NuvaRing hormonal ring: clear instructions for use. Contraceptive ring "NovaRing": side effects, instructions, analogues, reviews

Or frequently asked questions about the NuvaRing hormonal ring, which the doctor hears at every appointment.

What is NuvaRing?

is an elastic ring that is inserted deep into the vagina. The system is installed in the first days of the menstrual cycle and remains in the genital tract for 21 days. The contraceptive ring contains the female sex hormones estrogen and progesterone. These substances are gradually released and enter the bloodstream, blocking ovulation and making pregnancy impossible. Hormones also make the cervical mucus viscous so that nimble sperm do not penetrate inside and fulfill their intended purpose.

Today, the NuvaRing vaginal ring is considered one of the most effective contraceptives with a minimal amount of hormones. This fact makes the system popular with both young and older women. What should you know about NuvaRing and how to use this contraceptive correctly?

Who is NuvaRing suitable for?

The contraceptive ring is a good choice for different categories of women:

• Young and nulliparous women with one sexual partner.
• After childbirth and completion of breastfeeding.
• In the premenopausal period (in the absence of chronic pathology that can become a contraindication).

Why is NuvaRing better than birth control pills?

The vaginal ring has three clear advantages over COCs with a similar composition:

• The dosage of estrogen is lower than in any hormonal pills.
• The drug does not pass through the gastrointestinal tract and does not affect digestion.
• You don’t need to remember to take the pills every day - just insert the ring once and forget about it for 21 days.

Can NuvaRing be given to nursing mothers?

The instructions for using the contraceptive ring do not recommend using NuvaRing during lactation. You should wait until breastfeeding is completed and only then insert the ring. Nursing mothers can use mini-pills (purely progestin preparations) as contraception. Don't forget about condoms.

Can a woman put on a contraceptive ring herself or should she go to a doctor?

NuvaRing is simple, convenient and affordable. Any woman can insert a ring on her own without any problems. To do this, you need to take a comfortable position - squatting, standing or lying - and insert the ring as deeply as possible. If any difficulties arise, you can make an appointment with a doctor. The doctor will insert the ring and then tell the patient in detail how to do it at home.

Can a man feel the ring during sex?

No, NuvaRing is not felt at all during sexual intercourse.

Can a woman feel the vaginal ring?

No, if the NuvaRing is installed correctly, it is not felt in the vagina.

Why doesn't the ring fall out?

NuvaRing, inserted deeply, is securely fixed into the vagina by muscles. In addition, the ring lies horizontally in the genital tract, like on a shelf, and the likelihood of it falling out is extremely low.

Can the ring fall out?

It's rare, but it happens. In this case, you need to wash the ring with warm or cool water and carefully insert it back into the vagina. The contraceptive effect does not suffer if less than 3 hours have passed since the ring fell out.

The ring fell out, but I didn’t have time to quickly put it back in place. What to do?

If more than 3 hours have passed since the ring fell out or was removed, you need to proceed according to the following scheme:

1. If such a problem occurs in the 1st or 2nd week of using the NuvaRing ring, you need to return it to its place as quickly as possible. The contraceptive effect of the drug is reduced, and for some time the woman will not be protected from unwanted pregnancy. It is recommended to additionally use a condom for the next 7 days.
2. If the ring falls out during the 3rd week of use, it should be thrown away and a new one should be inserted immediately. In this case, there will be no menstrual-like bleeding, but scanty spotting may be observed. This is normal, there is no need to panic. The ring is removed after the prescribed 21 days, then a break is taken for 7 days and a new drug is introduced.
3. If a woman does not want to get a new ring immediately, she can wait for the withdrawal bleeding and insert NuvaRing after 7 days. This option is only possible if the ring never falls out during the first two weeks. If the problem has occurred before, see point 2.

Is it possible to remove a vaginal ring during sex?

Yes, but this makes no sense, because NuvaRing does not feel like a woman or a man. If the ring is nevertheless removed, it must be returned within 2-3 hours and no later.

Can a NuvaRing sink in too deep?

No, the contraceptive ring is securely attached to the vagina. It will not fall into the uterus, since the entrance to the reproductive organ is blocked by a closed pharynx. The ring has nowhere to go from the woman's genital tract, and even during sex it will not penetrate too deeply.

