Patient Information. NuvaRing (NEW-vah-ring) (etonogestrel/ethinyl estradiol vaginal ring)

Transcription

1 Patient Infrmatin NuvaRing (NEW-vah-ring) (etngestrel/ethinyl estradil vaginal ring) What is the mst imprtant infrmatin I shuld knw abut NuvaRing? D nt use NuvaRing if yu smke cigarettes and are ver 35 years ld. Smking increases yur risk f serius cardivascular side effects (heart and bld vessel prblems) frm cmbinatin hrmnal cntraceptives (CHCs), including death frm heart attack, bld clts r strke. This risk increases with age and the number f cigarettes yu smke. Hrmnal birth cntrl methds help t lwer the chances f becming pregnant. They d nt prtect against HIV infectin (AIDS) and ther sexually transmitted infectins. What is NuvaRing? NuvaRing (NEW-vah-ring) is a flexible birth cntrl vaginal ring used t prevent pregnancy. NuvaRing cntains a cmbinatin f a prgestin and estrgen, 2 kinds f female hrmnes. Birth cntrl methds that cntain bth an estrgen and a prgestin are called cmbinatin hrmnal cntraceptives (CHCs). Hw well des NuvaRing wrk? Yur chance f getting pregnant depends n hw well yu fllw the directins fr using NuvaRing. The better yu fllw the directins, the less chance yu have f getting pregnant. Based n the results f a US clinical study, apprximately 1 t 3 wmen ut f 100 wmen may get pregnant during the first year they use NuvaRing. The fllwing chart shws the chance f getting pregnant fr wmen wh use different methds f birth cntrl. Each bx n the chart cntains a list f birth cntrl methds that are similar in effectiveness. The mst effective methds are at the tp f the chart. The bx n the bttm f the chart shws the chance f getting pregnant fr wmen wh d nt use birth cntrl and are trying t get pregnant. 1

2 Wh shuld nt use NuvaRing? D nt use NuvaRing if yu: smke and are ver 35 years ld have r have had bld clts in yur arms, legs, eyes r lungs have an inherited prblem with yur bld that makes it clt mre than 2

3 nrmal have had a strke have had a heart attack have certain heart valve prblems r heart rhythm prblems that can cause bld clts t frm in the heart have high bld pressure that medicine can't cntrl have diabetes with kidney, eye, nerve, r bld vessel damage have certain kinds f severe migraine headaches with aura, numbness, weakness, r changes in visin, r have any migraine headaches if yu are ver age 35 have liver disease, including liver tumrs have unexplained vaginal bleeding are pregnant r think yu may be pregnant. NuvaRing is nt fr pregnant wmen. have r have had breast cancer r any cancer that is sensitive t female hrmnes are allergic t etngestrel, ethinyl estradil r any f the ingredients in NuvaRing. See the list f ingredients in NuvaRing at the end f this leaflet. Hrmnal birth cntrl methds may nt be a gd chice fr yu if yu have ever had jaundice (yellwing f the skin r eyes) caused by pregnancy r related t previus use f hrmnal birth cntrl. Tell yur healthcare prvider if yu have ever had any f the cnditins listed abve. Yur healthcare prvider can suggest anther methd f birth cntrl. What shuld I tell my healthcare prvider befre using NuvaRing? Befre yu use NuvaRing tell yur healthcare prvider if yu: have any medical cnditins smke are pregnant r think yu are pregnant recently had a baby recently had a miscarriage r abrtin have a family histry f breast cancer have r have had breast ndules, fibrcystic disease, an abnrmal breast x- ray, r abnrmal mammgram use tampns and have a histry f txic shck syndrme have been diagnsed with depressin have had liver prblems including jaundice during pregnancy 3

