Nuvaring, the contraceptive vaginal ring, how does it work?

NuvaRing is the brand name for a type of contraceptive vaginal ring.

In essence, it is a flexible plastic ring capable of releasing estrogen and progesterone (precisely etonogestrel and ethinylestradiol) , once it has been inserted into the vagina, near the cervix.

The release of these hormones prevents ovulation.

Since the concentrations of the two hormones released (it is a combined contraceptive) are low, NuvaRing is considered a low-dose hormonal contraceptive. 

Around 1.5 million women worldwide use this device as a means of birth control.

NuvaRing does not protect against HIV and other sexually transmitted infections and is not suitable for all women.

How does the vaginal ring work?

NuvaRing is a small, flexible vaginal ring that is easy to insert and remove.

For it to be effective in its contraceptive function, it must be positioned correctly in the vagina, and once inserted, it should stay in place and not move.

Its mechanism of action is based on the release of estrogen and progesterone.

These hormones act on the one hand by preventing ovulation but also by making the cervical mucus thicker, so that the sperm cannot reach the fallopian tubes and travel through them.

The device is worn for 3 weeks and then removed to allow for menstruation. A normal menstrual cycle usually begins within 2 to 3 days after removal. After 7 days from the removal, the new ring is inserted even if the period has not finished yet. Basically the same day and same time as the previous ring. If the new ring is inserted more than 3 hours late , the protection from pregnancy may be reduced.

When should it be entered?

The first NuvaRing should be inserted on the 1st day of your menstrual cycle. NuvaRing starts working immediately.

You can also insert the ring for the first time between day 2 and day 5, but if you have sex in the first 7 days of NuvaRing use, you must also use an additional contraceptive method (e.g. a male condom ). This advice should only be followed when using NuvaRing for the first time. For subsequent uses it is always important to start on the same day and at the same time.

In any case, it is advisable to clarify all doubts about the use of the device with the doctor prescribing the vaginal ring

To avoid contagion from sexually transmitted diseases, you can safely use the male condom even if you wear Nuvaring.

When a woman stops using the device, she can also become pregnant from the first menstrual cycle, although it usually takes 1 to 2 months for the menstrual cycle to return to normal as before.

Insertion of the vaginal ring

• Wash and dry your hands.
• Hold the ring between your thumb and forefinger.
• Squeeze the ring with your two fingers as in figure 2.
• Choose the position you prefer: lying, standing, squatting
• Gently insert the ring inside the vagina as far as possible. It can’t go too far, as it can’t pass the cervix.
• Keep the ring for 3 weeks.
• After 3 weeks, remove the ring by hooking your index finger under the front edge to pull it out.

Currently, an applicator is also sold, similar to those used for internal tampons:

The advantages of Nuvaring

• it is 99 percent effective when used correctly. This means that it is as effective as the contraceptive pill.
• it’s easy to use and you don’t have to think about it every day like with the pill
• if it is inserted at the right time , it works immediately.

Risks and side effects

• NuvaRing is an effective means of contraception, but the instructions must be followed carefully. About 9% of women get pregnant every year because they don’t follow the directions carefully.
• you may experience some discomfort/discomfort during the first few weeks as your body adjusts to the hormonal changes. These can include bleeding between periods, breast tenderness and nausea. They should disappear after 2 to 3 months of use.

As with all hormonal contraceptives, the ring also has contraindications and may not be suitable for everyone.

Contraindications

The device secretes hormones that can cause changes in the blood clotting system. Wearing the ring can make the blood clot more easily, so it is not suitable for women with a history of blood clotting problems or who suffer from conditions that can cause clotting problems.

Women should not use NuvaRing if:

• have a previous history of heart attack, stroke or deep vein thrombosis or pulmonary embolism
• are allergic to any of the ingredients of NuvaRing
• have a heart rhythm disorder
• have liver cancer
• suffer from hypertension
• have a history of breast or ovarian cancer

Smoking significantly increases the risk of serious cardiovascular side effects in women using a hormonal contraceptive such as NuvaRing.

The manufacturer warns women not to use it if they smoke cigarettes and are over 35 years old.

In 2011, the United States Food and Drug Administration (FDA) published a study showing that NuvaRing could increase the risk of developing blood clots by 56% and that 40 patients died from ring use. This risk was higher than the risk from taking a low-dose estrogen pill used as a contraceptive.

Manufacturers have faced more than 730 lawsuits due to complications with blood clotting, complications resulting in amputations, pulmonary embolisms, strokes and deaths.

Other risks associated with NuvaRing include:

• Strokes and heart attacks: NuvaRing can increase the risk of strokes or heart attacks, especially when used by a smoker or a woman over 35.
• Hypertension : Like other combined hormonal contraceptives, NuvaRing can raise blood pressure levels.
• Cancer : There is a small increase in the risk of cancer of the reproductive organs and breast associated with the use of NuvaRing.
• Diabetes : A woman who has diabetes with kidney, eye, nerve, or blood vessel damage should not use the device.
• Other conditions include headaches, migraines or liver tumors, cardiovascular disease, unexplained vaginal bleeding, breast cancer or other types of cancer that are sensitive to hormonal changes. It should not be used if the woman suspects she is pregnant.

Side effects include:

• irritation in the vagina or cervix
• vaginal infections
• weight gain
• headache, including migraine
• mood changes and depression
• vaginal discharge
• appetite changes
• edema
• dizziness, nausea and vomiting
• skin rashes
• breast pain or discomfort

Manufacturer Merck warns that some women may experience a decrease in libido or sex drive. However, not having to think about contraception can also help a woman feel more relaxed during sex.

Drug interactions

As with other hormonal contraceptives, some medicines can interact with NuvaRing, making it less effective

These include:

• rifampicin (antibiotic)
• griseofulvin (antifungal)
• certain HIV medicines (e.g. ritonavir, nelfinavir, nevirapine, efavirenz)
• hepatitis C virus medications (eg, boceprevir, telaprevir);
• certain anti-epileptic drugs (primidone, phenytoin, barbiturates, carbamazepine, oxcarbazepine, topiramate, felbamate)
• St. John’s Wort (Hypericum perforatum) medicines

If you are taking medicines or herbal products that may lead to a reduction in the effectiveness of NuvaRing, you should also use barrier methods of contraception. As the effect of other medicines on NuvaRing may last up to 28 days after they have stopped, you should use an additional barrier method of contraception throughout this period.