Is it possible to leave the NuvaRing ring in the vagina for 4 weeks?

This is acceptable because the contraceptive effect of the system lasts up to 28 days. After 4 weeks, the ring must be removed: hormone levels drop, and the woman loses protection against unwanted pregnancy.

Is it possible to freeze a NuvaRing?

You can store the birth control ring in the refrigerator for up to 12 hours. It is not recommended to freeze the system in the freezer. If you need to take a contraceptive with you (for example, when traveling to another city), use a special cooler bag.

Is it possible to cancel periods?

Yes, you can insert a new ring without a week's break. Menstruation will not come, but spotting may occur in the middle of the cycle. The new ring can be left in the vagina for 21 days (as usual).

How to postpone the date of menstruation when using the NuvaRing ring?

It’s very simple: you just need to insert a new ring not after 7 days, but, for example, 5 or 6 after removing the previous one. It is important to know: the shorter the break, the higher the likelihood of spotting in the middle of the cycle.

Can girls under 18 years old use the birth control ring?

The safety of NuvaRing has not been studied in adolescents. An in-person consultation with a doctor is required.

Should I use a ring if I have uterine prolapse?

With this pathology, the NuvaRing may fall out. It is recommended to use other means of contraception.

Why can't you take antibiotics if you have a ring?

This is not entirely true. If the doctor has prescribed antibacterial drugs, they must be taken. The problem is that when using some antibiotics (in particular ampicillin and tetracycline), there is a decrease in the contraceptive effect. While a woman is taking antibiotics, she should additionally use condoms - for the entire period of treatment and for 7 days after completing the course of therapy.

Can a NuvaRing break?

Yes, this is possible. The risk of ring rupture increases with the simultaneous use of vaginal suppositories against a fungal infection (thrush). During treatment, you must additionally use condoms and monitor the condition of the NuvaRing.

Can I use a birth control ring with tampons?

Yes, the use of tampons does not affect the functionality of NuvaRing. In rare cases, the ring may fall out after removing the tampon.

Does NuvaRing cause cervical cancer?

It is believed that the main cause of malignant lesions of the cervix is ​​the human papillomavirus (HPV), but not the use of hormonal contraceptives. Statistics show that women who have used NuvaRing are more likely to develop cervical cancer, but gynecologists attribute this to regular examinations by a doctor and annual tests (smear for oncocytology). It is worth noting that in this situation, the disease is usually detected in the early stages, when it is much easier to cure.

How quickly can you get pregnant after removing the NuvaRing?

Fertility restoration occurs within 1-3 months after discontinuation of the drug. This means that a woman can become pregnant in the first cycle after removing the ring. In some cases, conception of a child occurs after 3-12 months.

How does the menstrual cycle change after the installation of a vaginal ring?

After the introduction of NuvaRing, the gradual release of hormones begins. The menstrual cycle becomes monotonous. The level of your own hormones remains stable. Menstruation, as a rule, becomes less abundant and its duration decreases. Menstrual-like bleeding due to NuvaRing occurs every 28 days strictly according to schedule.

How much does NuvaRing cost?

The average price for a contraceptive ring is about 1,000 rubles.

A combined hormonal contraceptive drug containing etonogestrel and ethinyl estradiol.

Etonogestrel is a progestogen (19-nortestosterone derivative) that binds with high affinity to 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) in women aged 18 to 40 years for the drug NuvaRing ® 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 them 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 levonorgestrel/ethinyl estradiol (0.150/0.030 mg) or drospirenone/ethinyl estradiol (3/0.30 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 a one-year period in 1000 women using NovaRing ® and COCs containing levonorgestrel/ethinyl estradiol (0.150/0.030 mg) showed a significant reduction in the incidence of breakthrough bleeding or spotting when using NovaRing ® compared to COCs. . 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 two-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.

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

Pharmacokinetics

Etonogestrel

Suction

Etonogestrel, released from the NuvaRing ® vaginal ring, is rapidly absorbed through the vaginal mucosa. The etonogestrel plasma Cmax of approximately 1700 pg/ml is achieved approximately 1 week after ring administration. Plasma concentrations vary over a small range and decrease slowly to approximately 1600 pg/mL after 1 week, 1500 pg/mL after 2 weeks, and 1400 pg/mL after 3 weeks. The 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 0.150 mg of desogestrel and 0.020 mg of ethinyl estradiol, the observed values ​​of etonogestrel concentrations were comparable.

