NuvaRing contraceptive: instructions, side effects. The principle of action of the contraceptive vaginal ring - effectiveness, side effects and price

Another barrier method of contraception to protect against unwanted pregnancy, which can be purchased at the pharmacy, is a vaginal ring. This progressive remedy is gaining more and more popularity among women. In this publicly accessible way, you can eliminate abortions from your life and reduce the risk of infections after surgery. Before inserting a vaginal device, you need to consult a gynecologist to eliminate the risk of contraindications and side effects. The hormonal ring is sold at the pharmacy, instructions are included.

Nuvaring vaginal ring

This medication is a hormonal contraception suitable for use during reproductive age. Nuvaring makes sexual intercourse safe, but there is a risk of penetration of a pathogenic infection with the subsequent course of the inflammatory process. Studying all existing methods of contraception, Nuvaring is the most productive, since the contraceptive effect is 97% with proper administration and installation.

Compound

This contraceptive ring has a hormonal basis, which reduces sperm activity and the risk of unwanted pregnancy. Such a pharmacological prescription can only be made by a gynecologist, otherwise the method of contraception loses its effectiveness in practice many times over. The features of the chemical formula are detailed below in table form:

Operating principle

This vaginal “device” has a diameter of 54 mm, a transparent and flexible structure so that it can be installed correctly to avoid pregnancy. The ring is impregnated with the hormone estrogen, which provides contraceptive effectiveness. With direct contact, such a device is not felt by the sexual partner and does not interfere with the achievement of natural orgasm. The prevailing dose of hormones is enough to stop buying condoms, but do not exclude oral birth control pills (for greater effectiveness).

Among the additional pharmacological properties of the vaginal ring, doctors highlight the reduction in the abundance of menstrual bleeding, the timeliness of the onset of menstruation, and the elimination of painful sensations during uterine hemorrhages. When wearing such a device, the risk of developing ovarian cancer or cysts, ectopic pregnancy, and inflammatory processes of the genitourinary tract is reduced. In addition, it is possible to solve the problem of disrupted menstrual cycle with timely identification of the etiology of the pathology.

Indications for use

The vaginal ring is a progressive local contraceptive that significantly reduces and even minimizes the risk of unwanted pregnancy. A high concentration of sex hormones suppresses the natural process of ovulation, while weakening the sexual activity of sperm. In case of abnormal uterine prolapse and other physiological characteristics of the reproductive organ, it is better not to use such a contraceptive device, but to choose an alternative.

Nuvaring ring - instructions for use

Before placing the ring in the vagina, it is important to study the instructions for use in detail and first visit a specialist. If there are no medical contraindications, the release of the hormone progesterone will ensure safe sex and support women's health. Features of the use of such a contraceptive are as follows:

• carefully remove the ring from the special packaging;
• choose a comfortable position - standing with one leg raised, sitting on a chair with a backrest or lying down;
• tightly squeeze the vaginal ring and insert it into the genitals;
• You can remove the vaginal device with your fingers using this algorithm;
• Discard the used ring and use the next ring in the same way.

If this method of contraception is chosen, it is important to remember: insert the ring into the vagina for 21 days, and after the specified time interval, continue protection against pregnancy with a week-long break. If the ring ruptures, you can get pregnant, so it should be installed correctly. After carefully removing the characteristic device, doctors do not exclude the risk of uterine bleeding 2-3 days after the release of the vagina.

special instructions

When using a hormonal ring, the risk of developing arterial and venous thrombosis increases, therefore, when the first symptoms appear, the use of the contraceptive should be stopped immediately. Among additional complications, doctors identify acyclic bleeding, chloasma, and frequent migraine attacks. If placed incorrectly, the risk of vaginal ring rupture increases.

By-effect

Local use of a vaginal ring is not suitable for all women of reproductive age, since some experience side effects during intensive therapy that are associated not only with hormonal levels and sudden mood swings. Alternatively, it could be:

• a sharp increase in body weight;
• pain in muscles and bones;
• decreased visual acuity;
• signs of dyspepsia;
• allergic, local reactions;
• frequent urination;
• decreased libido, symptoms of depression.

Contraindications

When choosing a contraceptive, it is important not only to take into account the reviews of friends, but the recommendations of a specialist, information from the instructions. For example, vaginal rings have the following restrictions for use:

• diabetes;
• progressive pregnancy;
• uterine bleeding;
• malignant tumors;
• complicated thrombosis;
• obesity;
• arterial hypertension, myocardial pathologies.

Nuvaring - analogues

A ring with a contraceptive effect may not be suitable for the patient, so the gynecologist recommends choosing an equally effective analogue. Alternatively, these could be the following pharmacological positions:

• Janine;
• Erotex;
• Logest;
• Benatex;
• Midiana;
• Novinet;
• Yarina.

Nuvaring price

You can buy a ring with a contraceptive effect at a pharmacy, but it’s cheaper to order it online. The purchase is not cheap, however, it is also not recommended to skimp on the quality of pharmacological products, otherwise such protection may lead to unwanted childbirth. In addition to real reviews, it is recommended that you familiarize yourself with the prices:

Video

The NuvaRing ring is a hormonal drug that has a high contraceptive effect and does not cause negative consequences for the body. The instructions for use characterize it as a reliable method of protection.

It is not fussy to use, since it does not require the daily participation of a woman, acting independently. How exactly is this level of protection against unwanted conception achieved, and in what situations should it be preferred?

The Nuvaring ring, the instructions for use of which describe in detail the rules of use, is a highly effective new generation contraceptive. The artificial material from which the ring is made is also used for breast enlargement and in the manufacture of implants.

This is a translucent, almost colorless rim, 6 cm in diameter, which reliably protects the egg from fertilization by sperm and the onset of conception. The material from which the drug is made is hypoallergenic, so a negative reaction to it occurs extremely rarely.

Composition and principle of action

The instructions for the NuvaRing ring describe in detail the active substance and mechanism of action. Inside the ring are ethinyl estradiol and etonogestrel, which are released from their membrane every day in strictly limited doses. Due to the fact that there are many vessels in the vagina, the active substance quickly penetrates the blood and begins to act.

Birth control pills work in the same way, when taken the substance is absorbed through the stomach, and not through the walls of the vagina.

NuvaRing has the following effects on the female body:

1. Suppresses the onset of ovulation.
2. Does not allow the hormonal system to work.
3. Promotes the formation of thick mucus in the cervix, preventing sperm from penetrating inside and fertilizing the egg.

These processes can be reversed if you stop removing the ring from the body and wait for the cycle to normalize.

Advantages of the method

In addition to the reliability of this type of contraception, the NuvaRing ring has other positive aspects:

1. Low doses of hormones that a woman receives daily while using the ring. According to researchers, it releases almost a third less ethinyl estradiol than oral contraceptives.
2. A woman does not need to think about taking contraceptives every day, since the drug works independently of her, releasing the required amount of the active substance.
3. With its help, it is easy to regulate your monthly cycle, namely, delay or bring forward the onset of menstrual bleeding.
4. Like any hormonal drug, NuvaRing has a beneficial effect on appearance - it improves skin, hair and nails, and helps reduce discomfort during menstruation and pain.

Disadvantages of the method

The main disadvantages of using a contraceptive ring are the presence of an impressive list of contraindications and side effects, as well as the need to strictly adhere to the regimen of using the drug.

But the disadvantages do not end there:

1. The NuvaRing cannot protect a woman from sexually transmitted diseases, such as AIDS and syphilis. The same can be said about all hormonal contraceptives.
2. Additionally, if a woman is susceptible to infection, the presence of a foreign object in the vagina can increase inflammation and increase the amount of discharge.
3. Due to the fact that the ring can move and even be removed from the vagina on its own, there is a need to periodically check its presence in order to prevent sperm from fertilizing the egg.
4. This method of contraception is psychologically unusual for women, and therefore often causes mistrust in its contraceptive properties.

Technique of use

You can use the NuvaRing ring only after fully reading the instructions and consulting with a gynecologist. You should not prescribe the use of this contraceptive yourself, as it is difficult to take into account all the nuances known only to a professional.

