ethinylestradiol + etonogestrel: clinical use

Prescribing considerations

• Assess individual venous and arterial thromboembolism risk and compare this product’s VTE risk with lower-risk combined hormonal contraceptives.
• Take personal and family history, exclude pregnancy and measure blood pressure before initiation or restarting.
• Review smoking, age, obesity, migraine pattern, planned surgery or immobilisation, postpartum status, cardiovascular disease, diabetes, liver disease and interacting medicines.
• Counsel about thromboembolism symptoms, expulsion, reduced efficacy, STI protection, bleeding changes and mood symptoms.

Contraindications and cautions

• Current or previous venous thromboembolism, thrombophilia, major surgery with prolonged immobilisation or high VTE risk
• Current or previous arterial thrombosis, stroke or transient ischaemic attack, or high arterial-thrombosis risk
• Migraine with focal neurological symptoms
• Severe hypertension, diabetes with vascular involvement or severe dyslipidaemia where these confer high arterial risk
• Severe liver disease with abnormal function, liver tumour, or pancreatitis associated with severe hypertriglyceridaemia
• Known or suspected sex-steroid-sensitive breast or genital malignancy
• Unexplained vaginal bleeding
• Pregnancy or hypersensitivity to an ingredient
• Concomitant use of contraindicated ethinylestradiol-interacting hepatitis C regimens listed in the product information

Monitoring

• Reassess blood pressure and evolving cardiovascular or thrombotic risks.
• Review new or worsening migraine, sustained hypertension, significant mood change, jaundice or thrombosis symptoms.
• Investigate persistent or new irregular bleeding after previously regular use, including pregnancy and non-hormonal causes.
• Review adherence, ring expulsion and interacting medicines if bleeding or possible contraceptive failure occurs.

Clinical pharmacology

Etonogestrel is a progesterone-receptor agonist and ethinylestradiol is a synthetic oestrogen. Both are absorbed systemically through vaginal mucosa; inhibition of ovulation is the principal contraceptive mechanism.

Formulation and product differences

• A flexible, transparent, colourless to nearly colourless ethylene-vinyl-acetate vaginal delivery system.
• Some packs may include a disposable applicator; availability and marketed pack sizes can vary.
• Return the ring to its sachet for household disposal; do not flush it.