Instructions for use of NuvaRing: effect on menstruation

What is NuvaRing: composition and principle of action

Externally, the NuvaRing vaginal ring is a smooth, almost colorless ring belonging to the group of combined contraceptives that combine estrogen plus gestagen. The Nuvaring contraceptive ring includes:

1. Etonogestrel – 11.7 mg. The contraceptive effect is mainly manifested by suppression of ovulation.
2. Ethinyl estradiol – 2.7 mg. The substance is an artificial estrogen and a complete analogue of natural estradiol.

The composition also contains additional substances such as vinyl acetate and magnesium stearate. When using a contraceptive, the following effects of components on the female body are noted:

• delayed ovulation;
• minor changes in the inner layer of the uterine wall;
• increased viscosity of mucus in the cervical canal.

The influence of the above processes leads to the impossibility of pregnancy.

What is the reason for the creation of a vaginal hormonal ring?

The choice of the vaginal route of drug administration is determined by the anatomical and functional features of the vagina.

The vagina is anatomically a hollow connective tissue-muscular tube, truncated in the upper third, 10-12 cm long, covered with a folded mucous membrane, which provides good extensibility of the walls and significant capacity of the organ. Just imagine, physiologically it is created to carry out one of the most important functions of a woman - reproduction! During vaginal delivery, the vagina stretches to the size of the head of a full-term fetus: diameter 9.5 cm, circumference 32 cm! Do you think a woman will feel a ring with a diameter of 54 mm?

It is also known that the temperature and tactile sensitivity of the vagina in the upper two-thirds is reduced, and the upper third of the vagina is located horizontally. This indicates that the ring will not fall out and will not be felt by the woman (although anything can happen in life!).

The ring is also held in place by the muscles of the urogenital and pelvic diaphragms and the physiologically closed vaginal walls. The vaginal mucosa is well supplied with blood, which creates favorable conditions for the absorption of active substances into the systemic circulation.

Instructions for use

According to the instructions, the ring is used at intervals of 7 days during menstruation. A woman self-injects Nuvaring into her vagina on the first day of her period and leaves it there for three weeks.

Intermittently

The Nuvaring contraceptive ring without a break for menstruation is used only in exceptional cases. One ring is enough for one woman's menstrual cycle. The ring is inserted into the vagina from days 1 to 5 of the cycle (from the first to the fifth day of menstruation). After insertion, exactly three weeks are counted, and exactly on the 22nd day, the ring is removed for 7 days. During the 2-3 day break, the woman should have her period. On the seventh day, a new ring is inserted into the vagina.

If your period came with a Nuvaring ring, then you should not remove it to avoid cycle failure.

According to the instructions, be sure to use additional methods of contraception during the first 7 days after inserting the first ring.

Continuous use of contraception

You can take NuvaRing without interruption if you need to miss your period. In such a situation, the old ring is removed on day 22 and a new one is immediately installed. However, it should be remembered that such use is not very beneficial for health. As a result of the lack of a break, spotting or bleeding may occur. The newly installed ring should remain inside the vagina for no more than 3 weeks without interruption.

Using the same ring for more than 22 days clearly reduces the effectiveness of protection against unplanned pregnancy. We advise you to continuously take this contraceptive only as exceptions.

Change in libido when using a vaginal ring

In terms of libido, most women who use the ring note an increase in sexual desire and increased sexual satisfaction.

It is interesting to note that the presence of such an extraordinary thing as a ring in the vagina stimulates sexual interest on the part of not only the woman, but also the opposite sex. A number of couples surveyed draw an analogy between a ring and a sex toy, which cannot but affect the fantasies that precede sexual intercourse.

However, there is also the exact opposite point of view. One thing I can say for sure is that no one remains indifferent, and interest, whatever it may be, is interest.

Can I take it during pregnancy?

According to the instructions, the use of Nuvaring during pregnancy is prohibited. If pregnancy occurs while using the vaginal ring, it should be removed as soon as possible. According to clinical studies, the negative impact of contraception on the development of the fetus at the initial stage of pregnancy, as well as before its onset, has not been identified.

If a woman still decides to get pregnant, she should wait 1-2 cycles of regular natural menstruation and then start conceiving a child. This will help track the exact date of conception.

Reasons for decreased effectiveness of the vaginal ring

The effectiveness of the vaginal ring may be reduced if the following medications are used simultaneously:

• anticonvulsants (phenytoin, barbiturates, carbamazepine, primidone, topiramate, oxcarbazepine, lamotrigine);
• antifungal (griseofulvin);
• drugs used to treat HIV infection (ritonavir);
• products containing St. John's wort;
• some antibacterial drugs (ampicillin, rifampicin, tetracycline antibiotics).

At the same time, if there is a need to take antibacterial drugs, the manufacturer of the vaginal contraceptive has provided two antibiotics that can be taken together with the drug safely and without fear: amoxicillin and doxycycline (the latter is from the tetracycline group). Their intake affects the metabolism of steroids to a small extent, which has been proven in clinical studies.