Distribution

Etonogestrel binds to serum 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. Apparent plasma clearance is about 3.5 l/h. No direct interaction with ethinyl estradiol taken concomitantly has been identified.

Removal

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

Ethinyl estradiol

Suction

Ethinyl estradiol, released from the NuvaRing ® vaginal ring, is rapidly absorbed through the vaginal mucosa. Plasma Cmax of approximately 35 pg/ml is achieved 3 days after ring administration and decreases to 19 pg/ml after 1 week, to 18 pg/ml after 2 weeks and 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 NuvaRing ® and women using oral contraceptives containing 0.150 mg of desogestrel and 0.020 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 vaginal release of ethinyl estradiol 0.015 mg), transdermal patch (norelgestromin/ethinyl estradiol; daily release of ethinyl estradiol 0.020 mg) and COC (levonorgestrel/ethinyl estradiol; daily release of ethinyl estradiol 0.030 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 COC, and amounted to 10.9, 37.4 and 22.5 ngch/ml, respectively.

Distribution

Ethinyl estradiol binds to serum 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, which circulate both in the free state and in the form of glucuronide and sulfate conjugates. The apparent clearance is approximately 3.5 l/h.

Removal

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

Special patient groups

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.

Release form

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

Excipients: ethylene and vinyl acetate copolymer (28% vinyl acetate) - 1677 mg, ethylene and vinyl acetate copolymer (9% vinyl acetate) - 197 mg, magnesium stearate - 1.7 mg.

1 PC. - waterproof bags made of aluminum foil (1) - cardboard packs.
1 PC. - waterproof bags made of aluminum foil (3) - cardboard packs.

Dosage

NuvaRing ® is inserted into the vagina once every 4 weeks. The ring is in the vagina for 3 weeks and then removed on the same day of the week on which it was placed in the vagina; after a week's break, a new ring is inserted. For example: if the NuvaRing ® ring was installed on Wednesday at approximately 10:00 pm, then it should be removed on Wednesday 3 weeks later at approximately 10:00 pm; on the following Wednesday a new ring is inserted.

Bleeding associated with discontinuation of the drug usually begins 2-3 days after removal of NuvaRing ® and may not completely stop until a new ring is installed.

Hormonal contraceptives were not used in the previous menstrual cycle

NuvaRing ® should be administered on the first day of the cycle (i.e., the first 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 taking combined oral contraceptives

NuvaRing ® should be administered on the last day of the usual interval between cycles of combined hormonal contraceptives (pills or patches). If a woman has been taking the combined hormonal contraceptive correctly and regularly and is confident that she is not pregnant, she can switch to using a vaginal ring on any day of her cycle.

Switching from progestogen-only medications (mini-pills, progestin-only oral contraceptives, implants, injectables, or hormone-containing intrauterine systems (IUDs))

A woman taking the mini-pill 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 performed in the first trimester of pregnancy

You can start using NuvaRing ® immediately after an abortion. In this case, there is no need for additional use of other contraceptives. If the use of NuvaRing ® immediately after an abortion is undesirable, the ring should be used in the same way as if hormonal contraceptives were not used in the previous cycle. In the interval, the woman is recommended an alternative method of contraception.

After childbirth or abortion performed in the second trimester of pregnancy

The use of NuvaRing ® should begin within the 4th week after childbirth (if the woman is not breastfeeding) or abortion in the second trimester. If the use of NuvaRing ® is started at a later date, then additional use of barrier methods of contraception is necessary in the first 7 days of using NuvaRing ® . However, if sexual intercourse has already taken place during this period, 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 the patient does not comply with the recommended regimen. To avoid loss of contraceptive effect in case of deviation from the regimen, the following recommendations must be followed.

Extending the break from using the ring

If you had sexual intercourse during a break from using the ring, pregnancy should be ruled out. The longer the break, the higher the likelihood of pregnancy. If pregnancy is ruled out, a new ring should be inserted 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.

