Nuvaring

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NuvaRing® is the brand name for the contraceptive vaginal ring which releases a small daily dose of hormones.

What is NuvaRing®?

NuvaRing® is a soft plastic ring which is self inserted into the vagina. It is left in place for three weeks and taken out for a week. Once inserted it slowly releases low doses of two hormones, oestrogen and a progestogen, into the bloodstream. These hormones are similar to those naturally produced by the female body and the same as those used in the combined oral contraceptive (“the Pill”).

How does NuvaRing® work?

The ring works by:

preventing ovulation (egg release from the ovary)
thickening mucus in the cervix so sperm cannot enter the uterus (womb)
changing the lining of the uterus, making it unsuitable for pregnancy

How effective is NuvaRing®?

The ring is about 99% effective when used perfectly. If 100 women use the ring, 1 of the women could become pregnant in a year. It is less effective if not used according to instructions.

What are the advantages of NuvaRing® as a method of contraception?

highly effective method of contraception
releases a consistently low level of hormones which are absorbed directly into the bloodstream
predictable and regular bleeding pattern
does not require daily pill taking
fertility returns soon after stopping

What are the disadvantages of NuvaRing® as a method of contraception?

more expensive than most other methods
does not protect against sexually transmitted infections
must remember to remove/reinsert new ring at correct intervals
medical review required each year for ongoing prescriptions

What are the possible health benefits of NuvaRing®?

periods may be lighter, shorter and more regular with less discomfort
as the ring contains the same hormones as the combined oral contraception pill, benefits such as skin improvement, reduction of symptoms such as endometriosis, benign breast problems, recurrent ovarian cysts, premenstrual syndrome and protection against ovarian and uterine cancer, should be similar. This has not yet been fully evaluated.

What are the possible side effects of using NuvaRing®?

The ring generally has few side effects. Some women may experience:

nausea
breast tenderness or enlargement
mood changes
breakthrough bleeding
headaches

These side effects often settle within 2 or 3 months after first using the ring.

Other possible side effects may include:

skin changes including acne or chloasma (patchy brown skin discolouration of the face)
missed periods
change in sexual interest
weight change can occur – however no significant increase in weight has been linked with NuvaRing®

What are the possible serious complications of using NuvaRing®?

While serious complications are extremely rare in healthy women, when using NuvaRing® it is important to note:

• Thrombosis is a rare but very serious complication. It can occur when blood clots form in major blood vessels. It is important to recognise the warning signs and seek immediate medical help if any of the following are experienced:

sudden severe chest pains
severe calf pain or swelling in one leg
sudden severe headache
sudden onset of blurred vision or loss of sight

To reduce the risk of thrombosis after surgery, women may be advised to stop using NuvaRing® and use another method of contraception for four weeks before and after a major operation.

Is NuvaRing® suitable for all women?

Most women can safely use NuvaRing®.

The ring may be PARTICULARLY SUITABLE for women who:

prefer a method of contraception which does not require daily pill taking
prefer a method with a predictable regular bleeding pattern
prefer a method that can be stopped easily
have conditions which may benefit from using the ring – including acne, heavy and/or painful periods, endometriosis, ovarian cysts, premenstrual symptoms

The ring MAY NOT BE SUITABLE for women who:

have diabetes
have gall bladder disease
are significantly overweight
have family history of thrombosis or heart attack
have migraine headaches which worsen when using the ring or taking the Pill
have high blood pressure
have abnormal vaginal bleeding (the cause of the bleeding needs to be diagnosed before commencing use of NuvaRing®)
have chronic constipation or vaginal prolapse
are not comfortable with inserting a ringinto the vagina

The ring is NOT SUITABLE for women who

are over 35 years of age and also smoke
have suffered from thrombosis (blood clots in veins)
have had a stroke or heart attack
have had certain types of migraine headaches
have had breast or genital cancer
have liver disease
are pregnant or breastfeeding

What do I need to know about starting NuvaRing®?

Starting NuvaRing® for the first time requires an assessment by a doctor and a prescription. This allows the doctor to assess your medical history and allows you to ask any questions that you may have about using the ring.

Your first ring should be inserted on any day in the first 5 days of your normal cycle (Day 1-5).

Day 1 is the first day of your usual period. If you insert it on Day 1 you will be covered for contraception immediately. If inserted later than Day 1 you will be protected from pregnancy after the ring has been in place for 7 days.

To insert the ring, simply squeeze the ring between thumb and index fingers, then gently insert into the vagina. Your vaginal muscles will keep it in place, even during exercise and sex.

More detailed information about the use of the ring is provided in a booklet included in each NuvaRing® packet. It is important to store and use the ring according to the manufacturer’s instructions.

What do I need to know about the ongoing use of NuvaRing®?

A new ring is inserted into the vagina every 4 weeks. After insertion the ring is left in place for 3 weeks, then removed and a new ring inserted a week later. A monthly bleed (a withdrawal bleed) occurs in the week when there is no ring in place. It is important to replace with a new ring, no more than 7 days after removal of the previous one.

While many women prefer to have a regular period it is possible to delay or avoid a withdrawal bleed. See your health professional for more information.

Though it is not necessary, the ring can be removed during sex if desired. If removed it should be reinserted within 3 hours to maintain the contraceptive effect.

To renew your NuvaRing® prescription you will need to see a doctor at least once a year.

NuvaRing® may not be effective if:

you forget to insert a new ring
If you forget to insert your new ring after the 7 day break, or if you remove it at any other time for longer than 3 hours, insert the ring as soon as you remember and use another form of contraception or abstain from sexual intercourse for 7 more days.
you leave the same ring in for more than 4 weeks
Effectiveness cannot be assured if you leave the same ring in for longer than 4 weeks.
medication is taken
Certain medication may interfere with the effectiveness of NuvaRing®. If you have been prescribed medication, always ask your doctor if you need extra precautions. Extra precautions may be required while you are on medication and for an extra 7 days. Some nonprescribed medication, such as St Johns wort, can make NuvaRing® less effective. Check with the pharmacist.

Do I need emergency contraception if I have been late with my ring insertion?

Emergency contraception may be required if you do not use NuvaRing® according to instructions and sexual activity occurred without a condom being used. Emergency contraception should be considered if a new ring is not inserted at the correct time and unprotected sex has occurred during the ring free week or in the 7 days after. Contact a health professional if you are unsure if you need emergency contraception.

Emergency contraception is most effective when taken within 24 hours, but may be taken up to 120 hours (5 days) after unprotected sexual intercourse. It is available without a prescription from pharmacies, general practitioners (GP’s), Sexual Health or Family Planning Queensland (FPQ) clinics. See FPQ’s Emergency Contraception factsheet.

What should I do if I am sick?

Unlike the Pill, the hormones of NuvaRing® don’t go through the stomach, so effectiveness is not altered by vomiting and diarrhoea. No extra precautions are required.

Where is NuvaRing® available?

NuvaRing® is available on a prescription obtained from your local GP or FPQ clinic.

www.fpq.com.au
Phone 07 3250 0240

Disclaimer

Family Planning Queensland (FPQ) has taken every care to ensure that the information contained in this publication is accurate and up-to-date at the time of being published. As information and knowledge is constantly changing, readers are strongly advised to confirm that the information complies with present research, legislation and policy guidelines. FPQ accepts no responsibility for difficulties that may arise as a result of an individual acting on the advice and recommendations it contains.