NuvaRing

What is NuvaRing?

NuvaRing is also known as the vaginal ring. It's a form of hormonal contraception in the shape of a small, plastic ring which is placed inside of the vagina. 

How does NuvaRing work?

NuvaRing works in a similar way to the combined pill. It releases the estrogen and progesterone hormones into the womb to prevent ovulation from taking place each month. It also thins the womb lining, making it difficult for a fertilised egg to attach itself and thickens the mucus surrounding the cervix so that sperm have a difficult time entering. 

How effective is NuvaRing?

With typical use, NuvaRing is 91% effective. If it used perfectly (i.e. inserted correctly, on time and not forgetting about it) then it is 99% effective. 

When does NuvaRing start to work?

If you insert NuvaRing on the first day of your period it will start to work right away. You can start using it at any time during your cycle but you will need to use condoms if NuvaRing is used any other day of the month. You should avoid using a diaphragm or cap as these devices can dislodge the ring.

NuvaRing for non-contraceptive purposes

Due to the hormones it contains, NuvaRing can help to ease heavy, painful periods and symptoms of PMS. This usually results in lighter, less painful periods. 

Active ingredients

The active ingredients within NuvaRing are etonogestrel and ethinylestradiol. 

Inactive ingredients

The inactive ingredients in NuvaRing are ethylene vinylacetate copolymers (28% and 9% vinylacetate) and magnesium stearate.

How long does NuvaRing last?

Each ring lasts for 28 days. After insertion, you leave it in for 21 days before removing it. You then wait 7 days before inserting a new one, in a similar way to having a pill free week if you were on the combined pill. You are still protected from pregnancy during these 7 days and this is when you will have your period. 

When to start NuvaRing

The best time to start using NuvaRing is on the first day of your period as you will be protected against pregnancy right away. You can start using NuvaRing at any time during your cycle but you will need to use an additional barrier method of contraception for the first seven days. 

How to use NuvaRing

NuvaRing is inserted into the vagina and left in for 21 days. When you are ready, wash your hands and take the ring out of the packaging. Squeeze it between your thumb and finger before inserting it into the vagina. Carefully push it upwards until you can no longer feel it, as you would do with a tampon. It does not need to cover the cervix to work as it is not a barrier method of contraception such as a diaphragm or cap. It may take a bit of time to get the hang of it so ensure you give yourself plenty of time and do not rush.

The ring is then removed after 21 days, leaving a 7 day gap before inserting a new one. This is when you will have your period. The new one should always be inserted on time, even if you are still having your monthly bleed.

How to remove the ring

After 21 days, NuvaRing should be removed. Wash your hands before beginning and get into a position that is comfortable for you. Gently insert a finger into the vagina so that you are able to hook it around the edge of the ring and carefully pull it out. There are bags provided with NuvaRing to place a used ring inside of before discarding it in the bin. It should not be flushed down the toilet. If you have trouble removing it or experience bleeding, see a nurse or GP as soon as possible. 

What should I do if I forget to remove the ring on time?

If your ring has been left in for up to an additional 7 days, remove it as soon as you can. Wait 7 days before inserting another ring as usual. Your period will be delayed slightly but your contraception will not be affected. 

If your ring has been left in for more than 28 days, take it out right away and insert a new ring immediately. You will need to use condoms for an additional 7 days as your protection may be affected. If you have had sexual intercourse between day 28 of your cycle and taking out the ring, you should see a GP or pharmacist right away for emergency contraception.

What should I do if I forget to put the ring in on time?

If you forget to insert NuvaRing on time after the 7 day break, put it in as soon as you can. You will need to use additional contraception, such as condoms, for the next 7 days to ensure you are protected against pregnancy. If you insert a new ring more than 48 hours after you should have and have had sex during this time you should seek emergency contraception. 

What should I do if the ring falls out?

Occasionally, NuvaRing may come out on its own. This is most likely to happen during sex if the ring wasn't inserted properly. the action you should take will depend on where you are in your cycle and how long the ring has been out for. 

• If NuvaRing has been out for less than 3 hours rinse it with cool water and reinsert it. Your contraception will not be affected 

• If NuvaRing has been out for more than 3 hours during the first or second week rinse it will cool water and reinsert it right away. You will need to use additional contraception for the following 7 days and emergency contraception if you have had sex in the past couple of days. 

• If NuvaRing has been out for more than 3 hours in the third week, discard it and either put a new one in straight away or begin your 7 day break which means your period will start early. If you insert a new ring right away you might not have a period. Either way, you should use additional contraception for the next 7 days and seek emergency contraception if you have had sex in the past few days.

Use one NuvaRing at a time. Each one should be left in for 21 days.

Common side effects include: 

• Tissue irritation inside the vagina or cervix

• Headaches 

• Nausea 

• Vomiting 

• Mood changes 

• Depression 

• Vaginal discharge 

• The ring slipping out 

• Discomfort 

• Weight gain 

• Breast pain or tenderness 

• Painful periods 

• Abdominal pain 

• Acne 

• Lowered libido 

• Spotting 

Uncommon side effects include: 

• Chloasma 

• High blood sugar 

• High levels of fat in the blood 

• The ring getting stuck to the vaginal tissue 

If you are having difficulty removing NuvaRing, see a doctor or nurse for assistance. 

