The Nuvaring vaginal ring allows women to protect themselves from unwanted pregnancy without the additional use of barrier contraceptive methods and pills.

The device has a large list of contraindications and sometimes causes adverse reactions.

Therefore, before use, you must carefully study the instructions, and it is better to consult a specialist.

The structure of the Nuvaring contraceptive ring is simple. Externally, it appears to be a silicone translucent rim that can be easily reshaped. The diameter of the protective agent is 5-6 cm.

Synthetic elastic material is used in pharmacology for the manufacture of various implants, therefore it is considered safe and proven.

Observations and studies show that the product is hypoallergenic. An allergic reaction to elastic material is a rare occurrence.

Inside the silicone rim contains a combination of drugs: etonogestrel.

Every day, a certain dose of active substances is released from the Nuvaring hormonal ring. They are absorbed into the vascular network of the vagina and penetrate into the bloodstream.

The effect of the drug begins immediately after installation and ends after removal. Using the ring has the following effect:

• prevents their opening and release of the egg;
• disrupts the process of endometrial proliferation, which creates unfavorable conditions for implantation;
• organizes a special one that allows not only to protect against pregnancy, but also to obtain a therapeutic effect;
• affects the secretory activity of the cervix, as a result of which the mucus thickens and reduces the activity of the sperm that enter it.

The mechanism of action of the ring is a reversible process.

Is it possible to get pregnant with a birth control ring?

The Nuvaring gynecological ring is intended to prevent unwanted pregnancy when maintaining an active sexual life without the use of others.

The mechanism of action of the silicone rim provides reliable protection against conception. When asked whether it is possible to get pregnant with a ring, gynecologists answer negatively.

However, there are exceptions to every rule. Medicine knows of cases where women became pregnant while using the hormonal system.

The reliability of the product is determined by the Pearl index, an indicator of the effectiveness of the contraceptive method. It is believed that the higher the value, the more dangerous the method.

The Pearl Index is determined from the number of random pregnancies involving 100 women of childbearing age during one year of use of the hormonal system.

For the Nuvaring ring, the rate is less than 1. This means that out of 100 representatives of the fairer sex who used the silicone device, only 1 became pregnant.

Nuvaring: instructions for use

The drug Nuvaring is recommended for use in the instructions for use for contraception. The hormonal agent is injected into.

It is permissible to start using Nuvaring on the 3rd or even 5th day. But only in this case will it be necessary to use additional means of protection against pregnancy throughout the entire month.

The product is approved for use after oral contraceptives, abortion, miscarriage and even childbirth (subject to refusal of breastfeeding).

For each case, an individual application scheme is provided.

How to insert the ring correctly?

The vaginal ring should only be inserted with clean hands. You must first open the package and remove the silicone rim.

To insert the system, you need to take a comfortable position: lying down, squatting, raising your leg on a chair. The ring is inserted in a similar way to sanitary tampons.

Use your thumb and index finger to flatten the elastic circle, insert it into the vagina and push it further away.

Over the next three weeks, the protective agent will remain in place. Its presence should be checked periodically, and in case of premature removal, the following measures should be taken:

• take a break for a week, then use a new ring;
• if the ring is not lost, then rinse it with water and reinsert it;
• if the system is lost, introduce a new remedy immediately.

The effectiveness of the product after loss is not reduced if it is replaced no later than 3 hours later. If the gap is longer, then barrier protection must be used over the next few days.

How to take out Nuvaring?

Removal of the contraceptive ring is done with clean hands. You need to take a comfortable position, insert your finger into the vagina, pick up the system and pull it out.

Over the next week, menstrual-like withdrawal bleeding will begin.

The new device should be inserted exactly 7 days later at the same time as removal. During this period, bleeding may not yet be completed, but this does not affect the effectiveness of the hormonal ring.

If the break was more than 7 days, then the reliability of the protective agent decreases, which requires additional contraceptive measures.

Instructions for use after abortion

When used for the first time, Nuvaring is administered directly on the day of curettage.

If the use of vaginal products on the first day is undesirable, then you can start using the ring in the period from 2 to 5 days. This regimen requires additional contraception in the first week.

How to delay menstruation

To delay the onset of vaginal bleeding, you must remove the ring after 21 days and immediately insert a new one.

With this bleeding pattern, there will be no withdrawal, but some women experience spotting in the middle of the cycle.

