NUVARING 0.120 mg/0.015 mg EVERY 24 HOURS, VAGINAL RELEASE SYSTEM

Introduction

Package Leaflet: Information for the User

NuvaRing 0.120 mg/0.015 mg every 24 hours, vaginal release system

etonogestrel/ethinylestradiol

Important things you should know about combined hormonal contraceptives (CHCs):

• They are one of the most reliable reversible contraceptive methods if used correctly.
• They slightly increase the risk of having a blood clot in the veins and arteries, especially in the first year or when restarting a combined hormonal contraceptive after a break of 4 weeks or more.
• Be alert and consult your doctor if you think you may have symptoms of a blood clot (see section 2 "Blood Clots").

Read the entire package leaflet carefully before starting to use NuvaRing, as it contains important information for you.

• Keep this package leaflet, as you may need to read it again.

• If you have any questions, consult your doctor or pharmacist.
• This medicine has been prescribed to you only, and you should not give it to others, as it may harm them.
• If you experience side effects, consult your doctor or pharmacist, even if they are side effects not listed in this package leaflet. See section 4.

Contents of the Package Leaflet

1. What NuvaRing is and what it is used for
2. What you need to know before you start using NuvaRing
3. How to use NuvaRing
4. Possible side effects
5. Storage of NuvaRing and the NuvaRing Applicator
6. Package contents and additional information

1. What NuvaRing is and what it is used for

NuvaRing is a vaginal contraceptive ring used to prevent pregnancy. Each ring contains a small amount of two female sex hormones, etonogestrel and ethinylestradiol. The ring slowly releases these hormones into the bloodstream. Given the small amount of hormones released, NuvaRing is a low-dose hormonal contraceptive. As NuvaRing releases two different types of hormones, it is a combined hormonal contraceptive.

NuvaRing works like the combined oral contraceptive pill (the "Pill"), but instead of taking a pill every day, the ring is used for 3 weeks in a row. NuvaRing releases two female sex hormones that prevent the ovaries from releasing an egg. If no egg is released, you cannot become pregnant.

2. What you need to know before starting to use NuvaRing

General considerations

Before starting to use NuvaRing, you should read the information about blood clots in section 2. It is particularly important that you read the symptoms of a blood clot (see section 2 "Blood clots").

In this prospectus, various situations are described in which you should stop using NuvaRing, or in which NuvaRing may be less reliable. In these situations, you should not have sexual intercourse, or you should take additional non-hormonal contraceptive measures, such as a male condom or another barrier method. Do notuse the rhythm method or the temperature method. These methods may not be reliable since NuvaRing alters the monthly temperature changes of the body and cervical mucus.

NuvaRing, like other hormonal contraceptives, does not protect against HIV infection (AIDS) or any other sexually transmitted disease.

2.1 When you should not use NuvaRing

You should not use NuvaRing if you have any of the conditions listed below. Inform your doctor if you have any of the conditions listed below. Your doctor will discuss with you what other form of contraception would be more suitable.

• If you have (or have ever had) a blood clot in a blood vessel of the legs (deep vein thrombosis, DVT), in the lungs (pulmonary embolism, PE) or in other organs.
• If you know you have a disorder that affects blood clotting: for example, protein C deficiency, protein S deficiency, antithrombin III deficiency, factor V Leiden or antiphospholipid antibodies.
• If you need an operation or if you spend a lot of time without getting up (see section "Blood clots").
• If you have ever had a heart attack or a stroke.
• If you have (or have ever had) angina pectoris (a condition that causes severe chest pain and may be the first sign of a heart attack) or a transient ischemic attack (TIA, temporary symptoms of a stroke).
• If you have any of the following diseases that may increase your risk of forming a clot in the arteries:

• Severe diabetes with blood vessel damage.
• Very high blood pressure.
• Very high levels of fat in the blood (cholesterol or triglycerides).
• A condition called hyperhomocysteinemia.
• If you have (or have ever had) a type of migraine called "migraine with aura".
• If you have or have had inflammation of the pancreas (pancreatitis), associated with high levels of fat in your blood.
• If you have or have had a severe liver disease and your liver is not functioning normally.
• If you have or have had a benign or malignant tumor in the liver.
• If you have, have had, or may have breast cancer or cancer of the genitals.
• If you have any vaginal bleeding of unknown origin.
• If you are allergic to ethinylestradiol or etonogestrel, or to any of the other components of this medicine (listed in section 6).

