NuvaRing

NuvaRing Contraceptive Vaginal Ring

How does NuvaRing work?

NuvaRing is a combined hormonal contraceptive vaginal ring used to prevent pregnancy, containing two female sex hormones: etonogestrel (a progestogen) and ethinylestradiol (an oestrogen). Once inserted, the flexible ring sits inside your vagina and slowly releases a low, steady dose of both hormones directly into the bloodstream.

Unlike contraceptive pills, there’s no daily tablet to remember. A single ring is worn for three weeks at a time, then removed for a one-week break before a new ring is inserted into the vagina.

NuvaRing prevents pregnancy in three ways:

• Stopping ovulation: the hormones prevent your ovaries from releasing an egg each month. Without an egg, pregnancy can’t occur.
• Thickening cervical mucus: the ring makes the mucus at the entrance to the womb thicker, making it much harder for sperm to reach an egg.
• Thinning the womb lining: the lining of the uterus becomes thinner, reducing the chance of a fertilised egg implanting and developing.

How effective is NuvaRing at preventing pregnancy?

When used correctly and consistently, NuvaRing is over 99% effective at preventing pregnancy – meaning fewer than 1 in 100 women will become pregnant in a year of perfect use.

In practice, with typical use (accounting for mistakes such as late insertion or a ring being out for too long), effectiveness is around 91-93%. The more closely you follow the instructions, the more reliable NuvaRing will be.

NuvaRing is comparable in effectiveness to the combined contraceptive pill and the contraceptive patch. It has an advantage over daily pills in that there’s no tablet to remember each day – just one ring every three weeks.

Certain factors can reduce how well NuvaRing works, including:

• Not inserting the new ring on time after the ring-free interval
• The ring being out of the vagina for more than 3 hours
• Taking certain medicines that interfere with the hormones, such as rifampicin, some epilepsy medications, or St John’s Wort

If any of these apply, use additional contraception such as a condom and speak to your pharmacist or doctor for guidance.

How to Use NuvaRing Contraceptive Ring

NuvaRing is a vaginal contraceptive ring worn for 3 weeks, then removed for a 1-week break. You’ll usually have a withdrawal bleed during this ring-free week. After the break, insert a new ring to start the next cycle.

1. Wash your hands, then choose a comfortable position: standing with one leg raised, squatting, or lying down.
2. Take the ring from its sachet and compress it by pressing the sides together between your thumb and finger.
3. Gently insert the ring into your vagina until it feels comfortable. The exact position doesn’t matter. If you can still feel it, push it in a little further.
4. Leave the ring in place for 3 weeks.
5. To remove the NuvaRing, hook your index finger under the front rim and pull it out. Place the used ring back in its sachet and dispose of it in your household waste. Don’t flush it down the toilet.
6. After the 1-week break, insert a new ring to begin the next cycle, even if you’re still bleeding.

If you haven’t used a hormonal contraceptive in the past month, insert your first NuvaRing on the first day of your period for immediate protection. If you’re switching from another contraceptive method, you’ll need to use additional contraception for 7 days. Speak to your doctor or nurse for guidance on when to start.

• Check regularly that the ring is still in place, particularly before and after sex. Some partners may notice the ring during sex, but it doesn’t need to be removed.
• You can use tampons while using NuvaRing. Insert the ring first, and take care not to pull the ring out when removing a tampon.
• If the ring slips out, rinse it with cool or lukewarm water and reinsert it as soon as possible. If it’s been out for more than 3 hours, contraceptive protection may be reduced. See the patient information leaflet for full guidance.
• Don’t use NuvaRing alongside a diaphragm, cervical cap, or female condom as a back-up method, as the ring may interfere with correct placement.
• If you miss a period and haven’t been using the ring consistently and correctly, a pregnancy test should be performed before starting a new ring.

Who can use NuvaRing?

NuvaRing is suitable for women who need a reliable method of birth control. However, it’s not right for everyone, and there are some situations where you shouldn’t use it.