If the ring has been temporarily removed from the vagina

If the ring remains outside the vagina for less than 3 hours, the contraceptive effect will not decrease. The ring should be reinserted into the vagina as soon as possible (no later than after 3 hours).

If the ring was left outside the vagina for more than 3 hours during the first or second week of use, the contraceptive effect may be reduced. You should place the ring in your vagina as soon 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 left outside the vagina for more than 3 hours during the third week of use, the contraceptive effect may be reduced. The woman should throw away the ring and choose one of the following two methods.

1. Immediately install a new ring. Please note that the new ring can be used for the next 3 weeks. In this case, there may be no bleeding associated with the cessation of the drug's effect. However, spotting or bleeding in the middle of the cycle is possible.

2. Wait for bleeding associated with the cessation of the drug’s effect, and insert a new ring no later than 7 days after removing the previous ring. This option should only be chosen if the ring use regimen has not previously been violated during the first 2 weeks.

Extended 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. You can take a week's break from using the ring and then insert a new ring. If NuvaRing ® remains in the vagina for more than 4 weeks, the contraceptive effect may deteriorate, so pregnancy must be excluded before inserting a new ring.

How to shift or delay the onset of menstrual bleeding

To delay menstrual-like withdrawal bleeding, you can insert a new ring without a week's break. The next ring must be used within 3 weeks. This may cause bleeding or spotting. Then, after the usual one-week break, you should return to regular use of NuvaRing ®.

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

Ring damage

In rare cases, when using NuvaRing ®, ring rupture has been observed. The core of the NuvaRing ® ring 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. If the ring ruptures, a new ring must be inserted (following the recommendations above "If the ring has been temporarily removed from the vagina").

Ring falling out

NuvaRing ® has sometimes been reported to fall out of the vagina, for example, when it is inserted incorrectly, when 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 ® ring in the vagina. If the ring falls out of the vagina, you should follow the recommendations above "If the ring has been temporarily removed from the vagina."

Rules for using NuvaRing ®

A woman can independently insert NuvaRing ® into the vagina. To insert the ring, a woman should choose the position that is most comfortable for her, for example, standing, raising one leg, squatting, or lying down. NuvaRing ® must be squeezed and inserted into the vagina until the ring is in a comfortable position. The exact position of NuvaRing ® in the vagina is not decisive for the contraceptive effect.

After insertion, the ring must remain in the vagina continuously for 3 weeks. If the ring was accidentally removed, it should be washed with warm (not hot) water and immediately inserted into the vagina.

To remove the ring, you can pick it up with your index finger or squeeze it between your index and middle fingers and pull it out of the vagina. The used ring should be placed in a bag (keep out of the reach of children and pets) and discarded.

Overdose

Serious consequences of an overdose of hormonal contraceptives have not been described.

Suspected symptoms: nausea, vomiting, slight vaginal bleeding in young girls.

Treatment: carry out symptomatic therapy. There are no antidotes.

Interaction

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.

There is a possibility of interaction with drugs that induce microsomal liver enzymes, which can lead to an increase in the clearance of sex hormones. Interactions have been established with the following drugs: phenytoin, barbiturates, primidone, carbamazepine, rifampicin, and possibly also oxcarbazepine, topiramate, felbamate, ritonavir, griseofulvin and preparations containing St. John's wort.

When treating any of the listed drugs, you should temporarily use a barrier method of contraception (condom) in combination with the drug NuvaRing ® or choose another method of contraception. During concomitant use of drugs that cause the induction of microsomal liver enzymes, and for 28 days after their discontinuation, barrier methods of contraception should be used.

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

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 pharmacokinetic interaction study, oral administration of amoxicillin (875 mg 2 times / day) or doxycycline (200 mg / day, and then 100 mg / day) for 10 days while using the drug NuvaRing ® had a slight 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 did not reveal 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, it is necessary to study the instructions for use of other drugs.

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.

Side effects

Determination of the frequency of side effects: often (≥1/100), infrequently (<1/100, ≥1/1000), редко (<1/1000, ≥1/10 000).

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: ≥1/10,000 -<1/1000 женщин-лет.

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

Side effects that occurred when taking combined hormonal contraceptives: 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.

Indications

Contraception.