If any of these circumstances occur for the first time while using NuvaRing, remove the ring immediately and consult your doctor. In the meantime, use non-hormonal contraceptive measures.

Do not use NuvaRing if you have hepatitis C and are taking medications that contain ombitasvir/paritaprevir/ritonavir and dasabuvir or glecaprevir/pibrentasvir (see also section 2.4. "Other medicines and NuvaRing").

2.2 Warnings and precautions

Tell your doctor if you suffer from any of the following conditions.

If the condition develops or worsens while you are using NuvaRing, you should also inform your doctor.

• If a close relative has or has had breast cancer.
• If you suffer from epilepsy (see section 2.4. "Other medicines and NuvaRing").
• If you have a liver disease (e.g., jaundice) or a gallbladder disease (e.g., gallstones).
• If you have Crohn's disease or ulcerative colitis (chronic inflammatory bowel disease).
• If you have systemic lupus erythematosus (SLE, a disease that affects your natural defense system).

• If you have hemolytic uremic syndrome (HUS, a blood clotting disorder that causes kidney failure).
• If you have sickle cell anemia (a hereditary disease of red blood cells).
• If you have high levels of fat in the blood (hypertriglyceridemia) or a known family history of this condition. Hypertriglyceridemia has been associated with an increased risk of pancreatitis (inflammation of the pancreas).
• If you need an operation or spend a lot of time without getting up (see section 2 "Blood clots").
• If you have just given birth, you are at a higher risk of blood clots. You should ask your doctor when you can start taking NuvaRing after childbirth.
• If you have inflammation of the veins that are under the skin (superficial thrombophlebitis).
• If you have varicose veins.
• If you suffer from any disease that appeared for the first time or worsened during pregnancy or previous use of sex hormones (e.g., hearing loss, porphyria [a blood disease], pregnancy herpes [skin rash with blisters during pregnancy], or Sydenham's chorea [a nervous system disease in which involuntary movements are produced]).
• If you experience symptoms of angioedema, such as swelling of the face, tongue, and/or throat, and/or difficulty swallowing, or urticaria possibly with difficulty breathing, contact your doctor immediately. Medicines that contain estrogens can cause or worsen the symptoms of hereditary and acquired angioedema.

• If you have or have had chloasma (yellowish-brown spots on the skin, called "pregnancy spots", particularly on the face); if this is the case, avoid excessive exposure to the sun or ultraviolet rays.
• If you have disorders that make it difficult to use NuvaRing, for example, if you suffer from constipation, uterine prolapse (descent of the uterus or cervix) or feel pain during sexual intercourse.

• If you have urgent, frequent, burning, and/or painful urination, and you cannot locate the ring in the vagina. These symptoms may indicate accidental placement of NuvaRing in the urinary bladder.

BLOOD CLOTS

The use of a combined hormonal contraceptive like NuvaRing increases your risk of having a blood clot compared to not using it. In rare cases, a blood clot can block blood vessels and cause serious problems.

Blood clots can form:

• In the veins (this is called "venous thrombosis", "venous thromboembolism" or VTE).
• In the arteries (this is called "arterial thrombosis", "arterial thromboembolism" or ATE).

Recovery from blood clots is not always complete. In rare cases, there can be serious long-term effects or, very rarely, they can be fatal.

It is essential to remember that the overall risk of a harmful blood clot due to NuvaRing is small.

HOW TO RECOGNIZE A BLOOD CLOT

Seek urgent medical attention if you notice any of the following signs or symptoms.

BLOOD CLOTS IN A VEIN

What can happen if a blood clot forms in a vein?

• The use of combined hormonal contraceptives has been associated with an increased risk of blood clots in the veins (venous thrombosis). However, these side effects are rare. They occur more frequently in the first year of use of a combined hormonal contraceptive.
• If a blood clot forms in a vein in the leg or foot, it can cause deep vein thrombosis (DVT).
• If a blood clot moves from the leg and lodges in the lung, it can cause a pulmonary embolism.
• In very rare cases, a clot can form in a vein of another organ, such as the eye (retinal vein thrombosis).

When is the risk of a blood clot in a vein higher?

The risk of having a blood clot in a vein is higher during the first year you take a combined hormonal contraceptive for the first time. The risk may also be higher if you start taking a combined hormonal contraceptive (the same medicine or a different one) after an interruption of 4 weeks or more.

