NuvaRing

What is NuvaRing & what is it used for?

NuvaRing is a flexible, prescription contraceptive vaginal ring that releases hormones to prevent pregnancy. It contains etonogestrel and ethinyl estradiol, which work together to inhibit ovulation, thicken cervical mucus, and thin the uterine lining. Users insert the ring for three weeks, followed by a one-week break during which menstruation occurs. It's an effective and convenient option for birth control.

How does NuvaRing work?

NuvaRing works by releasing a combination of two hormones, etonogestrel and ethinyl estradiol, into the body. These hormones prevent ovulation (the release of an egg from the ovaries). Additionally, they thicken the cervical mucus, making it harder for sperm to enter the uterus, and thin the lining of the uterus, which reduces the likelihood of implantation. The ring is inserted into the vagina for three weeks, then removed for one week to allow for menstruation.

Alternatives to NuvaRing

Alternatives to NuvaRing include various hormonal and non-hormonal contraceptive options:

1. Birth Control Pills: Daily oral contraceptives containing either a combination of estrogen and progestin or progestin only.
2. IUDs (Intrauterine Devices): T-shaped devices inserted into the uterus, available in hormonal and non-hormonal (copper) forms.
3. Contraceptive Patch: A skin patch that releases hormones absorbed through the skin.
4. Implant: A small rod inserted under the skin that releases progestin.
5. Contraceptive Injection: An injection of progestin given every three months.

For more options, consulting with a healthcare provider is recommended.

Sources

• NuvaRing, Patient Information Leaflet:
  

• https://www.nhs.uk/conditions/contraception/combined-contraceptive-pill/

https://www.nuvaring.com/

How to use NuvaRing

To use NuvaRing, follow these steps:

1. Insertion: Wash your hands, squeeze the ring, and insert it into the vagina. The exact position isn't crucial as long as it's comfortable.
2. Wearing Time: Keep the ring in place for three weeks.
3. Removal: After three weeks, remove the ring for a one-week break, during which you'll have your period.
4. New Cycle: Insert a new ring after the one-week break.

For detailed instructions on inserting NuvaRing into your vagina please read the patient leaflet:

Starting NuvaRing

If you have no used hormonal contraception in the past month

NuvaRing has to be inserted on the first day of the woman's natural cycle (i.e. the first day of her menstrual bleeding). Starting on days 2-5 is allowed, but during the first cycle a barrier method is recommended in addition for the first 7 days of NuvaRing use.

If you are switching from a combined contraceptive pill

The woman should insert NuvaRing at the latest on the day following the usual tablet-free, patch-free or placebo tablet interval of her previous combined hormonal contraceptive.

If the woman has been using her previous method consistently and correctly and if it is reasonably certain that she is not pregnant she may also switch from her previous combined hormonal contraceptive on any day of the cycle.

If you are changing from a progesterone-only pill, injection, implant or IUD

The woman may switch on any day from the minipill (from an implant, or the IUS on the day of its removal, from an injectable when the next injection would be due)

You will need to use a barrier method of protection such as a condom for the first 7 days to avoid getting pregnant.

NuvaRing and missed ring insertion

What to do in case of a lengthened ring-free interval

The woman should insert a new ring as soon as she remembers. A barrier method such as a male condom should be used in addition for the next 7 days. If intercourse took place during the ring-free interval, the possibility of a pregnancy should be considered. The longer the ring-free interval, the higher the risk of a pregnancy.

What to do if the ring was temporarily outside the vagina

NuvaRing should be left in the vagina for a continuous period of 3 weeks. If the ring is accidentally expelled, it can be rinsed with cool to lukewarm (not hot) water and should be reinserted immediately.

If NuvaRing has been out of the vagina for less than 3 hours contraceptive efficacy is not reduced. The woman should reinsert the ring as soon as possible, but at the latest within 3 hours.

If NuvaRing has been out of the vagina, or is suspected to have been out of the vagina for more than 3 hours during the 1^st or 2^nd week of use, contraceptive efficacy may be reduced. The woman should reinsert the ring as soon as she remembers. A barrier method such as a male condom should be used until NuvaRing has been in the vagina continuously for 7 days. The longer the time NuvaRing has been out of the vagina and the closer this is to the ring-free interval, the higher the risk of a pregnancy.

If NuvaRing has been out of the vagina, or is suspected to have been out of the vagina for more than 3 hours during the 3^rd week of the three-week use period, contraceptive efficacy may be reduced. The woman should discard that ring, and one of the following two options should be chosen:

1. Insert a new ring immediately

Note: Inserting a new ring will start the next three-week use period. The woman may not experience a withdrawal bleed from her previous cycle. However breakthrough spotting or bleeding may occur.

