Contraception

CONTRACEPTIVE RING  NUVARING

Description

NuvaRing is a flexible ring that measures about 2 inches (5.4 cm) in diameter that you insert in your vagina once a month.

Mechanism of action

Once in place, the ring releases a steady stream of contraceptive hormones (estrogen and progestin), protecting against pregnancy around the clock. It mainly prevents ovulation as does the pill.

Effectiveness of action

Its effectiveness rate is the same as that of the pill, 99%, if used as directed.

Cost

A ring costs between $25 and $32. Private insurance plans usually reimburse the cost but it is still not refunded by the Quebec Prescription Drug Insurance Plan.

Before using NuvaRing

A medical appointment is required in order to determine whether you have some medical condition that may prevent your using the ring. Contraindications are the same as those listed for the pill.

When to start using Nuvaring

It is recommended to start using the ring within the first five days of your period. You will then be immediately protected against pregnancy. NuvaRing may also be used on any other day. A back-up birth control method, such as condoms, is required for the first seven days.

How to use the ring

Once the ring is inserted in your vagina, it remains in place for three weeks. On the fourth week, you must remove it for seven days. During that time, you will have your period, which will begin two or three days after removing the ring. After the seven-day stoppage, you must insert a new ring for the next 21 days, etc.

How to insert the ring

• 1st step: After washing and drying your hands, remove the ring from its foil pouch.
   
• 2nd step: Choose the position that is most comfortable. For example, lying down, squatting, or standing with one leg up and bent knee.
   
• 3rd step: Hold the NuvaRing between your thumb and index finger and press the opposite sides of the ring together. It is easy since the ring is very flexible.
   
• 4th step: Gently push the folded ring into your vagina. The exact position of the NuvaRing in the vagina is not important for it to work. If you feel discomfort, the ring is probably not inserted far enough into the vagina. Use your finger to gently push it further into your vagina. There is no risk of pushing the ring too deeply.

How to remove the ring

After using the ring for 21 days, it must be removed for seven days. You can remove the NuvaRing by hooking the index finger under the forward rim or by holding the rim between the index and middle finger and pulling it out. Place the used ring in the foil pouch and properly dispose of it in a waste receptacle.

Possible side effects

The ring’s most frequent side effects are nausea, headaches as well as increased vaginal discharge.

As is the case with the pill, side effects are most often observed within the first three months of use, after which time they usually disappear or decrease. If side effects persist or if you feel discomfort, contact your doctor but do not remove the ring.

Despite these side effects, the ring is still as effective if used as directed.

Benefits of the ring

It is a reversible and very effective birth control method:

• It regularizes the cycle;
• It decreases the frequency of menstrual pain, bleeding and premenstrual syndrome. It decreases the risk of ovarian and endometrial (inner lining of the uterus) cancer, benign tumours, ovarian cysts, salpingitis (infection of the fallopian tubes) and ectopic pregnancies (in the fallopian tubes).

Forgetting to insert the ring

If you forgot to put the ring back after the seven-day pause, insert it as soon as possible. You will need to use a back-up birth control method, such as condoms, for the next seven days and make sure you don’t need an oral emergency contraceptive.

If you have removed the ring for a short period of time, because of discomfort or during sexual intercourse, you should still be protected if you insert it within three hours of the removal. If the delay is longer than three hours, insert the ring immediately. You will need to use another birth control method (condoms) for seven days and make sure you don’t have to take an oral emergency contraceptive.

Complications

As with the pill, complications are very rare and mainly occur in women who have health problems or women who are smokers. If side effects appear, you must consult with a doctor as soon as possible. Possible complications are:

• severe thoracic pain with difficulty breathing
• severe headaches
• severe vision disorder (decrease or sudden loss of sight)
• significant pain to thigh or calf and/or swelling of leg
• continued numbness and/or weakness on one side of the body

Special circumstances

• If the ring falls out of the vagina: You can rinse it with cold water (never with hot water) and quickly put it back in place. This rarely happens since vaginal muscles help keep the ring in place.

• Partner discomfort: Your partner may feel the ring during intercourse. If it becomes too uncomfortable, the ring may be removed for three hours each day without becoming less effective. Do not forget to put it back after rinsing it with cold or warm water.

• NuvaRing and antibiotics: The effectiveness of the ring should not be affected.

• NuvaRing and pregnancy: Pregnancy is possible as soon as the ring stops being used. There may be a delay of a few months before the cycle becomes regular again. A woman’s future fertility is unaffected, regardless of the number of years during which she has used the ring.

• NuvaRing and pre-menopause: Women who are in good health and who do not smoke can use the ring until menopause.

• NuvaRing and surgery: While using the ring, if you have to undergo surgery requiring immobilisation, inform your surgeon.

• NuvaRing and tobacco: Tobacco increases the risk of heart disease for women who take the pill. The same is true of NuvaRing. Risks increase with age. Why not take this opportunity to quit smoking right now?

• NuvaRing, blood-borne infections, STDs and HIV (aids): The ring provides no protection against sexually transmitted diseases. Your sexual health is important and the use of condoms is still recommended if you are at risk of contracting STDs. 

The above was translated from an excellent text produced by the family planning team of the Centre hospitalier régional de Rimouski.
http://www.planningchrr.com/