When the first period occurs, you can inject the drug into the vagina, and the procedure should be as follows:

1. To wash hands.
2. Take a comfortable position that allows access to the vagina and allows you to completely relax, for example, lie on the sofa.
3. Open the package and remove the ring from the aluminum wrapping.
4. Flatten it with two fingers and insert the ring deeply into the vagina, adhering to the back wall.

The whole process does not take much time and is very similar to inserting a tampon when menstruation occurs. There should not be any pain, therefore, if you feel discomfort, you should immediately remove the drug and consult a doctor. The elastic NuvaRing ring, if used correctly, should adhere to the walls of the vagina and be secured to them.

After three weeks of use, the contraceptive should be removed. This needs to be done correctly, although there is nothing complicated in the process.

You need to again take a comfortable position and pick up the ring with your finger to carefully remove it from the body. This item can no longer be reused, so it can be disposed of. Next, the girl can expect bleeding, which should begin within the next 7 days. A new ring should be inserted 8 days after the previous one is removed.

Use if hormonal contraceptives were not used in the previous cycle

The NuvaRing ring can be introduced already on the first day of the cycle at the initial signs of bleeding in order to protect yourself as much as possible from conception. If necessary, you can delay using the ring for 2-5 days if you turn to alternative methods of protection.

Switching from combined hormonal contraceptives

If desired, a woman can change the method of contraception and choose the NuvaRing ring instead of combined hormonal drugs. The instructions for use do not exclude this possibility if the woman followed the gynecologist’s instructions and did not miss taking pills.

Switching from drugs containing only progestogen

Mini-pills can also be easily replaced with NuvaRing. Moreover, the transition can be made on any day of the cycle by instantly replacing the implant or IUD with a ring. When using injections to prevent conception, you should not take breaks, but replace them after the final injection.

After this, it is better to use condoms for a week due to the possible decrease in the protective effect of the ring.

After an abortion in the first trimester

Using a NuvaRing ring after an early abortion, the instructions of which clearly describe this situation, does not require resorting to alternative methods of protection against conception. An exception may be medical indications, in which a woman is allowed to delay the insertion of the ring for up to 5 days.

After childbirth or after an abortion in the second trimester

More serious abortion, performed surgically for medical reasons, or childbirth requires a more delicate approach in further protection. NuvaRing should be used only after a month if the woman is not breastfeeding her newborn.

If you delay contraception and use the ring at a later date, you should use condoms to protect yourself as much as possible from conception. In addition, you need to make sure that you are not pregnant. It is necessary to continue using barrier methods of protection for 7 days after inserting the ring.

Use during pregnancy and breastfeeding

Due to the fact that the NuvaRing ring is a hormonal drug intended to prevent pregnancy, its use during this period is strictly prohibited. Although studies of the drug have not been conducted among women expecting to give birth, there is no need to risk the health of the baby.

In addition, once pregnancy has already occurred, there is no need for contraception. The same cannot be said about the lactation period, which is also not recommended to be combined with the use of hormonal contraceptives. This is due to the fact that the active substance contained in the ring can change the composition of breast milk or reduce its volume.

Break in use

Violation of the contraceptive regimen prescribed by the gynecologist can lead to conception. Before using the NuvaRing ring after a break, the instructions provided by the manufacturer advise you to make sure there is no pregnancy.

If fertilization of the egg has not occurred, the drug should be installed as soon as possible, while simultaneously using alternative methods of contraception. But a break does not always happen due to the fault of a woman who simply got lost in the dates.

The NuvaRing ring tends to involuntarily move into the vagina and even be removed from it. Then it is urgent to return it to its place. If the contraceptive was absent from the vagina for no more than 3 hours, then there is no need to be afraid of conception. Otherwise, it is better to play it safe and resort to condoms or other barrier methods.

Extended use

If NuvaRing was used longer than prescribed, but not longer than a month, then the contraceptive effect will remain sufficient to prevent conception. The woman needs to take the prescribed week break and use the following drug.

After 4 weeks of use, the contraceptive effect of NuvaRing decreases, therefore, before inserting a new ring, you need to do a pregnancy test or consult a doctor to establish the fact that you are not pregnant.

Menstruation and bleeding during use

Bleeding during contraception with this hormonal drug is considered normal. Most often, menstruation begins immediately after the ring is removed and stops with the introduction of a new contraceptive. Less often, bleeding does not start at all, and this is also not a deviation, provided that all recommendations are followed.

Repeated absence of menstruation requires the intervention of a gynecologist, as this may mean pregnancy. However, when using the NuvaRing ring, the instructions require strict monitoring of the body’s condition, since severe bleeding must be observed by the attending gynecologist.

Cancellation of NuvaRing

A woman can refuse contraception with NuvaRing at any time, since this process does not require special preparation. If necessary, the drug can be safely removed without waiting for 21 days of use.

Pregnancy after stopping the contraceptive ring

Refusal of hormonal contraception leads to the cessation of effects on the woman’s body, and NuvaRing is no exception. Conception can occur as early as 4-5 weeks after the contraceptive ring is removed.

Drug interactions

Parallel use of the NuvaRing ring with other medications may lead to a decrease in contraceptive effect, as the instructions warn about.

Medicines that should not be combined with hormonal contraception:

1. Drugs that are excreted in large quantities by the liver, leading to hepatic metabolism. This refers to medications such as barbitures, carbamazepine, phenytoin, rifampicin, and some other medications containing St. John's wort. When undergoing therapy with these drugs, it is better to resort to alternative methods of contraception without removing the ring from the vagina.
2. Antibiotics also lead to a decrease in the contraceptive effect, as they have a great effect on the active substance of NuvaRing. When taking these drugs, with the exception of doxycycline and amoxicillin, you should use barrier contraceptives during treatment and for a week after the end of the course.

Protection using a hormonal ring can also affect the biochemical parameters of some organs and change the composition of the blood. If during contraception a woman needs to undergo a medical examination, the attending physician should be aware of the use of the NuvaRing ring.

Side effects

A negative reaction to the drug is extremely rare, but not completely excluded. Side effects that occur in connection with the use of the NuvaRing ring usually do not require emergency medical attention, since they go away on their own.

Side effects include:

1. Intoxication – nausea, diarrhea, and sometimes vomiting.
2. Dizziness, constant anxiety, changeable mood, pain in the head, as a result of the effect on the nervous system.
3. Weight gain, breast hardening, decreased libido.
4. Cystitis.
5. Minor discharge, vaginitis.

In addition, a woman may be bothered by the sensation of a foreign object in the vagina, as well as spontaneous removal of the ring.

Contraindications for use and use with caution

Not everyone is recommended to use the NuvaRing ring, since it has quite a lot of prohibitions and contraindications.

• Hormone-dependent malignant tumors.
• Vaginal bleeding that occurs for unknown reasons.
• Blood disorders such as thrombosis or bleeding disorders.
• Pregnancy and lactation.
• Severe liver pathologies, including tumors.
• Inflammatory processes in the vagina - vaginitis, colpitis.
• Allergies to contraceptive components.

Careful use of the product is possible for:

• varicose veins;
• heart disease;
• autoimmune diseases;
• when the walls of the female genital organ droop or fall out;
• cholelithiasis;
• smoking.

It is necessary to stop using NuvaRing before the proposed surgery.

Conditions and shelf life

To ensure that the drug does not lose its contraceptive properties, it must be kept at 2-8 ° C, then the NuvaRing ring will not lose its properties for 3 years from the date of release. The best place for this would be a regular refrigerator compartment, where the required temperature is maintained.

In addition, the contraceptive ring should be protected from children's attention, since if it enters the body of a minor child, it can negatively affect the development of the baby. After the expiration date, it is strictly forbidden to use the drug for its intended purpose.

Where to buy and price

The NuvaRing ring is freely available, so you can find it at any pharmacy. A large selection of drugs is offered by online portals for the sale of medicines. This makes it possible to resort to the use of NuvaRing in the most remote corners of the country, thanks to well-established logistics and courier delivery. On average, the price of one ring ranges from 600 to 1000 rubles.

