature 68º F to 77º F (20º C to 25º C).
KEEP FEMRING and all other medicines out of the reach of children.
1. Femring® (estradiol acetate vaginal ring) [accessed on Jul 29, 2019]

These FAQs provide a summary of the most important information about Estradiol Acetate Vaginal Ring. The drug should not be used for a condition other than that for which it is prescribed. Do not give it to other people, even if they have the same symptoms that you have. It may harm them. If you would like more information or have any questions, talk to your healthcare provider.

Segesterone and Ethinyl Estradiol Vaginal Ring

Segesterone and Ethinyl Estradiol Vaginal Ring

Also called: Annovera™

Annovera is a vaginal birth control system used to prevent pregnancy in women. This system consists of a vaginal ring and two hormones (segesterone acetate and ethinyl estradiol).

Segesterone and Ethinyl Estradiol Vaginal Ring

Also called: Annovera™

Annovera is a vaginal birth control system used to prevent pregnancy in women. This system consists of a vaginal ring and two hormones (segesterone acetate and ethinyl estradiol).

- Do not use Annovera if you smoke cigarettes and are over 35 years old. Smoking increases your risk of serious heart and blood vessel (cardiovascular) side effects from hormonal birth control methods, including death from heart attack, blood clots, or stroke. This risk increases with age and the number of cigarettes you smoke.
Annovera does not protect against HIV infection (AIDS) and other sexually transmitted infections (STIs).
Do not use Annovera if you:
- smoke and are over 35 years old.
- have or have had a blood clot in your arms, legs, lungs, or eyes.
- have had a stroke.
- have reduced blood flow to your brain (cerebrovascular disease).
- have reduced blood flow or blockage in 1 or more of the arteries that supply blood to your heart (coronary artery disease).
- have had a heart attack.
- have heart rhythm or heart valve problems that increase your risk of having blood clots, such as an infection of the inner lining of the heart and heart valves or a type of irregular heartbeat called atrial fibrillation.
- have a problem with your blood that makes it clot more than normal.
- have high blood pressure that is not controlled with medicine or have high blood pressure with blood vessel damage.
- have diabetes and are over 35 years old; have diabetes with high blood pressure or problems with your kidneys, blood vessels, eyes, or nerves; or have had diabetes for longer than 20 years.
- have headaches with changes in vision, numbness or weakness, have migraine headaches with aura, or are over age 35 years old and have any type of migraine headaches.
- have liver disease or liver tumors.
- have or have had breast cancer or any cancer that is sensitive to the female hormones estrogen or progesterone.
- have unexplained vaginal bleeding.
- are allergic to segesterone acetate, ethinyl estradiol, or any of the ingredients in Annovera. See the end of this leaflet for a complete list of ingredients in Annovera.
- take any Hepatitis C drug combination medicine containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir. This may increase levels of the liver enzyme alanine aminotransferase (ALT) in the blood.
Before you use Annovera tell your healthcare provider if you:
- have any of the conditions listed above.
- smoke.
- are pregnant or think you are pregnant.
- recently had a baby, miscarriage, or abortion.
- have breast problems such as an abnormal mammogram or breast x-ray, breast nodules, fibrocystic breast disease, or a family history of breast cancer.
- have any medical condition, especially migraine headaches, depression, seizures, diabetes, high blood pressure, high cholesterol or triglycerides, gallblalier disease, liver disease, heart disease, or kidney disease.
- have a family history of blood clots or stroke.
- have yellowing of the skin or eyes (jaundice).
- have a condition that makes your vagina become irritated easily.
- have a history of toxic shock syndrome.
- had gallblalier problems when you were pregnant.
- are scheduled for surgery. The hormones in Annovera may increase your risk of blood clots after surgery. You should stop using Annovera at least 4 weeks before you have surgery and not restart until at least 2 weeks after your surgery.
- are scheduled for any laboratory tests. Certain blood tests may be affected by hormonal birth control methods.
- are breastfeeding or plan to breastfeed. You should not use Annovera if you are breastfeeding. The hormones in Annovera may decrease your milk production. The hormones in Annovera pass into your breast milk. Talk with your healthcare provider about the best birth control method for you while breastfeeding.
Tell your healthcare provider about all medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
Some medicines, vitamins, and herbal supplements make hormonal contraception less effective, such as:
- anti-seizure medicines
- medicine used to treat fungal infections
- combinations of HIV medicines
- Hepatitis C (HCV) medicines
- non-nucleoside reverse transcriptase inhibitors
- medicine to treat tuberculosis
- medicine to treat high blood pressure in the vessels of the lung
- medicine to treat chemotherapy-induced nausea and vomiting
- St. John's wort
Talk to your healthcare provider if you take any of the medicines listed above to see if the specific medicine you take may make hormonal contraceptives less effective. Use a back-up or another birth control method when you take medicine that may make hormonal contraceptives less effective and for 28 days after stopping the medicine.
Do not use any vaginal products such as oil-based suppositories, oil-based creams, or oil-based gels while the vaginal system is in your vagina. Do not use any vaginal lubricants that have silicone or oil in them. Water-based lubricants are ok to use. Be sure to read the ingredients on the label carefully before you buy a vaginal lubricant.