Contraindications

• 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), arterial hypertension, lesions of the valvular apparatus of the heart, atrial fibrillation, extensive surgery, prolonged immobilization, extensive trauma, obesity (BMI>30 kg/m2), smoking in women over 35 years of age;
• pancreatitis (including a history) in combination with severe hypertriglyceridemia;
• severe liver disease;
• liver tumors, malignant or benign (including history);
• established or suspected hormone-dependent malignant tumors (for example, genital organs or breast);
• vaginal bleeding of unknown etiology;
• pregnancy (including suspected);
• breastfeeding period;
• hypersensitivity to any of the active or excipients of the drug NuvaRing ®.

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

If any of the above conditions occur, you should immediately stop using the drug.

The drug should be prescribed with caution if any of the following diseases, conditions or risk factors are present; in such cases, the doctor must carefully weigh the benefit-risk ratio of using the drug NuvaRing ®:

• the presence of 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 relatives), smoking, obesity, dyslipoproteinemia, arterial hypertension, migraine without focal neurological symptoms, valve diseases heart, 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 dysfunction;
• 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;
• angioedema (hereditary) edema;
• chronic inflammatory bowel diseases (Crohn's disease and ulcerative colitis);
• sickle cell anemia;
• chloasma;
• conditions that make it difficult to use a vaginal ring: cervical prolapse, bladder hernia, rectal hernia, severe chronic constipation.

In case of exacerbation of diseases, deterioration of the condition, or the occurrence of any of the listed conditions, you should first consult a doctor to decide on the possibility of further use of the drug NuvaRing ® .

Features of application

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 found an increased risk of birth defects in children born to women who took COCs before pregnancy, nor have there been teratogenic effects in cases where women took COCs in early pregnancy without knowing about it. Although this applies to all COCs, it is unknown 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 hormones inside the uterus when using the drug NuvaRing ® are similar to those when using the COC. 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 steroids and/or their metabolites may be excreted in breast milk, but there is no evidence of their negative effects on the health of children.

Use for liver dysfunction

Use in children

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 venous thromboembolism (VTE) compared to the risk of VTE in patients not using COCs. The greatest risk of developing VTE is observed in the first year of using COCs. 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 nonpregnant 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 standard studies; when converted to a pregnancy duration of 9 months, the risk ranges from 7 to 27 cases per 10,000 JL). 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 NuvaRing ® is similar to that in women using COCs (the adjusted risk ratio is presented in the table below). A large prospective observational study, TASC (Transatlantic Active Study of the Cardiovascular Safety of NuvaRing ®), assessed the risk of developing VTE in women who started using NuvaRing ® or COCs, switched to NuvaRing ® or COCs from other contraceptives, or resumed use of the drug NuvaRing ® or PDA, in a population of typical users. The women were observed for 24-48 months. The results showed a similar level of risk of developing VTE in women using NuvaRing ® (incidence 8.3 cases per 10,000 YL) and in women using COCs (incidence 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 showed that the incidence of VTE in women who started using NuvaRing ® was 11.4 cases per 10,000 YL, while in women who started using COCs containing levonorgestrel, the incidence of VTE was 9.2 cases per 10,000 women. 10,000 JL.

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

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

2 Taking into account age, BMI, duration of use, history of VTE.

3 Incl. low-dose COCs containing the following gestagens: 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) with the use of 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 of 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; "sharp" 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 relatively early 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;
• for obesity (BMI more than 30 kg/m2);
• possibly thrombophlebitis of the 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 (BMI more than 30 kg/m2);
• arterial hypertension;
• migraine;
• heart valve disease;
• atrial fibrillation;
• presence of diseases in the family history (arterial thrombosis in brothers/sisters at any age or in 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 cause 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 COCs should be advised to consult a doctor if possible symptoms of thrombosis appear. If thrombosis is suspected or confirmed, use of the COC 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 (HPV). 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 smear examinations 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 the results of 54 epidemiological studies found a small increase (1.24) in the relative risk of developing 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 the earlier diagnosis of breast cancer in women taking COCs, the biological effects of COCs, or a combination of both.

In rare cases, cases of development of benign, and even more rarely, malignant liver tumors have been observed in women taking COCs. In some cases, these tumors led to the development of life-threatening bleeding into the abdominal cavity. A physician 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, angioedema (hereditary) edema.