Packages of the NuvaRing ring containing 3 contraceptives will cost from 1300 to 1800 rubles.

Every woman will find her own positive aspects of this method of contraception, because the convenience and effectiveness of the NuvaRing ring are obvious. Before deciding to use a hormonal drug, you should study the instructions and also consult a gynecologist.

Video about the NuvaRing ring, its effectiveness and rules of use

Instructions for use of the NuvaRing ring:

Expert opinion about the Nuvaring ring:

Does Nuvaring have side effects? This question interests any modern woman who is considering options for hormonal contraception in general and this ring in particular. Indeed, the manufacturer’s promises look tempting, but on the Internet you can find a lot of frightening reviews - supposedly some have completely stopped menstrual bleeding while using this effective contraceptive, others suffer from mood swings, emotional instability, and some cannot get pregnant. Is it true? To understand what to watch out for, you should read the instructions for use.

There are different probabilities

In the instructions, the manufacturer indicates that Nuvaring can cause side effects, and then provides an exhaustive list of such phenomena. Mostly these are fairly minor threats, such as temporary bowel disorders or increased gas formation. All of them soon disappear on their own when the body adapts to the hormonal drug. But on the World Wide Web, some mention more severe consequences - even unsuccessful attempts to get pregnant due to prolonged use of contraception. For some, these stories are an important incentive to completely abandon the drug that corrects female hormonal levels. Let's first look at what the manufacturer pays attention to first, and to do this, let's look at what we're talking about in general.

As can be seen from the instructions, the Nuvaring ring is a colorless product made of smooth material. This is a transparent object that has no damage on the outer sides that is visible to the human eye. The junction is either completely transparent or close to it. This unique development of Dutch doctors has a reliable contraceptive effect, helps prevent unwanted pregnancy, and provides the highest level of reliability. The ring is easy to use; you don’t need to remember every day, as is the case with tablets, what time and how to take the drug. Its only weakness is the somewhat probable negative response of the body.

What is possible?

It is known that the side effects of Nuvaring can bother those who use the drug uncontrollably, without the consent of the treating doctor, and without following the instructions. In addition, there are intolerances and allergic reactions. Persons for whom Nuvaring is prohibited according to the instructions or is allowed only with great caution may encounter a negative response from the body. To minimize the dangers to yourself and reduce the chance of unpleasant experiences, before starting to use the product you should consult a professional gynecologist, and possibly undergo tests to determine the characteristics of your hormonal levels. In this case, you are guaranteed to find the best option.

Due to side effects, Nuvaring, as indicated in the accompanying documentation, can cause a decrease in sexual desire, as well as cause increased sensitivity. The manufacturer draws attention to the possibility of activating appetite and weight gain. In rare cases, the use of Nuvaring causes depression, sudden changes in mood, sometimes unpredictable. There is a possibility of headaches similar to migraines. In addition, Nuvaring can provoke a deterioration in the functioning of the visual system.

Forewarned is forearmed

As you know, the side effects of the Nuvaring ring include a negative effect on the functioning of the heart and vascular system. The likelihood of thromboembolism increases, and blood pressure may be impaired. Some women have experienced hot flashes while using this contraceptive method. In addition, the ring can have a negative effect on the stomach and intestines. This is expressed in stool disorders, increased gas formation, and other disorders. There is a risk of itching, skin rashes, minor inflammations, including the facial area.

Side effects mentioned in patient reviews about the Nuvaring ring include unpleasant, even painful sensations in muscle tissue, limbs, and various parts of the spinal column. Some complain of swelling and a general sluggish state of the body. There is a risk of cystitis, possible increased urge to urinate, dysuria. Negative responses can also be noticed from the reproductive system. Some women, when using Nuvaring as a method of contraception, experience engorgement of the breast glands, there is a possibility of disruption of the monthly cycle, and lack of bleeding in the prescribed time frame. It is known that under the influence of hormonal compounds contained in the ring, a genital node may appear, bleeding for no reason, and spotting during intimate contact are possible. Nuvaring can cause unpleasant local sensations - itching, burning, pain.

Is the devil really that scary?

As the manufacturer mentions in the instructions, although the Nuvaring ring can cause side effects, in practice this is really rare. Mostly unpleasant impressions accompany the very beginning of using a contraceptive and gradually disappear over time. No specific treatment is required. If the symptoms are severe and difficult to tolerate, you should seek help from a qualified doctor as quickly as possible. The doctor will help you choose the best replacement option if Nuvaring is not suitable as a contraceptive.

Some people note in their reviews the side effects of Nuvaring: dizziness, headache. It is known that in rare cases, the use of contraceptives has even caused anxiety. When using this method of protection, vomiting is possible, although this is observed quite rarely, since the drug is used topically and not orally, and does not irritate the intestines or stomach at the stage of primary processing of the medication. The possibility of weight gain was mentioned above, but in rare cases the effect on a woman using Nuvaring was exactly the opposite - when using a contraceptive there is a risk of sudden, causeless weight loss.

Experiments and results

To understand how well-founded the reviews about the side effects of Nuvaring are, the manufacturer organized special tests. The first wave was carried out before the launch of the ring for sale, and the second - after the marketing campaign, promotion of the product, and the appearance of information about possible negative reactions in sources accessible to the general public. The peculiarity of such a study is associated with a specific effect of the human psyche, which determines the possibility of developing a negative response of the body in conditions of awareness of the likelihood of such an event. However, the results of all stages of testing clearly show that negative phenomena are recorded in a really small percentage of cases.

As noted in reviews of the Nuvaring ring, side effects can be expressed by the response of the reproductive system in the form of increased formation of leucorrhoea. In rare cases, under the influence of active compounds, an inflammatory process began in the vaginal mucosa. There is also a risk of inflammation in the urinary tract. Some women noted that the main disturbing phenomenon was the constant sensation of a foreign object in the body. The manufacturer draws attention to the possibility of the ring falling out. This cannot be directly attributed to side effects, but when using the product you will have to check that the contraceptive is in place.

Rarely, but aptly: this happens too

The instructions for use indicate that the side effects of Nuvaring are discharge resembling leucorrhoea. These are relatively common, although not in all women who use contraception. There are reactions that are observed much less frequently. On average, their frequency is one case in every thousand, or even ten thousand, of women using the product. This is how the risk of hair loss due to contraception is assessed. With the same small degree of probability, eczema and rash may appear. An allergic reaction to the drug may result in hives. “Novaring” can cause hypoesthesia and provoke unpleasant, painful sensations in the pelvic organs. In rare cases, hormonal contraception causes an increase in breast size, provokes uterine polyps, and ectropion of the uterine cervix.

Reviews of the side effects of the Nuvaring ring mention unpleasant, painful sensations associated with intimate contact. Against the background of hormonal contraception, mastopathy (cystic, fibrous type) may develop. There may be heavy discharge, similar to the usual menstrual discharge, or a complete absence of it, as well as bleeding that does not have a cycle. In rare cases, women have experienced PMS, an unpleasant odor from the vagina. “Novaring” can provoke negative local sensations, cause too dry mucous membranes, and general discomfort in the genital area.

Attention to every detail

In the instructions for the Nuvaring hormonal ring, the manufacturer points out that estimates of the frequency of occurrence of negative responses of the body are quite approximate, since they are based on information provided voluntarily. It is currently impossible to make a more accurate assessment of the situation. Some spontaneous reports contained information about the negative consequences of using the product not only for women, but also for men. When having sexual intercourse with this method of birth control, there is a risk of pain in the male penis. The risk of hyperemia increases, abrasions and bruises may form. All received messages were taken into account by the manufacturer and recorded in the accompanying documentation for the product.

The manufacturer, in the instructions for using Nuvaring, additionally draws attention to possible negative consequences when using a contraceptive in cases where the method of protection is contraindicated for a woman. In particular, with angioedema, Nuvaring can cause a deterioration in the general condition and exacerbation of symptoms. This result is shown not only by the described ring, but also by any exogenous hormonal compounds. Also, side effects will likely accompany the use of a contraceptive if a woman is sick with pancreatitis, cholecystitis, if neoplasms (malignant, benign) are detected, depending on hormonal levels, as well as some other conditions. All of them are listed in detail in the instructions in the part devoted to contraindications and conditions requiring special care.

