Nuvaring

NuvaRing is a combined hormonal contraceptive. It is a soft, see-through ring that you place in the vagina.

The ring holds two hormones: etonogestrel (a progestogen) and ethinylestradiol (an oestrogen). It releases them at a steady rate.

The body absorbs them through the lining of the vagina and into the blood. NuvaRing mainly works by stopping ovulation, so no egg is released.

It also thickens the mucus at the neck of the womb and changes the womb lining. NuvaRing works about as well as the combined pill. In trials it had a Pearl Index of about 0.

96, a measure of how often pregnancy happens. Because it works through the vagina, hormone levels stay steady. You avoid the daily highs and lows that come with pills.

This may also reduce some side effects linked to oestrogen. You use each ring for 3 weeks without a break. Then you take a 1-week break with no ring, when a withdrawal bleed usually starts.

The BNF lists NuvaRing as a combined hormonal contraceptive. It suits women who want a method that does not rely on a daily routine.

Place the ring in the vagina on day 1 of your period. You can also start on days 2-5, but then use a barrier method, such as a condom, for the first 7 days.

Squeeze the ring between your thumb and index finger and push it into the vagina. The exact spot does not affect how well it works. Leave the ring in place for 3 weeks in a row (21 days).

To remove it, hook a finger under the rim and pull gently. After a 7-day break with no ring, put a new ring in on the same day of the week.

If the ring slips out and stays outside the vagina for less than 3 hours, rinse it with cool water and put it back. If it has been out for more than 3 hours, it may not protect you as well.

Check the patient information leaflet for what to do next.

Use one ring per cycle. It releases etonogestrel 0.120 mg/day and ethinylestradiol 0.015 mg/day for 21 days. The break with no ring must not last longer than 7 days.

If you switch from a combined pill, put the ring in the day after your last active pill. At the latest, put it in the day after your usual hormone-free break.

If you switch from a progestogen-only pill, you can put the ring in on any day. Use another method for the first 7 days. You do not need to change the dose based on your weight.

Do not use NuvaRing at the same time as other vaginal products, such as spermicides or lubricants. These may affect how the hormones are absorbed.

These side effect rates come from pooled clinical trial data.

Very common (≥1/10): Headache, vaginal infections and discharge.

Common (≥1/100 to <1/10): Mood changes (including low mood), lower sex drive, tummy pain, nausea, acne, tender breasts, painful periods (dysmenorrhoea), ring-related events (the ring slipping out, discomfort, feeling the ring), weight gain.

Uncommon (≥1/1,000 to <1/100): Inflammation of the neck of the womb (cervicitis), urinary tract infection, changed appetite, dizziness, migraine, sight problems, hot flushes, a bloated tummy, vomiting, hair loss (alopecia), eczema, itching (pruritus), muscle and bone pain, milk leaking from the breasts (galactorrhoea), discomfort around the vulva and vagina.

Rare (≥1/10,000 to <1/1,000): Blood clots in the veins (deep vein thrombosis, pulmonary embolism) and blood clots in the arteries.

The overall risk of a venous clot (VTE) with combined hormonal contraceptives is small. Still, it is higher than in women who do not use them.

The risk is highest in the first year, and after you restart following a break.

NuvaRing carries the same blood clot risks as combined oral contraceptives. The MHRA advises talking through your VTE risk factors before you start.

These risk factors include being over 35, a BMI over 30, a family history of VTE, being unable to move about, and smoking.

Stop NuvaRing at least 4 weeks before any planned major surgery, or before a long period when you cannot move about.

Combined hormonal contraceptives raise the risk of breast cancer by a small amount. This extra risk falls again after you stop. Your blood pressure should be checked before and during use.

Stop NuvaRing if your blood pressure stays high. NuvaRing does not protect against sexually transmitted infections. Some medicines that speed up the liver may make NuvaRing work less well.

If you take these, you should think about another method.

Do not use NuvaRing if you have, or have had, a blood clot in a vein or artery (venous or arterial thromboembolism).

Do not use it if you have a known clotting gene fault (such as Factor V Leiden or prothrombin G20210A), or severe or several VTE risk factors.

Avoid it if you have migraine with aura, high blood pressure that is not controlled, or diabetes with blood vessel damage.

Do not use it if you have severe liver disease now or in the past, liver tumours, or a known or suspected cancer that is sensitive to sex hormones.

Also avoid it with unexplained vaginal bleeding, or if you are allergic to any part of the ring. Do not use NuvaRing during pregnancy, and do not use it while breastfeeding.