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 steroids, 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 ultraviolet 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.

Laboratory research

The use of contraceptive hormonal drugs may affect the results of certain laboratory tests, including biochemical indicators of liver, thyroid, adrenal and kidney function, plasma concentrations of transport proteins (for example, corticosteroid binding globulin and sex hormone binding globulin), lipid/lipoprotein fractions, carbohydrate metabolism and indicators of coagulation and fibrinolysis. Indicators, as a rule, vary within normal values.

Impact on the ability to drive vehicles and operate machinery

Based on information about the pharmacodynamic properties of the drug NovaRing ®, it can be expected that it does not affect the ability to drive vehicles and operate machinery.

NuvaRing is a flexible contraceptive ring (diameter 54 mm, ring shell thickness 4 mm). In the form of a ring, you can see the ring only in the package, since when inserted into the vagina, it adapts to the individual contours of the woman’s body and occupies the optimal position. The ring is soft, it does not violate sexual harmony and does not reduce the sensitivity of partners. The ring does not interfere with playing sports, actively moving, swimming, running. Most women claim that NuvaRing is very convenient to use.

How Nuvaring works

Hormones (estrogen and progestogen) in microdoses, smaller than even in any microdosed birth control pill, are released daily from the ring directly into the uterus and ovaries, without penetrating into other organs. They prevent the egg from being released from the ovary and fertilization, so pregnancy is impossible.

Hormones begin to be released from the ring located in the vagina under the influence of body temperature. You should know that under various conditions, the temperature of the human body can fluctuate in the range from 34°C to 42°C. Fluctuations in this range do not affect the effectiveness of NuvaRing.

Rice. 1. The location of the NuvaRing ring in the vagina.

The shell of the ring is made of hypoallergenic material and consists of a complex system of membranes that allow the release of a strictly defined amount of hormones every day. Regardless of any individual characteristics of a woman, the dose of hormones released per day is always strictly the same (15 micrograms of estrogen and 120 micrograms of progestogen).

They enter the bloodstream through the vaginal mucosa. In this case, there is no primary passage through the liver and gastrointestinal tract. This allows you to achieve high efficiency (more than 99%). The ability to conceive is fully restored within a month after stopping the use of NuvaRing.

The main advantages of NovoRing are that you cannot gain weight, there is no effect on blood clotting (varicose veins of the lower extremities) and liver function. All these side effects, unfortunately, are present to one degree or another with birth control pills. Also, hormones from NuvaRing do not reduce the level of tissue testosterone, so the ring does not reduce libido and sensations during orgasm.

How to use NovoRing?

One hormonal ring is designed for one menstrual cycle. A woman inserts it into the vagina from the 1st to the 5th day of the menstrual cycle. NuvaRing is conveniently placed inside and remains in the vagina for 21 days (3 weeks); on day 22 the ring is removed. A week later, on day 8, a new one is introduced.

NuvaRing does not require any special position in the vagina. The flexible and elastic ring itself will take the optimal position, adapting to the individual contours of the woman’s body.

Do not forget to consult a gynecologist to assess the possibility of using this method of contraception. The doctor will teach you how to insert the ring correctly, and will also tell you about the scheme for switching from birth control pills to NuvaRing.

ATTENTION!!!
The NuvaRing hormonal ring does not protect against sexually transmitted diseases. Therefore, a prerequisite for its use is the presence of one permanent sexual partner, and the absence of sexually transmitted infections in both of you.

The self-sufficiency and success of a modern woman allows her to plan her lifestyle the way she wishes.

Gone are the days when women were little aware of methods of contraception. One of the innovations in contraception can be successfully called the Nuvaring contraceptive ring - a hormonal method that prevents unwanted pregnancy.

The cost of one ring ranges from 975 - 1730 rubles. The three-ring pack costs more.

Instructions for using the Nuvaring ring

The protective properties of the vaginal ring are based on the activity of etonogestrel, a progestogen derivative, and ethinyl estradiol. The latter is an estrogen widely used in contraceptives. The main effect of the ring is based on inhibition of ovulation.

How to use the Nuvaring birth control ring?

