What is NuvaRing and How does it Work?

Answer 1

NuvaRing®, (pictured on the right) is a soft flexible ring that is approximately two inches in diameter. The ring is worn in the vagina for three weeks. It is then removed for one week. The menstrual period will usually occur during this week.

NuvaRing® contains a combination of estrogen and progestin hormones similar to the hormones used in most birth control pills and in the patch. The primary difference is in the method by which the medication is delivered into the body. The hormones contained within the ring are absorbed continuously, directly into the blood stream through the vaginal wall.



HOW DOES THE RING WORK?
The estrogen and progestin hormones are similar to the natural hormones produced by the ovaries. The progestin component is absorbed in small amounts and prevents the ovary from releasing an egg (ovulation). The uterine lining also becomes thinner than usual, which would inhibit implantation of a fertilized egg. In addition, the cervical mucus also becomes thicker and this helps prevent sperm from entering the uterus. When properly placed, the ring is held in place by the vaginal muscle structure, even during exercise or intercourse. The NuvaRing® cannot “get lost” in the vagina. The vagina is flexible, but no longer than the palm of your hand. The cervix forms the back wall of the vagina so the ring remains in the vagina.

HOW EFFECTIVE IS NuvaRing®?
According to studies provided to the Food and Drug Administration (FDA) during the approval process, effectiveness ratings are listed at 99% when used according to label instructions. This is comparable to the patch and better than the Pill’s effectiveness ratings.

WHAT ARE THE BENEFITS OF USING NuvaRing®?

Medication is absorbed directly into the blood stream through the vaginal wall membrane providing a consistent level of medication in the blood, which improves effectiveness and helps limit side effects. Oral contraceptives take time to be absorbed into the blood stream and this causes peaks and valleys in the hormone blood levels.

Once monthly insertion eliminates the need to think about birth control on a daily or weekly basis; usually neither partner is aware of its presence during intercourse.

Very discreet and private; no one can see it or know that you are wearing it.

Easily reversible - ovulation returns quickly when use of the ring is discontinued; however, women who have irregular menstrual cycles will probably return to the irregular cycle.

Provides a regular menstrual period, but menses are usually lighter and may be shorter than a normal period.

Thickened cervical mucus helps decrease the risk of pelvic inflammatory infections.

Reduces the chances of ovarian cysts and tubal pregnancy.

Vomiting and diarrhea should not interfere with the effectiveness of the ring.

ARE THERE OTHER THINGS THAT SHOULD BE CONSIDERED?

Insertion and removal require that a woman insert her finger inside the vagina; therefore she must be comfortable touching her genitalia and vagina.

NuvaRing® does not offer any protection against transmission of sexually transmitted infections (STIs), such as chlamydia, gonorrhea, syphilis, hepatitis or HIV. Condoms may be used with the ring to reduce the risk of STIs.

Always inform your health care provider that you are using the ring. It is a medication just like any others that you are taking.

Disposal is easy - Keep the original foil package and when the ring is removed just place it back in the foil pack, seal and throw away.

NuvaRing® is nonabsorbent, odorless, and contains no latex.

Do not breast feed while using NuvaRing®.

If for any reason, the ring is removed or slips out, it may be rinsed in cool water and reinserted. If it is out for three hours or more, there will be reduced contraceptive protection and an alternative method of birth control must be used until the ring has been in place for seven consecutive days. Emergency contraception is available if it is out three hours or longer.

Unopened NuvaRing® packs will expire in four months unless stored in the refrigerator. (Refer to the package insert for additional information or talk with the pharmacist.)

If unopened NuvaRing® packs are stored in temperatures greater than 86° the effectiveness may be lessened.

It is safe to use other vaginal medications/lubricants with the NuvaRing®.

WHAT ABOUT CANCER AND THE NuvaRing®?
There is little information available specifically about the ring and cancer. However, since the ring and birth control pills utilize the same types of hormones, it is expected to have similar effects. That information is included for your review.