Some medicines and grapefruit juice may increase the level of ethinyl estradiol in your blood if used together, including:
- the pain reliever acetaminophen
- ascorbic acid (vitamin C)
- types of medicines used to treat fungal infections
- HIV medicines
- non-nucleoside reverse transcriptase inhibitors
- medicines to lower cholesterol
Annovera may affect the way that lamotrigine (a medicine used to treat seizures) works and may increase the risk of seizures. Your healthcare provider may need to adjust your dose of lamotrigine.
Females who take thyroid hormone replacement medicine or corticosteroid replacement medicine may need increased doses of their thyroid hormone or cortisol medicines.
Ask your healthcare provider if you are not sure if you take any of the medicines listed above.
Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine. Talk to your healthcare provider before you start taking a new medicine.
Annovera is a hormonal birth control method that is used for 3 out of 4 weeks every month. The same vaginal system is reusable for up to 1 full year (1 year includes 13 cycles; each cycle is 28 days).
- Read the Instructions for Use at the end of this Patient Information that comes with Annovera for information about the right way to insert, remove, clean, store, and dispose of (throw away) Annovera.
- Use Annovera exactly as your healthcare provider tells you to use it.
Annovera can cause serious side effects, including:
- See: “What is the most important information I should know about Annovera?”
- blood clots. Like pregnancy, hormonal contraceptives increase the risk of serious blood clots, especially in women who have other risk factors, such as smoking, obesity, or age greater than 35. This increased risk is highest when you first start taking hormonal contraceptives and when you restart the same or different hormonal contraceptive after not using it for 4 weeks or more.
  It is possible to die or be permanently disabled from a problem caused by a blood clot, such as a heart attack or a stroke.Some examples of serious blood clots are blood clots in the:
  legs (deep vein thrombosis)
  lungs (pulmonary embolus)
  eyes (loss of eyesight)
  heart (heart attack)
  brain (stroke)
  Call your healthcare provider or get emergency medical care right away if you have:
  leg pain that does not go away
  sulien shortness of breath
  sulien changes in vision or blindness
  severe pain or pressure in your chest
  a sulien, severe headache unlike your usual headaches
  weakness or numbness in an arm or leg
  trouble speaking
- toxic shock syndrome (TSS). Some symptoms of TSS are the same as flu symptoms, but they can become serious very quickly. Call your healthcare provider or get emergency medical care right away if you have the following symptoms:
  sulien high fever
  vomiting
  diarrhea
  fainting or feeling faint when standing up
  a sunburn-like rash
  muscle aches
  dizziness
- liver problems, including liver tumors. Tell your healthcare provider right away if you have yellowing of your skin or eyes (jaundice).
- high blood pressure.
- gallblalier problems or worsening of a gallblalier problem you already have. You may have an increased risk of gallblalier problems with the use of Annovera if you had gallblalier problems when you were pregnant.
- changes in the sugar and fat (cholesterol and triglycerides) levels in your blood.
- headache. Tell your healthcare provider if you have new headaches that keep coming back, that do not go away, or are severe. Also tell your healthcare provider if your migraine headaches happen more often or are more severe than normal.
- irregular or unusual vaginal bleeding and spotting between your menstrual periods, especially during the first month of using Annovera, or the absence of menstrual periods (amenorrhea).
- depression.
- possible cancer in your cervix.
- swelling of your skin especially around your mouth, eyes, and in your throat (angioedema). Call your healthcare provider or get emergency medical care right away if you have a swollen face, lips, mouth, tongue, or throat as this may lead to difficulty swallowing or breathing. Your risk of having angioedema is higher if you have a history of angioedema.
- dark patches of skin on your forehead, cheeks, upper lip, and chin (chloasma). Your risk of getting chloasma with the use of Annovera is higher if you had chloasma during pregnancy. Women who tend to get chloasma should avoid spending a long time in sunlight, tanning booths, and under sunlamps while using Annovera. Use sunscreen if you have to be in the sunlight.
The most common side effects of Annovera include:
- headache, including migraine
- nausea/vomiting
- vaginal yeast infection (candidiasis)
- lower/upper abdomen pain
- painful periods
- vaginal discharge
- urinary tract infection
- breast pain/tenderness
- irregular vaginal bleeding
- diarrhea
- genital itching
This is not a complete list of possible side effects. Call your healthcare provider for medical advice about side effects.
No serious problems have been reported from a hormonal contraceptive overdose.
1. ANNOVERA™ (segesterone acetate and ethinyl estradiol vaginal system) [accessed on Jan 29, 2019]
2. FDA Drug Approvals and Databases - Drug Trial Snapshot: ANNOVERA [accessed on Jan 29, 2019]
3. FDA NEWS RELEASE: FDA approves new vaginal ring for one year of birth control [accessed on Aug 13, 2018]

These FAQs provide a summary of the most important information about Segesterone and Ethinyl Estradiol Vaginal Ring. If you would like more information or have any questions, talk to your healthcare provider.

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