How it works?

Having considered the possible side effects of Nuvaring (no menstruation, headache, bowel problems), it makes sense to understand how and why this contraceptive works. In the description, the manufacturer indicates that the contraceptive is a combination contraceptive and contains two types of hormones that correct the functioning of the female reproductive system - ethinyl estradiol and etonogestrel. The first is estrogen, now widely used as a contraceptive. The second name is progestogen, characterized by increased affinity for progesterone receptors.

The contraceptive “Novaring” is effective due to its combined effect on the female body. Active compounds can suppress the ovulation process, but to increase reliability, components have been introduced that affect other features of the female body, including the quality of mucus. As specialized tests have shown, the rate of conception per hundred women who used the medication for one year is 0.96. The studies were conducted with women aged 18-40 years. The results obtained are comparable to combined hormonal contraceptives intended for oral administration.

The big picture: attention to all factors

By the way, the negative features described above, as many people note in their responses, are completely equalized by the advantages of Nuvaring. Studies have proven that with the use of this contraceptive, in most women the menstrual cycle becomes clear, orderly, regular, pain and the intensity of bleeding decrease. Consequently, Nuvaring reduces the risk of iron deficiency in the female body. Currently, analytical data allow us to conclude that the use of this medication is a method of reducing the risk of malignant neoplasms in the ovaries and endometrium.

There are no complete analogues of Nuvaring on sale, but an alternative with a similar degree of effectiveness can be called tablets that correct hormonal levels. The manufacturer clearly proves that the ring is more convenient and practical. Statistical studies show that using the item results in less spotting than using pills. The likelihood of breakthrough bleeding is reduced. Among those who used Nuvaring, there was a higher percentage of women whose bleeding was observed strictly during a break in the use of the contraceptive.

Important aspect

At the moment, there is no official information about the possible negative consequences of using Nuvaring by underage girls. No special studies were organized to determine this fact.

Analyzes were conducted to determine the effects of the active compounds on bone mineral density. The duration of the program is two years. Nuvaring was compared with the results. A reasonable conclusion was made that there was no effect on bone density when choosing Nuvaring as a method of contraception.

Some have questioned what Nuvaring's withdrawal should look like. The manufacturer points out that no special measures are required. Consent with the treating doctor is only necessary if the ring was used against the background of fibroids. Otherwise, the woman simply stops using the contraceptive at any time of her own free will.

What happens in the body?

To understand why the previous periods are restored after Nuvaring, and for what reason they change during the period of use of the drug, you should delve into the logic of its influence on a woman. Hormonal compounds contained in a small ring are automatically injected daily into the surrounding tissues, affecting the reproductive system. They quickly reach target organs, minimize the unpleasant symptoms associated with eating tablets, since they do not have the same effect on the stomach and intestines as drugs intended for oral administration.

Etonogestrel, released from the ring, quickly penetrates the body, being adsorbed through the mucous membranes of the reproductive system. The highest concentration of the compound in the circulatory system is observed approximately seven days after administration of the drug. In blood plasma, the concentration changes gradually, although the limits are relatively small. The bioavailability of the active component is 100%, that is, higher than when used orally.

Ethinyl estradiol is the second hormonal compound contained in the ring and regularly injected in small doses into the female body. The highest level of concentration in the circulatory system is observed within three days from the start of use of the product. After three weeks, a slight decrease is observed, the process of decreasing the amount occurs smoothly. Bioavailability is estimated at 56%, which is approximately the same as tablets.

Special case

As stated above, the risk of encountering negative phenomena when using Nuvaring is higher if a woman belongs to certain groups of patients. For example, a number of dangers are associated with insufficient functioning of the renal and hepatic systems. There is no official information about how the circulation of active compounds of a contraceptive drug in the body may change under such conditions. It is assumed that when liver functionality is impaired, the metabolism of sex hormones slows down and worsens.

When to use and when not to?

“Novaring” is intended for all modern women interested in preventing unwanted pregnancy through a reliable method associated with a minimum of unpleasant experiences. But the list of contraindications for the name is much wider than the indications. When using the ring by women belonging to the group of those for whom it is contraindicated, there is a high probability of a negative response from the body.

You should not install Nuvaring if hypersensitivity or intolerance to any of the components used in the production of the product has been detected. This applies not only to the main compounds, but also to the excipients. You should not use Nuvaring if thrombosis or thromboembolism is diagnosed. This applies not only to the current moment, but also to the entire medical history. "Novaring" is not intended for persons whose condition suggests imminent thrombosis, as well as in determining a predisposition to it.

You should not use the Nuvaring contraceptive ring if you have focal migraines and the symptoms are neurological. This applies not only to the current moment, but also to the anamnesis. The ring is not intended for contraception in diabetics if vascular lesions are established; it is not suitable for patients with pancreatitis, malignant, benign neoplasms, bleeding of the genital organs, the cause of which cannot be determined. You should not use Nuvaring in case of severe liver diseases, during pregnancy and suspicion of conception, or when breastfeeding.

Possible, but carefully

An increased risk of side effects is associated with the use of the Nuvaring ring by persons diagnosed with thrombophlebitis, heart valve disease, high blood pressure, diabetes, acute pathologies of the liver, kidneys, gallstones, systemic lupus, minor chorea, otosclerosis, which provoked depression of auditory function.

Latest update of the description by the manufacturer 26.12.2014

Filterable list

Active substance:

ATX

Pharmacological group

Compound

Description of the dosage form

A smooth, transparent, colorless or almost colorless ring without major visible damage with a transparent or almost transparent area at the junction.

pharmachologic effect

Pharmacodynamics

Mechanism of action. The drug NuvaRing ® is a hormonal combined contraceptive containing etonogestrel and ethinyl estradiol. Etonogestrel is a progestogen (19-nortestosterone derivative) that has a high affinity for progesterone receptors in target organs.

Ethinyl estradiol is an estrogen and is widely used in the production of contraceptives.

The contraceptive effect of the drug NuvaRing ® is due to a combination of various factors, the most important of which is the suppression of ovulation.

Efficiency. In clinical studies, it was found that the Pearl index (an indicator reflecting the frequency of pregnancy in 100 women during 1 year of contraception) for the drug NuvaRing ® in women aged 18 to 40 years was 0.96 (95% CI: 0.64 -1.39) and 0.64 (95% CI: 0.35-1.07) in the statistical analysis of all randomized participants (ITT analysis) and the analysis of study participants who completed the study according to the protocol (PP analysis), respectively. These values ​​were similar to the Pearl index values ​​obtained in comparative studies of combined oral contraceptives (COCs) containing levonogrestrel/ethinyl estradiol (0.15/0.03 mg) or drospirenone/ethinyl estradiol (3/0.3 mg).

With the use of the drug NuvaRing ®, the cycle becomes more regular, the pain and intensity of menstrual-like bleeding decreases, which helps reduce the incidence of iron deficiency conditions. There is evidence of a reduction in the risk of endometrial and ovarian cancer with the use of the drug.

Nature of bleeding. A comparison of bleeding patterns over one year in 1000 women using the drug NuvaRing ® and COCs containing levonorgestrel/ethinyl estradiol (0.15/0.03 mg) showed a significant reduction in the incidence of breakthrough bleeding or spotting when using the drug NuvaRing ® compared with COC. In addition, the frequency of cases where bleeding occurred only during a break in the use of the drug was significantly higher among women using the drug NuvaRing ® .

Effect on bone mineral density. A comparative 2-year study of the effect of the drug NuvaRing ® (n=76) and a non-hormonal intrauterine device (n=31) did not reveal any effect on bone mineral density in women.

Children. The safety and effectiveness of NuvaRing ® for adolescents under 18 years of age have not been studied.