After the first year, the risk decreases, but it is always slightly higher than if you were not taking a combined hormonal contraceptive.

When you stop using NuvaRing, your risk of having a blood clot returns to normal within a few weeks.

What is the risk of having a blood clot?

The risk depends on your natural risk of VTE and the type of combined hormonal contraceptive you are taking.

The overall risk of having a blood clot in the leg or lung (DVT or PE) with NuvaRing is small.

• Out of 10,000 women who do not use a combined hormonal contraceptive and are not pregnant, about 2 will have a blood clot in a year.
• Out of 10,000 women who use a combined hormonal contraceptive that contains levonorgestrel, norethisterone, or norgestimate, about 5-7 will have a blood clot in a year.
• Out of 10,000 women who use a combined hormonal contraceptive that contains norelgestromin or etonogestrel, such as NuvaRing, about 6-12 will have a blood clot in a year.
• The risk of having a blood clot will depend on your personal history (see "Factors that increase your risk of a blood clot" below).

Factors that increase your risk of a blood clot in a vein

The risk of having a blood clot with NuvaRing is small, but some conditions increase the risk. Your risk is higher:

• If you are overweight (body mass index or BMI over 30 kg/m2).
• If any of your close relatives have had a blood clot in the leg, lung, or other organ at a young age (i.e., before the age of about 50). In this case, you may have a hereditary blood clotting disorder.
• If you need an operation or spend a lot of time without getting up due to an injury or illness, or if you have a leg in a cast. You may need to stop using NuvaRing several weeks before surgery or while you have reduced mobility. If you need to stop using NuvaRing, ask your doctor when you can start using it again.
• As you get older (especially above about 35 years).
• If you have had a baby less than a few weeks ago.

The risk of having a blood clot increases with the number of conditions you have.

Long-haul flights (more than 4 hours) may temporarily increase the risk of a blood clot, especially if you have any of the other risk factors listed.

It is essential to inform your doctor if you suffer from any of the above conditions, even if you are not sure. Your doctor may decide that you should stop using NuvaRing.

If any of the above conditions change while you are using NuvaRing, for example, a close relative experiences a thrombosis without a known cause, or you gain a lot of weight, inform your doctor.

BLOOD CLOTS IN AN ARTERY

What can happen if a blood clot forms in an artery?

Like a blood clot in a vein, a clot in an artery can cause serious problems. For example, it can cause a heart attack or a stroke.

Factors that increase your risk of a blood clot in an artery

It is essential to note that the risk of a heart attack or stroke due to NuvaRing is very small, but it can increase:

• With age (above about 35 years).
• If you smoke.When you use a combined hormonal contraceptive like NuvaRing, you are advised to stop smoking. If you are unable to stop smoking and are over 35 years old, your doctor may advise you to use a different type of contraceptive.
• If you are overweight.
• If you have high blood pressure.
• If any of your close relatives have had a heart attack or stroke at a young age (less than about 50 years). In this case, you may also be at higher risk of having a heart attack or stroke.
• If you or any of your close relatives have high levels of fat in the blood (cholesterol or triglycerides).
• If you suffer from migraines, especially migraines with aura.
• If you have a heart problem (valve disorder, heart rhythm disturbance called atrial fibrillation).
• If you have diabetes.

If you have one or more of these conditions or if any of them are particularly severe, the risk of having a blood clot may be increased further.

If any of the above conditions change while you are using NuvaRing, for example, you start smoking, a close relative experiences a thrombosis without a known cause, or you gain a lot of weight, inform your doctor.

Cancer

The following information has been obtained from studies with combined oral contraceptives and may be applicable to NuvaRing. There is no information available on the vaginal administration of contraceptive hormones (such as NuvaRing).

Cases of breast cancer have been observed with a slightly higher frequency in women who use oral contraceptives, but it is not known if this is due to the treatment. For example, it may be that more tumors are found in women who use oral contraceptives because they have more frequent medical check-ups. This increased frequency decreases gradually after stopping treatment.

It is essential to examine your breasts regularly and inform your doctor if you notice any lump. Inform your doctor if any close relative has or has had breast cancer (see section 2.2 "Warnings and precautions").

Rare cases of benign liver tumors, and even more rarely, malignant liver tumors, have been reported in women who use oral contraceptives. Contact your doctor if you have severe and unusual abdominal pain.