Existing contraindications and restrictions

The Nuvaring hormonal ring has limitations in its use. Before prescribing this method of contraception, it is very important to study the overall picture of the patient’s health and all possible weaknesses. If a woman is allergic, she should be careful about installing a vaginal ring and carefully monitor her condition during the first 7-10 days.

It is prohibited to use the Nuvaring ring as a method of contraception for women with:

• varicose veins starting from degree 2;
• thrombophlebitis;
• vein thrombosis;
• diabetes mellitus;
• hepatosis;
• liver and heart failure;
• liver fibrosis;
• benign and malignant liver tumors;
• overweight and obesity;
• arterial hypertension;
• arrhythmia;
• epilepsy.

The ring should be used with caution in women over 35 years of age who smoke.

Why are they looking for an alternative to birth control pills?

The search for alternative options for the use of combined contraception is due to the fact that not every woman is satisfied with daily oral administration of the drug.

1. Not everyone is so disciplined that they have never missed a pill, at least among my patients - only a few are able to take the drug at the same time.
2. Moreover, the passage of the drug through the stomach and primarily through the hepatic circulation, whatever one may say, is an additional burden on the above organs.
3. And the most justified reason for searching for a non-tablet method of introducing the drug into the body: the search for the minimum effective dose of active ingredients. I know of only one oral drug that is equivalent in dose to the vaginal ring of ethinyl estradiol. The lower the hormonal load and systemic exposure, the safer the drug profile.

Side effects

According to statistics, more than 80% of women tolerate the use of the Nuvaring hormonal ring well. If you are allergic to one of the components of the product, the following symptoms may occur:

• burning;
• itching;
• hives;
• redness;
• pain and stinging during urination;
• swelling.

If you experience any of the above symptoms, contact your doctor immediately. Try not to take out the hormonal ring on your own initiative, but be sure to consult a gynecologist.

There are also rare cases of such side effects from using Nuvaring:

• sudden mood changes;
• pain in the mammary glands;
• headache;
• bleeding;
• dizziness;
• decreased sexual desire;
• nausea;
• stomach pain;
• discomfort during sexual intercourse.

Does a vaginal hormonal active ring cause bacterial vaginosis?

There is an opinion that the use of vaginal contraception contributes to the development of bacterial vaginosis, which has not been confirmed in studies.

In 63% of cases, women using a hormonal ring note increased moisture in the mucous membrane and increased secretion (more vaginal discharge). This fact can be explained both by the local effect of hormonal influences and by the presence of a foreign body in the vagina. For reference, 43% of women who use COCs also report increased vaginal moisture. In their practice, obstetrician-gynecologists often use pessaries, which is also associated with an increase in vaginal secretion.

Analysis of the discharge showed the absence of inflammatory and dysbiotic changes.

On the contrary, vaginal ring users, compared to patients using COCs, had a 2.7 times higher number of lactobacilli producing hydrogen peroxide, a natural protective factor that suppresses the growth of conditional pathogens and protects against absolute ones.

In addition, one of the mechanisms of action of the vaginal ring is the thickening of cervical mucus, which also provides infection protection.

The effect of Nuvaring on menstruation

The ring is aimed at changing a woman's monthly cycle. During a normal and natural cycle, the female body is involved in daily hormonal changes throughout the entire month. In the absence of pregnancy, menstruation begins and after its end the process begins anew. If the Nuvaring ring is installed, the active components suppress the production of those hormones that are responsible for the formation of the egg, so periods when using Nuvaring become fully regulated.

If your period starts in a few days, it’s time to buy your first Nuvaring ring. It is installed on days 1-2 of the cycle and during the first 22 days the ring increases progesterone levels and suppresses estrogen levels in the female body. After the ring is removed, progesterone levels drop and artificial menstruation occurs.

Most often, after installing the ring, a woman expects two scenarios of events - the first menstruation with Nuvaring does not occur or lasts for a very long time. Such failures and adjustments can last up to 3 months of using the ring and are considered completely normal.

Does a vaginal ring bother men?

It would be more correct to ask the stronger half of humanity about the sensations that a man experiences when using this method.

Publications about the drug describe increased sensations or no changes.

The instructions for the drug describe cases of local reactions in the partner, including irritation, abrasions, and discomfort.

Similar situations occur in life, although most patients and their partners are satisfied with the method.

In addition, the manufacturer writes in the instructions about the possibility of removing the contraceptive “with impunity” (in terms of reducing the contraceptive effect) for a period of up to three hours. Therefore, sexual intercourse may well occur without a ring, if suddenly it interferes.

Is it possible to “push back your period” using a contraceptive?

Many women sooner or later become interested in how to delay their periods with Nuvaring before a wedding, a trip to the sea, or other important event. If you do not want to increase the chances of an unplanned pregnancy, we do not recommend installing the ring for longer than 3 weeks. If you want to “push back your period” after the end of the three-week period, you need to replace the old hormonal ring with a new one and, at the end of the new three weeks, remove the ring and wait for the arrival of your period.

To delay your period, you do not need to take a 7-day break. This induced period delay will allow you to delay your period by three weeks, although the chance of spotting increases.

