You can put and take NuvaRing yourself. Your doctor will tell you when to start using it for the first time. The vaginal ring must 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. Check regularly that NuvaRing is in your vagina (for example, before and after sexual intercourse) to ensure that you are protected against pregnancy. After the third week, remove NuvaRing and leave a week of rest. You will usually have your menstrual period or bleeding during this pause without a ring.

While using NuvaRing, you should not use some barrier female contraceptives, such as the vaginal diaphragm, cervical cap, or female condom. These barrier contraceptives should not be used as a backup method of birth control since 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 put on and take off NuvaRing

1. Before putting on the ring, check that it is not expired (see section 5 “Storage of NuvaRing and the NuvaRing Applicator”).
2. Wash your hands before putting on or taking off the ring.
3. Choose a comfortable position for you to insert it, for example, standing with one leg raised, squatting, or lying down.
4. Remove NuvaRing from its package.
5. Hold the ring between your index and middle fingers, press the opposite sides, and insert the ring into the vagina (see figures 1-4).Alternatively, you can use the NuvaRing Applicator to help you insert the ring (see the usage instructions below).When NuvaRing is in place, you should not feel anything. If you feel uncomfortable, change the position of NuvaRing (for example, push the ring a little 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 cannot remove the ring despite having located it, contact your doctor.
7. Dispose of the used ring in the household trash, preferably in its package. Do not flush NuvaRing down the toilet.

Insertion of NuvaRing only with your fingers:

Figure 4AFigure 4BFigure 4C

Put the ring in 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 3 weeks (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 only.
3. DO NOT share the applicator with others.
4. If the applicator falls accidentally, wash the applicator with cold or lukewarm water (DO NOT use hot water).
5. Dispose of the applicator in the trash immediately after use.
6. Do not flush the applicator down the toilet.

Insertion of 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 must remain in the vagina from the day you put it in for 3 consecutive weeks, uninterrupted.
2. After 3 weeks, remove the ring on the same day of the week and at the same time as you put it in. For example, if you put it in on a Wednesday around 10:00 PM, remove it 3 weeks later, on a Wednesday, around 10:00 PM.
3. Once you have removed the ring, do not use it for a week. During this week, you should experience vaginal bleeding. Normally, it starts 2-3 days after removing the NuvaRing.
4. Put a new ring exactly 1 week after removing the previous one (again, on the same day of the week and around the same time), even if you have not stopped bleeding yet.
5. 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 pause without a ring.”

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

3.3 When to start with the first ring

Put on 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 any other contraceptive measures.

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

Start using NuvaRing as late as the day after your current pill pause. If your pill package also contains inactive pills, start NuvaRing as late as the day after the last inactive pill. If you are unsure which pill is which, consult your doctor or pharmacist. Do not extend your pill pause beyond what is recommended.

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

Start using NuvaRing as late as the day after your patch-free pause. Do not extend your patch-free pause beyond what is recommended.

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

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 use an additional contraceptive method (such as a male condom) during the first 7 days of using the ring.

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

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

Consult your doctor.

3.4 What to do if...

Your ring is expelled accidentally from the vagina

NuvaRing can be expelled accidentally from the vagina, for example, if it was 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 check regularly if the ring is in your vagina (for example, before and after sexual intercourse).

Your 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:

1. Put a new ring in the vagina as soon as possible.

When you put on a new ring, you will start a new 3-week cycle of use. You may not experience your period. However, you may experience spotting (bloody discharge) or irregular bleeding during that cycle.

1. Do not put on a new ring. Leave the spotting and put on 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 putting on a new ring.

Your ring has opened

In rare cases, the NuvaRing ring may open. Vaginal injury associated with ring rupture has been reported. If you notice that NuvaRing has opened, remove the ring and put on a new one as soon as possible. Take additional contraceptive precautions (such as a male condom) for the next 7 days. If you had sexual intercourse before noticing that the ring had opened, consult your doctor.

You have put on more than one ring

No serious injuries have been reported due to NuvaRing overdose. If you accidentally put on 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 subside. You can also call the Toxicology Information Service, phone: 91 562 04 20, indicating the medication and the amount used.

If you forget to put on a new ring after the pause without a ring

Yourpause without a ringhas lastedmore than 7 days. Put a new ring in the vagina as soon as you remember. Take additional contraceptive precautions (such as a male condom) if you have sexual intercourse during the next 7 days.If you have had sexual intercourse during this pause without a ring, there is a possibility that you may be pregnant. In that case, inform your doctor immediately. The longer the pause without a ring, the higher the risk of pregnancy.

If you have forgotten to remove the ring

If you do not experience your period or menstrual bleeding

If you do not experience your period, but have used NuvaRing as instructed and have not taken any other medications, it is highly unlikely that you are pregnant. Continue using NuvaRing as usual. However, if you have two consecutive missed periods, you may be pregnant, so inform your doctor immediately. Do not put on the next NuvaRing until your doctor has confirmed that you are not pregnant.

If you do not experience your menstrual bleeding during the pause without a ring and have deviated from the recommended regimen, there is a possibility that you may be pregnant, so contact your doctor before putting on a new ring.

If you experience unexpected vaginal bleeding

During the use of NuvaRing, some women may experience unexpected vaginal bleeding between their menstrual periods. You may need sanitary protection. However, continue using 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 when your period or menstrual bleeding starts

If you use NuvaRing as instructed, your menstrual period (withdrawal bleeding) will start during the pause without a ring. If you want to change the day when your period starts, you must shorten (never extend!) the pause without a ring.

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

If the pause is made very short (e.g., 3 days or less), you may not experience your usual menstrual bleeding. You may experience spotting (bloody discharge) or irregular bleeding during the use of the next ring.

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

If you want to delay your period or menstrual bleeding

Although this is not the recommended regimen, you can delay your menstrual bleeding by putting on a new ring immediately after removing the current ring, without leaving the pause between rings. You can leave the new ring in for a maximum of 3 weeks. During the use of the new ring, you may experience spotting (bloody discharge) or irregular bleeding. When you want your period to start, simply remove the ring. Leave the usual pause without a ring and put on a new ring.

You can consult your doctor before deciding to delay your menstrual bleeding.

3.5 If you want to stop using NuvaRing

You can stop using NuvaRing at any time you want. If you do not want to become pregnant, consult your doctor about other contraceptive methods.

If you stop using NuvaRing because you want to become pregnant, it is recommended to wait until you have had your first natural menstrual period before trying to conceive. This will help you calculate the due date.

Like all medications, NuvaRing may cause side effects, although not all women will experience them. If you experience any side effect, especially if it is severe and persistent, or if you have any health changes that you think may be related to NuvaRing, consult your doctor.

All women taking 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 experience 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”).

Users of NuvaRing have reported the following side effects:

Frequent:may affect up to 1 in 10 women.

Infrequent:may affect up to 1 in 100 women.

• back pain, muscle cramps, leg or arm pain
• reduced skin sensitivity
• tension or pain in the breasts or increased size; fibrocystic breast disease (cysts in the breasts that may become swollen or painful)
• inflammation of the cervix, polyps that grow on the cervix, displacement of tissue from the inside of the cervix to the outside (ectropion)
• changes in menstrual period (more intense, longer, irregular, or absent), pelvic discomfort, premenstrual syndrome, uterine cramps
• vaginal infection (by fungi or bacteria), burning, odor, pain, discomfort, or dryness of the vagina or vulva
• hair loss, eczema, itching, rash, or hot flashes
• urticaria

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

• breast secretion

• melasma (yellow-brown patches on the skin, particularly on the face)
• discomfort in the penis of the partner (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 rupture