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Brand Names:

Contraindications:

Uses:

• Your doctor will tell you how much of this medicine to use and how often. Do not use more medicine or use it more often than your doctor tells you to.
• This medicine is contained in a ring that you or your health caregiver will put into your vagina. The ring will slowly release small amounts of medicine for your body to absorb. Your health caregiver will show you how to insert the ring.
• This medicine comes with patient instructions. Read and follow these instructions carefully. Ask your doctor or pharmacist if you have any questions.
• Wash your hands with soap and water before and after inserting the ring.
• Leave the ring in its sealed wrapper until you are ready to use it.
• Once the ring is in place in your vagina, you should not be able to feel the ring. If you feel uncomfortable, the ring may not be pushed in far enough. Gently push the ring farther into your vagina. If you feel pain, talk to your doctor.
• You will leave the ring in for 90 days (3 months), unless your doctor tells you a different schedule. After that time, remove the ring and insert a new one. If you forget to remove the ring after 90 days, call your doctor for instructions.
• The ring may move down into the lower part of your vagina accidently. One thing that could make this happen is straining to have a bowel movement. Use your finger to gently push the ring back into place. If the ring comes all the way out of your vagina, rinse it off with warm water and put it back in. Call your doctor if the ring comes out several times.
• If you need to remove the ring, hook your finger through the ring and pull it out.

Storage:

• Store the unopened packages of this medicine at room temperature, away from heat, moisture, and direct light.
• Wrap any used ring in tissue and throw it away where children and pets cannot get to it. Do not flush the ring down the toilet.
• Keep all medicine away from children and never share your medicine with anyone.

Special precautions:

• Make sure your doctor knows if you are also using a blood thinner such as warfarin (Coumadin®), St. John's wort, phenobarbital, carbamazepine (Tegretol®), rifampin (Rifadin®, Rifater®), erythromycin (E.E.S.®, Ery-tab®), clarithromycin (Biaxin®), itraconazole (Sporanox®), ketoconazole (Nizoral®), ritonavir (Kaletra®, Norvir®), or thyroid medicine (levothyroxine, Synthroid®).
• Do not eat grapefruit or drink grapefruit juice while you are using this medicine.
• Ask your doctor before using any other products or medicines in your vagina. You might need to remove the ring when using other vaginal products.

Warnings:

• Using this medicine while you are pregnant can harm your unborn baby. If it is possible for you to become pregnant, use an effective form of birth control. If you think you have become pregnant while using the medicine, tell your doctor right away.
• Make sure your doctor knows if you have gallbladder disease, diabetes, kidney disease, liver disease, endometriosis, asthma, epilepsy, migraine headaches, porphyria, or history of cancer. Your doctor needs to know about any problems with your heart or blood, such as heart disease, blood clotting problems, or high blood pressure. Make sure your doctor knows if you have high blood cholesterol or a family history of high cholesterol. Tell your doctor if you have ever had liver problems caused by pregnancy or estrogen.
• Tell your doctor about any problems with your vagina, such as having an unusually shaped or narrow vagina. Tell your doctor if you have other medical conditions that are in the pelvic area. This includes problems with your reproductive organs, bladder, or rectum.
• Very rarely, this medicine can cause serious side effects such as heart attack or stroke. You are much more likely to have these side effects if you smoke cigarettes or are overweight, or if you have diabetes, high blood pressure, or high blood cholesterol. Talk with your doctor if you think you might be at risk.
• Using large doses of estrogen over a long period of time may increase your risk of some kinds of cancer. Talk with your doctor about this risk. If you still have your uterus (womb), ask your doctor if you should also use a progestin medicine.
• Make sure any doctor or dentist who treats you knows that you are using this medicine. This medicine may affect the results of certain medical tests. Also, you may need to stop using this medicine for a few weeks before and after having surgery, or if you are inactive for a period of time.
• Your doctor will need to check your progress at regular visits while you are using this medicine. These check-ups are usually every 6 months to 1 year. Be sure to keep all appointments.

Side Effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing.
• Breast lump.
• Chest pain, coughing up blood, sudden trouble breathing.
• Numbness or weakness in your arm or leg, or on one side of your body.
• Pain in your lower leg (calf).
• Redness, pain, burning, or itching in or near your vagina.
• Skin or eyes turn yellow.
• Sudden or severe headache, problems with speech or walking.
• Sudden or severe pain, swelling, or tenderness in or near your stomach.
• Swelling in your hands, ankles, or feet.
• Unusual or unexpected vaginal bleeding or heavy bleeding.
• Vision problems or changes, or bulging eyeballs.
• Light, irregular vaginal bleeding or spotting.
• Nausea, diarrhea, mild cramps, bloated feeling.
• Swollen or tender breasts.
• Trouble wearing contact lenses.