2. Have a withdrawal bleeding and insert a new ring no later than 7 days (7x24 hours) from the time the previous ring was removed or expelled.

Note: This option should only be chosen if the ring was used continuously for the preceding 7 days.

If NuvaRing was out of the vagina for an unknown amount of time, the possibility of pregnancy should be considered. A pregnancy test should be performed prior to inserting a new ring.

What to do in case of lengthened ring-use

Although this is not the recommended regimen, as long as NuvaRing has been used for maximally 4 weeks, contraceptive efficacy is still adequate. The woman may maintain her one-week ring-free interval and subsequently insert a new ring. If NuvaRing has been left in place for more than 4 weeks, contraceptive efficacy may be reduced and pregnancy should be ruled out before inserting a new NuvaRing.

If the woman has not adhered to the recommended regimen and subsequently has no withdrawal bleed in the following ring-free interval, pregnancy should be ruled out before inserting a new NuvaRing.

NuvaRing ingredients

The active ingredients contained in NuvaRing are: ethinylestradiol, etonogestrel

NuvaRing is made of: Ethylene vinylacetate copolymer, 28% vinylacetate; ethylene vinylacetate copolymer, 9% vinylacetate and magnesium stearate.

NuvaRing side effects

The NuvaRing, a form of hormonal birth control, can have various side effects. The five most common ones include:

1. Vaginal Discharge or Irritation: Some users experience increased discharge or irritation in the vaginal area, which can be bothersome but is usually not severe.
2. Headaches: Hormonal changes from the NuvaRing can lead to headaches or migraines in some people.
3. Nausea: Like many hormonal contraceptives, NuvaRing can cause nausea, especially when first starting the ring or if it's not inserted properly.
4. Breast Tenderness: Hormonal fluctuations may cause your breasts to become sore or tender.
5. Mood Changes: Some users report mood swings or changes in their emotional state, which can be linked to hormonal changes.

Most of these side effects are usually mild and may diminish over time. If they are severe or persist, it's a good idea to talk to your healthcare provider.

NuvaRing warnings

NuvaRing carries several important warnings. It may increase the risk of serious cardiovascular events, especially in women over 35 who smoke. It is not recommended for women with a history of blood clots, certain cancers, liver disease, or uncontrolled high blood pressure. Additionally, NuvaRing should not be used during pregnancy or by women who have unexplained vaginal bleeding.

NuvaRing is unsuitable for you if you have:

• Ever had a blood clot in the leg or lungs
• A blood clotting disorder
• A history of heart attack or stroke
• Migraines with aura
• Impaired liver function
• A tumour in the liver
• Kidney failure
• Ever had cancer of the cervix, breast, vagina or uterus
• Unexplained vaginal bleeding
• An allergy to any of the ingredients of Yasmin

NuvaRing is unsuitable for you if you have suffered from any of the following problems while pregnant:

• Jaundice
• Pemphigoid gestationis (a rash involving blisters of the hands and feet)
• Pruritus

NuvaRing and cancer

NuvaRing, like other hormonal contraceptives, may slightly increase the risk of certain types of cancer, such as breast and cervical cancer. However, it also has protective effects against other cancers, including ovarian and endometrial cancers. The risk varies depending on individual factors such as family history, lifestyle, and duration of use.

For detailed information on the risks and benefits, consulting with a healthcare provider and reviewing official sources like the NuvaRing website is recommended.

NuvaRing and blood clots

NuvaRing has been associated with an increased risk of blood clots, including deep vein thrombosis (DVT) and pulmonary embolism (PE). This risk is heightened in women with a history of clotting disorders, smoking, or prolonged immobilization. It's important to discuss individual risk factors with a healthcare provider before using NuvaRing. You are also at a heightened risk of developing a blood clot if you:

• Smoke
• Are obese
• Have a family history of blood clots
• Do not exercise regularly
• Have had a miscarriage in the past
• Have recently given birth

NuvaRing and other medicines

The following medicines may impact the effectiveness of NuvaRing:

• Epilepsy medicines (e.g. phenytoin, barbiturates, carbamazepine
• Tuberculosis medicines (e.g. rifampicin)
• HIV medicines
• Hepatitis C medicines (e.g. telaprevir, boceprevir)
• Antifungal medicines (e.g. ketoconazole)
• Arthritis medicines (e.g. etoricoxib)
• Bosentan
• St John’s Wort

NuvaRingmay impact the effectiveness of the following medicines:

• Ciclosporin
• Theophylline
• Lamotrigine
• Tizanidine

Please read all packaging and the Patient Information Leaflet before taking any new medicine and inform your doctor of medicines you are taking or intend to take.