Nuvaring should be removed after another 21 days or at the appropriate period for menstruation.

Using a ring for fibroids

The results of clinical studies show that the use of the Nuvaring ring for uterine fibroids has unexpected results.

In most patients, the tumor stopped growing under the influence of the new hormonal levels.

There are clinical cases showing the ineffectiveness of the silicone system for benign myometrial tumors. It is believed that today there are more effective rings than the Nuvaring ring.

Treatment of endometriosis

With endometriosis, focal spread of the functional layer of the uterus occurs. Under the influence of hormonal levels, they bleed, causing heavy menstruation.

The Nuvaring ring helps manage this condition by suppressing ovarian activity. The use of the hormonal system shows good results. Treatment is carried out in two ways:

1. The standard method is to use the ring with regular 7-day breaks;
2. Continuous use of the system for 3-6 months.

Use during pregnancy and pregnancy

The use of the Nuvaring ring is contraindicated during pregnancy. If conception occurs while using the device, the system should be removed immediately and consult a doctor.

The drug is intended to prevent unplanned pregnancy, so it is not advisable to use it while pregnant.

Nuvaring is not prescribed for breastfeeding. The medication is able to change a woman’s hormonal levels, reducing the amount of milk produced. Also, the substances that make up the ring are excreted in breast milk.

Modern pharmacology offers more effective and safe hormonal agents for preventing pregnancy during breastfeeding.

Contraindications to the use of Nuvaring

• Thrombosis and varicose veins of the lower extremities. Any conditions accompanied by blood thickening.
• Migraine accompanied by additional neurological symptoms. Including in the anamnesis.
• Vascular lesions in diabetes mellitus.
• Severe hypertriglyceridemia accompanied by pancreatitis.
• Acute liver pathologies.
• Malignant organ lesions with hormonal dependence.
• Bloody vaginal discharge not associated with the menstrual cycle.
• Hypersensitivity and high likelihood of an allergic reaction to the components.

If the described cases occur while using the ring, you should remove it immediately. The medication should be used with caution by women over 35 years of age and by smoking patients.

Advantages and disadvantages of the Nuvaring ring

The main advantage is the ability to realize reproductive function even after long-term use. Pregnancy after Nuvaring occurs in healthy women within 1-3 cycles.

The advantage of the drug can be called the method of its use. Vaginal administration eliminates problems with the digestive tract, as well as missed hormonal doses.

It is convenient to insert the ring and forget about contraceptive methods for 3 weeks. The advantages of the device are:

• ease of use;
• the ability to regulate the cycle;
• reducing the intensity of bleeding.

The disadvantages include the price of Nuvaring. The cost of one ring is about 25 dollars. The triple system costs $55.

Like any medicine, Nuvaring can cause side effects.

They often manifest themselves in the form of spotting in the middle of the cycle, headaches, and decreased libido.

The drug affects the thickness of the blood, and therefore increases the risk of heart and vascular pathologies. Also, the disadvantages are listed:

• Some patients find it difficult to insert and remove the system;
• you can lose a ring and not notice it;
• there may be increased secretion of vaginal mucus.

Latin name: NovaRing
ATX code: G02BB01
Active ingredient: Ethinyl estradiol
and etonogestrel
Manufacturer: Organon, Netherlands
Conditions for dispensing from a pharmacy: By prescription

Nuvaring is a new highly effective contraceptive drug of the latest generation, intended for intravaginal use.

Indications for use

The Nuvaring contraceptive ring is prescribed for contraceptive purposes.

Compound

The active ingredients of the vaginal ring are ethinyl estradiol together with etonogestrel, the dosages of the active components are 2.7 mg and 11.7 mg, respectively.

Additional components include:

• Magnesium stearate
• Ethylene and vinyl acetate copolymer.

Medicinal properties

Price from 989 to 3897 rub.

Synthetic hormones released by the ring when used vaginally have a contraceptive effect by blocking the onset of ovulation. Each of the hormones entering the body affects the functioning of the ovaries, preventing the maturation of the follicles. Etonogestrel is the progestogen component of the ring, which binds to specific progesterone receptors in the so-called target organs.

Ethinyl estradiol is an estrogen component; the action of this drug is associated with the occurrence of various processes, which are mainly aimed at suppressing ovulation.

