Nuvaring

NuvaRing is a combined hormonal contraceptive delivered as a flexible, transparent vaginal ring.

It contains etonogestrel (a progestogen) and ethinylestradiol (an oestrogen), which are released at a constant rate and absorbed through the vaginal epithelium into the systemic circulation.

The primary mechanism of contraception is ovulation suppression, with additional effects on cervical mucus viscosity and endometrial receptivity.

NuvaRing offers a contraceptive efficacy comparable to combined oral contraceptive pills, with a Pearl Index of approximately 0.96 in clinical trials.

The vaginal route of administration provides steady hormone levels, avoiding the daily peaks and troughs associated with oral pills and potentially reducing oestrogen-related side effects.

Each ring is used for 3 weeks continuously, followed by a 1-week ring-free interval during which a withdrawal bleed typically occurs.

NuvaRing is listed in the BNF as a combined hormonal contraceptive option and is suitable for women seeking a user-independent method that does not require daily adherence.

Insert the ring into the vagina on day 1 of the menstrual cycle (or on days 2-5, using additional barrier contraception for the first 7 days).

Compress the ring between the thumb and index finger and insert into the vagina; the exact position is not critical for efficacy. Leave the ring in place for 3 consecutive weeks (21 days).

Remove by hooking a finger under the rim and pulling gently. After a 7-day ring-free interval, insert a new ring on the same day of the week.

If the ring is accidentally expelled and remains outside the vagina for less than 3 hours, rinse with cool water and reinsert.

If expelled for more than 3 hours, contraceptive protection may be reduced; consult the patient information leaflet for further guidance.

One ring per cycle, delivering etonogestrel 0.120 mg/day and ethinylestradiol 0.015 mg/day for 21 days. The ring-free interval must not exceed 7 days.

If switching from a combined oral pill, insert the ring on the day after the last active pill or at the latest on the day following the usual hormone-free interval.

If switching from a progestogen-only pill, insert on any day and use additional contraception for the first 7 days. No dose adjustment is required based on body weight.

NuvaRing should not be used simultaneously with other vaginal products such as spermicides or lubricants that may affect hormone absorption.

Side effect frequencies are derived from pooled clinical trial data.

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

Common (≥1/100 to <1/10): Mood changes (including depressed mood), decreased libido, abdominal pain, nausea, acne, breast tenderness, dysmenorrhoea, ring-related events (expulsion, discomfort, foreign body sensation), weight gain.

Uncommon (≥1/1,000 to <1/100): Cervicitis, urinary tract infection, altered appetite, dizziness, migraine, visual disturbances, hot flushes, abdominal distension, vomiting, alopecia, eczema, pruritus, musculoskeletal pain, galactorrhoea, vulvovaginal discomfort.

Rare (≥1/10,000 to <1/1,000): Venous thromboembolism (deep vein thrombosis, pulmonary embolism), arterial thromboembolism.

The absolute risk of VTE with combined hormonal contraceptives is small but exceeds that in non-users; the risk is highest in the first year and after restarting following a break.

NuvaRing carries the same thromboembolic risks as combined oral contraceptives. The MHRA advises discussing VTE risk factors before prescribing.

Risk factors include age >35, BMI >30, family history of VTE, immobilisation, and smoking. Discontinue NuvaRing at least 4 weeks before elective major surgery or prolonged immobilisation.

Combined hormonal contraceptives are associated with a small increase in breast cancer risk that declines after discontinuation. Blood pressure should be monitored before and during use.

Discontinue if sustained hypertension develops. NuvaRing does not protect against sexually transmitted infections.

Women using hepatic enzyme-inducing medications may have reduced contraceptive efficacy and should consider alternative methods.

NuvaRing must not be used in women with current or past venous or arterial thromboembolism, known thrombogenic mutations (e.g.

Factor V Leiden, prothrombin G20210A), severe or multiple VTE risk factors, migraine with aura, uncontrolled hypertension, diabetes mellitus with vascular complications, active or history of severe hepatic disease, liver tumours, known or suspected sex steroid-sensitive malignancies, undiagnosed vaginal bleeding, or hypersensitivity to any component.

It is contraindicated during pregnancy and should not be used during breastfeeding.