NuvaRing is a small vaginal ring with a contraceptive effect. It contains an estrogenic and progestational component (ethinyl estradiol and ethonogestrel, respectively). Using this ring, you can get an effective monthly protection from pregnancy.
Contents:
Indications for use
NuvaRing is used as a contraceptive. In addition, the drug helps to normalize the menstrual cycle, reduce the severity of algodismenorea and premenstrual syndrome, and reduce the intensity of bleeding during menstruation, which can lead to a reduced risk of developing iron deficiency anemia.
Mechanism of action
The ring daily releases hormones (estrogen and progestogen) in micro-doses directly to the uterus and the ovaries without penetrating into other organs. They prevent the release of the ovum from the ovary and fertilization, so the onset of pregnancy is impossible. This birth control method is highly effective (99%). The ability to conceive is fully restored within a month after the cessation of NuvaRing use.
Mode of application and dosage
One hormonal ring is designed for one menstrual cycle. The woman inserts it into the vagina from the 1st to the 5th day of the menstrual cycle. NuvaRing is put inside and remains in the vagina for 21 days (3 weeks), the ring is removed on the 22nd day. A week later, on the 8th day, a new one is inserted.
NuvaRing does not require any special position in the vagina. The flexible and elastic ring will occupy the optimal position, adjusting to the individual contours of the woman’s body.
The ring daily releases etonogestrel 0.12mg and ethinyl estradiol 0.015mg. Unlike birth control pill, the ring requires no daily dosing so a woman gets a reliable monthly protection from pregnancy without having to take it every day.
Contraindications
NuvaRing is contraindicated in the following cases:
- venous or arterial thrombosis or thromboembolism (current or in an anamnesis);
- risk factors for thrombosis (current or in anamnesis);
- migraine with focal neurologic symptoms;
- diabetes mellitus with vascular complications;
- pancreatitis or transferred pancreatitis, which is accompanied by high hypertriglyceridemia;
- severe liver disease;
- benign or malignant liver tumors (current or in an anamnesis);
- hormone-dependent malignant tumors (established or suspected, for example tumors of the genitals or mammary glands);
- vaginal bleeding of unknown etiology;
- pregnancy;
- lactation period;
- hypersensitivity to ethinylestradiol or etonogestrel
The ring is used with caution:
- smoking over the age of 35;
- diabetes;
- obesity;
- high blood pressure;
- atrial fibrillation;
- heart valve disease;
- disease of the liver and gallbladder;
- Crohn’s disease and ulcerative colitis;
- sickle cell anemia;
- systemic lupus erythematosus;
- hemolytic uremic syndrome;
- epilepsy;
- prolonged immobilization, significant surgical interventions;
- fibrocystic mastopathy;
- uterine fibroids;
- congenital hyperbilirubinemia (Gilbert syndrome, Dubin-Johnson and Rotor syndrome);
- chloasma (avoid exposure to the sun or ultraviolet radiation);
- any of the conditions when a woman can not properly insert NuvaRing or a ring falls out: cervical prolapse, cystocele (hernia of the bladder) or rectocele (hernia of the rectum), severe or chronic constipation.
Side Effects
NuvaRing, as a rule, is well tolerated by patients. There are data on individual cases of development of the following side effects caused by the active components:
- Nervous system: emotional lability, headache, migraine and migraine-like headache, depressive states, dizziness, unreasonable anxiety, increased fatigue;
- Reproductive system: decreased libido, an increase of the mammary glands, dysmenorrhea, vaginal discharge, cervicitis, vaginitis, problems associated with sexual intercourse, which are due to the location of the ring;
- Digestive system and liver: pain in the epigastric region, stool disorders, nausea, vomiting, weight change;
- Allergic reactions: urticaria, skin itch, Quincke’s edema.
- Other: cystitis
Interactions
Drugs that induce microsomal liver enzymes reduce a contraceptive effect of NuvaRing. You should use a barrier method of contraception if you use phenobarbital, phenytoin, rifampicin, primidone, carbamazepine, topiramate, oxcarbazepine, ritonavir, felbamate, St. John’s wort, and griseofulvin.
The effectiveness of the ring may reduce when it’s combined with tetracyclines and penicillins. To avoid this, you need to use a barrier method of contraception.
What to do if you make a mistake using NuvaRing?
Contraceptive effect and cycle control may be impaired if a woman violates the recommended regimen. To avoid losing the contraceptive effect in the event of a deviation from the regime, the following recommendations should be followed.
What happens if I miss a dose?
NuvaRing should remain in the vagina continuously for 3 weeks. If it was accidentally removed and remained outside the vagina for less than 3 hours, the contraceptive effect will remain the same. The woman should put the ring back in the vagina as soon as possible.
If the ring was outside the vagina for more than 3 hours, the contraceptive effect may be reduced. The woman should place the ring in the vagina as soon as possible, after which the ring should remain in the vagina for at least 7 days, and the barrier method of contraception must be additionally used during these 7 days. If the ring was outside the vagina for more than 3 hours during the third week of its use, then it should be extended beyond the prescribed three weeks (until the end of 7 days after re-insertion of the ring). After that, the ring should be removed, a new one should be inserted after a one-week break.
If the ring was removed from the vagina for more than 3 hours during the first week of using NuvaRing, the probability of pregnancy should be taken into account.
What if I forget to insert my Nuvaring?
A woman should put a new ring in the vagina as soon as possible. In addition, during the next 7 days, a barrier method of contraception, such as a condom, should be used. If a woman had sexual intercourse during the interruption of the use of the ring, the possibility of pregnancy should be considered. The longer the break, the higher the risk of pregnancy.
What if I leave Nuvaring in too long?
If the ring was used no longer than the maximum period of 4 weeks, the contraceptive effect is still sufficient. A woman can make a short break in using a ring and then place a new one. If the ring was in the vagina for more than 4 weeks, the contraceptive effect may be weakened, and before the application of the new ring, it is necessary to exclude pregnancy. If a woman removes the ring and then during a one-week break bleeding does not occur, pregnancy should be excluded before using the new vaginal ring.
NuvaRing and pregnancy
If a woman wants to stop using the drug to conceive, it is recommended to wait for the recovery of the natural cycle as this will help to correctly calculate the date of conception and childbirth.
Pregnancy
The use of NuvaRing during pregnancy is contraindicated. In case of pregnancy, the ring should be removed. Extensive epidemiological studies did not reveal an increased risk of congenital malformations in children born to women taking hormones before pregnancy, as well as teratogenic effects in cases where women took hormones early in pregnancy without knowing about it. Although this applies to all hormonal contraceptives, it is not known whether this also applies to NuvaRing. Pregnancy outcomes in women using this contraceptive method are not described.
Breastfeeding period
The use of NuvaRing during breastfeeding has not been studied. The composition of the drug can affect lactation, reduce the amount and change the composition of breast milk. Small amounts of contraceptive sex hormones and/or their metabolites can be excreted with milk, but there is no evidence of their negative impact on children’s health.