The hormonal drug exhibits not only contraceptive properties, normalizes the menstrual cycle, reduces pain during the first days of menstrual-like discharge, reducing blood loss. Due to this effect, the risk of iron deficiency and anemia is reduced.

When using Nuvaring, the likelihood of ectopic pregnancy, the development of ovarian and endometrial cancer of the uterus is significantly reduced. At the same time, cystic formations in the ovaries, inflammatory processes in the pelvic organs, and benign neoplasms in the mammary glands are less often diagnosed.

Etonogestrel penetrates the vaginal walls, its highest concentration is observed after 7 days, precisely when it begins to act as a contraceptive. Moreover, its bioavailability is 100%, which is significantly higher than that of oral contraceptives. Metabolic processes occur in liver cells, excretion is carried out by the intestines and the renal system. The half-life of metabolic products is about 6 days.

Ethinyl estradiol is characterized by fairly high absorption rates. The highest level of the hormone is observed after 3 days. from the moment of installation of the hormonal ring. The bioavailability rate is 56%, which is almost the same as the oral use of hormones. Metabolism occurs in the intestines and kidneys, metabolites are eliminated within 36 hours.

Release form

The surface of the hormonal ring is smooth, transparent and completely colorless. There is a small transparent area in the connection area. Inside the moisture-resistant bag there is 1 Nuvaring hormonal ring. A pack may contain 1 or 3 packets (with 3 rings - Nuvaring 3) along with instructions.

Nuvaring: instructions for use

The ring must be inserted into the vagina for 21 days. After this period, it must be removed on the day of the week on which it was installed. After a week break (7 days), a new contraceptive is introduced. It is worth noting that after 2-3 days. after removing the Nuvaring ring, menstrual-like bleeding usually begins, which ends after the next intravaginal installation of the contraceptive. If this contraceptive is used for the first time, then you should pay attention to some features of its use:

• A hormonal contraceptive has not been used before - the Nuvaring ring is inserted in the first days of the cycle (best on the 1st day). If the installation occurred later than 1 day. cycle, it is recommended to use additional methods of contraception for the next seven days.
• If you have previously used hormonal contraceptive drugs, the ring should be introduced in the interval between taking COCs (seven-day withdrawal period). If COCs are used correctly and it is confirmed that the woman is not pregnant, the Nuvaring ring can be inserted on any day of the MC. You can go from Yarina using the same scheme.
• After taking the mini-pill, single-component progestin contraceptive pills, using hormonal intrauterine systems, injectable contraceptives, and implants, the ring is inserted according to certain rules. After progestin pills (mini-pills), you can insert a contraceptive drug any day, regardless of when the last pill was taken, whether the cycle after childbirth has improved or not. After removing the IUD, you will need to insert a contraceptive ring on the same day (according to the instructions). If you have previously used an injectable contraceptive, you will need to install the ring on the day when the hormone injection procedure is to be carried out. During the seven-day use of the ring, it is necessary to use a barrier method of protection against unwanted pregnancy.

Instructions for use after abortion

If an abortion is performed before 4 months of pregnancy, you will need to insert the rings immediately after this procedure or wait until the first menstruation (in this case, the contraceptive is administered on the 1st day of the cycle).

After termination of pregnancy during the second trimester or after delivery, a vaginal ring can be installed no earlier than a month (4 weeks) after natural childbirth (breastfeeding is stopped) or abortion.
If the use of a hormonal drug deviates from the standard regimen, the following recommendations should be followed:

• The break in using the hormonal ring exceeds 7 days. in the presence of unprotected sexual contacts: first of all, pregnancy is excluded and a contraceptive is immediately introduced, the next 7 days. It is preferable to use barrier methods of protection against unwanted pregnancy.
• Temporary removal of the hormonal ring: its stay outside the vagina is less than three hours, but the level of protection against pregnancy is not reduced. If the period of absence of a hormonal drug in the vagina was more than 3 hours in the first weeks of using this contraceptive, the ring must be inserted as soon as possible. In this case, the contraceptive effect may be reduced, and there is a need to take additional measures to prevent pregnancy. If the ring was removed for more than 3 hours in the third week, you must stop using this drug and insert a new one. The break in use should not last more than 7 days. You can also wait until your period; on the first day your period starts, you can insert an intravaginal contraceptive. Use condoms for the next 7 days. is mandatory.
• Use of vaginal contraception for more than 4 weeks. requires further exclusion of pregnancy due to the fact that the contraceptive effect of the drug has significantly decreased. After pregnancy has been ruled out, you can use the drug according to the standard regimen.