In users of the combined pill, it has been observed that there is a lower frequency of endometrial cancer (the tissue that lines the uterus) or ovarian cancer. This may also be the case with NuvaRing, but it has not been confirmed.

Psychiatric disorders

Some women who use hormonal contraceptives like NuvaRing have reported depression or a depressed mood. Depression can be severe and sometimes can induce suicidal thoughts. If you experience mood changes and depressive symptoms, contact your doctor.

To obtain additional medical advice as soon as possible.

1. Children and adolescents

The safety and efficacy of NuvaRing in adolescents under 18 years of age have not been established.

1. Other medications and NuvaRing

Always inform your doctor about the medications or herbal remedies you are taking. Also, inform any doctor or dentist (or pharmacist) who prescribes you another medication that you are using NuvaRing. They will be able to inform you if you need to take any complementary contraceptive measures (for example, using male condoms) and if so, for how long, or if you should modify the use of the other medication.

Some medications

• may have an influence on NuvaRing blood levels;
• may make it less effective in preventing pregnancy;
• may cause unexpected bleeding.

These include medications used to treat:

• epilepsy (for example, primidone, phenytoin, barbiturics, carbamazepine, oxcarbazepine, topiramate, felbamate);
• tuberculosis (for example, rifampicin);
• HIV infection (for example, ritonavir, nelfinavir, nevirapine, efavirenz);
• Hepatitis C virus infection (for example, boceprevir, telaprevir);
• other infectious diseases (for example, griseofulvin);
• high blood pressure in the pulmonary blood vessels (bosentan);
• depressive mood disorders (the herbal remedy St. John's Wort).

If you are taking medications or herbal remedies that could make NuvaRing less effective, you should also use a barrier contraceptive method (for example, a male condom). Since the effect of another medication on NuvaRing can last up to 28 days after stopping the medication, during that time, it is necessary to use an additional barrier contraceptive method. Note: Do not use NuvaRing with a diaphragm, cervical cap, or female condom.

NuvaRing may affect the effect of other medications, for example:

• medications containing cyclosporine
• the antiepileptic lamotrigine (this could lead to an increased frequency of seizures).

Do not use NuvaRing if you have Hepatitis C and are taking medications containing ombitasvir/paritaprevir/ritonavir and dasabuvir or glecaprevir/pibrentasvir, as increases in liver test results (increase in liver enzyme ALT) may occur.

Your doctor will prescribe another type of contraceptive before starting treatment with these medications.

NuvaRing can be used again approximately 2 weeks after the end of this treatment. See section 2.1 "When not to use NuvaRing".

Consult your doctor or pharmacist before taking any medication.

Tampons can be used while using NuvaRing. First, insert NuvaRing and then the tampon. Be careful when removing the tampon so that the ring is not accidentally expelled. If it is expelled, simply wash the ring with cold or warm water and reinsert it immediately.

The ring can open when using a vaginal product such as a lubricant or treatment for an infection (see section 3.4 "What to do if... The ring opens"). The use of spermicides or products for vaginal fungi does not reduce the contraceptive efficacy of NuvaRing.

Laboratory tests

If you have blood or urine tests, inform your doctor that you are using NuvaRing, as it may affect the result of some tests.

1. Pregnancy and breastfeeding

Pregnant women or those who suspect they may be pregnant should not use NuvaRing. If you become pregnant while using NuvaRing, you should remove the ring and consult your doctor.

If you want to stop using NuvaRing because you want to become pregnant, see section 3.5 "If you want to stop using NuvaRing".

In general, it is not recommended to use NuvaRing while breastfeeding. If you want to use NuvaRing while breastfeeding, consult your doctor.

1. Driving and using machines

NuvaRing is unlikely to affect your ability to drive or use machines.

3. How to use NuvaRing

You can insert and remove NuvaRing yourself. Your doctor will tell you when to start using it for the first time. The vaginal ring should be inserted on the correct day of your menstrual cycle (see section 3.3 "When to start with the first ring") and remain in the vagina for 3 consecutive weeks. Regularly check that NuvaRing is in your vagina (e.g., before and after sexual intercourse) to ensure you are protected against pregnancy. After the third week, remove NuvaRing and take a 1-week break. You will normally have your menstrual period or bleeding during this ring-free break.