Pharmacokinetics

Etonogestrel

Suction. Etonogestrel, released from the NuvaRing ® vaginal ring, is rapidly absorbed through the vaginal mucosa. Cmax of etonogestrel in blood plasma, which is about 1700 pg/ml, is achieved approximately 1 week after insertion of the ring. Plasma concentrations vary within a small range and slowly decrease to approximately 1600 pg/ml after 1 week, 1500 pg/ml after 2 weeks and 1400 pg/ml after 3 weeks of use. Absolute bioavailability is about 100%, which exceeds the bioavailability of etonogestrel when taken orally. Based on the results of measurements of etonogestrel concentrations in the cervix and inside the uterus in women using the drug NuvaRing ® and women using oral contraceptives containing 0.15 mg of desogestrel and 0.02 mg of ethinyl estradiol, the observed values ​​of etonogestrel concentrations were comparable.

Distribution. Etonogestrel binds to plasma albumin and sex hormone binding globulin (SHBG). The apparent V d of etonogestrel is 2.3 l/kg.

Metabolism. Biotransformation of etonogestrel occurs through known pathways of sex hormone metabolism. The apparent clearance of blood plasma is about 3.5 l/h. No direct interaction with ethinyl estradiol taken concomitantly has been identified.

Excretion. The concentration of etonogestrel in the blood plasma decreases in 2 phases. In the terminal phase, T1/2 is approximately 29 hours. Etonogestrel and its metabolites are excreted by the kidneys and through the intestines with bile in a ratio of about 1.7:1. T1/2 of metabolites is approximately 6 days.

Ethinyl estradiol

Suction. Ethinyl estradiol, released from the NuvaRing ® vaginal ring, is rapidly absorbed through the vaginal mucosa. Cmax in blood plasma, which is about 35 pg/ml, is achieved 3 days after administration of the ring and decreases to 19 pg/ml after 1 week and to 18 pg/ml after 3 weeks of use. Absolute bioavailability is approximately 56% and is comparable to that of oral ethinyl estradiol. Based on the results of measurements of ethinyl estradiol concentrations in the cervix and inside the uterus in women using the drug NuvaRing ® and women using oral contraceptives containing 0.15 mg of desogestrel and 0.02 mg of ethinyl estradiol, the observed values ​​of ethinyl estradiol concentrations were comparable.

Ethinyl estradiol concentrations were studied in a comparative randomized study of NovaRing ® (daily release of ethinyl estradiol in the vagina - 0.015 mg), transdermal patch (norelgestromin / ethinyl estradiol; daily release of ethinyl estradiol - 0.02 mg) and COC (levonorgestrel / ethinyl estradiol; daily release of ethinyl estradiol — 0 .03 mg) during one cycle in healthy women. Systemic exposure to ethinyl estradiol over a month (AUC 0-∞) for the drug NuvaRing ® was statistically significantly lower than for the patch and COCs, and amounted to 10.9 ng·h/ml compared to 37.4 and 22.5 ng·h /ml for the patch and COC, respectively.

Distribution. Ethinyl estradiol binds nonspecifically to plasma albumin. The apparent Vd is about 15 l/kg.

Metabolism. Ethinyl estradiol is metabolized by aromatic hydroxylation. During its biotransformation, a large number of hydroxylated and methylated metabolites are formed. They circulate freely or as sulfate and glucuronide conjugates. The apparent clearance is approximately 35 l/h.

Excretion. The concentration of ethinyl estradiol in the blood plasma decreases in 2 phases. T 1/2 in the terminal phase varies widely; the median is about 34 hours. Ethinyl estradiol is not excreted unchanged. Ethinyl estradiol metabolites are excreted by the kidneys and through the intestines with bile in a ratio of 1.3:1. Half life of metabolites is about 1.5 days.

Special patient groups

Children. The pharmacokinetics of NovaRing ® in healthy adolescent girls under 18 years of age who have already menstruated have not been studied.

Renal dysfunction. The effect of kidney disease on the pharmacokinetics of NovaRing ® has not been studied.

Liver dysfunction. The effect of liver diseases on the pharmacokinetics of NovaRing ® has not been studied. However, in patients with impaired liver function, the metabolism of sex hormones may deteriorate.

Ethnic groups. The pharmacokinetics of the drug in representatives of ethnic groups has not been specifically studied.

Indications of the drug NuvaRing ®

Contraception.

Contraindications

The drug NuvaRing ® is contraindicated in the presence of any of the conditions listed below. If any of these conditions occur during the use of the drug NuvaRing ®, you should immediately stop using the drug.

hypersensitivity to any of the active or excipients of the drug NuvaRing ®;

thrombosis (arterial or venous) and thromboembolism currently or in history (including deep vein thrombosis, pulmonary embolism, myocardial infarction, cerebrovascular disorders);

conditions preceding thrombosis (including transient ischemic attacks, angina) currently or in history;

predisposition to the development of venous or arterial thrombosis, including hereditary diseases: resistance to activated protein C, antithrombin III deficiency, protein C deficiency, protein S deficiency, hyperhomocysteinemia and antiphospholipid antibodies (anticardiolipin antibodies, lupus anticoagulant);

migraine with focal neurological symptoms currently or in history;

diabetes mellitus with vascular damage;

pronounced or multiple risk factors for venous or arterial thrombosis: hereditary predisposition to thrombosis (thrombosis, myocardial infarction or cerebrovascular accident at a young age in one of the immediate family), hypertension, lesions of the valvular apparatus of the heart, atrial fibrillation, extended surgery, prolonged immobilization, extensive trauma, obesity (body weight >30 kg/m2), smoking in women over 35 years of age (see “Special Instructions”);

pancreatitis with severe hypertriglyceridemia currently or in history;

severe liver disease;

liver tumors (malignant or benign), incl. in the anamnesis;

known or suspected hormone-dependent malignant tumors (for example, tumors of the genital organs or breast);

bleeding from the vagina of unknown etiology;

pregnancy, incl. alleged;

breastfeeding period;

The safety and effectiveness of NuvaRing ® for adolescent girls under 18 years of age have not been studied.

Carefully

If any of the diseases, conditions or risk factors listed below are present, the benefits of using the drug NuvaRing ® and the possible risks for each individual woman should be assessed before she starts using the drug NuvaRing ® (see section “Special Instructions”). In case of exacerbation of diseases, deterioration of the condition, or the first occurrence of any of the conditions listed below, a woman should consult a doctor to decide on the possibility of further use of the drug NuvaRing ®.

The drug NuvaRing ® should be used with caution in the following cases:

risk factors for the development of thrombosis and thromboembolism: hereditary predisposition to thrombosis (thrombosis, myocardial infarction or cerebrovascular accident at a young age in one of the immediate family), smoking, obesity, dyslipoproteinemia, arterial hypertension, migraine without focal neurological symptoms, heart valve disease , heart rhythm disturbances, prolonged immobilization, serious surgical interventions;

thrombophlebitis of superficial veins;

dyslipoproteinemia;

heart valve disease;

adequately controlled arterial hypertension;

diabetes mellitus without vascular complications;

acute or chronic liver diseases;

jaundice and/or itching caused by cholestasis;

cholelithiasis;

porphyria;

systemic lupus erythematosus;

hemolytic-uremic syndrome;

Sydenham's chorea (minor chorea);

hearing loss due to otosclerosis;

(hereditary) angioedema;

chronic inflammatory bowel diseases (Crohn's disease and ulcerative colitis);

sickle cell anemia;

Conditions that may make it difficult to use a vaginal ring: cervical prolapse, bladder hernia, rectal hernia, severe chronic constipation.

Use during pregnancy and breastfeeding

The drug NuvaRing ® is intended to prevent pregnancy. If a woman wants to stop using the drug in order to become pregnant, it is recommended to wait for the restoration of the natural cycle to conceive, because this will help to correctly calculate the date of conception and birth.