4 have r have had elevated chlesterl r triglycerides have r have had gallbladder, liver, heart, r kidney disease have diabetes have a histry f jaundice (yellwing f the skin r eyes) caused by pregnancy (als called chlestasis f pregnancy) have a histry f scanty r irregular menstrual perids have any cnditin that makes the vagina becme irritated easily have r have had high bld pressure have r have had migraines r ther headaches r seizures are scheduled fr surgery. NuvaRing may increase yur risk f bld clts after surgery. Yu shuld stp using NuvaRing at least 4 weeks befre yu have surgery and nt restart it until at least 2 weeks after yur surgery. are scheduled fr any labratry tests. Certain bld tests may be affected by hrmnal birth cntrl methds. are breastfeeding r plan t breastfeed. Hrmnal birth cntrl methds that cntain estrgen, like NuvaRing, may decrease the amunt f milk yu make. A small amunt f hrmnes frm NuvaRing may pass int yur breast milk. Cnsider anther nn-hrmnal methd f birth cntrl until yu are ready t stp breastfeeding. Tell yur healthcare prvider abut all medicines and herbal prducts yu take, including prescriptin and ver-the-cunter medicines, vitamins and herbal supplements. Sme medicines and herbal prducts may make hrmnal birth cntrl less effective, including, but nt limited t: certain anti-seizure medicines (such as barbiturates, carbamazepine, felbamate, xcarbazepine, phenytin, rufinamide, tpiramate) medicine t treat fungal infectins (grisefulvin) certain cmbinatins f HIV medicines, (such as nelfinavir, ritnavir, darunavir/ritnavir, (fs)amprenavir/ritnavir, lpinavir/ritnavir, and tipranavir/ritnavir) certain hepatitis C (HCV) medicines (such as bceprevir, telaprevir) nn-nucleside reverse transcriptase inhibitrs (such as nevirapine) medicine t treat tuberculsis (such as rifampicin and rifabutin) medicine t treat high bld pressure in the vessels f the lung (bsentan) medicine t treat chemtherapy-induced nausea and vmiting (aprepitant) St Jhn s wrt 4

5 Use an additinal birth cntrl methd (such as a male cndm with spermicide) when yu take medicines that may make NuvaRing less effective. Cntinue back-up birth cntrl fr 28 days after stpping the medicine t help prevent yu frm becming pregnant. Sme medicines and grapefruit juice may increase the level f ethinyl estradil in yur bld if used tgether, including: the pain reliever acetaminphen ascrbic acid (vitamin C) medicines that affect hw yur liver breaks dwn ther medicines (such as itracnazle, ketcnazle, vricnazle, and flucnazle) certain HIV medicines (atazanavir/ritnavir, indinavir) nn-nucleside reverse transcriptase inhibitrs (such as etravirine) medicines t lwer chlesterl such as atrvastatin and rsuvastatin Hrmnal birth cntrl methds may interact with lamtrigine, a medicine used fr seizures. This may increase the risk f seizures, s yur healthcare prvider may need t adjust yur dse f lamtrigine. Wmen n thyrid replacement therapy may need increased dses f thyrid hrmne. Ask yur healthcare prvider if yu are nt sure if yu take any f the medicines listed abve. Knw the medicines yu take. Keep a list f them t shw yur dctr and pharmacist when yu get a new medicine. Hw shuld I use NuvaRing? Read the Instructins fr Use at the end f this Patient Infrmatin that cmes with yur NuvaRing fr infrmatin abut the right way t use NuvaRing. Use NuvaRing exactly as yur healthcare prvider tells yu t use it. NuvaRing is used in a 4 week cycle. Insert 1 NuvaRing in the vagina and keep it in place fr 3 weeks (21 days). Remve the NuvaRing fr a 1 week break (7 days). During the 1-week break (7 days), yu will usually have yur menstrual perid. Nte: Insert and remve NuvaRing n the same day f the week and at the same time: Fr example, if yu insert yur NuvaRing n a Mnday at 8:00 am, yu shuld remve it n the Mnday 3 weeks later at 8:00 am. After yur 1 week (7 days) break, yu shuld insert a new NuvaRing n the next Mnday at 8:00 am. 5

