NuvaRing (vaginal ring)

Definition

NuvaRing is a contraceptive device for women that contains the hormones estrogen and progestin. A flexible, transparent plastic ring, NuvaRing is inserted deep into the vagina and worn for three weeks. You remove NuvaRing for one week — allowing menstruation to occur — then insert a new ring.

Similar to combination birth control pills, NuvaRing prevents pregnancy by releasing hormones into your body. NuvaRing suppresses ovulation — keeping your ovaries from releasing an egg. NuvaRing also thickens cervical mucus to keep sperm from reaching the egg.

NuvaRing is the only vaginal contraceptive that's approved by the Food and Drug Administration (FDA) in the U.S. To use NuvaRing, you'll need a prescription from your health care provider. NuvaRing doesn't offer protection from sexually transmitted infections (STIs).

NuvaRing

NuvaRing

NuvaRing is a contraceptive device that contains the hormones estrogen and progestin. NuvaRing is a flexible, transparent ring that's inserted into the vagina and worn for three weeks to prevent ...

Why it's done

NuvaRing helps prevent pregnancy. Among various benefits, NuvaRing:

• Eliminates the need to interrupt sex for contraception or seek partner compliance
• Can be removed at any time, followed by a quick return to fertility
• Doesn't require a personalized fitting

NuvaRing isn't appropriate for everyone, however. Your health care provider may discourage use of NuvaRing if:

• You're older than age 35 and smoke
• You're breast-feeding or recently gave birth, had a miscarriage or had an abortion
• You have a history of heart attack or stroke
• You have a history of breast, uterine or liver cancer
• You have a history of blood clots in your legs, lungs or eyes
• You have severe high blood pressure
• You have unexplained vaginal bleeding
• You have diabetes-related complications of the kidneys, eyes, nerves or blood vessels
• You have migraines with aura
• You have liver disease
• You have chest pain
• You've developed yellowing of the whites of the eyes or of the skin (jaundice) during pregnancy or previous use of hormonal contraceptives
• You're about to be immobilized for a prolonged period due to major surgery
• You're sensitive to any components of NuvaRing
• The ring repeatedly falls out after insertion

In addition, tell your health care provider if you have:

• A family history of breast cancer
• Breast lumps, fibrocystic disease or an abnormal mammogram
• Diabetes
• High cholesterol or triglycerides
• High blood pressure
• Epilepsy
• Depression
• Gallbladder, liver, heart or kidney disease
• Irregular periods
• A condition that makes you susceptible to vaginal irritation
• A condition that could be worsened by fluid retention
• Severe constipation
• A history of toxic shock syndrome
• A prolapsed uterus, a dropped bladder or rectal prolapse

Risks

Side effects of NuvaRing may include:

• An increased risk of blood-clotting problems, heart attack, stroke, liver cancer, gallbladder disease and high blood pressure
• Breakthrough bleeding or spotting
• Fluid retention
• Vaginal infection or irritation
• Vaginal secretion
• Headache
• Upper respiratory tract infection or sinusitis
• Nausea
• Weight gain
• Mood swings
• Decreased sex drive
• Breast tenderness

The vaginal ring doesn't offer protection from sexually transmitted infections (STIs).

An estimated 5 out of 100 women who use NuvaRing for one year will get pregnant.

Consult your health care provider as soon as possible if you have:

• Signs of a blood clot in your lung, such as coughing blood, sharp chest pain or sudden shortness of breath
• Signs of a blood clot in your leg, such as persistent pain in your calf
• Signs of a heart attack, such as crushing chest pain
• Signs of a stroke, such as a sudden severe headache, problems with vision or speech, or numbness in an arm or leg
• Signs of a blood clot in your eye, such as sudden partial or complete blindness
• Signs of a gallbladder or liver problem, such as severe pain, swelling or tenderness in your abdomen
• Signs of jaundice, such as yellowing of the skin or whites of the eyes, especially with fever, fatigue, loss of appetite, dark urine or light-colored bowel movements
• Signs of toxic shock syndrome, such as a sudden fever, vomiting, diarrhea, dizziness, fainting or a rash
• Breast lumps
• Irregular vaginal bleeding during more than one menstrual cycle or that lasts for more than a few days
• Signs of depression, such as trouble sleeping, fatigue or feeling sad
• New or worsening headaches
• Two missed periods or other signs of pregnancy
• Foul vaginal odor or vaginal itching

How you prepare

You'll need to request a prescription for NuvaRing from your health care provider. Your health care provider will review your medical history and check your blood pressure. Talk to your health care provider about any medications you're taking, including nonprescription and herbal products.

Your health care provider will determine the appropriate timing for you to start using NuvaRing based on your menstrual cycle and your previous birth control method. You may need to take a pregnancy test and use a nonhormonal backup method of contraception for one week when you start using NuvaRing.

A backup method of contraception may not be necessary if you previously used combination birth control pills or the skin patch (Ortho Evra) and insert NuvaRing on any day up to the day you would have started your new pack of pills or applied a new skin patch.

What you can expect

To use NuvaRing:

• Insert NuvaRing. Remove NuvaRing from its foil pouch. Find a position that's comfortable, such as standing with one leg up, squatting or lying down. Separate your labia with one hand. With your other hand, squeeze together the opposite sides of NuvaRing between your thumb and index finger. Gently push NuvaRing deep inside your vagina. The exact placement of the ring doesn't change its effectiveness. If you feel discomfort, try pushing NuvaRing deeper inside your vagina. You might also try inserting NuvaRing by placing it inside a tampon applicator. Keep the ring in place for three weeks. You don't need to remove NuvaRing during sex.
• Gently remove NuvaRing. After three weeks of continuous use, gently remove NuvaRing. Hook your index finger under the rim of the ring or grasp the ring between your index and middle fingers and gently pull it out. Discard NuvaRing. Don't flush it down the toilet. Wait one week to insert a new ring. You'll typically have withdrawal bleeding two to three days after removing the ring. You may still be bleeding when you insert the new ring. If you locate NuvaRing in your vagina but can't remove it, consult your health care provider.
• If NuvaRing falls out, reinsert it. NuvaRing can be expelled during tampon removal, sex or a bowel movement. If NuvaRing accidentally falls out, rinse the ring with cool or warm — not hot — water and reinsert it within three hours.
• If NuvaRing remains outside of your vagina for longer than three hours, use backup contraception. If this happens during the first or second week of NuvaRing use, reinsert NuvaRing as soon as possible and use a backup method of contraception for a week. If this happens during the third week of NuvaRing use, discard the ring. You can start using a new ring right away, which may cause breakthrough spotting or bleeding. Use a backup method of contraception until you use the new ring continuously for seven days. Or, if you used NuvaRing continuously for the previous seven days, you can wait up to seven days from the time the ring was removed or expelled to insert a new ring. You'll have withdrawal bleeding. Use a backup method of contraception until you use the new ring continuously for seven days.

You can use a tampon while using the NuvaRing. NuvaRing, however, can interfere with the placement of a diaphragm. Don't use a diaphragm as a backup method of birth control while using NuvaRing. If a ring breaks, discard it and use a new ring.

NuvaRing insertion

NuvaRing insertion

NuvaRing is a contraceptive device that contains the hormones estrogen and progestin. NuvaRing is inserted deep into the vagina to prevent pregnancy. The exact placement of NuvaRing in the vagina ...