How to delay menstruation

To postpone your period (the onset of bleeding) by a day or several days, you can administer a hormonal ring without the standard seven-day break. However, the possibility of bleeding should not be ruled out.

How to properly insert a ring into the vagina

Before inserting the ring, you need to squeeze it with your index finger and thumb and carefully place it inside the vagina.

If the ring accidentally falls out when using tampons, it is recommended to rinse the contraceptive under running warm water, then reinsert it. If necessary, you can check with your doctor: “What should I do if I pull out the tampon along with the ring?” It is worth noting that with a tampon a woman will not feel any discomfort. When using tampons, you need to be more careful to prevent the ring from falling out of the vagina.

To remove the ring, you should pick it up with your index finger, squeeze it slightly, and then pull it towards you. The used hormonal drug, which the woman removed from the vagina after 21 days, should be disposed of.

If a woman inserts the ring incorrectly, it is accidentally placed in the urethra, the likelihood of developing cystitis increases, and frequent urination may occur. In this case, the woman can become pregnant. Before you fight cystitis, it is worth finding out the true cause of its occurrence. You will need to remove the ring as quickly as possible. As a result of subsequent correct administration, it must be securely fastened, frequent inflammatory processes of the genitourinary system, and in particular cystitis, after Nuvaring will no longer bother you, pain during urination will disappear.

Using a ring for fibroids

The presence of fibroids is not a contraindication to the use of this contraceptive; you can use the ring without harm to your own health. It is worth noting that fibroids do not grow during the use of the ring, as evidenced by ultrasound. Patients with fibroids are advised to consult with their doctor about the advisability of using the ring. If necessary, you can switch from Nuvaring to tablets. Whether it is possible to treat fibroids in this way and which contraceptives to give preference, check with your gynecologist. Cancellation of Nuvaring should be agreed with a specialist. Recovery of the cycle after hormone therapy will occur after six months.

Treatment of endometriosis

For endometriosis, the use of a hormonal ring may be indicated; when switching from other COCs (for example, if Yarina was previously prescribed), a significant improvement in the course of the disease is observed; during menstruation, a woman loses less blood. During the first month of use, the severity of pain decreases, which contributes to the gradual restoration of the endometrial layer of the uterus. After a woman switches to using the ring, her periods are painless. The drug acts gently, without disturbing the functioning of other organs and systems. Each of the active ingredients has a local therapeutic effect.

Use during pregnancy and pregnancy

Such contraceptives are not prescribed to this group of patients. The use of Nuvaring during lactation and pregnancy is contraindicated.

Contraindications

• Tendency to develop thrombosis and thromboembolism
• Conditions that indicate the development of thrombosis
• Current or previous severe migraine-like headaches with significant focal neurological symptoms
• Diabetes mellitus complicated by vascular lesions
• Pancreatitis with hypertriglyceridemia
• Serious liver disorders (including benign and malignant tumor processes)
• Presence of hormone-dependent neoplasms
• Bloody discharge from the internal genital organs of unknown origin
• Pregnancy, GW
• Excessive sensitivity to Nova Ring (main components).

Precautions

If you have not previously used contraceptives of this type, you should undergo a medical examination to identify diseases that are a contraindication to the use of a hormonal ring. Control visits to the gynecologist should take place every 6 months.

It must be remembered that this contraceptive does not protect against AIDS and other infectious diseases that are sexually transmitted. When using a contraceptive, the risk of thrombosis increases significantly.

Possible symptoms include:

• Feeling of heat in the lower extremities, pain or severe swelling
• Hyperemia of certain areas of the skin
• Cough syndrome, developing shortness of breath with characteristic attacks
• Impaired vision clarity
• Intense and prolonged headaches
• Blurred speech
• Collapse
• Impaired motor activity
• Lethargy, decreased sensitivity of some part of the body
• Acute abdomen syndrome.

If possible blockage of blood vessels by blood clots cannot be ruled out, you must immediately stop taking the drug and seek medical help.