6 While using NuvaRing, yu shuld nt use a vaginal diaphragm as yur back-up methd f birth cntrl because NuvaRing may interfere with the crrect placement and psitin f a diaphragm. Use f spermicides r vaginal yeast prducts will nt make NuvaRing less effective at preventing pregnancy. Use f tampns will nt make NuvaRing less effective r stp NuvaRing frm wrking. If NuvaRing has been left inside yur vagina fr mre than 4 weeks (28 days), yu may nt be prtected frm pregnancy and yu shuld see yur healthcare prvider t be sure yu are nt pregnant. Until yu knw the results f yur pregnancy test, yu shuld use an extra methd f birth cntrl, such as male cndms with spermicide, until the new NuvaRing has been in place fr 7 days in a rw. D nt use mre than 1 NuvaRing at a time. T much hrmnal birth cntrl medicine in yur bdy may cause nausea, vmiting, r vaginal bleeding. Yur healthcare prvider shuld examine yu at least 1 time a year t see if yu have any signs f side effects frm using NuvaRing. What are the pssible side effects f using NuvaRing? See What is the mst imprtant infrmatin I shuld knw abut NuvaRing? NuvaRing may cause serius side effects, including: bld clts. Like pregnancy, cmbinatin hrmnal birth cntrl methds increase the risk f serius bld clts (see fllwing graph), especially in wmen wh have ther risk factrs, such as smking, besity, r age greater than 35. This increased risk is highest when yu first start using a cmbinatin hrmnal birth cntrl methd r when yu restart the same r different cmbinatin hrmnal birth cntrl methd after nt using it fr a mnth r mre. Talk with yur healthcare prvider abut yur risk f getting a bld clt befre using NuvaRing r befre deciding which type f birth cntrl is right fr yu. In sme studies f wmen wh used NuvaRing, the risk f getting a bld clt was similar t the risk in wmen wh used cmbinatin birth cntrl pills. Other studies have reprted that the risk f bld clts was higher fr wmen wh use cmbinatin birth cntrl pills cntaining desgestrel (a prgestin similar t the prgestin in NuvaRing) than fr wmen wh use cmbinatin birth cntrl pills that d nt cntain desgestrel. It is pssible t die r be permanently disabled frm a prblem caused by a bld clt, such as heart attack r strke. Sme examples f serius bld clts are bld clts in the: legs (deep vein thrmbsis) lungs (pulmnary emblus) 6

7 eyes (lss f eyesight) heart (heart attack) brain (strke) T put the risk f develping a bld clt int perspective: If 10,000 wmen wh are nt pregnant and d nt use hrmnal birth cntrl are fllwed fr ne year, between 1 and 5 f these wmen will develp a bld clt. The figure belw shws the likelihd f develping a serius bld clt fr wmen wh are nt pregnant and d nt use hrmnal birth cntrl, fr wmen wh use hrmnal birth cntrl, fr pregnant wmen, and fr wmen in the first 12 weeks after delivering a baby. Likelihd f Develping a Serius Bld Clt (Venus Thrmbemblism [VTE]) *CHC=cmbinatin hrmnal cntraceptin **Pregnancy data based n actual duratin f pregnancy in the reference studies. Based n a mdel assumptin that pregnancy duratin is nine mnths, the rate is 7 t 27 per 10,000 WY. Call yur healthcare prvider right away if yu have: leg pain that des nt g away sudden shrtness f breath sudden blindness, partial r cmplete severe pain r pressure in yur chest sudden, severe headache unlike yur usual headaches 7

8 weakness r numbness in an arm r leg, r truble speaking yellwing f the skin r eyeballs Other serius risks include: Txic Shck Syndrme (TSS). Sme f the symptms are much the same as the flu, but they can becme serius very quickly. Call yur healthcare prvider r get emergency treatment right away if yu have the fllwing symptms: sudden high fever muscle aches vmiting dizziness diarrhea fainting r feeling faint when a sunburn-like rash standing up liver prblems, including liver tumrs high bld pressure gallbladder prblems accidental insertin int bladder symptms f a prblem called angiedema if yu already have a family histry f angiedema The mst cmmn side effects f NuvaRing are: tissue irritatin inside yur vagina r n yur cervix headache (including migraine) md changes (including depressin, especially if yu had depressin in the past). Call yur healthcare prvider immediately if yu have any thughts f harming yurself. NuvaRing prblems, including the ring slipping ut r causing discmfrt nausea and vmiting vaginal discharge weight gain vaginal discmfrt breast pain, discmfrt, r tenderness painful menstrual perids abdminal pain acne less sexual desire Sme wmen have sptting r light bleeding during NuvaRing use. If these symptms ccur, d nt stp using NuvaRing. The prblem will usually g away. If it desn t g away, check with yur healthcare prvider. 8

