Insert 1 ring vaginally (prior to or on Day 5 of cycle) and leave in place for 3 weeks, then remove for 1 ring-free week; repeat; backup method (eg, condoms) recommended during first week. Switching from combination oral contraceptives: insert 1 ring any time within 7 days after last tablet and no later than the day a new cycle of pills was to start (no back-up method needed). Switching from progestin-only contraceptives: see literature.
Premenarchal: not applicable.
Hormonal vaginal contraceptive (progestin + estrogen).
See literature. Thrombophlebitis or thromboembolic disorders. Breast or other estrogen-dependent neoplasms. Undiagnosed abnormal genital bleeding. Cholestatic jaundice of pregnancy or jaundice with prior hormonal contraceptive use. Pregnancy (Cat.X).
Predisposition to vaginal irritation, ulceration, or expulsion of ring (eg, vaginal stenosis, cervical prolapse, rectoceles, cystoceles). Smokers (>15 cigarettes/day) >35 years of age: not recommended. Discontinue if jaundice, visual disturbances, migraine or other severe headaches occur. Uncontrolled hypertension. Do regular complete physical exams. Nursing mothers: not recommended.
Do not use with diaphragm (ring device may interfere with diaphragm positioning). Antagonized by hepatic enzyme inducing drugs (eg, rifampin, griseofulvin, St. John's wort, protease inhibitors), possibly others.
Vaginitis, leukorrhea, ring device related events (eg, foreign body sensation, coital problems, ring device expulsion), hypertension, nausea, vomiting, breakthrough bleeding, amenorrhea, transient delay of ovulation after discontinuation, edema, mastodynia, weight gain, headache. Increased risk of gallbladder disease, thromboembolic events. See literature.