The use of NuvaRing ® during pregnancy is contraindicated. If pregnancy occurs, the ring should be removed. Extensive epidemiological studies have not revealed an increased risk of congenital malformations in children born to women who took COCs before pregnancy, as well as teratogenic effects in cases where women took COCs in early pregnancy without knowing about it. Although this applies to all COCs, it is not known whether this also applies to NuvaRing ® . A clinical study in a small group of women showed that, despite the fact that the drug NuvaRing ® is administered into the vagina, the concentrations of contraceptive sex hormones inside the uterus when using the drug NuvaRing ® are similar to those when using COCs. Pregnancy outcomes in women who used NuvaRing ® during a clinical trial have not been described.

The use of NuvaRing ® during breastfeeding is contraindicated. The composition of the drug can affect lactation, reduce the amount and change the composition of breast milk. Small amounts of contraceptive sex hormones and/or their metabolites may be excreted in milk, but there is no evidence of their negative impact on the health of children.

Side effects

When using the drug, side effects may occur, occurring with varying frequencies: often (≥1/100); uncommon (≥1/1000,<1/100); редко (≥1/10000, <1/1000) см. табл. 1.

Table 1

1 The list of side effects is based on data obtained from spontaneous reports. It is not possible to accurately determine the frequency.

2 Observational cohort study data ≥1/10000 -<1/1000 женщино-лет.

3 Local reactions in a partner include reports of local reactions on the penis (eg pain, flushing, bruising and abrasions).

Side effects that occurred when taking CGC are described in detail in the “Special Instructions” section: pancreatitis, cholecystitis, cerebrovascular disorders, benign and malignant liver tumors, chloasma, changes in insulin resistance.

In women with hereditary forms of angioedema, exogenous estrogens may cause or worsen symptoms of angioedema.

Interaction

Interaction with other drugs

Interactions between hormonal contraceptives and other drugs may lead to the development of acyclic bleeding and/or contraceptive failure. The literature describes the following interactions with combined oral contraceptives in general.

Hepatic metabolism: interactions may occur with drugs that induce microsomal liver enzymes, which can lead to an increase in the clearance of sex hormones. Interactions have been established, for example with phenytoin, barbiturates, primidone, carbamazepine, rifampicin, and also possibly with oxcarbazepine, topiramate, felbamate, ritonavir, griseofulvin and preparations containing St. John's wort (Hypericum perforatum). When treating with any of the listed drugs, you should temporarily use a barrier method of contraception (condom) in combination with the use of the drug NuvaRing ® or choose another method of contraception. During concomitant use of drugs that induce microsomal enzymes, and for 28 days after their discontinuation, barrier methods of contraception should be used.

Antibiotics: a decrease in the effectiveness of oral contraceptives containing ethinyl estradiol has been observed with concomitant use of antibiotics such as ampicillin and tetracyclines. The mechanism of this effect has not been studied. In a study of pharmacokinetic interactions, oral administration of amoxicillin (875 mg 2 times a day) or doxycycline (200 mg/day, and then 100 mg/day) for 10 days while using the drug NuvaRing ® had little effect on the pharmacokinetics of etonogestrel and ethinyl estradiol. When using antibiotics (excluding amoxicillin and doxycycline), you should use a barrier method of contraception (condom) during treatment and for 7 days after stopping antibiotics.

If concomitant therapy is to be continued after 3 weeks of ring use, the next ring should be administered immediately, without the usual interval.

Pharmacokinetic studies have not revealed the effect of the simultaneous use of antifungal agents and spermicides on the contraceptive effectiveness and safety of the drug NuvaRing ®. When combined with suppositories and antifungal drugs, the risk of ring rupture slightly increases. Hormonal contraceptives can cause disruption of the metabolism of other drugs. Accordingly, their concentrations in plasma and tissues may increase (for example, cyclosporine) or decrease (for example, lamotrigine).

To exclude possible interactions, you should read the instructions for use of other drugs.

Other types of interaction

Laboratory research. The use of contraceptive steroids may affect the results of certain laboratory tests, including biochemical parameters of liver, thyroid, adrenal and kidney function; on plasma concentrations of transport proteins, such as corticosteroid binding globulin and SHBG in plasma; for lipid/lipoprotein fractions; on indicators of carbohydrate metabolism; as well as on indicators of blood clotting and fibrinolysis. Indicators, as a rule, vary within normal values.

Combined use with tampons. Pharmacokinetic data show that the use of tampons does not affect the absorption of hormones released from the NovaRing ® vaginal ring. In rare cases, the ring may be accidentally removed when removing the tampon (see section in the section “Method of administration and dosage”).

Directions for use and doses

Intravaginally. To achieve a contraceptive effect, the drug NuvaRing ® must be used according to the instructions.

A woman can independently insert the NuvaRing ® vaginal ring into the vagina.

The doctor should inform the woman how to insert and remove the NuvaRing ® vaginal ring (Fig. 1, 2).

To insert the ring, the woman should choose a comfortable position, such as standing with one leg elevated, squatting, or lying down. The NuvaRing ® vaginal ring should be squeezed and inserted into the vagina until the ring is in a comfortable position. The exact position of the ring in the vagina is not decisive for the contraceptive effect (Fig. 3).

Method of administration (see Figure 4a, 4b, 4c).

1. Insert the ring into the vagina with one hand, and, if necessary, spread the labia with the other hand (Fig. 4a).

2. Push the ring into the vagina until the ring is in a comfortable position (Fig. 4b).

3. Leave the ring in the vagina for 3 weeks (Figure 4c).

After administration (see ) the ring should be in the vagina continuously for 3 weeks. It is advisable for a woman to regularly check whether it remains in the vagina. If the ring was accidentally removed, you must follow the instructions in subsection

The NuvaRing ® vaginal ring should be removed after 3 weeks, on the same day of the week when the ring was inserted into the vagina. After a week's break, a new ring is inserted (for example, if the NuvaRing ® vaginal ring was installed on Wednesday at approximately 10:00 pm, it should be removed on Wednesday 3 weeks later at approximately 10:00 pm. A new ring is inserted on the next Wednesday). To remove the ring, you need to pick it up with your index finger or squeeze it with your index and middle fingers and pull it out of the vagina (Fig. 5).

The used ring should be placed in a bag (keep out of the reach of children and pets) and discarded. Bleeding associated with the cessation of the action of the drug NuvaRing ® usually begins 2-3 days after removal of the NovaRing ® vaginal ring and may not completely stop until a new ring is installed.

How to start using NuvaRing ®

In the previous cycle, hormonal contraceptives were not used. The drug NuvaRing ® should be administered on the 1st day of the cycle (i.e., on the 1st day of menstruation). It is possible to install a ring on days 2-5 of the cycle, however, in the first cycle in the first 7 days of using the drug NuvaRing ®, additional use of barrier methods of contraception is recommended.

Switching from combined hormonal contraceptives (CHCs). A woman should insert the NuvaRing ® vaginal ring on the last day of the usual interval between cycles when taking CHC (tablets or patch). If a woman has taken CHC correctly and regularly and is sure that she is not pregnant, she can switch to using the vaginal ring on any day of the cycle. In no case should you exceed the recommended hormone-free interval of the previous method.

Switching from progestogen-only medications (mini-pills, progestin-only oral contraceptives, implants, injectables, or hormone-containing intrauterine systems (IUDs). A woman taking mini-pills or progestin-only oral contraceptives can switch to using NuvaRing ® on any day. The ring is inserted on the day of removal of the implant or IUD. If a woman received injections, then use of the drug NuvaRing ® begins on the day when the next injection should have been given. In all these cases, the woman should use a barrier method of contraception for the first 7 days after insertion of the ring.

After an abortion in the first trimester. A woman can insert the ring immediately after an abortion. In this case, she does not need additional contraceptives. If the use of the drug NuvaRing ® immediately after an abortion is undesirable, you must follow the recommendations given in subsection No hormonal contraceptives were used in the previous cycle. In the interval, the woman is recommended an alternative method of contraception.

After childbirth or after an abortion in the second trimester. A woman is recommended to insert the ring no earlier than the 4th week after childbirth (if she is not breastfeeding) or an abortion in the second trimester. If the ring is installed at a later date, it is recommended to use an additional barrier method for the first 7 days. However, if sexual intercourse has already taken place, then before using the drug NuvaRing ® it is necessary to exclude pregnancy or wait until the first menstruation.