9 Other side effects seen with NuvaRing include allergic reactin, hives, breast discharge, and penis discmfrt f the partner (such as irritatin, rash, itching). Less cmmn side effects seen with cmbinatin hrmnal birth cntrl include: Bltchy darkening f yur skin, especially n yur face High bld sugar, especially in wmen wh already have diabetes High fat (chlesterl, triglycerides) levels in the bld Tell yur healthcare prvider abut any side effect that bthers yu r that des nt g away. These are nt all the pssible side effects f NuvaRing. Fr mre infrmatin, ask yur healthcare prvider r pharmacist. Call yur healthcare prvider fr medical advice abut side effects. Yu may reprt side effects t FDA at FDA Hw shuld I stre NuvaRing and thrw away used NuvaRings? Stre NuvaRing at rm temperature between 68 F t 77 F (20 C t 25 C). Stre NuvaRing at rm temperature fr up t 4 mnths after yu receive it. Thrw NuvaRing away if the expiratin date n the label has passed. D nt stre NuvaRing abve 86 F (30 C). Avid direct sunlight Place the used NuvaRing in the re-clsable fil puch and prperly thrw it away in yur husehld trash ut f the reach f children and pets. D nt flush yur used NuvaRing dwn the tilet. Keep NuvaRing and all medicines ut f the reach f children. General infrmatin abut the safe and effective use f NuvaRing Medicines are smetimes prescribed fr purpses ther than thse listed in the Patient Infrmatin. D nt use NuvaRing fr a cnditin fr which it was nt prescribed. D nt give NuvaRing t ther peple. It may harm them. This leaflet summarizes the mst imprtant infrmatin abut NuvaRing. If yu wuld like mre infrmatin, talk with yur healthcare prvider. Yu can ask yur pharmacist r healthcare prvider fr infrmatin abut NuvaRing that is written fr health prfessinals. Fr mre infrmatin, g t r call NUVARING ( ). What are the ingredients in NuvaRing? Active ingredients: etngestrel and ethinyl estradil Inactive ingredients: ethylene vinylacetate cplymers (28% and 9% vinylacetate) and magnesium stearate. 9

10 NuvaRing is nt made with natural rubber latex. D Hrmnal Birth Cntrl Methds Cause Cancer? Hrmnal birth cntrl methds d nt seem t cause breast cancer. Hwever, if yu have breast cancer nw r have had it in the past, d nt use hrmnal birth cntrl, including NuvaRing, because sme breast cancers are sensitive t hrmnes. Wmen wh use hrmnal birth cntrl methds may have a slightly higher chance f getting cervical cancer. Hwever, this may be due t ther reasns such as having mre sexual partners. What shuld I knw abut my perid when using NuvaRing? When yu use NuvaRing yu may have bleeding and sptting between perids, called unplanned bleeding. Unplanned bleeding may vary frm slight staining between menstrual perids t breakthrugh bleeding, which is a flw much like a regular perid. Unplanned bleeding ccurs mst ften during the first few mnths f NuvaRing use, but may als ccur after yu have been using NuvaRing fr sme time. Such bleeding may be temprary and usually des nt indicate any serius prblems. It is imprtant t cntinue using the ring n schedule. If the unplanned bleeding r sptting is heavy r lasts fr mre than a few days, yu shuld discuss this with yur healthcare prvider. What if I miss my regular scheduled perid when using NuvaRing? Sme wmen miss perids n hrmnal birth cntrl, even when they are nt pregnant. Cnsider the pssibility that yu may be pregnant if: 1. yu miss a perid and NuvaRing was ut f the vagina fr mre than 3 hurs during the 3 weeks (21 days) f ring use 2. yu miss a perid and waited lnger than 1 week t insert a new ring 3. yu have fllwed the instructins and yu miss 2 perids in a rw 4. yu have left NuvaRing in place fr lnger than 4 weeks (28 days) What if I want t becme pregnant? Yu may stp using NuvaRing whenever yu wish. Cnsider a visit with yur healthcare prvider fr a pre-pregnancy checkup befre yu stp using NuvaRing. 10

11 Instructins fr Use NuvaRing (NEW-vah-ring) (etngestrel/ethinyl estradil vaginal ring) Read these Instructins fr Use befre yu start using NuvaRing and each time yu get a refill. There may be new infrmatin. This infrmatin des nt take the place f talking t yur healthcare prvider abut yur treatment. Hw shuld I start using NuvaRing? If yu are nt currently using hrmnal birth cntrl, yu have 2 ways t start using NuvaRing. Chse the best way fr yu: First Day Start: Insert NuvaRing n the first day f yur menstrual perid. Yu will nt need t use anther birth cntrl methd since yu are using NuvaRing n the first day f yur menstrual perid. Day 2 t Day 5 Cycle Start: Yu may chse t start NuvaRing n days 2 t 5 f yur menstrual perid. Make sure yu als use an extra methd f birth cntrl (barrier methd), such as male cndms with spermicide fr the first 7 days f NuvaRing use in the first cycle. If yu are changing frm a birth cntrl pill r patch t NuvaRing: If yu have been using yur birth cntrl methd crrectly and are certain that yu are nt pregnant, yu can change t NuvaRing any day. D nt start NuvaRing any later than the day yu wuld start yur next birth cntrl pill r apply yur patch. If yu are changing frm a prgestin-nly birth cntrl methd, such as a minipill, implant r injectin r frm an intrauterine system (IUS): Yu may switch frm a minipill n any day. Start using NuvaRing n the day that yu wuld have taken yur next minipill. Yu shuld switch frm an implant r the IUS and start using NuvaRing n the day that yu remve the implant r IUS Yu shuld switch frm an injectable and start using NuvaRing n the day when yur next injectin wuld be due. If yu are changing frm a minipill, implant r injectin r frm an intrauterine system (IUS), yu shuld use an extra methd f birth cntrl, such as a male cndm with spermicide during the first 7 days f using NuvaRing. 11

