NuvaRing

NuvaRing is a vaginal ring used by women as method of contraception (pregnancy prevention).

What is NuvaRing?

NuvaRing is a combined hormonal contraceptive, preventing unwanted pregnancy. This vaginal ring contains low doses of etonogestrel (a progesterone) and ethinylestradiol (an oestrogen), which are both female sex hormones. NuvaRing releases low doses of these hormones, which prevent pregnancy by inhibiting ovulation (release of the egg from the ovary).

Can I buy NuvaRing online?

The Online Clinic can prescribe the NuvaRing online following a quick consultation. Just complete the free consultation to proceed. Your consultation will be reviewed by a doctor online. If approved, you can then proceed with a purchase.

How to use NuvaRing

NuvaRing is a vaginal ring that you insert and remove from the vagina yourself. The ring is inserted on a specific day of your monthly cycle and removed after 3 consecutive weeks. To be sure you are protected, check regularly that the ring is in the vagina and has not fallen out. There is then a 1-week break when it is usual to have a bleed. The ring must be inserted and removed on the same week day and at about the same time. It must be inserted despite bleeding and within 3 hours of the usual time (or you may not be protected). You may become pregnant if you do not follow the instructions.

Wash your hands before and after inserting NuvaRing. Position yourself in a way that you find most comfortable for insertion, such as standing with one leg on a chair, squatting down, or lying down with knees bent upwards. Once removed from the sachet, squeeze the sides of the ring together and insert it into the vagina. There is a separate NuvaRing Applicator that can help with insertion. NuvaRing should not be uncomfortable; if it is, then push the ring higher up in the vagina. Three-weeks later remove the ring by holding the rim of the ring and gently pulling it out. Place the ring back in the sachet and dispose with the household waste (not down the toilet). Contact your doctor if you cannot remove it.

Your doctor will tell you on when to start the first NuvaRing. This will be dependent on whether in the last month you have used a hormonal contraceptive and the type you have used. You should also be informed about whether you need to use any other contraceptive methods/precautions such as a condom for the first 7 days after NuvaRing insertion. The doctor will also advise on what to do after having a baby (sometimes this is after your natural periods start, sometimes it is earlier), a miscarriage or an abortion, or if you are breastfeeding.

If the NuvaRing accidentally comes out of the vagina, then what you do is dependent on how long it has been out.

• Less than 3 hours: You are still protected. Put the same NuvaRing back in your vagina within 3 hours.
• More than 3 hours during weeks 1 and 2: You may not be protected. Put the same NuvaRing back in your vagina as soon as possible and leave there for 7 days or more. If having sexual intercourse on these 7 days, use a condom. If in week 1, and you had sex in the last 7 days, you could be pregnant.
• More than 3 hours during week 3: You may not be protected. Discard that NuvaRing and either immediately insert a new ring to start a new 3-weeks of use OR (if you used the ring on the previous 7 days) do not replace the ring, have your bleed, and then insert a new NuvaRing up to 7 days from the time your ring was removed/fell out.

Other potential situations that you may encounter include the following:

• The NuvaRing breaks: Discard it and insert a new one as soon as possible. Use extra precautions to prevent pregnancy over the following 7 days. If you noticed ring breakage after sexual intercourse, it is advisable to contact the doctor.
• If you insert 2 or more NuvaRings: You may experience feeling or being sick or have vaginal bleeding. Simply remove all but one ring and, if side effects persist then contact your doctor.
• If you forget to insert a new NuvaRing for more than 7 days after the 1-week break: Insert a new ring when you remember. It may be prudent to contact your doctor as you may be/become pregnant.
• Leaving a NuvaRing in for 3–4 weeks: You are still protected. Have a 1-week ring break and then insert a new ring.
• Leaving a NuvaRing in for over 4 weeks: You may not be protected. Do not insert a new ring before talking to your doctor.
• Missing a menstrual bleed: You are unlikely to be pregnant if you followed instructions for NuvaRing use with no additional medicines. Missing two periods may indicate you are pregnant. Do not use NuvaRing and seek medical help immediately.
• Unexpected bleeding: Leave the NuvaRing in the vagina and continue use as normal. Tell your doctor if bleeding is irregular, continuous, heavy or restarts again.

