The contraceptive vaginal ring
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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. Once inserted the ring 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 99% effective when used perfectly. If 100 women use the ring, 1 woman 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?
- releases a consistently low level of hormones which are absorbed directly into the bloodstream
- does not require daily pill taking
- very effective method of contraception when used correctly
- fertility returns soon after stopping
- predictable and regular bleeding pattern
- can be stopped and started to suit contraceptive needs
What are the disadvantages of NuvaRing® as a method of contraception?
- must remember to remove/reinsert new ring at correct intervals
- medical review required each year for ongoing prescriptions
- more expensive than most other methods
- does not protect against sexually transmitted infections
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. Most side effects tend to settle within two or three months of first using the ring. During this time some women may experience:
- breast tenderness or enlargement
- mood changes
- breakthrough bleeding
Other possible side effects that may occur over time include:
- skin changes including acne or chloasma (patchy brown skin discolouration of the face)
- missed periods
- change in sexual interest
No significant increase in weight gain has been linked with NuvaRing®.
If you continue to have problems while using the ring, discuss it with your doctor, as there may be a more suitable method for you.
What are the possible serious risks of using NuvaRing®?
While serious risks are extremely rare in healthy women, when using NuvaRing® it is important to note the following:
A rare but very serious complication occurring 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 in the veins after surgery, women may be advised to stop using NuvaRing® and use another method of contraception before and after a major operation.
- Cancer risk
Many studies have been conducted that have examined cancer risk and the use of the combined oral contraceptive pill ("the Pill"). As NuvaRing® contains the same hormones as the combined oral contraceptive pill, the same study findings can be applied to the ring. Some studies have shown a slightly increased risk of breast cancer in women currently taking the Pill. However more recent studies found no increase in breast cancer. It is important to discuss your individual concerns with your doctor.
There is also some research that suggests that cancer of the cervix may be slightly more common in women taking the Pill. This should not be a concern if you take part in a regular cervical screening by having a Pap smear every 2 years.
Is NuvaRing® suitable for all women?
Most women can safely use NuvaRing®.
Your doctor will review the suitability of the method with you prior to providing a prescription.
In assessing your suitability, consideration is given to a number of important factors:
- history of clotting disorders or thrombosis
- history of stroke or heart attacks
- cardiovascular risk factors including smoking, high blood pressure, high cholesterol levels or being overweight
- certain types of migraine headaches
- liver or gall bladder disease
- breast cancer
- unexplained vaginal bleeding (this should be investigated before using the ring)
The doctor will also review:
- any history in your family of clotting disorders or thrombosis
- any medications that may interfere with NuvaRing® working effectively
- if you are breastfeeding or if you have recently had a baby
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 assessment enables you to ask any questions you may have and be certain that it is the most suitable method for you.
Your doctor will explain starting Nuva Ring® with you.
Key points when commencing this method are:
- insert the first ring on any day from day 1 to 5 of your normal cycle. Day 1 of the cycle is the day your normal period starts so Day 5 is 4 days later.
- if you insert the first ring during Day 1-5 of your cycle then you are protected against pregnancy immediately
- if the first ring is inserted at any other time in your menstrual cycle, you will be protected from pregnancy only after it has been in place 7 days
- to insert the ring, squeeze the ring between thumb and index fingers, then 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 recommended, the ring can be removed during sex if desired.
If removed it should be reinserted within 3 hours to maintain the contraceptive protection.
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 after the 7 day break
- you remove it at any time for longer than 3 hours during the ring use phase
- the same ring is left in for more than 4 weeks
If any of the above situations occur you should check the advice in the booklet that is provided with each packet. Follow the advice and remember to use another form of contraception or abstain from sexual intercourse for 7 more days.
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 (or Hypericum), can make NuvaRing® less effective. Check with the pharmacist.
If you are concerned about any of the above situations, check with your doctor or health professional.
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.
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 (GPs), 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.
Phone 07 3250 0240
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.
© Family Planning Queensland
Version 2 / October 2010
P: 10/2010 5m
Funded with assistance by Queensland Health