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The Vaginal Hormonal Ring (NuvaRing®)

December 13, 2010

The vaginal ring is a method of birth control that provides both estrogen and progestin hormones. You need a prescription from your health care provider. The vaginal ring is also used to treat conditions such as irregular periods, menstrual cramps, or endometriosis. Talk to your health care provider to find out if the vaginal ring is right for you.
The Vaginal Hormonal Ring (NuvaRing)

What is the vaginal hormonal “ring”?

The vaginal hormonal ring, also called “NuvaRing®” or “ring” for short, is about 2 inches across, and is as flexible as a rubber band. You insert the ring into your vagina like a tampon. Once in place, you keep the ring in your vagina for 3 weeks at a time.

How does the ring work?

There are two different hormones called estrogen and progestin in the vaginal ring. When the ring is inserted into your vagina, the hormone medicine is absorbed through the wall of the vagina and enters your bloodstream to stop your ovaries from releasing eggs. The hormones also affect the lining of your uterus and mucus in your cervix.

Can teenagers use the ring?

Yes. The vaginal ring is safe for most teens. Be sure to tell your health care provider if you have any health problems such as blood clots, heart problems, high blood pressure, or severe migraine headaches with aura (such as flashing lights 5 to 30 minutes before the migraine).

Do I need a prescription for the ring?

Yes. Talk to your health care provider to see if you can use hormone methods such as the ring. Cigarette smoking increases your risk for heart problems. So if you smoke, work with your health care provider to quit.

Is the ring as effective as the pill in preventing pregnancy?

Yes, when used correctly. The ring is 99% effective in preventing pregnancy.

Do I need to use condoms when I’m using the ring?

Yes. The ring does not prevent STDs, so make sure you use condoms 100% of the time. The first month you start using the ring, it may not be as effective in preventing pregnancy so it is especially important for you to use condoms the first 7 days.

How should I use the ring?

When you have had your questions answered and you have learned how to insert the ring, you are ready to begin. Fill the prescription at your pharmacy. Like other hormonal methods, the ring can be used in a cyclic fashion with a week off or continuously with no week off.

When should I begin using the ring for the first time?

You should begin using the ring by inserting it between Day 1 and Day 5 of your menstrual cycle. Day 1 of your cycle is the first day of your period bleeding. The ring should be inserted by cycle day 5 at the very latest, even if you still have your period. Your health care provider may also have you start using it right after your appointment (“quick start”) and use condoms for the first cycle.

Cyclic Use (3 weeks on, 1 week off): Once you insert the ring, you leave it in place for 3 weeks in a row. After 3 full weeks, you remove the ring for 1 week before you start your next cycle. You will most likely get your period during the “ring-free” week. This is the (7 day) break in between cycles when you are not using the ring. Usually your period comes 2-3 days after you remove the ring.

The calendar below shows an example of a ring cycle (Cyclic Use), starting the ring on the first day of your period.

NuvaRing Cyclic Use Calendar

Continuous Use: If your health care provider is treating you for certain medical conditions such as painful periods or endometriosis, he or she may feel it is best for you to use the ring continuously, so you won’t have a period. You will probably not have a period because you will not have a “ring free week” but you will need to take the vaginal ring out after 3 full weeks and replace it with a new ring. Some girls may have spotting.

The calendar below shows an example of a ring cycle (Continuous Use), starting the ring on the first day of your period.

NuvaRing Continuous Use Calendar

How do I insert the ring?

  1. Before you begin, wash and dry your hands.
  2. With clean hands, gently open the foil pouch that the ring comes in. Save the pouch so you can throw the used vaginal ring away in it later.
  3. Make sure you find a private place such as your room or the bathroom, so you’ll feel relaxed.
  4. You may want to lie down in bed with knees bent, or squat down with knees bent or standing with one leg on a chair or toilet seat. (It’s similar to inserting a tampon.)
  5. Using 1 hand (right hand if you are right handed, left if you are left handed), hold the vaginal ring between your thumb and index finger. Hold the sides together so they are touching.
  6. While holding the ring, gently insert the ring into your vagina as far as it will go. (If you don’t want to touch your vagina to put it in you can use a cardboard tampon container with the tampon removed and place the ring inside the empty container. Insert the container with the ring inside and push the applicator to insert the ring.)

Will I feel the ring?

The exact position of the ring is not important for it to be effective but it should be comfortable. Most teens and women who use the vaginal ring do not feel it once it is in place. If you do feel it, gently push the ring a little further back into the vagina. The ring should not hurt or cause discomfort once it is inserted and placed correctly. If it feels uncomfortable, remove it, read the “How do I insert the ring?” directions again, and then try to insert it once more. If you still can’t insert the ring without discomfort, stop and contact your health care provider.

If I push the ring too far up inside my vagina, will it get lost?

No. The ring can’t get lost inside of your vagina. Your cervix, which is located at the end of your vagina, prevents the ring from traveling up into your uterus.

How long do I leave the ring inside my vagina?

Once in place, the ring should stay inside your vagina for 3 complete weeks unless you are having problems such as new migraine headaches or severe nausea (feeling like you want to throw up most of the time).

If you are using the ring in a cyclic way, you will remove the ring after 3 complete weeks and wait 1 full week before you insert a new ring. If you are using the ring continuously, you will take the ring out after 3 complete weeks and insert a new ring right away.

