NuvaRing

NuvaRing is a flexible, transparent plastic ring for hormonal contraception. It is inserted into the vagina, where it continuously releases low doses of hormones over 3 weeks – the progestin etonogestrel and the estrogen ethinylestradiol.

Unlike with the pill, the hormones are not absorbed through the gastrointestinal tract but directly through the vaginal wall into the bloodstream. As a result, the effect is not impaired by vomiting or diarrhea.

In clinical studies, the Pearl Index was 0.96 (including user errors) or 0.64 (method failures only) – comparable to the combined pill.

NuvaRing prevents pregnancy through the same mechanisms as the combined pill:

Inhibition of ovulation: The hormones suppress ovulation by inhibiting the release of gonadotropins from the pituitary gland.

Cervical mucus: The cervical mucus becomes thicker and forms a barrier to sperm.

Endometrium: The uterine lining builds up less.

Special feature of vaginal use: Because the hormones are absorbed directly through the vaginal wall, the first-pass effect is partly bypassed. The daily hormone release is lower than with most pills, but still effective.

NuvaRing is suitable for women who:

• Want hormonal contraception
• Do not want to take a pill every day
• Have trouble taking the pill regularly
• Suffer from gastrointestinal problems (vomiting, diarrhea)

Particularly suitable in case of:

• An irregular daily routine
• Frequently forgetting the pill
• Nausea while taking the pill
• A wish for discreet contraception

Not suitable in case of:

• Severe overweight (BMI > 30) – increases the risk of blood clots (thrombosis), especially together with other risk factors
• Uterine prolapse or vaginal prolapse
• Certain vaginal infections
• The same contraindications as combined pills

Active ingredient content of the ring:

• Etonogestrel: 11.7 mg (daily release: approx. 0.120 mg)
• Ethinylestradiol: 2.7 mg (daily release: approx. 0.015 mg)

Ring dimensions:

• Diameter: approx. 54 mm
• Cross-section: approx. 4 mm

Pack sizes:

• 1 ring (1 month)
• 3 rings (3 months)

Cycle of use: 3 weeks of wear, 1 week break.

Inserting the ring: 1. Take the ring out of the packaging 2. Squeeze the ring between your thumb and index finger 3. In a comfortable position (standing with one leg raised, squatting, or lying down), insert it deep into the vagina 4. The exact position is not important – the ring does not need to sit directly at the cervix

Duration of wear: The ring stays in the vagina for 3 weeks (21 days). It is then removed, followed by a 1-week break during which bleeding usually occurs.

Removing: Hook your index finger under the ring and pull it out. Dispose of the used ring in its packaging (do not flush it down the toilet).

Inserting a new ring: After exactly 7 ring-free days, insert the new ring – on the same day of the week and at about the same time of day as when it was removed.

If the ring slips out:

• Less than 3 hours: Rinse with cold/lukewarm water and reinsert
• More than 3 hours in week 1 or 2: Reinsert the ring immediately and additionally use a condom until the ring has been worn again for 7 days without interruption
• More than 3 hours in week 3: Dispose of the ring. Either insert a new ring immediately (this starts the next 3 weeks) or wait for the withdrawal bleed and insert a new ring no later than 7 days after it slipped out. The second option only applies if the ring was worn without interruption during the previous 7 days

Sex with the ring: The ring can stay in the vagina during intercourse. Most couples do not feel it. If desired, it can be removed for a maximum of 3 hours.

NuvaRing must not be used in cases of:

• Thromboembolic disorders (current or past)
• High risk of thrombosis
• Severe cardiovascular diseases
• Migraine with aura
• Severe liver diseases
• Liver tumors
• Hormone-dependent tumors
• Unexplained vaginal bleeding
• Pregnancy

Special caution:

• Smoking over the age of 35
• Severe overweight
• High blood pressure
• Diabetes
• Familial predisposition to thrombosis

Risk of thrombosis: The risk is comparable to that of pills containing etonogestrel or desogestrel and somewhat higher than with levonorgestrel-containing pills.

Common (1-10%):

• Headache
• Migraine
• Decreased libido
• Vaginal inflammation, discharge
• Nausea
• Acne
• Weight gain
• Breast tenderness
• Pain in the pelvic area
• Dysmenorrhea
• Ring-related discomfort (foreign body sensation)

Uncommon (0.1-1%):

• Mood swings
• Flatulence
• Alopecia
• Skin rash

Rare but serious:

• Thromboembolism (venous and arterial)

Local discomfort: Some women report a foreign body sensation, which usually disappears after a few days.

Reduced effectiveness due to:

• Antiepileptic drugs (phenytoin, carbamazepine)
• Rifampicin
• Some HIV medications (e.g. ritonavir, efavirenz)
• St. John's wort

No impairment from:

• Vaginal antifungals (treatment of vaginal yeast infections)
• Tampons
• Spermicides

Important: Unlike with the pill, the effect is not impaired by vomiting or diarrhea.