The contraceptive effect and cycle control may be impaired if a woman does not comply with the recommended regimen. To avoid a decrease in the contraceptive effect, the following recommendations must be followed.

What to do if the break in using the ring is prolonged. If you had sexual intercourse during a break in using the ring, pregnancy should be ruled out. The longer the break, the higher the likelihood of pregnancy. If pregnancy is ruled out, the woman should insert a new ring into the vagina as quickly as possible. Over the next 7 days, an additional barrier method of contraception, such as a condom, can be used.

What to do if the ring has been temporarily removed from the vagina. The ring must remain in the vagina continuously for 3 weeks. If the ring is accidentally removed, it should be washed with cold or slightly warm (not hot) water and immediately inserted into the vagina.

If the ring remains outside the vagina for less than 3 hours, its contraceptive effect is not reduced. The woman should insert the ring into the vagina as quickly as possible (no later than after 3 hours).

If the ring was outside the vagina for more than 3 hours during the 1st or 2nd week of use, the contraceptive effect may be reduced. A woman should insert the ring into her vagina as quickly as possible. Over the next 7 days, you must use a barrier method of contraception, such as a condom. The longer the ring was outside the vagina and the closer this period is to the 7-day break in using the ring, the higher the likelihood of pregnancy.

If the ring was outside the vagina for more than 3 hours in the 3rd week of use, the contraceptive effect may be reduced. The woman should throw away this ring and choose one of the following two methods:

1. Immediately install a new ring (the new ring can be used for the next 3 weeks. There may be no bleeding associated with the cessation of the drug. However, spotting or bleeding in the middle of the cycle is possible).

2. Wait for bleeding associated with the cessation of the drug, and insert a new ring no later than 7 days after removing the previous ring (this option should be chosen only if the regimen of use of the ring was not violated during the first 2 weeks).

What to do in case of prolonged use of the ring. If the drug NuvaRing ® was used for no more than a maximum period of 4 weeks, then the contraceptive effect remains sufficient. A woman can take a week's break from using the ring and then insert a new ring.

If the NuvaRing ® vaginal ring remains in the vagina for more than 4 weeks, the contraceptive effect may worsen, so pregnancy must be excluded before inserting a new ring. If a woman does not adhere to the recommended regimen and bleeding does not occur after a week's break in using the ring, then pregnancy should be ruled out before introducing a new ring.

How to shift or delay the onset of menstrual bleeding. To delay menstrual-like withdrawal bleeding, a woman can insert a new ring without a week's break. The next ring must be used for 3 weeks. This may cause spotting or bleeding. Then, after the usual one-week break, the woman returns to regular use of the drug NuvaRing ® .

To postpone the onset of bleeding to another day of the week, a woman may be advised to take a shorter break from using the ring (for as many days as necessary). The shorter the interval between using the ring, the higher the likelihood that there will be no bleeding occurring after the ring is removed, and bleeding or spotting will occur during the use of the next ring.

Children

The safety and effectiveness of NuvaRing ® in adolescent girls under 18 years of age have not been studied.

Overdose

Serious consequences of an overdose of hormonal contraceptives have not been described. Possible symptoms include nausea, vomiting and light vaginal bleeding in young girls. There are no antidotes. Treatment is symptomatic.

special instructions

If any of the diseases, conditions or risk factors listed below are present, the benefits of using the drug NuvaRing ® and the possible risks for each individual woman should be assessed before she starts using the drug NuvaRing ® . In case of exacerbation of diseases, deterioration of the condition, or the occurrence of any of the conditions listed below for the first time, a woman should consult a doctor to decide on the possibility of further use of the drug NuvaRing ® .

Circulatory disorders

The use of hormonal contraceptives may be associated with the development of venous thrombosis (deep vein thrombosis and pulmonary embolism) and arterial thrombosis, as well as associated complications, sometimes fatal.

The use of any COC increases the risk of developing VTE compared to the risk of VTE in patients not using COCs. The greatest risk of developing VTE is observed in the 1st year of COC use. Data from a large prospective cohort study of the safety of various COCs suggest that the greatest increase in risk compared with the risk in women not using COCs is observed in the first 6 months after starting COC use or resuming their use after a break (4 weeks or more). In non-pregnant women not using oral contraceptives, the risk of developing VTE is 1 to 5 per 10,000 woman-years (WY). In women using oral contraceptives, the risk of developing VTE ranges from 3 to 9 cases per 10,000 women. However, the risk increases to a lesser extent than during pregnancy, when it is 5-20 cases per 10,000 YL (pregnancy data are based on the actual duration of pregnancy in studies; when converted to a pregnancy duration of 9 months, the risk ranges from 7 to 27 cases per 10,000 ZhL). In postpartum women, the risk of developing VTE ranges from 40 to 65 cases per 10,000 women. VTE is fatal in 1-2% of cases.

According to research results, the increased risk of developing VTE in women using the drug NuvaRing ® is similar to that in women using COCs (adjusted risk ratio, see Table 2 below). A large prospective observational study, TASC (Transatlantic Active Study of the Safety of NuvaRing ® for Cardiovascular Stress), assessed the risk of VTE in women who started using NuvaRing ® or COCs, switched to NuvaRing ® or COCs from other contraceptives, or resumed using NuvaRing ® ® or COC, in a population of typical users. Women were observed for 24-48 months. The results showed a similar level of risk of developing VTE in women using the drug NuvaRing ® (8.3 cases per 10,000 YL) and women using COCs (9.2 cases per 10,000 YL). For women using COCs other than those containing desogestrel, gestodene and drospirenone, the incidence of VTE was 8.5 cases per 10,000 women.

A retrospective cohort study initiated by the FDA (US Food and Drug Administration) showed that the incidence of VTE in women who started using the drug NuvaRing ® was 11.4 cases per 10,000 YL, while in women of those who started using COCs containing levonorgestrel, the incidence of VTE is 9.2 cases per 10,000 young people.

table 2

Assessment of the risk (risk ratio) of developing VTE in women using the drug NuvaRing ® compared with the risk of developing VTE in women using COCs

1 Incl. low-dose COCs containing the following progestins: chlormadinone acetate, cyproterone acetate, desogestrel, dienogest, drospirenone, ethynodiol diacetate, gestodene, levonorgestrel, norethindrone, norgestimate or norgestrel.

2 Taking into account age, body mass index, duration of use, history of VTE.

3 Incl. low-dose COCs containing the following progestins: norgestimate, norethindrone or levonorgestrel.

4 Taking into account age, place and year of inclusion in the study.

There are extremely rare cases of thrombosis of other blood vessels (for example, arteries and veins of the liver, mesenteric vessels, kidneys, brain and retina) when using COCs. It is unknown whether these cases are related to the use of COCs. Possible symptoms of venous or arterial thrombosis may be unilateral swelling and/or pain in the lower extremity, local increase in temperature in the lower extremity, hyperemia or discoloration of the skin on the lower extremity; sudden severe chest pain, possibly radiating to the left arm; attack of shortness of breath, cough; any unusual, severe, prolonged headaches; sudden partial or complete loss of vision; double vision; slurred speech or aphasia; dizziness; collapse, accompanied or not accompanied by a focal epileptic seizure; sudden weakness or severe numbness on one side of the body or any part of the body; movement disorders; acute stomach

Risk factors for the development of venous thrombosis and embolism:

Age;

Presence of diseases in the family history (venous thrombosis and embolism in brothers/sisters at any age or in parents at a young age). If a hereditary predisposition is suspected, before starting any hormonal contraceptives, the woman should be referred to a specialist for consultation;

Prolonged immobilization, major surgery, any surgery on the lower extremities, or serious trauma. In such situations, it is recommended to stop using the drug (in the case of a planned operation, at least 4 weeks in advance) with subsequent resumption of use no earlier than 2 weeks after complete restoration of motor activity;

Possibly thrombophlebitis of superficial veins and varicose veins.

There is no consensus on the possible role of these conditions in the etiology of venous thrombosis.