Since 1960, when birth control pills first became available, important information has been learned about pills and cancer. Pills reduce the risk of ovarian cancer – three years of use reduces the risk of ovarian cancer by 40%; ten years reduces the risk by 80%. Pills reduce the risk for endometrial (uterine lining) cancer. Most studies suggest that pills neither reduce nor increase the risk for breast cancer. Research continues to evaluate this. Women are encouraged to do monthly self-breast exams and report any changes or problems to their health care provider. Some studies indicate an increased incidence of cervical cancer. However, this may be more related to factors such as numbers of sexual partners, STI exposure, etc., than to birth control pill use. Annual pap smears provide the best screening for cervical cancer.

WHAT ABOUT DRUG INTERACTIONS?
Contraceptive effectiveness may be reduced when hormonal contraceptives are administered at the same time other drugs are being taken. Break through bleeding or unintended pregnancy can result. Examples of drugs that potentially interfere with contraceptive hormones include antifungals, seizure medications and, potentially, antibiotics. For additional information please refer to the handout Pill Interactions with Other Drugs.

ARE THERE RISKS ASSOCIATED WITH USE OF NuvaRing®?
Health risks related to the contraceptive ring are low when compared to the risks of pregnancy and childbirth and are the same as with the birth control pill and the patch. The risks are usually associated with the estrogen component in the ring. In a small number of women estrogen affects the way the body forms blood clots. This may cause blood clots to form in the legs, lungs, brain or other vital organs causing serious health problems.

Cigarette smoking increases the risk of cardiovascular complications and is greater when a woman smokes more than 15 cigarettes daily and increases significantly when a she is also over 35 years of age. Women are advised to quit smoking if they use hormonal contraception in any form.

Other factors increasing the risk of blood clots are high cholesterol, diabetes, high blood pressure, obesity, and migraine headaches with aura or neurological symptoms.

If you experience any of the following symptoms, you should seek medical care immediately.

A - Abdominal pain (severe)
C - Chest pain, shortness of breath, coughing up blood
H - Headache (severe), numbness or weakness in arms or legs
E - Eye problems (vision loss, blurring, flashing lights)
S - Severe leg pain in calf or thigh

WHAT ARE THE SIDE EFFECTS?
The estrogen component is responsible for many of the side effects that occur with all of the combined hormonal methods of birth control (ring, patch or pill). The ring has less estrogen than either the pill or the patch; therefore nausea, headaches and breast tenderness may occur less often or be less severe.

The most common side effect is an increased amount of normal vaginal discharge. Occasionally women report an increased number of vaginal infections and irritation. Clinical studies show women using the ring experience an increased amount of lactobacillus in the vagina. Lactobacillus is a normal bacteria present in the vagina that actually helps decrease the incidence of yeast infections.

Headaches may occur. These should be reported to your health care provider right away if the headache or accompanying symptoms (light sensitivity, nausea, vomiting, etc.) is more severe than you have experienced before, do not respond to over-the-counter medications or last more than one month.

Mild nausea may occur with initial use, but usually will resolve within a few days. Rarely, vomiting may occur. If nausea lasts throughout the month or occurs persistently at the beginning of every ring cycle, report it to your health care provider. Vitamin B-6 (50 mg. 1-2 tablets daily) may help reduce nausea.

Weight gain may occur, but is usually limited to a few pounds.

Moodiness may occur within the first 1-2 months of use, but will usually diminish with continued use. Vitamin B-6 (50 mg. 1-2 tablets daily) may help decrease moodiness as well as relieve nausea. Notify your provider right away if severe depression symptoms occur.

Occasionally spotting and mid-cycle bleeding may occur while the ring is in the vagina. The amount of bleeding is usually minimal and will normally be reduced as you continue use, but may occur from time to time for no apparent reason. This is a normal occurrence and does not indicate that it is not working as a contraceptive.

Reactions to any method of birth control will vary from person to person. For some the reaction will be beneficial, but others may find them detrimental. For instance, acne may improve for some, but worsen for others; cramps usually improve, but occasionally a woman will experience increased cramps instead.

HOW DO I OBTAIN A NuvaRing® PRESCRIPTION?
A prescription for the ring can be obtained from a McKinley Women's Health provider or your health care provider at home. For a prescription from a McKinley provider, an annual exam within the past 12 months needs to be documented in the McKinley chart. First time users of hormonal birth control methods must complete the on-line birth control class at: http://www.mckinley.uiuc.edu/bcclass/classoptions1.html.

