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Etonogestrel-Ethinyl Estradiol
Etonogestrel-Ethinyl Estradiol is a combination hormonal contraceptive used to prevent pregnancy. It is available as a vaginal ring and contains etonogestrel (a progestin) and ethinyl estradiol (an estrogen). This combination works by preventing ovulation, thickening cervical mucus to block sperm from reaching the egg, and changing the uterine lining to prevent implantation. The vaginal ring offers a once-monthly contraceptive option, providing continuous hormone release over 21 days.
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Frequently Asked Questions
How long does it take for the Etonogestrel-Ethinyl Estradiol vaginal ring to work?
If inserted on the first day of your period, the ring is effective immediately. If inserted at any other time during your cycle, use a backup form of contraception (e.g., condoms) for the first 7 days.
Can I remove the ring during intercourse?
Yes, you can remove the ring for up to 3 hours during intercourse. Afterward, rinse it with lukewarm water and reinsert it. If the ring is out for longer than 3 hours, you may need to use backup contraception.
What should I do if the ring falls out?
If the ring falls out, rinse it with lukewarm water and reinsert it. If the ring has been out for more than 3 hours, use backup contraception for 7 days.
Can I skip the withdrawal bleeding by using the ring continuously?
Yes, you can insert a new ring immediately after removing the old one (without the 1-week break) to skip withdrawal bleeding. Speak with your healthcare provider before doing so.
Is the Etonogestrel-Ethinyl Estradiol ring safe for long-term use?
The vaginal ring can be used long-term for contraception, but regular health check-ups are recommended to monitor for any potential side effects, especially cardiovascular risks and cancer concerns.
Comprehensive Drug Guide
How Does Etonogestrel-Ethinyl Estradiol Work?
- Inhibiting ovulation: Prevents the release of an egg from the ovaries.
- Thickening cervical mucus: Makes it more difficult for sperm to travel through the cervix to fertilize an egg.
- Altering the uterine lining: Prevents a fertilized egg from attaching to the uterus.
Common Dosages
For contraception: Insert one vaginal ring into the vagina for 3 weeks. Remove the ring for a 1-week break to allow for withdrawal bleeding. After the 1-week break, insert a new ring.
Typical Dosing
FDA Approved Indications
Prevention of pregnancy.
Who Shouldn't Take Etonogestrel-Ethinyl Estradiol?
- Known hypersensitivity to etonogestrel, ethinyl estradiol, or any of the ingredients in the formulation.
- History of blood clots (deep vein thrombosis or pulmonary embolism).
- Stroke or heart attack.
- Breast cancer or other estrogen- or progestin-dependent cancers.
- Liver disease or liver tumors.
- Uncontrolled hypertension.
- Migraines with aura.
- Undiagnosed abnormal vaginal bleeding.
Advice From The Pharmacist
- Insert the ring into the vagina and leave it in place for 3 weeks. Remove the ring for 1 week to allow for withdrawal bleeding, then insert a new ring after the 1-week break.
- If the ring falls out, rinse it with lukewarm water and reinsert it as soon as possible. If the ring has been out for more than 3 hours, you may need to use backup contraception (e.g., condoms) for the next 7 days.
- Do not smoke while using this contraceptive, especially if you are over 35, as smoking increases the risk of serious cardiovascular side effects.
- The ring should not interfere with sexual activity, but it can be removed for up to 3 hours if needed and reinserted without affecting its efficacy.
- Store the ring at room temperature and avoid exposing it to extreme heat or direct sunlight.
Side Effects of Etonogestrel-Ethinyl Estradiol
Common Side Effects
- Vaginal irritation or discharge
- Nausea
- Headache
- Breast tenderness
- Weight gain
- Mood changes
Uncommon/Severe Side Effects
- Blood clots (deep vein thrombosis, pulmonary embolism)
- Stroke or heart attack
- Severe allergic reactions (hives, swelling, difficulty breathing)
- Liver problems (jaundice, dark urine, upper abdominal pain)
- Breast or cervical cancer
Risks and Warnings of Etonogestrel-Ethinyl Estradiol
- Cardiovascular Risks: The use of combination hormonal contraceptives can increase the risk of blood clots, heart attack, and stroke, especially in women who smoke and are over 35 years old.
- Cancer Risk: Long-term use of hormonal contraceptives may slightly increase the risk of breast cancer and cervical cancer. Regular monitoring and screenings are advised.
- Liver Issues: Rarely, the use of combination hormonal contraceptives can lead to liver tumors or other liver-related problems.
Interactions with Etonogestrel-Ethinyl Estradiol
Common Drug Interactions
- Antibiotics (e.g., rifampin): May reduce the effectiveness of hormonal contraceptives, increasing the risk of pregnancy.
- Anticonvulsants: Certain seizure medications can decrease the effectiveness of hormonal contraceptives.
- St. John’s Wort: Can decrease the effectiveness of Etonogestrel-Ethinyl Estradiol.
- Anticoagulants (e.g., warfarin): Hormonal contraceptives may affect blood clotting and increase the risk of bleeding.
Alternatives to Etonogestrel-Ethinyl Estradiol
- Oral contraceptives: A daily pill that contains estrogen and progestin, offering an alternative to the vaginal ring.
- Progestin-only pills: A contraceptive option for women who cannot take estrogen.
- Intrauterine devices (IUDs): Long-term contraceptive devices inserted into the uterus.
- Contraceptive implants: A small rod inserted under the skin that releases hormones to prevent pregnancy.
