Vaginal ring

NuvaRing® is a soft plastic ring which is inserted by the woman 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 pill.

How does NuvaRing® work?

• It prevents ovulation (egg release from the ovary)
• It thickens mucus in the cervix so sperm cannot enter the uterus (womb)
• It changes the lining of the uterus, making it unsuitable for pregnancy

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

• Important to 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 transmissible infections

• Periods may be lighter, shorter and more regular with less discomfort
• Similar to the combined oral contraceptive pill, there may be benefits such as reduction of symptoms for endometriosis, benign breast problems, recurrent ovarian cysts, premenstrual syndrome

The ring 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:

• Nausea
• Breast tenderness or enlargement
• Mood changes
• Breakthrough bleeding
• Headaches

• Skin changes including acne or chloasma (patchy brown skin discolouration of the face)
• Change in sexual desire

Thrombosis is 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

Most women can safely use NuvaRing®.Your doctor will review the suitability of the method with you prior to providing a prescription and will ask you about:

• History of clotting disorders or thrombosis for you or in the family
• 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
• Diabetes
• Breast cancer
• Unexplained vaginal bleeding (this should be investigated before using the ring)
• Medications that you are taking

• 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 seven 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. You do not feel the ring once in place
• A new ring is inserted into the vagina every four weeks. After insertion the ring is left in place for three 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 seven 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. This can be achieved by using the ring continuously, and inserting a new ring straight after taking out the old one
• Though it is not recommended, the ring can be removed during sex if desired. If removed it must be reinserted within three hours to maintain contraceptive protection.

• You forget to insert a new ring after the seven day break
• You remove it at any time for longer than three hours
• The same ring is left in for more than four weeks
• Certain medication may interfere with the effectiveness of NuvaRing®. Always ask your doctor if you need extra precautions
• Some non-prescribed medication, such as St Johns wort (or hypericum), can make NuvaRing® less effective. Check with the pharmacist.
• Emergency contraception may be required if you do not use NuvaRing® according to instructions, and sexual activity occurred without a condom being used
• More detailed information about the use of the ring is provided in a booklet included in each NuvaRing® packet.