Don’t use NuvaRing if you:

• Have or have ever had a blood clot in your legs, lungs, or other organs
• Have had a heart attack or stroke
• Have migraines with aura
• Have severe diabetes with blood vessel damage
• Have very high blood pressure or very high cholesterol
• Have or have had breast cancer or other hormone-sensitive cancers
• Have severe liver disease or liver tumours
• Have any unexplained vaginal bleeding
• Are pregnant or think you might be pregnant
• Are allergic to etonogestrel, ethinylestradiol, or any other ingredient in NuvaRing
• Have hepatitis C and are taking certain antiviral medicines, including ombitasvir/paritaprevir/ritonavir or glecaprevir/pibrentasvir

Speak to your doctor before using NuvaRing if you:

• Smoke, especially if you are over 35
• Are overweight
• Have a family history of blood clots, heart disease, or stroke
• Have epilepsy, Crohn’s disease, or ulcerative colitis
• Have recently given birth or are breastfeeding
• Have varicose veins or a history of superficial thrombophlebitis
• Have systemic lupus erythematosus (SLE)
• Have ever had chloasma (yellowish-brown pigmentation patches on the skin)

Your doctor or pharmacist will assess if NuvaRing is suitable based on your medical history and any risk factors you may have.

Side Effects of NuvaRing

Like all medicines, NuvaRing can cause side effects, although not everyone experiences them. Most side effects are mild and settle down after the first few months of use.

Common Side Effects

These may affect up to 1 in 10 women:

• Headache or migraine
• Nausea or abdominal pain
• Vaginal yeast infection (thrush)
• Vaginal discomfort or discharge
• Genital itching
• Depressed mood or low sex drive
• Breast pain
• Pelvic pain or painful periods
• Acne
• Weight gain
• The ring slipping out

Uncommon Side Effects

These may affect up to 1 in 100 women:

• Dizziness or disturbed vision
• Vomiting, diarrhoea, or constipation
• Swollen abdomen or fluid retention
• Tiredness, irritability, or mood swings
• Increased blood pressure or increased appetite
• Back pain or muscle spasms
• Urinary tract or bladder infections
• Difficulty or pain when passing urine
• Pain, bleeding, or discomfort during sex
• Changes to menstrual periods, including irregular, heavy, or absent periods
• Vaginal dryness, burning, or bacterial infection
• Hair loss, eczema, rash, or hot flushes

Serious Side Effects

Stop using NuvaRing and seek medical attention straight away if you experience any signs of a blood clot, including:

• Swelling, pain, or redness in one leg
• Sudden breathlessness or chest pain
• Sudden vision changes in one or both eyes
• Sudden severe headache, weakness, or difficulty speaking

These may be signs of a deep vein thrombosis (DVT), pulmonary embolism, heart attack, or stroke. Although rare, these conditions are serious and require urgent medical attention.

If you experience any severe or persistent side effects, speak to your doctor or pharmacist. You can also report side effects directly via the MHRA Yellow Card Scheme.

NuvaRing Ingredients

Active ingredients: Etonogestrel 11.7mg and ethinylestradiol 2.7mg. The ring releases etonogestrel and ethinylestradiol at rates of 0.120mg and 0.015mg, respectively, per 24 hours over 3 weeks.

Other ingredients: Ethylene vinylacetate copolymers (28% and 9% vinylacetate) and magnesium stearate.

Warnings and Precautions

• Some medicines can make NuvaRing less effective, including certain epilepsy medications (such as carbamazepine and phenytoin), rifampicin, some HIV and hepatitis C treatments, and St John’s Wort. Always tell your doctor or pharmacist that you’re using NuvaRing before you start any new medicines.
• NuvaRing is not suitable for use as emergency contraception. If you need emergency contraception, speak to your pharmacist or doctor as soon as possible.
• If you need surgery or will be immobile for a long period, tell your doctor you’re using NuvaRing. It may need to be temporarily stopped to reduce the risk of blood clots.
• Using NuvaRing slightly increases the risk of developing a blood clot. This risk is highest in the first year of use, or when restarting after a break of 4 or more weeks.
• Some women using hormonal contraceptives, including NuvaRing, have reported depression or low mood. If you experience mood changes, contact your doctor as soon as possible.
• NuvaRing does not protect against HIV or any other sexually transmitted infection. Use a condom alongside the ring if STI protection is needed.
• Do not use NuvaRing alongside a diaphragm, cervical cap, or female condom, as the ring may interfere with correct placement.
• Keep NuvaRing out of the sight and reach of children.
• Store below 30°C in the original packaging to protect from light and moisture.
• Do not use after the expiry date shown on the packaging, or if you notice any colour change or visible deterioration in the ring.