12 If yu start using NuvaRing after an abrtin r miscarriage: Fllwing a first trimester abrtin r miscarriage: Yu may start NuvaRing within 5 days fllwing a first trimester abrtin r miscarriage (the first 12 weeks f pregnancy). Yu d nt need t use an additinal birth cntrl methd. If yu d nt start NuvaRing within 5 days after a first trimester abrtin r miscarriage, use a nn-hrmnal birth cntrl methd, such as male cndms and spermicide, while yu wait fr yur perid t start. Begin NuvaRing at the time f yur next menstrual perid. Cunt the first day f yur menstrual perid as Day 1 and start NuvaRing ne f the fllwing 2 ways belw. First Day Start: Insert NuvaRing n the first day f yur menstrual perid. Yu will nt need t use anther birth cntrl methd since yu are using NuvaRing n the first day f yur menstrual perid. Day 2 t Day 5 Cycle Start: Yu may chse t start NuvaRing n Days 2 t 5 f yur menstrual perid. Make sure yu als use an extra methd f birth cntrl (barrier methd), such as male cndms with spermicide fr the first 7 days f NuvaRing use in the first cycle. Fllwing a secnd trimester abrtin r miscarriage: Yu may start using NuvaRing n sner than 4 weeks (28 days) after a secnd trimester abrtin (after the first 12 weeks f pregnancy). If yu are starting NuvaRing after childbirth: Yu may start using NuvaRing n sner than 4 weeks (28 days) after having a baby if yu are nt breastfeeding. If yu have nt gtten yur menstrual perid after childbirth, yu shuld talk t yur healthcare prvider. Yu may need a pregnancy test t make sure yu are nt pregnant befre yu start using NuvaRing. Use anther birth cntrl methd such as male cndms with spermicide fr the first 7 days in additin t NuvaRing. If yu are breastfeeding yu shuld nt use NuvaRing. Use ther birth cntrl methds until yu are n lnger breastfeeding. Step 1. Chse a psitin fr insertin f NuvaRing. Chse the psitin that is cmfrtable fr yu. Fr example, lying dwn, squatting, r standing with 1 leg up (See Figures A, B, and C). 12

13 Psitins fr NuvaRing insertin Figure A Figure B Figure C Step 2. Open the puch t remve yur NuvaRing. Each NuvaRing cmes in a re-sealable fil puch. Wash and dry yur hands befre remving NuvaRing frm the fil puch. Open the fil puch at either ntch near the tp. Keep the fil puch s yu can place yur used NuvaRing in it befre yu thrw it away in yur husehld trash. Step 3. Prepare NuvaRing fr insertin. Hld NuvaRing between yur thumb and index finger and press the sides f the ring tgether (See Figures D and E). Figure D Figure E 13

14 Step 4. Insert NuvaRing int yur vagina. Insert the flded NuvaRing int yur vagina and gently push it further up int yur vagina using yur index finger (See Figure F and G). When yu insert NuvaRing it may be in different psitins in yur vagina, but NuvaRing des nt have t be in an exact psitin fr it t wrk (See Figure H and I). NuvaRing may mve arund slightly within yur vagina. This is nrmal. Althugh sme wmen may be aware f NuvaRing in the vagina, mst wmen d nt feel it when it is in place. Figure F Figure G Figure H Figure I Inserting NuvaRing (Figure F, Figure G) and psitining NuvaRing (Figure H, Figure I) Nte: If the NuvaRing feels uncmfrtable, yu may nt have pushed the ring int yur vagina far enugh. Use yur finger t gently push the NuvaRing as far as yu can int yur vagina. There is n danger f NuvaRing being pushed t far up in the vagina r getting lst (See Figure G). Sme wmen have accidently inserted NuvaRing int their bladder. If yu have pain during r after insertin and yu cannt find NuvaRing 14

