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This document provides essential safety and warning information for the use of NuvaRing (etonogestrel / ethinyl estradiol), a form of combined hormonal birth control. Please review the details below carefully and discuss any concerns with your healthcare provider.

• Cigarette Smoking and Heart Risks: Using NuvaRing while smoking increases the risk of serious cardiovascular events such as blood clots, heart attacks, and strokes. This risk is particularly heightened for women over the age of 35. It is advised that women in this category do not use NuvaRing. Consider alternative birth control methods and consult your healthcare provider.

• Blood Clots and Related Complications: There is a risk of blood clots associated with NuvaRing, which can lead to serious conditions such as heart attacks or strokes. This risk is elevated for those over 35 who smoke, have a personal or family history of blood clots, high blood pressure, diabetes, migraines, or have been immobile for extended periods.

• Toxic Shock Syndrome (TSS): Although rare, there have been reports of TSS in individuals using NuvaRing, especially when used concurrently with tampons. Seek immediate medical attention if you experience symptoms like flu-like signs, sunburn-like rash, muscle aches, or dizziness, as these could indicate TSS.

• Liver Concerns: NuvaRing may cause liver damage, particularly for those with a history of liver issues or when used for more than eight years. If you are taking hepatitis C medications, consult your provider, as combining these can increase liver damage risk. Discontinue use and seek medical advice if symptoms such as jaundice, abdominal pain, or dark urine occur.

• High Blood Pressure: Users may experience elevated blood pressure. Regular monitoring is recommended, and NuvaRing should be discontinued if significant blood pressure changes occur. Symptoms like vision changes, headaches, or a racing heart should prompt immediate medical evaluation.

• Vaginal Irritation: NuvaRing can cause irritation or, in rare cases, injury to the vaginal or cervical area. If you experience unusual symptoms such as itching or discharge, contact your doctor.

• Gallbladder Issues: There is a potential for new or worsening gallbladder problems. Notify your provider if you have a history of gallbladder issues and seek assistance if symptoms like jaundice or severe stomach pain arise.

• Blood Sugar and Cholesterol: NuvaRing may increase blood sugar and cholesterol levels. Those with diabetes or a history of high triglycerides should monitor their levels closely.

• Cancer Risks: There is no definitive evidence linking NuvaRing to increased cancer risk, but caution is advised for those with a history of breast or cervical cancer. Discuss risks with your healthcare provider if you have concerns.

Contraindications: Do not use NuvaRing if you have any of the following conditions, as they may exacerbate risks:

• High risk of blood clots or history of clots, stroke, or heart attack
• Women over 35 who smoke or have migraines with aura
• Uncontrolled high blood pressure or diabetes with vascular issues
• Obesity or coronary artery disease
• Certain heart rhythm issues
• Liver tumors or disease
• Current pregnancy or history of breast cancer
• Unexplained vaginal bleeding
• Taking certain hepatitis C medications

Always consult your healthcare provider to ensure NuvaRing is safe and suitable for you.

Common side effects:

• Vaginal discomfort or irritation
• Headaches
• Mood changes such as depression or mood swings
• Accidental removal or discomfort from the ring
• Nausea
• Vomiting
• Vaginal discharge
• Potential weight gain

Less common but important to monitor:

• Breast tenderness or pain
• Menstrual cramps
• Stomach pain
• Acne
• Reduced sex drive

Serious side effects:

• Symptoms of a stroke such as sudden changes in vision, speech, or balance
• Severe headaches
• Heart attack symptoms like chest or arm pain and shortness of breath
• Signs of blood clots including leg swelling or pain, sudden blindness, or unexplained shortness of breath
• Toxic shock syndrome characterized by sudden high fever, rash, muscle aches, and dizziness
• Liver or gallbladder issues such as yellowing skin or eyes, upper stomach pain, or dark urine

Interactions with high risk of serious adverse effects and should be avoided:

• Dasabuvir
• Ombitasvir
• Paritaprevir
• Ritonavir
• Tranexamic Acid

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Amifampridine
• Amobarbital
• Amoxicillin
• Carbamazepine
• Modafinil
• Griseofulvin
• Rifampin
• Rifabutin
• St. John's Wort
• Seizure medications
• HIV treatments