• The ring is inserted into the vagina at comfortable for this pose.
• From the moment of insertion, the ring must remain inside the vagina three weeks.
• After three weeks, the ring must be removed and menstruation will begin.
• After a week's break, it is introduced new Nuvaring ring.

Nuvaring is administered between the first and fifth day of the menstrual cycle.

If menstruation does not end on the fifth day, the ring still needs to be inserted into the vagina on 5th day of the cycle.

For the first seven days the ring is in place, you must use a condom.

After childbirth or abortion, the ring can be used as a contraceptive for fourth week.

Contraindications to the use of a vaginal ring

Contraindications to the use of the ring are the following diseases of the woman:

• vein thrombosis
• predisposition to blood clots
• diabetes
• vaginal bleeding of unknown cause
• malignant tumors
• pancreatitis
• allergic reaction to the components of the drug
• pregnancy
• lactation
• ulcerative colitis
• smoking in older age 35 years
• chronic constipation

If the ring falls out, the contraceptive properties of the ring remain for several hours, and an unwanted pregnancy cannot occur.

It is necessary to insert the ring into the vagina as quickly as possible.

Reviews of women who used the Nuvaring ring

More and more women are choosing the vaginal ring as a method of contraception.

The Nuvaring ring used, which has varying reviews, causes some controversy among women. They mainly concern the high price of contraception. As reviews show, the ring has its advantages:

• menstruation becomes regular and predictable
• pain decreases during menstruation
• reduces the intensity of bleeding during menstruation
• reduces the risk of developing anemia

Anastasia, 25 years old: I used the spiral for a long time.

Yulia, 30 years old: I thought about this method of contraception for a long time. There was no doubt about the reliability of the method. I decided to use the ring a year ago and have never regretted it. The ring never falls out and is very effective.

Anna, 32 years old: Unlike other hormonal methods, the ring is a modern remedy for unwanted pregnancy. Once a month you insert the ring and there are no problems. You immediately forget about the ring, it doesn’t cause any inconvenience. Despite the fact that the vaginal ring is large, it is not felt inside.

Side effects

The popular birth control ring Nuvaring as a hormonal drug may cause some side effects when used. Possible manifestation:

• vaginal infections (cystitis, genital tract infection, cervicitis)
• headaches
• abdominal pain
• nausea
• acne
• decreased libido
• depression
• muscle cramps
• hypertension

When using a vaginal ring, it is possible violations blood circulation, venous thrombosis, the symptoms of which include acute uncharacteristic pain in the limbs and swelling.

Today, the vaginal ring is one of the most effective and efficient methods of contraception. The Nuvaring contraceptive ring is a hormonal method that works throughout the entire menstrual cycle. It is enough just to purchase a hormonal contraceptive and start using it on the fifth day of menstruation. A convenient method will allow you to feel free and control your life for a long time. You should not waste time taking pills. It is better to purchase a safe Nuvaring ring.

Just a few years ago, a new method of contraception for women appeared - the vaginal contraceptive ring. This method of birth control was claimed to be extremely convenient for women and to have few side effects, unlike hormonal pills.

What is a birth control ring?

If you look at the photo of this device, it will give some idea about this contraceptive. It looks like a transparent elastic ring with a diameter of 54 mm and a thickness of 4 mm. The size is universal and suits everyone, since due to use it takes on an anatomical shape. Contraceptives are produced in the Netherlands; one package can contain one or three rings (NovaRing 1 and NovaRing3, respectively). There are no other dosage forms of this drug.

How does the contraceptive work?

The vaginal ring is a contraceptive with a low dose of hormones. Under its shell are two types of female hormones - progestogen and estrogen. Warming up from the heat of the human body, it begins to secrete hormones that affect only the uterus and ovary, without affecting the liver, intestines and other organs. This reduces the number of side effects, such as nausea, weight gain, cholepathy and others. The released hormones affect the cervical mucus, thickening it and making it impossible for sperm to penetrate. The contraceptive ring is a completely new word in protection.

Instructions for use

How to insert a contraceptive ring? This should be done in a squatting position, lying down, or standing with one leg bent. During menstruation, from the 1st to the 5th day, you need to squeeze the contraceptive with clean, washed hands and insert it as deep as possible into the vagina. How to insert correctly? The ring cannot be inserted incorrectly. The only thing you need to pay attention to after insertion is how it feels. This means that it is not inserted deep enough. You should adjust the contraceptive ring with your fingers. The video will give a better idea of ​​how to use these contraceptives for women.