If you are obtaining your prescription from your home provider, refer to the handout, Transferring Outside Contraceptive Prescriptions to McKinley, for additional information and instructions.

WHEN DO I START USING NuvaRing®?

If you are starting NuvaRing® and HAVE NOT been using any other hormonal method of birth control (i.e. birth control pills or the patch): insert the ring between day one and five of your menses, even if you have not finished bleeding. Count the first day of your period as day one. You should use a condom during each act of intercourse for the first seven days during the first ring cycle.

If you are switching from birth control pills to the NuvaRing®: Insert the ring at any time during the seven days immediately following your last active birth control pill. It may be easiest to insert the ring on the day that you would have normally started a new pill pack. There should never be more than seven days between the last active pill and insertion of the ring. The ring may be inserted even if there is still some bleeding. No back up birth control is needed.

If you are switching from the patch to NuvaRing®: Insert the ring at any time during the seven days immediately following the removal of Patch #3. There should be no more than seven days between removing the patch and inserting the ring. The ring may be inserted even if there is still some bleeding. No back up birth control is needed.

If you are switching from a progestin-only pill: Insert the NuvaRing® on any day of the month. Do not skip any days between your last pill and the first day of NuvaRing® use. Use a back-up method of birth control (condoms) for seven days.

If switching from DepoProvera® to NuvaRing®: Insert NuvaRing® on the day your next injection is due. (12 weeks from previous injection plus or minus a week) Use a back up method of birth control (condoms) for seven days.

If starting NuvaRing® after a first trimester abortion: Insert NuvaRing® within the first five days after the abortion. No back up birth control is needed. If not started within the first five days, wait until the next menstrual period starts and insert within the first five days of bleeding. During the first cycle, use a back up method of birth control for seven days.

WHEN DO I REMOVE THE NuvaRing®?
Remove the ring three weeks after insertion, at approximately the same time of day, if possible. Place it in the foil envelope in which it was originally packaged and throw away. Contraceptive protection continues throughout the ring-free week.

WHEN DO I INSERT A NEW RING?
Seven days after removing the old ring, insert a new one. It is recommended that you insert and remove it at the same time of day each month. For example if you insert the first ring at 7 a.m. Sunday morning, it should be removed at approximately 7a.m. Sunday three weeks later and reinserted on the following Sunday at approximately the same time. The ring may be inserted sooner than this time if it is more convenient. It should not be inserted later than seven days.

You should expect your period during the ring-free week. Occasionally, due to the low dose of hormones used in the ring, you may experience a "missed" period (the absence of bleeding during the ring-free week). If this occurs, and the ring has been used properly, following all instructions, re-insert the ring as scheduled. For reassurance you may do a pregnancy test if you wish. If you miss two periods in a row, you should talk with your health care provider.

If the ring has been out of the vagina for more than three consecutive hours, or was not inserted as scheduled, and unplanned intercourse (UPI) has occurred, you may wish to consider using Plan B. If the ring has been out of the vagina for more than three consecutive hours, or was not inserted as scheduled, and vaginal intercourse occurred without using a condom; you may want to consider using emergency contraception/Plan B.

HOW DO I INSERT AND REMOVE THE NuvaRing®?

The NuvaRing® may be inserted while standing, squatting or lying down.



Positions for NuvaRing® Insertion


Using your thumb and index finger, press the sides of the ring together.



Holding NuvaRing® and Pressing the Sides Together


Gently push it deep into the vagina.



Inserting NuvaRing®


The exact position is not important. You should not be able to feel the ring when it is properly placed.

To remove the ring, reach into the vagina using your index finger. Hook the tip of your finger around the ring and pull gently. The ring will naturally fold slightly as it is removed from the vagina.

WHAT IF I FORGET TO REMOVE THE RING ON TIME?
If NuvaRing® remains in the vagina for 1-7 extra days, remove it and re-insert a new ring after a one-week break. You will still have contraceptive protection during the extra week and during your period. Do not leave the ring out more than seven consecutive days.

If it remains in place longer than four weeks, you may not have adequate protection against pregnancy. Remove the ring, take a one-week break and reinsert. Use a condom for back-up birth control until one week after the ring is re-inserted. If you do not have a menstrual cycle in three weeks, when you remove the re-inserted NuvaRing® you should do a home pregnancy test. For McKinley eligible students, home pregnancy test kits are available in the Resource Center at McKinley and the Illini Union.