15 in yur vagina, call yur healthcare prvider right away. Step 5. Hw d I remve NuvaRing? Wash and dry yur hands. Chse the psitin that is mst cmfrtable fr yu (See Figures A, B, and C). Put yur index finger int yur vagina and hk it thrugh the NuvaRing. Gently pull dwnward and frward t remve the NuvaRing and pull it ut (See Figure J). Figure J Step 6. Thrw away the used NuvaRing. Place the used NuvaRing in the re-sealable fil puch and put it in a trash can ut f the reach f children and pets. D nt thrw NuvaRing in the tilet. What else shuld I knw abut using NuvaRing? What If I leave NuvaRing in t lng? If yu leave NuvaRing in yur vagina fr up t 4 weeks (28 days) yu will still be getting pregnancy prtectin. Remve yur ld NuvaRing fr 1 week (7 days) and insert a new NuvaRing 1 week (7 days) later (See Steps 1 thrugh 4). If yu leave NuvaRing in yur vagina lnger than 4 weeks (28 days), remve the ring and check t make sure yu are nt pregnant. If yu are nt pregnant, insert a new NuvaRing (See Steps 1 thrugh 4). Yu must use anther birth cntrl methd, such as male cndms with spermicide, until the new NuvaRing has been used fr 7 days in a rw. What shuld I d if my NuvaRing cmes ut f my vagina? NuvaRing can slip r accidentally cme ut (expelled) f yur vagina, fr example, during sexual intercurse, bwel mvements, use f tampns, r if it breaks. 15

16 NuvaRing may break causing the ring t lse its shape. If the ring stays in yur vagina this shuld nt lwer NuvaRing s effectiveness at preventing pregnancy. If NuvaRing breaks and slips ut f yur vagina, thrw the brken ring in yur husehld trash ut f the reach f children and pets. Insert a new NuvaRing (See Steps 1 thrugh 4). Yu shuld pay attentin when remving a tampn t be sure that yur NuvaRing is nt accidentally pulled ut. Be sure t insert NuvaRing befre inserting a tampn. If yu accidentally pull ut yur NuvaRing while using tampns, rinse yur NuvaRing in cl t lukewarm (nt ht) water and insert it again right away. NuvaRing can be pushed ut f (expelled frm) yur vagina, fr example, during sexual intercurse r during a bwel mvement. If the expelled ring has been ut f yur vagina fr less than 3 hurs, rinse the expelled NuvaRing in cl t lukewarm (nt ht) water and insert it again right away. If the expelled NuvaRing has been ut f yur vagina fr mre than 3 cntinuus hurs: During Weeks 1 and 2, yu may nt be prtected frm pregnancy. Reinsert the ring as sn as yu remember (See Steps 1 thrugh 4). Use anther birth cntrl methd, such as male cndms with spermicide, until the ring has been in place fr 7 days in a rw. During Week 3, d nt reinsert the NuvaRing that has been ut f yur vagina; but thrw it away in yur husehld trash away frm children and pets. Use anther birth cntrl methd, such as male cndms with spermicide, until the new NuvaRing has been used fr 7 days in a rw, fllwing ne f the tw ptins belw: - Optin 1. Insert a new ring right away t start yur next 21 Day NuvaRing use cycle. Yu may nt have yur regular perid but yu may have sptting r vaginal bleeding. - Optin 2. Insert a new ring n later than 7 days frm the time the previus ring was remved r expelled. During this time, yu may have yur perid. Nte: Yu shuld nly chse t d ptin 2 if yu used NuvaRing fr 7 days in a rw, prir t the day that yur previus NuvaRing was accidently remved r expelled. 16

17 This Patient Infrmatin and Instructins fr Use have been apprved by the U.S. Fd and Drug Administratin. Manufactured by: N.V. Organn, Oss, The Netherlands, a subsidiary f Merck & C., Inc., Whitehuse Statin, NJ 08889, USA Fr patent infrmatin: Cpyright Merck Sharp & Dhme B.V., a subsidiary f Merck & C., Inc. All rights reserved. Revised: 10/2014 usppi-mk8342a-rng-1410r006 17