Indications 

Nuvaring is a combination hormonal contraceptive (CHC) that is used by women to prevent pregnancy. It contains etonogestrel/ethinyl estradiol and is inserted vaginally as a vaginal ring. It should be noted that this medication does not protect against sexually transmitted diseases, such as gonorrhea, chlamydia, and HIV. 

The mechanism of action of this medication is through the suppression of gonadotropins, leading to the inhibition of ovulation. Nuvaring thickens vaginal mucus to prevent sperm from reaching the egg and alters the uterine lining to prevent the attachment of a fertilized egg. 

Uses and Dosage 

Carefully read the Patient Information Leaflet provided by your pharmacist before using the vaginal ring and before each refill. This leaflet contains crucial information on the correct usage and disposal of the product. If you have any questions or concerns, consult your doctor or pharmacist. 

The vaginal ring is meant for vaginal use only. Before insertion, wash and dry your hands. Take the ring out of the resealable foil pouch, but keep the pouch for disposal of the used ring. Fold the ring in half and insert it into your vagina as directed until it feels comfortable. 

If you are using the ring for the first time, use an additional non-hormonal form of birth control such as condoms or spermicide for the first seven days to prevent pregnancy until the ring has time to work. Do not use a diaphragm, cervical cap, or female condom for additional birth control as the ring may interfere with proper placement. If you start using the ring on the first day of your period, you do not need to use additional birth control for the first week. 

After three weeks of use, remove the ring on the same day of the week and at about the same time that you inserted it. Place the used ring back into the foil pouch and dispose of it in the trash; do not flush it down the toilet. If you experience pain or bleeding when removing the ring or cannot remove it, contact your doctor immediately. 

Do not wear a ring for one week (7 days) after removal. You should have your period within 2 to 3 days after the ring is removed. After one ring-free week, insert a new ring on the same day of the week that you removed the old ring, whether or not you have your period. If you do not get your period, consult your doctor. Do not go more than 7 days without a ring as doing so increases the risk of pregnancy. 

Check regularly to ensure the ring is in place, particularly before and after sexual intercourse. The ring may accidentally fall out during intercourse, a bowel movement, or while removing a tampon.  

If you have left the ring in place longer than directed, up to an extra week (4 weeks total), you will still be protected from pregnancy. Remove the ring and insert a new ring after one ring-free week.  

On rare occasions, the vaginal ring may break at the weld joint after placement, increasing the risk of it slipping out of the vagina. If this happens, discard it and use a new ring. 

Side Effects 

Common Side Effects 

• Nausea 
• Headache 
• Dizziness 
• Fatigue 
• Vaginal discomfort or irritation 
• Breast tenderness 
• Bloating 
• Weight changes 

These side effects are typically mild. If they persist or worsen, please consult with your healthcare professional. 

Severe Side Effects 

• Elevated blood pressure 
• Lumps in the breast 
• Severe abdominal pain 
• Unusual vaginal bleeding 
• Dark urine 
• Yellowish skin 
• Painful urination 
• Chest pain 
• Rapid breathing 
• Trouble speaking 
• Severe headache 
• Weakness on one side of the body 
• Mental or mood changes 
• Signs of toxic shock syndrome or TSS such as:
  • Sudden high fever
  • Severe dizziness
  • Fainting
  • Unusual body pain
  • Sunburn-like rash

If you experience any of these severe side effects, please contact your healthcare professional immediately. 

Caution 

Prior to initiating treatment with Nuvaring hormonal contraceptives, provide your physician with a comprehensive medical history. This includes disclosing any pre-existing conditions such as blood clotting disorders, high cholesterol levels, angioedema, heart problems, gallbladder problems, migraine, liver disease, vaginal disease, diabetes, high blood pressure, or cancer. Certain medical conditions may affect how your body responds to this medication.  

Inform your physician of all prescription and non-prescription medications you are currently taking as they may interact with this medication. 

Remain vigilant for signs of an allergic reaction while using this contraceptive. Do not use this vaginal ring if you are known to have an allergy to etonogestrel, estradiol, progestin, or any inactive ingredients contained in the medication. Indicators of hypersensitivity may include severe dizziness, skin rashes, swelling of the face and neck, hives, and breathing difficulties. Seek immediate medical attention if these symptoms occur. 

Given that this medication increases the risk of blood clots, patients should inform their physicians if they expect to be in a fixed position for an extended period of time. If you will be taking a long-haul flight or undergoing surgery, you may need to temporarily discontinue using this medication. 

Women who are breastfeeding should not use this vaginal ring as it may harm a nursing infant and decrease milk production. Nuvaring should be used only when necessary in such cases.