WHAT IF THE RING SLIPS OUT?
If the ring is not inserted deep into the vagina it may slip out when straining to have a bowel movement or removing a tampon. If this occurs, rinse it with cool water and reinsert it as soon as possible. If it is out for less than three hours, there is no loss of contraceptive protection.

If the ring is lost, reinsert a new ring and use it following the original insertion/removal schedule. If the ring is out of place for more than three hours, you must use condoms as a back up birth control method for seven days. You may also wish to consider using Plan B Emergency Contraception.

If you are having problems with the ring slipping out of place frequently, talk with your health care provider.

IS IT SAFE TO USE VAGINAL MEDICATIONS OR LUBRICANTS WHEN THE RING IS IN PLACE?
Yes, you may use vaginal medications or water-based lubricants while the NuvaRing® is in place in the vagina. There will be no decrease in the contraceptive benefit. NuvaRing® is a medication and you should always advise all health care providers that you are using NuvaRing® for contraception.
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Effectiveness

The NuvaRing® is 99% effective in preventing pregnancy. After 4 weeks of consecutive use, the Ring is no longer considered effective.
A woman MUST reinsert a new ring every 4 weeks to maintain protection from pregnancy.
The Ring usually becomes effective within a few days of insertion, but use of an additional contraceptive method as back/up for 7 days with the first cycle of Ring use is highly recommended.
Advantages

provides highly effective protection against pregnancy
convenient, does not interfere with intercourse
lightens menstrual flow
decreases menstrual cramps in some cases
reduced risk of PID, endometrial and ovarian cancers
it’s easy to use and private
Disadvantages

can causes menstrual cycle irregularities especially during the first cycle
may cause weight gain, water retention, breast tenderness
may cause vaginal infections or irritation
it has be vaginally inserted and removed
provides no protection against HIV/AIDS and sexually transmitted diseases (STD’s), such as herpes, gonorrhea, syphilis and the HPV virus. Women who have multiple sexual partners or us IV drugs—or whose sexual partners have other partners or use IV drugs—should use condoms even if they rely on the NuvaRing® for pregnancy protection.
Don’t Use NuvaRing® if:

You smoke. Cigarette smoking increases the risk of serious cardiovascular side effects when you use combination oral contraceptives. This risk increases even more if you are over age 35 and if you smoke 15 or more cigarettes a day. Women who use combination hormonal contraceptives, including NuvaRing®, are strongly advised not to smoke.
you think you may be pregnant
you have or have ever had blood clots in your legs, lungs, or eyes
you have known or suspected breast cancer or cancer of the endometrium, cervix or vagina, now or in the past
you have unexplained vaginal bleeding
jaundice during past use of oral contraceptives, or during pregnancy
Women with any of the following conditions should be checked often by their doctor or healthcare provider if they choose to use NuvaRing®.

a family history of breast cancer
breast nodules, fibrocystic disease, an abnormal breast x-ray or abnormal mammogram
diabetes
high blood pressure
high cholesterol or triglycerides
headaches or epilepsy
depression
gallbladder or kidney disease
impending major surgery (discuss with your clinician—s/he may want you to stop the patch for awhile to reduce the risk of a possible blood clot)
any condition that makes the vagina get irritated easily
prolapsed (dropped) uterus, dropped bladder (cystocele), or rectal prolapse (rectocele)
severe constipation
Possible side effects

vaginal infections and irritation
headache
nausea
vaginal discharge (leukorrhea)
weight gain
In addition to the risks and side effects listed above, users of combination hormonal contraceptives have reported the following side effects:

vomiting
abdominal cramps and bloating
irregular vaginal bleeding or spotting
temporary infertility after treatment
spotty darkening of the skin, particularly on the face
weight changes
intolerance to contact lenses
change in appetite
breast tenderness or enlargement
changes in menstrual cycle
fluid retention (edema)
rash
depression
How should I use NuvaRing®?