What changes in the reproductive system may occur:

Some changes may begin in a woman’s body after the installation of a hormonal ring, so read the instructions in advance before starting to use Nuvaring.

Your period is coming early

If you have started your period with the Nuvaring ring, you definitely shouldn’t panic about this, especially if this concerns the first three months of using such contraception. In such cases, you should not remove the ring earlier than 3 weeks after its installation, but simply use the diagram according to the instructions.

During the period of adaptation of the body to Nuvaring, the onset of menstruation ahead of schedule is permissible and does not require a change in the use of the contraceptive. If your period begins prematurely after the adjustment period has passed, we advise you to consult a gynecologist, as this may indicate that the drug is not suitable for your body.

The menstrual cycle does not stop

There may be cases when menstruation does not stop when the Nuvaring ring is installed. This often happens when the ring is first installed, because it occurs during the period itself. Since the body begins to receive additional hormones from the outside, menstruation may last 3-4 days.

In the future, the hormonal ring reduces the number of days of menstruation and makes them more scanty, therefore, if after 3 months of adaptation, menstruation continues for more than 5-7 days, we advise you to visit a doctor as soon as possible.

Delayed periods occur when using Nuvaring

If in the first few months of using this method of contraception a woman takes out Nuvaring, but does not have her period after 3 weeks, this may be a sign of the body’s temporary adaptation to hormonal therapy. In addition, the reasons for a delay in menstruation may be:

1. Pregnancy. You should always remember that in the first 7-10 days after installing the first ring, you should use additional methods of contraception. In the future, drinking large amounts of alcohol can also negatively affect the health of the liver and increase the chances of pregnancy for a woman using hormonal contraception with Nuvaring.
2. Stress. After the first ring is installed, a period of hormonal changes begins in the female body. Stress at home and at work, as well as worries about a new method of contraception, can cause a delay in menstruation.
3. Adaptation period. According to the instructions, a woman may not get her period the first month, which is quite acceptable.

Amenorrhea can also occur in the first two months after o.

Heavy periods and bleeding during use of the drug and after its discontinuation

Too heavy periods with Nuvaring can signal to a woman that this method of contraception is not suitable for her. In addition, this symptom may indicate changes in the body when getting used to hormonal contraception after the prescription of the ring or its discontinuation. If such a failure occurs at the initial stage of use, simply follow the diagram for installing and removing the ring, and the cycle will normalize.

Brown spotting instead of menstruation

When using Nuvaring, scanty periods are quite normal. However, such a brown spot is acceptable only during the period of removal of the ring from the vagina. Brown spotting most often begins 1-2 days after removing the ring from the vagina and does not stop until a new device is installed. In most cases, brown discharge ends within 2-3 months after regular and correct use of the contraceptive.

Nuvaring can also help stop menstruation. This is due to hormones that are absorbed through the mucosa, increasing blood clotting. Therefore, your period may end quickly.

In other cases, brown discharge in the middle of the cycle may be side effects from using a contraceptive that is not suitable for the body.

Should I use a vaginal ring?

In my opinion, as a doctor, the method is worthy, but it is not suitable for patients with certain gynecological diseases.

The presence of only one combination of estrogen and gestagen components does not allow this option to be flexible enough and, if when using COCs it is possible to change the active ingredients, being in fact within the framework of one method, then here - alas and ah!

It has only one indication: contraception! And since healthy girls are at the appointment “with fire during the day...”, I personally don’t have to prescribe it very often. And yet, the non-contraceptive effect, although not specified in the instructions, is present thanks to the etonogestrel included in the composition: good cycle control.

Restoring the monthly cycle after stopping Nuvaring

According to statistics, women with an irregular natural menstrual cycle experience brown discharge after 4-6 months. Some women experience oligomenorrhea, when menstruation occurs less than once every 40 days. In more rare cases, heavy periods are possible. Most often, 4-6 months is enough to restore a healthy normal cycle after removal of the Nuvaring vaginal ring.

When to consult a doctor

Using Nuvaring, you should consult a doctor in the following cases:

• if menstruation has not started 1 month after the delay at the initial stage of using the ring;
• if you notice side effects from the installed ring and possible allergy symptoms;
• with too noticeable mood swings;
• if heavy periods last more than 5-7 days, although previously they were always scanty or normal;
• if the brown spotting does not stop in the middle of the cycle 3 months after the first ring is installed.

Reviews from gynecologists

The Nuvaring ring receives extremely positive reviews from experts. This is probably why this contraceptive is so often prescribed to women. So, what exactly information is contained in the reviews of gynecologists about the Nuvaring ring? The following are especially highlighted:

• A convenient means of contraception for those who cannot use others (hormonal IUD or oral contraceptives) and do not want or cannot use barrier methods of contraception.
• It is recommended to use it for some time for those women who are trying to get pregnant (shows good results in fertilization on the withdrawal effect).

Unfortunately, it is extremely rare today to select contraceptives based on the results of hormone tests. That is why the Nuvaring ring (reviews confirm this fact), even if it is used as prescribed by a doctor, is not suitable for every woman. Therefore, consumer feedback may provide a clearer and more truthful picture than physician opinions. We will consider them further.