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Before using this medication, it is crucial to understand various safety precautions and potential risks. Carefully review the following information and discuss any concerns with your healthcare provider.

• Smoking Risks: If you are over 35 and smoke cigarettes or use tobacco, refrain from using this medication, as it significantly increases your risk of serious heart problems, including strokes, heart attacks, and blood clots. The risk compounds with age and the number of cigarettes smoked.

• Blood Clots and Complications: Combined hormonal birth control like NuvaRing can heighten the risk of blood clots, potentially leading to severe issues such as heart attacks or strokes. This risk is elevated if you are over 35, smoke, have a history of blood clots, high blood pressure, diabetes, or if you are immobile for long periods.

• Toxic Shock Syndrome (TSS): Though rare, some users have reported TSS, especially when using tampons simultaneously. Seek emergency help if you experience flu-like symptoms, a rash, muscle aches, or dizziness.

• Liver Concerns: This medication can affect liver health. If taking hepatitis C medication, consult your provider as combined use may increase liver damage risk. Watch for symptoms like jaundice or dark urine and contact your provider if they occur.

• High Blood Pressure: Monitor your blood pressure regularly during use. If it becomes elevated or if symptoms like headaches or vision changes arise, stop using the medication and seek medical advice.

• Vaginal Irritation: Since NuvaRing is inserted vaginally, it may cause irritation or, rarely, injuries. Contact your provider if you notice itching, burning, or unusual discharge.

• Gallbladder Issues: Report any prior gallbladder problems to your provider and seek medical attention if symptoms like yellowing of the skin or severe stomach pain occur.

• High Blood Sugar and Cholesterol: If you have a history of high blood sugar or cholesterol, monitor your levels closely, as NuvaRing may exacerbate these conditions.

• Cancer Risks: There may be a slight increase in risk for breast or cervical cancer with long-term use. Discuss your risk factors with your provider, especially if you have a history of these cancers.

Contraindications:

This medication should not be used if you have any of the following:

• High risk of blood clots
• History of clots, strokes, or heart attacks
• Are over 35 and smoke or have migraines with aura
• Uncontrolled high blood pressure
• Diabetes with vascular complications
• Obesity
• Coronary artery disease
• Certain heart rhythm problems
• Liver disease or tumors
• Currently pregnant
• Current or past breast cancer
• Unexplained vaginal bleeding
• Taking specific hepatitis C drugs

Always consult your healthcare provider to ensure this medication is safe for your particular health circumstances.

When using this medication, some common side effects may occur, though they are often mild and manageable. These include vaginal discomfort or irritation, nausea, vomiting, headaches (including migraines), bloating, and mood changes such as depression or mood swings. You might also experience vaginal discharge, breast tenderness, menstrual cramps, or weight changes. Additionally, fluid retention can lead to swelling in the ankles or feet. If these symptoms persist or worsen, it is advisable to consult a healthcare provider.

More serious side effects, although rare, demand immediate medical attention. These include severe stomach or abdominal pain, unusual changes in vaginal bleeding, lumps in the breast, or significant mood changes. The medication can occasionally increase blood pressure, so regular monitoring is essential. Very rarely, the ring might accidentally move into the bladder, causing symptoms like painful urination.

Critical reactions such as blood clots, heart attacks, or strokes, though infrequent, are potentially life-threatening. Symptoms to watch for include chest or arm pain, sudden dizziness, difficulty speaking, or severe headaches. Toxic shock syndrome is another rare yet serious condition that can manifest as a high fever, rash, or muscle pain. Any signs of an allergic reaction, such as a rash, itching, or difficulty breathing, also require urgent medical care. Always stay observant of your body's reactions and seek medical advice when needed.

When using NuvaRing (etonogestrel / ethinyl estradiol), it's important to be aware of potential interactions with other medications. Some drugs that might interact with NuvaRing include aromatase inhibitors like Anastrozole and Exemestane, as well as fezolinetant, ospemifene, Tamoxifen, Tizanidine, and Tranexamic Acid. Additionally, certain medications can reduce the effectiveness of hormonal birth control by decreasing hormone levels in the body, potentially leading to pregnancy. These medications include griseofulvin, Modafinil, various rifamycins (such as Rifampin, Rifabutin), Ritonavir, St. John's wort, and drugs used for seizures (like barbiturates, Carbamazepine, Felbamate, Phenytoin, Primidone, Topiramate), as well as some HIV medications (such as nelfinavir and Nevirapine).

It's crucial to inform your healthcare provider about all medications and supplements you're using, including those obtained over-the-counter or as dietary or herbal supplements. In some situations, your doctor may suggest non-hormonal backup birth control methods or adjust your medication dosages. Also, notify your doctor if you experience spotting or breakthrough bleeding, as these may indicate reduced birth control effectiveness.

Moreover, NuvaRing could interfere with specific lab tests, potentially leading to inaccurate results. Ensure that all healthcare providers and laboratory personnel are aware of your use of this medication.