The ring stays in the body for exactly 21 days; the next day it should be removed and a break of 7 days should be taken. The next contraceptive from a new package should be inserted on the 8th day.

If a woman has previously used other methods of contraception, for example, hormonal pills, then after finishing taking the pills from the package, she will need to take a week's break and then start using hormonal contraceptive rings.

If this is the first contraceptive that a woman uses, then you need to know that the contraceptive effect will be achieved a week after starting use. At this time, you need to additionally use a condom.

Advantages of the method:

• minimal impact on the body: the hormones contained in NuvaRing act locally, on the uterus and ovaries, without affecting the stomach, liver, kidneys, in contrast to the systemic effect that other contraceptives for women have;
• a ring inserted into the vagina cancels the daily use of a contraceptive;
• when using the ring, a woman can live a full sex life, without fear of becoming pregnant;
• You don’t have to tell your partner about contraception;
• contraception - the vaginal ring regulates the menstrual cycle (in case of failure), and also eliminates pain and profuse menstrual bleeding;
• rapid onset of pregnancy after discontinuation of the contraceptive, within 4-5 weeks after removal of the drug.

Disadvantages of the method:

• a significant number of side effects;
• psychologically unusual contraception - ring;
• lack of protection against sexually transmitted infections;
• a large list of contraindications.

Side effects

As with other methods of preventing unwanted pregnancy, when using NuvaRing there are a number of side effects that accompany the first months of use.

From the nervous system, a woman may experience dizziness, mood changes, anxiety, and headache.

The reaction of the digestive system is manifested by nausea, abdominal pain, vomiting, diarrhea, constipation. From the genitourinary system and mammary glands, there may be unpleasant sensations in the mammary glands, their engorgement and hardening, pain during sexual intercourse, burning sensations and dryness in the vagina, vaginal discharge, cystitis, cervicitis.

There may be rashes, itching, and eczema on the skin. The vascular system is capable of producing reactions such as hot flashes. Other side effects: increased blood pressure, blurred vision, pain in the back and limbs, increased appetite, uncomfortable sensations at the installation site.

Contraindications for use

Vaginal contraceptive rings are not used if a woman has such diseases as:

1. hypersensitivity to substances contained in the drug;
2. venous diseases (thrombosis, thrombophlebitis, etc.) or the presence of a predisposition to such diseases;
3. diabetes;
4. malignant tumors of various organs;
5. severe diseases of the pancreas and liver;
6. bleeding from the vagina of unknown origin;
7. existing or suspected pregnancy.

The ring fell out, what should I do?

If the contraceptive accidentally falls out, it should be rinsed with water at room temperature and reinserted. The contraceptive ring should not be removed from the vagina for more than three hours. In case of longer absence of a contraceptive, its contraceptive effect is reduced. How to insert a contraceptive ring in such a situation? You need to insert it into the vagina as soon as possible. In the 1st and 2nd weeks of use, you should be safe by using a condom during sexual intercourse. In week 3, the options are as follows:

• insert a new contraceptive ring. The instructions indicate that in this case there may be no cyclic bleeding, which may appear in the middle of the cycle in the form of spotting;
• wait for bleeding and introduce a new drug 7 days after the first day of menstruation.

What should be done if the drug is used for a longer period of time?

If the product has been in the body for more than 3 weeks, its contraceptive effect will last up to 4 weeks. If more than 4 weeks have passed, then after removing the drug and before introducing a new one, you will need to make sure that the woman is not pregnant.

How to delay the onset of menstruation

Contraceptive hormonal rings can delay the onset of monthly bleeding for some period of time (menstruation). To do this, you do not need to take a 7-day break, but insert a new product from the package and use it for another 3 weeks. This option is also possible: shorten the weekly interval by as much as necessary and insert the drug from a new package. In both cases, spotting is possible at the beginning of the second cycle.

Contraceptive rings. How to use during pregnancy and breastfeeding

NuvaRing cannot be used during pregnancy. The drug is also contraindicated during breastfeeding, as it can affect the quantity and composition of breast milk.