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Etonogestrel + Ethinylestradiol (vaginal ring)

Combined hormonal contraceptive, vaginal route

ATC code: G02BB01(Etonogestrel and ethinylestradiol (vaginal ring))

Updated · Methodology

Indications

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

How to read tiers A–F
  • AStrong evidence – first or second line in international guidelines
  • BRecommended in selected cases
  • CStudy data contradict each other
  • DBenefit not proven, no documented harm
  • FDocumented harm, or risk without benefit

Mechanism of action

Flexible polymer ring releases 120 µg etonogestrel and 15 µg ethinylestradiol daily. Systemic estrogen dose is lower than in COCs (~50% of oral), but hemostatic effect persists – VTE risk comparable to 3rd-gen COCs (8–10 per 10,000 woman-years). Suppresses ovulation via FSH/LH suppression. Pearl Index 0.3 perfect-use.

Safety

Contraindications

  • VTE
  • Thrombophilia
  • Smoking after 35
  • Migraine with aura
  • HTN
  • Breast cancer
  • Cervicitis, vaginitis (relative)
  • First 6 weeks postpartum
  • Pregnancy

Serious adverse effects

  • VTE (8–10 per 10,000)
  • Ischemic stroke
  • HTN

Common adverse effects

  • Headache
  • Vaginitis
  • Vaginal discharge
  • Breast tenderness
  • Decreased libido

Pregnancy: can you take Etonogestrel + Ethinylestradiol (vaginal ring)?

Remove and stop using if pregnant.

Breastfeeding: can you take Etonogestrel + Ethinylestradiol (vaginal ring)?

Hale L3 · Probably compatible, limited data

Estrogen reduces milk supply. WHO MEC first 6 weeks – category 4. Etonogestrel RID about 0.7%, Hale L3.

RID, infant dose via milk
0.7%
Maternal half-life
28.0 h
Maternal peak time
1.5 h
Peak milk concentration
0 mg/L
Milk-to-plasma ratio
0.4
Calculate RIDSafe feeding windowFull profile on NIH LactMed ↗

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Practical notes

Timing and administration

Self-insert into vagina at any depth, leave for 21 days. Remove, 7 ring-free days with withdrawal bleed. New ring after 7 days. If expelled <3 h – rinse and reinsert. >3 h – additional contraception for 7 days.

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Frequently asked

What is Etonogestrel + Ethinylestradiol (vaginal ring) used for?

Etonogestrel + Ethinylestradiol (vaginal ring) is evaluated for the following indications with varying evidence strength: Contraception (evidence tier A), Contraception during breastfeeding (evidence tier D). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Etonogestrel + Ethinylestradiol (vaginal ring)?

Common side effects of Etonogestrel + Ethinylestradiol (vaginal ring) (≥ 1 in 100): Headache, Vaginitis, Vaginal discharge, Breast tenderness, Decreased libido. See the Safety section for uncommon and serious reactions.

Is Etonogestrel + Ethinylestradiol (vaginal ring) safe during pregnancy?

Remove and stop using if pregnant.

Is Etonogestrel + Ethinylestradiol (vaginal ring) compatible with breastfeeding?

Estrogen reduces milk supply. WHO MEC first 6 weeks – category 4. Etonogestrel RID about 0.7%, Hale L3.

Who should not take Etonogestrel + Ethinylestradiol (vaginal ring)?

Etonogestrel + Ethinylestradiol (vaginal ring) is contraindicated in: VTE; Thrombophilia; Smoking after 35; Migraine with aura; HTN. Full list in the Safety section.

Other drugs in this group

Black cohosh (Cimicifuga racemosa), Copper intrauterine device, Dong quai (Angelica sinensis), Levonorgestrel (intrauterine system)