Is it possible for the ring to fall out?

It’s possible but unlikely the ring will fall out. If the vaginal ring is inserted properly, the muscles inside your vagina hold the ring in place. The ring could possibly come out if it is not inserted high enough into your vagina, if you are very constipated, straining with a bowel movement, or it could slip out if you are removing a tampon.

What do I do if the ring slips out?

If the ring slips out of your vagina, it’s okay to gently rinse it under cool water (not hot water!) then re-insert the ring in your vagina as soon as possible. You must do this within 3 hours. If you wait longer than 3 hours or forget to put the ring back in your vagina, there is a chance that the ring will not prevent pregnancy. Place the ring back in your vagina and use a “back up” method of contraception, such as condoms for 7 days.

Can I use tampons?

Yes. However, the ring may come out when the tampon is removed. Generally you will not have your period during the 3 weeks while you have the ring in place. You will probably have your period during the “ring-free week” and you won’t have to worry about using a tampon at that time. If the ring slips out, follow the about directions.

How do I take the vaginal hormonal ring out of my vagina?

Insert your index and middle finger of one of your hands into your vagina and gently feel for the ring. Once you feel the ring, hook your index finger around it and guide it out with your middle finger, pulling forward until the ring comes out. This should not hurt at all because the ring is thin and flexible.

Once I take the ring out, do I just throw it away?

It may seem silly but how you throw the ring away is very important. This is because there may be some active medicine left on the ring. Once you have removed the ring, place it in the foil pouch that it came in, seal the pouch, and then throw it away in the trash- away from young children and/or pets. If you forgot to save the pouch, either wrap the ring in a piece of aluminum foil or place it in a zip-lock plastic sandwich size bag. The ring is NOT flushable, so DO NOT flush it down the toilet.

Do I need to take the ring out on the same day of the week that I put it in?

Yes, you should remove the ring on the same day of the week that you started. For example, if you inserted the ring in on Sunday at 9:00 pm, you will need to remove the ring 3 full weeks later on a Sunday at about the same time, at 9:00 pm.

What if I forget to take the ring out?

If you are using the ring in a cyclic way (3 weeks on, 1 week off) and you leave the ring in for up to 4 weeks, remove the ring, throw it away, and wait 1 week before you insert a new ring.

If you are using the ring in a continuous way, and you leave the ring in for up to 4 weeks, remove the ring, throw it away, and insert a new ring.

If you leave the ring in your vagina for longer than 4 weeks and you are sexually active, there’s a chance that you could become pregnant. You must use another birth control method, such as condoms, for 7 days, but insert a new ring.

Check right away with your health care provider about whether you need emergency contraception or a pregnancy test.

Can I have sex while I am wearing the ring and will my partner be able to tell?

Having intercourse is a personal decision. The ring is safe and should stay in the vagina during intercourse. Your partner will not usually be able to feel the ring. If the ring is a problem during intercourse, then the ring can be removed for up to three hours. It should then be rinsed and re-inserted into the vagina. A diaphragm (another form of birth control) is not meant to be used with the Nuvaring®.

Are there any side effects with the ring?

Side effects are uncommon; but are similar to the side effects of oral contraceptive pill as it contains the same hormones (progestin and estrogen). Occasionally women report headaches, nausea, and breast tenderness. Other side effects can include; vaginal infections and irritations and weight gain.

Are there any reasons why I shouldn’t use the ring?

The ring contains the same medicine that is in birth control pills, the hormones estrogen and progestin, so it may not be safe for you to use if you have a history of certain medical problems such as blood clots, high blood pressure, or serious migraine headaches. It is very important to tell your health care provider if you or other close family members have a history of any of these conditions. You should not use the ring if you are breastfeeding or you smoke. Cigarette smoking greatly increased your risk for serious cardiovascular conditions.

You and your health care provider should decide if the ring is a good choice for you., If you have additional questions or you are having problems using the ring for the first time, call your health care provider. Routine physical exams, and getting your blood pressure checked are important. Remember that the vaginal ring does not prevent the spread of HIV or other sexually transmitted infections. Always use a condom if you are sexually active. Source:Young Women’s Health

  • The use of combination oral contraceptives is associated with increased risks of several serious side effects, including blood clots, stroke or heart attack. NuvaRing is not for women with a history of these conditions. The risk of getting blood clots may be greater with the type of progestin in NuvaRing than with some other progestins in certain low-dose birth control pills. It is unknown if the risk of blood clots is different with NuvaRing use than with the use of certain birth control pills
  • Cigarette smoking increases the risk of serious cardiovascular side effects when you use combination oral contraceptives. This risk increases even more if you are over age 35 and if you smoke 15 or more cigarettes a day. Women who use combination hormonal contraceptives, including NuvaRing, are strongly advised not to smoke
  • NuvaRing® is not for women with certain cancers or those who may be pregnant.
  • NuvaRing® does not protect against HIV infection and other sexually transmitted diseases
  • The most common side effects reported by NuvaRing® users are: vaginal infections and irritation, vaginal secretion, headache, weight gain, and nausea

For additional important information, please see the FULL PRODUCT INFORMATION, INCLUDING BOXED WARNING.

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