While using NuvaRing, you should not use certain female barrier contraceptive methods, such as the vaginal diaphragm, cervical cap, or female condom. These barrier contraceptive methods should not be used as a backup method of birth control because NuvaRing may interfere with the correct placement and position of the diaphragm, cervical cap, or female condom. However, you can use a male condom as an additional barrier contraceptive method.

3.1 How to insert and remove NuvaRing

1. Before inserting the ring, check that it is not expired (see section 5 "Storage of NuvaRing and NuvaRing Applicator").
2. Wash your hands before inserting or removing the ring.
3. Choose the position that is most comfortable for you to insert it, for example, standing with one leg raised, squatting, or lying down.
4. Remove NuvaRing from its packaging.
5. Hold the ring between your index and thumb fingers, press the opposite sides, and insert the ring into the vagina (see figures 1-4). Alternatively, you can choose to use the NuvaRing Applicator to help you insert the ring (consult the instructions for use below). When NuvaRing is in place, you should not feel anything. If you feel uncomfortable, gently change the position of NuvaRing (e.g., push the ring a bit further into the vagina) until you feel comfortable. The exact position of the ring inside the vagina is not important.
6. After 3 weeks, remove NuvaRing from the vagina. You can do this by hooking the ring with your index finger or holding it with your fingers and pulling it out (see figure 5). If you are unable to remove the ring despite having located it, contact your doctor.
7. Dispose of the used ring with regular household trash, preferably in its packaging. Do not flush NuvaRing down the toilet.

Inserting NuvaRing with just your fingers:

Figure 4AFigure 4BFigure 4C

Insert the ring into the vagina with one hand (Figure 4A), if necessary, separate the vaginal lips with the other. Push the ring into the vagina until you feel comfortable (Figure 4B). Leave the ring in the vagina for 3weeks (Figure 4C).

Important information about the NuvaRing Applicator:

1. Optional use to help insert NuvaRing.
2. DO NOT reuse the applicator; it is designed for single use.
3. DO NOT share the applicator with other people.
4. If the applicator accidentally falls, wash the applicator with cold or warm water (NOT hot water).
5. Discard the applicator in the trash immediately after use.
6. Do not flush the applicator down the toilet.

Inserting NuvaRing with the applicator:

1: Preparation

2: Loading and placement

3: Insertion and removal

3.2 Three weeks in, one week out

1. The vaginal ring should remain in the vagina from the day you insert it for 3 consecutive weeks, without interruption.
2. After 3 weeks, remove the ring on the same day of the week that you inserted it and at approximately the same time. For example, if you inserted it on a Wednesday at approximately 10:00 PM, you should remove it 3 weeks later, on Wednesday, at approximately 10:00 PM.
3. Once you have removed the ring, do not use it for 1 week. During this week, you should experience vaginal bleeding. Normally, it starts 2-3 days after removing NuvaRing.
4. Insert a new ring exactly after the 1-week interval (again on the same day of the week and at approximately the same time), even if you have not stopped bleeding. If you put on a new ring more than 3 hours late, the contraceptive effectiveness may be reduced. Follow the instructions in section 3.4 "What to do if you forget to put on a new ring after the ring-free break".

If you use NuvaRing as described above, your bleeding will take place approximately on the same days each month.

3.3 When to start with the first ring

• If you have not usedhormonal contraceptionin the previous month

Insert NuvaRing on the first day of your natural cycle (i.e., the first day of your menstruation). NuvaRing starts working immediately. You do not need to take other contraceptive measures.

You can also start with NuvaRing between the 2nd and 5th day of your cycle, but if you have sexual intercourse during the first 7 days of using NuvaRing, make sure to use a complementary contraceptive method (such as a male condom). You should only follow this recommendation when using NuvaRing for the first time.

• If you were using acombined pillin the previous month

Start using NuvaRing no later than the day after the break from your current pill. If the packaging of your pill also contains inactive tablets, start NuvaRing no later than the day after the last inactive tablet. If you are unsure which tablet is which, consult your doctor or pharmacist. Never extend the break days of your current pill beyond what is recommended.

If you have taken your current pill continuously and correctly and are sure you are not pregnant, you can also stop taking the pill on any day of your current cycle and start with NuvaRing immediately.

• If you were using atransdermal patchin the previous month

Start using NuvaRing no later than the day after the patch-free break. Never extend the patch-free break days beyond what is recommended.