During contraceptive therapy (women used pills), the development of a tumor process in the liver tissue was diagnosed. The use of a vaginal ring does not exclude the development of such pathology, as with tablets.

During hormonal therapy, the risk of pancreatitis increases rapidly.

If you are prone to chloasma, you should avoid prolonged exposure to direct sunlight.

A worsening of the course of ulcerative colitis, as well as Crohn's disease, cannot be ruled out.

Persons with diabetes need to remain under strict medical supervision during the first months of hormonal therapy.

If your period stops and a woman becomes pregnant, you should stop using the contraceptive immediately.

Cross-drug interactions

It is necessary to read the instructions for drugs such as oxcarbazepine, carbamazepine, topiramate, phenytoin, felbamate, rifampicin, as well as barbiturates and drugs based on St. John's wort. This is due to the fact that with combined use the risk of acyclic bleeding increases. It is necessary to use additional means of protection during treatment with such drugs for a month.

The use of antibiotics (for example, tetracycline or ampicillin) reduces the contraceptive effect of the hormonal drug. It is recommended to use a condom during antibiotic treatment. It is better to ask your gynecologist which antibiotics to use and what the consequences of taking them are.

When using antifungal suppositories intravaginally, the risk of damage to the hormonal ring or its rupture increases.

During hormone therapy, changes in the metabolism of other drugs may be observed, these include cyclosporine and lamotrigine.

Side effects

With long-term use of hormonal drugs, it is worth studying the instructions for the drugs, as multiple side effects may develop, in particular with Nuvaring the following cannot be ruled out:

• Excessive sensitivity
• Increased appetite and weight gain
• Decreased libido
• Sudden mood swings, depressive mood
• Migraine-like pain
• Impaired visual acuity
• Deterioration of the cardiovascular system, which is characterized by thromboembolism, changes in blood pressure, and the occurrence of so-called hot flashes
• Gastrointestinal disorders
• Rashes, acne formations and severe itching
• Soreness in the muscles, spine and limbs
• Dysuria, tendency to frequent urination, cystitis
• Lethargy, swelling
• Reproductive system: breast engorgement, the appearance of a genital node, the development of dysmenorrhea, heavy periods or their absence, bleeding of unknown etiology, discharge mixed with blood during sexual intercourse, a local burning sensation, pain inside the vagina.

Overdose

No serious consequences of overdose were detected.

Bleeding and indigestion cannot be ruled out.

Please note that there is a dedicated hotline to help women with various vaginal ring concerns. If side symptoms develop due to an overdose, you should call the hotline (the number is listed on the official page of the drug Nuvaring in Russia). Hotline operators will advise and give recommendations on what to do in a given situation.

Storage conditions and shelf life

The hormonal ring must be stored under strict temperature conditions (2-8 C) for 3 years.

Analogs

Bayer, Germany

Price from 759 to 3295 rub.

Yarina belongs to combined hormonal drugs, the dose is designed for one month. The tablets act comprehensively, exhibiting a contraceptive effect and antiandrogenic effect. The package can contain 21 or 28 tablets.

Pros:

• Eliminate the appearance of acne
• Normalize MC
• Easy to switch from other COCs.

Cons:

• Produced by a foreign manufacturer, which is reflected in the price
• Has a negative effect on liver function
• Adverse reactions may occur during hormone therapy.

Does Nuvaring have side effects? This question interests any modern woman who is considering options for hormonal contraception in general and this ring in particular. Indeed, the manufacturer’s promises look tempting, but on the Internet you can find a lot of frightening reviews - supposedly some have completely stopped menstrual bleeding while using this effective contraceptive, others suffer from mood swings, emotional instability, and some cannot get pregnant. Is this true? To understand what to watch out for, you should read the instructions for use.

There are different probabilities

In the instructions, the manufacturer indicates that Nuvaring can cause side effects, and then provides an exhaustive list of such phenomena. Mostly these are fairly minor threats, such as temporary bowel disorders or increased gas formation. All of them soon disappear on their own when the body adapts to the hormonal drug. But on the World Wide Web, some mention more severe consequences - even unsuccessful attempts to get pregnant due to prolonged use of contraception. For some, these stories are an important incentive to completely abandon the drug that corrects female hormonal levels. Let's first look at what the manufacturer pays attention to first, and to do this, let's look at what we're talking about in general.