If you want to change the first day of your period (bleed) or delay your period or wish to stop using this method of contraception (whether or not you want to have a baby), then follow the NuvaRing packet leaflet instructions or get advice from your doctor. Tampons can be used when the NuvaRing is inserted (insert the ring first). Care must be taken not to pull the ring out on tampon removal (if it does come out, wash the ring in lukewarm water and reinsert immediately).

Who can use NuvaRing?

NuvaRing is for use by women of 18 years and older. NuvaRing must not be used if you are allergic to etonogestrel or ethinylestradiol or other constituents of the vaginal ring. Do not use the ring if have/have had blood clots, a blood clotting disorder, diabetes with blood vessel injury, angina chest pain, transient ischaemic attack (mini stroke), very high blood pressure, migraine with aura, very high blood fat levels, pancreatitis, severe liver disease (and liver function is not yet normal), liver tumours/cancer, breast cancer, cancer of the genitals, or if you have unexplained vaginal bleeding, or if you need surgery and have to sit for long periods.

Before using NuvaRing, you must let your doctor know if you or a close family member has/has had breast cancer or hypertriglyceridaemia (high blood fat levels); or if you have epilepsy, liver disease, gallbladder disease, chronic inflammatory bowel disease, systemic lupus erythematosus, haemolytic uraemic syndrome, sickle cell anaemia, superficial thrombophlebitis (inflamed veins under the skin), varicose veins, recently given birth, a condition that first started or worsened during pregnancy or with use of other sex hormones (e.g., brown skin patches, hearing loss, porphyria, or hereditary angioedema); or if you are waiting to have an operation, or sit down for a long time. NuvaRing may be unsuitable for you if a medical condition makes use difficult, e.g., constipation, uterine cervix prolapse, or have pain during sexual intercourse.

All current medicines, recently taken medicines or future medications (including herbal remedies) must be mentioned to the doctor before using NuvaRing, as they may alter the ring's pregnancy-protective effect or cause unexpected bleeds. These medicines include those treating epilepsy, infectious diseases including tuberculosis and HIV, and St John's wort. Spermicides and vaginal yeast products can be used with NuvaRing without loss of contraceptive efficacy.

NuvaRing side effects

Allergy to the sex hormones (etonogestrel (a progesterone) and ethinylestradiol) or other NuvaRing components manifests as swelling of the face, tongue, and/or throat, hives, and difficulty swallowing and breathing. Remove the ring and call for medical assistance immediately.

NuvaRing users have commonly reported nausea, abdominal pain, feeling sick, vaginal yeast infection, vagina discomfort, vagina secretion, genital itching, pelvic pain, period pain, breast pain, headache or migraine, depressed mood, reduced libido, acne, and weight gain. Some women report that the ring falls out or breaks. Less frequently, women experience vomiting, diarrhoea, constipation, swollen abdomen, increased appetite, feeling tired, changes in mood, disturbed vision, dizziness, increased blood pressure, water retention, bladder/urinary tract infection, difficulty passing urine, or increased frequency of urination. Also reported are painful larger breasts, breast cysts, premenstrual syndrome, menstrual period changes (longer, heavier, irregular), cervical inflammation or polyps, vaginal infection/smell/pain/dryness, uterine spasm, intercourse problems (pain, bleeding, partner can feel the ring), back pain, and loss of skin sensitivity, itching, rash or hair loss. Rarely, women have blood clots, heart attack, stroke, transient ischaemic attack, breast discharge, brown skin patches, breast cancer and liver tumours. A partner may have penis discomfort.

It is important to know that use of a combined hormonal contraceptive including NuvaRing increases the risk of a blood clot versus not using one. Additionally, the frequency of breast cancer is slightly higher in women using combined hormonal contraceptives.