If you have used the patch continuously and correctly and are sure you are not pregnant, you can also remove the patch on any day and start with NuvaRing immediately.

• If you were using aprogestin-only pillin the previous month

You can stop taking your progestin-only pill on any day and start NuvaRing the next day at the same time. However, make sure to also use a complementary contraceptive method (such as a male condom) during the first 7 days of using the ring.

• If you were using aninjectable, an implant, or an Intrauterine System (IUS) with hormonal load (progestin)in the previous month

Start using NuvaRing at the time you would normally receive the next injection or the day the implant or IUS is removed. However, make sure to use a complementary contraceptive method (such as a male condom) during the first 7 days of using the ring.

• After childbirth

If you have just given birth, your doctor may advise you to wait until your first normal menstrual period appears before starting with NuvaRing. Sometimes it is possible to start earlier; your doctor will advise you on how to do so. If you are breastfeeding and want to use NuvaRing, you should consult your doctor first.

• After an abortion

Consult your doctor.

3.4 What to do if...

The ring is accidentally expelled from the vagina

NuvaRing can be accidentally expelled from the vagina, for example, if it is not inserted correctly, when removing a tampon, during sexual intercourse, if you have constipation, or if you have uterine prolapse (uterine descent). Therefore, you should regularly check if the ring is in your vagina (e.g., before and after sexual intercourse).

The ring has been out of the vagina temporarily

NuvaRing may still protect you from pregnancy, but this will depend on how long it has been out of your vagina.

If the ring has been out of the vagina for:

• less than 3 hours, it will still protect you from pregnancy. Wash the ring with cold or warm water (do not use hot water) and reinsert the ring into the vagina as soon as possible, but only if the ring has been out of the vagina for less than 3 hours.
• more than 3 hours in the 1st or 2nd week, it may not protect you from pregnancy. Wash the ring with cold or warm water (do not use hot water) and insert the ring as soon as you remember. Leave it in the vagina for at least 7 consecutive days. Use a male condom if you have sexual intercourse during those 7 days. If you are in the first week and have had sexual intercourse in the 7 days prior, there is a possibility that you may be pregnant. In this case, consult your doctor.
• more than 3 hours in the 3rd week, it may not protect you from pregnancy. Remove the ring and choose one of the following two options:

1. Insert a new ring immediately.

By inserting a new ring, you will start a new 3-week cycle of use, and you may not experience your period. However, you may experience intermenstrual bleeding or spotting during that cycle.

1. Do not insert a new ring. Wait for the intermenstrual bleeding and insert a new ring no later than 7 days from the time the previous ring was removed or expelled.

Choose this option only if you have used NuvaRing consecutively for the previous 7 days.

• an unknown period of time, it may not protect you from pregnancy. Perform a pregnancy test and consult your doctor before inserting a new ring.

The ring breaks

In rare cases, the NuvaRing may break. Vaginal injury associated with ring breakage has been reported. If you notice that NuvaRing has broken, remove the ring and insert a new one as soon as possible. Take complementary contraceptive precautions (e.g., a male condom) for the following 7 days. If you have had sexual intercourse before noticing that the ring had broken, consult your doctor.

You have inserted more than one ring

There are no reports of serious harm due to overdose of the hormones in NuvaRing. If you accidentally insert more than one ring, you may feel unwell (nausea), vomit, or experience vaginal bleeding. Remove the extra ring and contact your doctor if these symptoms do not disappear. You can also call the Toxicology Information Service, phone: 91 562 04 20, indicating the medication and the amount used.

If you forget to insert a new ring after the ring-free break

Your ring-free breakhas lasted more than 7 days. Insert a new ring into the vagina as soon as you remember. Take additional contraceptive measures (such as a male condom) if you have sexual intercourse during the following 7 days. If you have had sexual intercourse during this ring-free break, there is a possibility that you may have become pregnant. In this case, inform your doctor immediately. The longer the ring-free break, the higher the risk of pregnancy.

If you forget to remove the ring

• If the ring has been in the vagina for 3 to 4 weeks, it will still protect you from pregnancy. Wait for the ring-free week and then insert a new ring.
• If the ring has been in the vagina for more than 4 weeks, there is a possibility of pregnancy. Contact your doctor before starting with a new ring.

If your period or bleeding does not occur

• You have used NuvaRing according to the instructions.