As can be seen from the instructions, the Nuvaring ring is a colorless product made of smooth material. This is a transparent object that has no damage on the outer sides that is visible to the human eye. The junction is either completely transparent or close to it. This unique development of Dutch doctors has a reliable contraceptive effect, helps prevent unwanted pregnancy, and provides the highest level of reliability. The ring is easy to use; you don’t need to remember every day, as is the case with tablets, what time and how to take the drug. Its only weakness is the somewhat probable negative response of the body.

What's possible?

It is known that the side effects of Nuvaring can bother those who use the drug uncontrollably, without the consent of the treating doctor, and without following the instructions. In addition, there are intolerances and allergic reactions. Persons for whom Nuvaring is prohibited according to the instructions or is allowed only with great caution may encounter a negative response from the body. To minimize the dangers to yourself and reduce the chance of unpleasant experiences, before starting to use the product you should consult a professional gynecologist, and possibly undergo tests to determine the characteristics of your hormonal levels. In this case, you are guaranteed to find the best option.

Due to side effects, Nuvaring, as indicated in the accompanying documentation, can cause a decrease in sexual desire, as well as cause increased sensitivity. The manufacturer draws attention to the possibility of activating appetite and weight gain. In rare cases, the use of Nuvaring causes depression, sudden changes in mood, sometimes unpredictable. There is a possibility of headaches similar to migraines. In addition, Nuvaring can provoke a deterioration in the functioning of the visual system.

Forewarned is forearmed

As you know, the side effects of the Nuvaring ring include a negative effect on the functioning of the heart and vascular system. The likelihood of thromboembolism increases, and blood pressure levels may be impaired. Some women have experienced hot flashes while using this contraceptive method. In addition, the ring can have a negative effect on the stomach and intestines. This is expressed in stool disorders, increased gas formation, and other disorders. There is a risk of itching, skin rashes, minor inflammations, including the facial area.

Side effects mentioned in patient reviews about the Nuvaring ring include unpleasant, even painful sensations in muscle tissue, limbs, and various parts of the spinal column. Some complain of swelling and a general sluggish state of the body. There is a risk of cystitis, possible increased urge to urinate, dysuria. Negative responses can also be noticed from the reproductive system. Some women, when using Nuvaring as a method of contraception, experience engorgement of the breast glands, there is a possibility of disruption of the monthly cycle, and lack of bleeding on time. It is known that under the influence of hormonal compounds contained in the ring, a genital node may appear, bleeding for no reason, and spotting during intimate contact are possible. Nuvaring can cause unpleasant local sensations - itching, burning, pain.

Is the devil really that scary?

As the manufacturer mentions in the instructions, although the Nuvaring ring can cause side effects, in practice this is really rare. Mostly unpleasant impressions accompany the very beginning of using a contraceptive and gradually disappear over time. No specific treatment is required. If the symptoms are severe and difficult to tolerate, you should seek help from a qualified doctor as soon as possible. The doctor will help you choose the best replacement option if Nuvaring is not suitable as a contraceptive.

Some people note in their reviews the side effects of Nuvaring: dizziness, headache. It is known that in rare cases, the use of contraceptives has even caused anxiety. When using this method of protection, vomiting is possible, although this is observed quite rarely, since the drug is used topically and not orally, and does not irritate the intestines or stomach at the stage of primary processing of the medication. The possibility of weight gain was mentioned above, but in rare cases the effect on a woman using Nuvaring was exactly the opposite - when using a contraceptive there is a risk of sudden, causeless weight loss.

Experiments and results

To understand how well-founded the reviews about the side effects of Nuvaring are, the manufacturer organized special tests. The first wave was carried out before the launch of the ring for sale, and the second - after the marketing campaign, promotion of the product, and the appearance of information about possible negative reactions in sources accessible to the general public. The peculiarity of such a study is associated with a specific effect of the human psyche, which determines the possibility of developing a negative response of the body in conditions of awareness of the likelihood of such an event. However, the results of all stages of testing clearly show that negative phenomena are recorded in a really small percentage of cases.

As noted in reviews of the Nuvaring ring, side effects can be expressed by the response of the reproductive system in the form of increased formation of leucorrhoea. In rare cases, under the influence of active compounds, an inflammatory process began in the vaginal mucosa. There is also a risk of inflammation in the urinary tract. Some women noted that the main disturbing phenomenon was the constant sensation of a foreign object in the body. The manufacturer draws attention to the possibility of the ring falling out. This cannot be directly attributed to side effects, but when using the product you will have to check that the contraceptive is in place.