Rare, serious side effects may include: 

• Blood clots 

• Toxic shock syndrome 

• Allergic reaction 

• Liver problems 

• High blood pressure 

• Gallbladder problems 

• Angioedema (if you have a family history of the condition) 

If you experience any of the following signs of toxic shock syndrome (TSS) seek immediate medical assistance: 

• Sudden high fever 

• Vomiting 

• Diarrhoea 

• A sunburn-like rash 

• Muscle aches 

• Dizziness 

• Fainting 

• Feeling faint when standing up

Contraindications

Do not use NuvaRing if: 

• You are a smoker over the age of 35

• You have ever experienced a blood clot 

• You have a condition which affects your blood clotting 

• You have ever had a stroke 

• You have ever had a heart attack 

• You have problems with your heart 

• You have severe high blood pressure 

• You have diabetes with blood vessel damage 

• You get migraines with aura 

• You are over 35 and get migraines 

• You have liver disease 

• You have unexplained vaginal bleeding 

• You may be pregnant 

• You have ever had breast, cervical or ovarian cancer 

• You are allergic to any of the ingredients 

• You have ever experienced jaundice during pregnancy or previous hormonal contraceptive use 

Tell your doctor or pharmacist before using NuvaRing if: 

• You have any underlying medical conditions 

• You smoke 

• You are, or might be, pregnant 

• You have recently given birth 

• You have recently had a miscarriage or abortion 

• You have a family history of breast cancer 

• You have experienced breast nodules or any irregularities in the breasts

• You have ever experienced toxic shock syndrome after using tampons 

• You have depression 

• You have experienced liver problems during pregnancy 

• You have a higher level of cholesterol or triglycerides in the blood 

• You have experienced gallbladder, heart, liver or kidney disease 

• You have a history of irregular periods 

• You have a condition which causes vaginal irritation 

• You have ever had high blood pressure 

• You have migraines or seizures 

• You are scheduled to have surgery 

• You are breastfeeding 

• You have ever experienced an allergic reaction from previous use of NuvaRing

Drug Interactions

Certain medications can cause NuvaRing to be less effective. These include: 

• Epilepsy medications 

• HIV medications 

• Hepatitis C treatments 

• Griseofulvin 

• Rifampicin 

• Rifabutin 

• Efavirenz 

• Nevirapine 

• Bosentan 

• Aprepitant 

• St John's wort

NuvaRing vs the pill

NuvaRing works in a similar way to the pill as it contains the same estrogen and progesterone hormones. NuvaRing is easy to use and you do not have to think about it everyday like the pill as long as you remove it and insert a new one on time. Unlike the pill, vomiting or severe diarrhoea will not interfere with it but there is a slight risk of NuvaRing being expelled from the vagina. 

Nuvaring vs IUD

NuvaRing is a hormonal contraceptive, like the combined pill. Each one lasts for 28 days and must be removed and replaced once a month. The IUD, also known as the copper coil, is a long term reversible contraceptive which is inserted by a doctor or nurse. Once it's in, it lasts for 5-10 years depending on the type. It's non-hormonal and works by being toxic to sperm. It does not produce the side effects of hormonal contraceptives but it does increase the risk of pelvic inflammatory infection and ectopic pregnancy should the contraceptive fail. This may be a better option if you find it difficult to remember to take NuvaRing in and out. 

Alternatives to NuvaRing

The combined pill contains the same hormonal components as NuvaRing and works in the same way to protect against unwanted pregnancy. It's taken everyday for 21 days and then you have a 7 day break before starting the next pack. NuvaRing is not suitable for all women however as it can pose health risks for those with high blood pressure, heart problems or anyone at risk of a blood clot. The mini pill, also known as the progesterone only pill, may be a suitable alternative. It does not produce as many side effects due to to the lack of estrogen. It must be taken on time everyday for it to be effective. Long term reversible contraceptives are available from your GP or family planning clinic. These include the implant, IUD (copper coil), IUS (hormonal coil) or injection. 

Will NuvaRing stop my period?

NuvaRing will not stop your period. It replaces your natural menstrual cycle with an artificial one but you will still have a monthly withdrawal bleed that is similar to a period. 

Will NuvaRing help with acne?

Acne is a potential side effect of NuvaRing but the hormones contained in the contraceptive may help to reduce the appearance of acne. NuvaRing is not usually prescribed for this reason however. 

Can NuvaRing be used as emergency contraception?

NuvaRing cannot be used as emergency contraception. If you have had unprotected sex, you can either take the morning after pill or have an IUD fitted. The IUD is the only type of regular contraception which can be used in this manner. 

Is Nuvaring effective in the 4th week of my cycle?

NuvaRing is still effective during the 4th week while the ring is out as long as you have used it correctly. Your NuvaRing should stay inside the vagina for 21 days before removing it. The ring free week is the same as the 7 day break between contraceptive pills and you are still protected from pregnancy during this time. 

Can I use tampons while using NuvaRing?

You can still use tampons while using NuvaRing. The ring should always be inserted first and you should take extra care when removing tampons to ensure the ring does not get pulled out by accident. If this happens, rinse it with cool water and reinsert it. 

Is NuvaRing uncomfortable?

NuvaRing should not feel uncomfortable but if it is not inserted correctly then you may be able to feel it. It may take a bit of practice to get the technique right so try to relax and adjust it if you need to.

Will my partner feel NuvaRing during sex?

In most cases NuvaRing will not be felt by your partner during sexual intercourse. 

Sources

NHS> Vaginal Ring https://www.nhs.uk/conditions/contraception/vaginal-ring/

Planned Parenthood> How Effective is the Birth Control Ring? https://www.plannedparenthood.org/learn/birth-control/birth-control-vaginal-ring-nuvaring/how-effective-birth-control-ring

NuvaRing> Resources https://www.nuvaring.com/resources/