If your period does not occur, but you have used NuvaRing according to the instructions and have not taken other medications, it is very unlikely that you are pregnant. Continue using NuvaRing as usual. However, if you experience two consecutive missed periods, you may be pregnant, so you should inform your doctor immediately. Do not insert the next NuvaRing until your doctor has checked that you are not pregnant.

• If you have deviated from the recommended use of NuvaRing.

If your usual bleeding does not occur during the 1-week ring-free break and you have deviated from the recommended regimen, there is a possibility that you may be pregnant, so you should contact your doctor before inserting a new ring.

If you experience unexpected bleeding

In some women, during the use of NuvaRing, unexpected vaginal bleeding may occur between menstrual periods. You may need to use hygienic protection. However, continue to use the ring as usual; do not remove it. If the bleeding continues, becomes heavier, or starts again, consult your doctor.

If you want to change the day your period or bleeding starts

If you use NuvaRing according to the instructions, your menstrual period (withdrawal bleeding) will start during the ring-free week. If you want to change the day it starts, you must shorten (never lengthen!) the ring-free break.

For example, if your period usually starts on a Friday, you can change it to a Tuesday, i.e., 3 days earlier, starting from the next month. Simply insert the next ring 3 days earlier than your usual day.

If the break is very short (e.g., 3 days or less), you may not experience your usual bleeding. You may experience spotting (drops or spots of blood) or intermenstrual bleeding during the use of the next ring.

If you are unsure how to do this, consult your doctor.

If you want to delay your period or bleeding

Although it is not the recommended regimen, you can delay your period (withdrawal bleeding) by inserting a new ring immediately after removing the current ring, without taking the break between rings. You can delay it, but you may experience intermenstrual bleeding or spotting during that cycle.

4. Possible side effects

Like all medicines, NuvaRing can cause side effects, although not all people experience them. If you suffer from any side effect, especially if it is severe and persistent, or if you have any change in health that you think may be due to NuvaRing, consult your doctor.

All women who take combined hormonal contraceptives are at a higher risk of developing blood clots in the veins (venous thromboembolism (VTE)) or blood clots in the arteries (arterial thromboembolism (ATE)). For more detailed information on the different risks of taking combined hormonal contraceptives, see section 2 "What you need to know before starting to use NuvaRing".

If you are allergic to any of the components of NuvaRing (hypersensitivity), you may have the following symptoms (frequency not known): angioedema and/or anaphylaxis [swelling of the face, lips, tongue, and/or throat and/or difficulty swallowing] or urticaria, possibly with difficulty breathing. If this occurs, remove NuvaRing and contact your doctor immediately (see also section 2.2 "Warnings and precautions").

NuvaRing users have reported the following side effects:

Frequent:may affect up to 1 in 10 women.

• abdominal pain, discomfort (nausea)
• vaginal yeast infection (similar to oral candidiasis), vaginal discomfort due to the ring, genital itching, vaginal discharge
• headache or migraine, depressive mood, decreased sexual desire
• breast pain, pelvic pain, painful menstruation
• acne
• weight gain
• ring expulsion

Uncommon:may affect up to 1 in 100 women.

• vision changes, dizziness
• bloating, vomiting, diarrhea, or constipation
• feeling tired, annoyed, or irritable, mood changes, mood swings
• fluid retention in the body (edema)
• urinary tract infection or bladder infection
• difficulty, pain when urinating; urgency to urinate. Need to urinate more frequently
• sexual intercourse problems such as pain, bleeding, or partner noticing the ring
• increased blood pressure
• increased appetite

• back pain, muscle cramps, pain in the legs or arms
• decreased skin sensitivity
• breast tension or pain, or increased size; fibrocystic breast disease (breast cysts that can become inflamed or painful)
• cervical inflammation, polyps that grow on the cervix, displacement of tissue from the inside of the cervix to the outside (ectropion)
• changes in menstrual period (heavier, longer, irregular, or absent), pelvic discomfort, premenstrual syndrome, uterine cramps
• vaginal infection (fungal or bacterial), burning, odor, pain, discomfort, or dryness of the vagina or vulva
• hair loss, eczema, itching, rash, or flushing
• urticaria

Rare:may affect up to 1 in 1,000 women.