Risk factors for the development of complications of arterial thromboembolism:

Age;

Smoking (with heavy smoking and with age, the risk increases even more significantly, especially in women over 35 years of age);

Dyslipoproteinemia;

Obesity (body mass index more than 30 kg/m2);

Increased blood pressure;

Migraine;

Heart valve disease;

Atrial fibrillation;

Presence of diseases in the family history (arterial thrombosis in brothers/sisters at any age or parents at a relatively early age).

If a hereditary predisposition is suspected, the woman should be referred to a specialist for consultation before starting any hormonal contraceptives. Biochemical factors that may indicate hereditary or acquired predisposition to venous or arterial thrombosis include activated protein C resistance, hyperhomocysteinemia, antithrombin III deficiency, protein C deficiency, protein S deficiency, antiphospholipid antibodies (anticardiolipin antibodies, lupus anticoagulant).

Other conditions that can lead to unwanted circulatory problems include diabetes mellitus, systemic lupus erythematosus, hemolytic uremic syndrome and chronic inflammatory bowel disease (such as Crohn's disease or ulcerative colitis), as well as sickle cell anemia. It is necessary to take into account the increased risk of thromboembolism in the postpartum period.

An increase in the frequency or severity of migraine (which may be a prodromal symptom of cerebrovascular accidents) while using hormonal contraceptives may be a reason to immediately discontinue use of hormonal contraceptives.

Women using CHCs should be advised to consult a doctor if possible symptoms of thrombosis occur. If thrombosis is suspected or confirmed, CHC use should be discontinued. In this case, it is necessary to use effective contraception, since anticoagulants (coumarins) have a teratogenic effect.

Risk of developing tumors

The most important risk factor for developing cervical cancer is infection with the human papillomavirus. Epidemiological studies have shown that long-term use of COCs leads to an additional increase in this risk, but it remains unclear to what extent this is due to other factors, such as more frequent cervical smears and differences in sexual behavior, including. use of barrier contraceptives. It remains unclear how this effect is related to the use of the drug NuvaRing ®.

A meta-analysis of 54 epidemiological studies found a small increase (1.24) in the relative risk of breast cancer in women taking COCs. The risk gradually decreases over 10 years after stopping the drugs. Breast cancer rarely develops in women under 40 years of age, so the additional incidence of breast cancer in women who take or have taken COCs is small compared to the overall risk of developing breast cancer. Breast cancer diagnosed in women who use COCs is clinically less severe than cancer diagnosed in women who have never used COCs. The increased risk of breast cancer may be due to both earlier detection of breast cancer in women taking COCs, the biological effects of COCs, or a combination of both.

In rare cases, women taking COCs have developed benign, and even more rarely, malignant liver tumors. In some cases, these tumors led to the development of life-threatening bleeding into the abdominal cavity. The doctor should consider the possibility of a liver tumor in the differential diagnosis of diseases in a woman taking NuvaRing ® if symptoms include acute pain in the upper abdomen, liver enlargement, or signs of intra-abdominal bleeding.

Other states

Women with hypertriglyceridemia or a corresponding family history have an increased risk of developing pancreatitis when taking hormonal contraceptives.

Many women taking hormonal contraceptives experience a slight increase in blood pressure, but clinically significant increases in blood pressure are rare. A direct connection between the use of hormonal contraceptives and the development of arterial hypertension has not been established.

If a constant increase in blood pressure is observed when using the drug NuvaRing ®, it is necessary to contact your doctor to decide whether it is necessary to remove the vaginal ring and prescribe antihypertensive therapy. With adequate blood pressure control using antihypertensive drugs, it is possible to resume use of the drug NuvaRing ®.

During pregnancy and during the use of COCs, the development or worsening of the following conditions was noted (although their relationship with the use of contraceptives has not been definitively established): jaundice and/or itching caused by cholestasis, formation of gallstones, porphyria, systemic lupus erythematosus, hemolytic uremic syndrome, Sydenham's chorea (minor chorea), herpes of pregnancy, hearing loss due to otosclerosis, (hereditary) angioedema.

Acute or chronic liver dysfunction may serve as a reason to discontinue the drug NuvaRing ® until liver function indicators normalize. Recurrence of cholestatic jaundice, previously observed during pregnancy or during the use of sex hormones, requires discontinuation of the drug NuvaRing ® .

Although estrogens and progestogens may influence peripheral insulin resistance and tissue glucose tolerance, there is no evidence to support the need to change hypoglycemic therapy during the use of hormonal contraceptives. However, women with diabetes should be under constant medical supervision when using the drug NuvaRing ® , especially in the first months of contraception.

There is evidence of a worsening of Crohn's disease and ulcerative colitis with the use of hormonal contraceptives.

In rare cases, pigmentation of the facial skin (chloasma) may occur, especially if it occurred earlier during pregnancy. Women predisposed to the development of chloasma should avoid exposure to sunlight and UV radiation while using NuvaRing ®.

The following conditions may prevent the ring from being inserted correctly or may cause it to fall out: cervical prolapse, bladder and/or rectal hernia, severe chronic constipation.

In very rare cases, women have unintentionally inserted the NuvaRing ® vaginal ring into the urethra and possibly into the bladder. When symptoms of cystitis appear, it is necessary to consider the possibility of incorrect insertion of the ring.

Cases of vaginitis have been described during use of the drug NuvaRing ® . There is no evidence that treatment of vaginitis affects the effectiveness of the use of the drug NuvaRing ® , as well as evidence of the influence of the use of the drug NuvaRing ® on the effectiveness of treatment of vaginitis.

Very rare cases of difficult ring removal have been described that required removal by a medical professional.

Medical examination/consultation

Before prescribing the drug NuvaRing ® or resuming its use, you should carefully review the woman’s medical history (including family history) and conduct a gynecological examination to exclude pregnancy. It is necessary to measure blood pressure, conduct an examination of the mammary glands, pelvic organs, including a cytological examination of cervical smears and some laboratory tests, to exclude contraindications and reduce the risk of possible side effects of the drug. The frequency and nature of medical examinations depend on the individual characteristics of each patient, but medical examinations are carried out at least once every 6 months. A woman should read the instructions and follow all recommendations. The woman should be informed that NuvaRing ® does not protect against HIV infection (AIDS) and other sexually transmitted diseases.

Reduced efficiency

The effectiveness of the drug NuvaRing ® may decrease if the regimen is not followed or concomitant therapy is carried out.

Changes in the nature of menstruation

During use of the drug NovaRing ®, acyclic bleeding (spotting or sudden bleeding) may occur. If such bleeding is observed after regular cycles while using the drug NuvaRing ® correctly, you should contact your gynecologist to conduct the necessary diagnostic tests, incl. to exclude organic pathology or pregnancy. A diagnostic curettage may be required. Some women do not bleed after the ring is removed. If the drug NuvaRing ® was used according to the instructions, it is unlikely that the woman is pregnant. If the recommendations of the instructions are not followed and there is no bleeding after removing the ring, as well as if there is no bleeding for two cycles in a row, pregnancy must be excluded.

Effects of ethinyl estradiol and etonogestrel on a sexual partner

The possible pharmacological effects and extent of exposure of ethinyl estradiol and etonogestrel to male sexual partners (due to absorption through penile tissue) have not been studied.

Ring damage

In rare cases, when using the drug NuvaRing ®, ring rupture was observed.

The core of the drug NuvaRing ® is solid, so its contents remain intact, and the release of hormones does not change significantly. If the ring ruptures, it usually falls out of the vagina (see recommendations in subsection What to do if the ring has been temporarily removed from the vagina in the section “Method of administration and dosage”). If the ring ruptures, a new ring must be inserted.

Ring falling out

Sometimes the NuvaRing ® vaginal ring may fall out of the vagina, for example, if it is inserted incorrectly, a tampon is removed, during sexual intercourse, or due to severe or chronic constipation. In this regard, it is advisable for a woman to regularly check the presence of the NuvaRing ® vaginal ring in the vagina. If the NuvaRing ® vaginal ring falls out of the vagina, you must follow the recommendations of the subsection What to do if the ring has been temporarily removed from the vagina in the section "Method of administration and dosage".