A complete gyn exam with a documented PAP smear within 6 months prior to starting the Ring
For the best protection from pregnancy, use NuvaRing® exactly as directed. Insert one NuvaRing® in the vagina and keep it in place for three weeks in a row. Remove it for a one-week break and then insert a new ring. During the one-week break, you will usually have your menstrual period. Your menstrual period will usually start two to three days after the ring is removed and may not have finished before the next ring is inserted. To continue to have pregnancy protection, you must insert the new ring one-week after the last one was removed, even if your menstrual period has not stopped.
Points to remember
If NuvaRing® slips out:
Rarely, NuvaRing® can slip out of the vagina if it has not been inserted properly, or while removing a tampon, moving the bowels, straining, or with severe constipation. If NuvaRing® slips out of the vagina, and it has been out less than three hours, you should still be protected from pregnancy. NuvaRing® can be rinsed with cool to lukewarm (not hot) water and should be reinserted as soon as possible, and at the latest within three hours. If you have lost NuvaRing®, you must insert a new NuvaRing® and use it on the same schedule as you would have used the lost ring. If NuvaRing® has been out of the vagina for more than 3 hours, you may not be adequately protected from pregnancy. NuvaRing® can be rinsed with cool to lukewarm (not hot) water and reinserted as soon as possible. You must use an extra method of birth control, such as male condoms or spermicide, until the NuvaRing® has been in place for seven days in a row. If NuvaRing® slips out repeatedly, you should consult with your healthcare provider.

If NuvaRing® is in your vagina too long:
If NuvaRing® has been left in your vagina for an extra week or fewer (four weeks total or less), remove it and insert a new ring after a one-week ring-free break. If NuvaRing® has been left in place for more than four weeks, you may not be adequately protected from pregnancy and you must check to be sure you are not pregnant. You must use an extra method of birth control, such as male condoms or spermicide, until the new NuvaRing® has been in place for seven days in a row.

If you miss a menstrual period:
You must check to be sure that you are not pregnant if:

you miss a period and NuvaRing® was out of the vagina for more than three hours during the three weeks of ring use
you miss a period and you had waited longer than one week to insert a new ring
you have followed the instructions and you miss two periods in a row
you have left NuvaRing® in place for longer than four weeks
What to avoid while using NuvaRing®?

Do not breast feed while using NuvaRing®. Some of the medicine may pass through the milk to the baby and could cause yellowing of the skin (jaundice) and breast enlargement. NuvaRing® could also decrease the amount and quality of your breast milk.
The hormones in NuvaRing® can interact with many other medicines and herbal supplements. Tell your healthcare provider about any medicines you are taking, including prescription medicines, over-the-counter medicines, herbal remedies, and vitamins.
The blood levels of the hormones released by NuvaRing® were increased when women used an oil-based vaginal medication (miconazole nitrate) for a yeast infection while NuvaRing® was in place. The pregnancy protection of NuvaRing® is not likely to be changed by use of these products. The blood levels of the hormones released by NuvaRing® were not changed when women used vaginal, water-based spermicides (nonoxynol or N-9 products) along with NuvaRing®.
While using NuvaRing®, you should not rely upon a diaphragm when you need a back-up method of birth control because NuvaRing® may interfere with the correct placement and position of a diaphragm.
If you are scheduled for any laboratory tests, tell your doctor or healthcare provider you are using NuvaRing®. Contraceptive hormones may change certain blood tests results.

Answer 2

I used it last year. I liked not having to change it so often and that's why I got it to begin with. The reason I stopped using it was because one of the common side effects is spotting and I did! For like 3 months straight! It made it really hard for my husband and I to be Intimate so it really defeated the purpose.... well, I guess not, abstinence is the only 100% birth control! :) It doesn't happen to everyone but it did for me.

Answer 3

it's birth control in the form of a ring that you insert into your vagina. You wear it for 3 weeks and then take it out for a week to have your period. It's great for people who don't like taking the pill or who forget. You don't feel it it doesn't cause discomfort and it is very low dosages.

Answer 4

It is a ring that fits inside your vagina that releases a steady flow of hormones that prevent pregnancy. You wear it in there for 3 weeks and then take it out so you have a period, and then put in another one.

Answer 5

the ring fits around the opening of the cervix and gives off horemones like any other birthcontrol to prevent pregnancy. It is just that much simpler because you only have to change it once a month