• harmful blood clots in a vein or artery, for example:

• in a leg or foot (i.e., DVT)
• in a lung (i.e., PE)
• heart attack
• stroke
• mild stroke or temporary symptoms similar to those of a stroke, called a transient ischemic attack (TIA)
• blood clots in the liver, stomach/intestine, kidneys, or eye

The chances of having a blood clot may be higher if you have any other condition that increases this risk (see section 2 for more information on conditions that increase the risk of blood clots and symptoms of a blood clot).

• breast secretion

Frequency not known(cannot be estimated from available data).

• chloasma (yellowish-brown spots on the skin, particularly on the face)
• partner's penis discomfort (irritation, rash, itching)
• inability to remove the ring without medical assistance (e.g., due to its adherence to the vaginal wall)
• vaginal injury associated with ring breakage.

There have been reports of breast cancer and liver tumors in women using combined hormonal contraceptives. For more information, see section 2.2 Warnings and precautions, Cancer.

In very rare cases, the NuvaRing ring may open. For more information, see section 3.4 What to do if…The ring opens.

Reporting side effects:

If you experience any type of side effect, consult your doctor or pharmacist, even if it is a possible side effect that is not listed in this prospectus. You can also report them directly through the Spanish Pharmacovigilance System for Human Use Medicines: https://www.notificaram.es. By reporting side effects, you can contribute to providing more information on the safety of this medicine.

5. Storage of NuvaRing and NuvaRing Applicator

Keep this medicine out of the sight and reach of children.

If you discover that a child has been exposed to NuvaRing hormones, ask your doctor for advice.

Store below 30°C. Store in the original packaging to protect it from light and moisture.

Do not use NuvaRing if it was dispensed more than 4 months ago. The dispensing date is shown on the box and on each ring package.

Do not use NuvaRing after the expiration date shown on the box and on each ring package.

Do not use NuvaRing if you notice changes in the color of the ring or any visible sign of deterioration.

Dispose of the used ring with normal household waste, preferably inside its closed package. Dispose of the used applicator with normal household waste. Neither NuvaRing nor the applicator should be flushed down the toilet.

As with other medicines, do not throw away unused or expired rings down the drain or in the trash.

Medicines should not be thrown away down the drain or in the trash. Deposit the packaging and medicines you no longer need at the SIGRE point in the pharmacy. In case of doubt, ask your pharmacist how to dispose of the packaging and medicines you no longer need. This will help protect the environment.

6. Package contents and additional information

NuvaRing composition

• The active ingredients are etonogestrel (11.7 mg) and ethinylestradiol (2.7 mg).
• The other components are: vinyl acetate and ethylene copolymer (28% and 9% vinyl acetate) (a type of plastic that does not dissolve in the body) and magnesium stearate.

Etonogestrel and ethinylestradiol are released from the ring in a ratio of 0.120 mg/day and 0.015 mg/day, respectively, for three weeks.

Appearance of NuvaRing and NuvaRing Applicator and package contents

NuvaRing is a flexible, transparent, and almost colorless ring, measuring 54 mm in width.

Each ring is packaged in a laminated aluminum package that can be reclosed.

The applicator is a non-sterile, single-use plastic device (i.e., disposable). Each applicator is packaged individually. The applicator has the CE marking engraved on it.

The ring package or packages and the applicator or applicators are presented in a cardboard box along with this prospectus. Each box contains 1 or 3 rings and the corresponding applicator or applicators.

Only some package sizes may be marketed.

Marketing authorization holder and manufacturer

Marketing authorization holder:

Organon Health, S.L.

Paseo de la Castellana, 77

28046 Madrid

Spain

Tel.: 915911279

Manufacturer:

N.V. Organon

Kloosterstraat 6,

5349 AB Oss

Netherlands

This medicine is authorized in the member states of the European Economic Area and in the United Kingdom (Northern Ireland) with the following name:

NuvaRing

0.120 mg/0.015 mg every 24 hours, vaginal release system

Germany, Austria, Belgium, Czech Republic, Denmark, Spain, Slovakia, Slovenia, Estonia, Finland, France, Greece, Hungary, Ireland, Iceland, Italy, Latvia, Lithuania, Luxembourg, Malta, Norway, Netherlands, Poland, Portugal, United Kingdom (Northern Ireland), Romania, Sweden.

Date of the last revision of this prospectus:09/2022.

Detailed and updated information on this medicine is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) (http://www.aemps.gob.es/)