Rarely, but aptly: this happens too

The instructions for use indicate that the side effects of Nuvaring are discharge resembling leucorrhoea. These are relatively common, although not in all women who use contraception. There are reactions that are observed much less frequently. On average, their frequency is one case in every thousand, or even ten thousand, of women using the product. This is how the risk of hair loss due to contraception is assessed. With the same small degree of probability, eczema and rash may appear. An allergic reaction to the drug may result in hives. “Novaring” can cause hypoesthesia and provoke unpleasant, painful sensations in the pelvic organs. In rare cases, hormonal contraception causes an increase in breast size, provokes uterine polyps, and ectropion of the uterine cervix.

Reviews of the side effects of the Nuvaring ring mention unpleasant, painful sensations associated with intimate contact. Against the background of hormonal contraception, mastopathy (cystic, fibrous type) may develop. There may be heavy discharge, similar to the usual menstrual discharge, or a complete absence of it, as well as bleeding that does not have a cycle. In rare cases, women have experienced PMS, an unpleasant odor from the vagina. “Novaring” can provoke negative local sensations, cause too dry mucous membranes, and general discomfort in the genital area.

Attention to every detail

In the instructions for the Nuvaring hormonal ring, the manufacturer points out that estimates of the frequency of occurrence of negative responses of the body are quite approximate, since they are based on information provided voluntarily. It is currently impossible to make a more accurate assessment of the situation. Some spontaneous reports contained information about the negative consequences of using the product not only for women, but also for men. When having sexual intercourse with this method of birth control, there is a risk of pain in the male penis. The risk of hyperemia increases, abrasions and bruises may form. All received messages were taken into account by the manufacturer and recorded in the accompanying documentation for the product.

The manufacturer, in the instructions for using Nuvaring, additionally draws attention to possible negative consequences when using a contraceptive in cases where the method of protection is contraindicated for a woman. In particular, with angioedema, Nuvaring can cause a deterioration in the general condition and exacerbation of symptoms. This result is shown not only by the described ring, but also by any exogenous hormonal compounds. Also, side effects will likely accompany the use of a contraceptive if a woman is sick with pancreatitis, cholecystitis, if neoplasms (malignant, benign) are detected, depending on hormonal levels, as well as some other conditions. All of them are listed in detail in the instructions in the part devoted to contraindications and conditions that require special care.

How does this work?

Having considered the possible side effects of Nuvaring (no menstruation, headache, bowel problems), it makes sense to understand how and why this contraceptive works. In the description, the manufacturer indicates that the contraceptive is a combination contraceptive and contains two types of hormones that correct the functioning of the female reproductive system - ethinyl estradiol and etonogestrel. The first is estrogen, now widely used as a contraceptive. The second name is progestogen, characterized by increased affinity for progesterone receptors.

The contraceptive “Novaring” is effective due to its combined effect on the female body. Active compounds can suppress the ovulation process, but to increase reliability, components have been introduced that affect other features of the female body, including the quality of mucus. As specialized tests have shown, the rate of conception per hundred women who used the medication for one year is 0.96. The studies were conducted with women aged 18-40 years. The results obtained are comparable to combined hormonal contraceptives intended for oral administration.

The big picture: attention to all factors

By the way, the negative features described above, as many people note in their responses, are completely equalized by the advantages of Nuvaring. Studies have proven that with the use of this contraceptive, in most women the menstrual cycle becomes clear, orderly, regular, pain and the intensity of bleeding decrease. Consequently, Nuvaring reduces the risk of iron deficiency in the female body. Currently, analytical data allow us to conclude that the use of this medication is a method of reducing the risk of malignant neoplasms in the ovaries and endometrium.

There are no complete analogues of Nuvaring on sale, but an alternative with a similar degree of effectiveness can be called tablets that correct hormonal levels. The manufacturer clearly proves that the ring is more convenient and practical. Statistical studies show that using the item results in less spotting than using pills. The likelihood of breakthrough bleeding is reduced. Among those who used Nuvaring, there was a higher percentage of women whose bleeding was observed strictly during a break in the use of the contraceptive.

Important aspect

At the moment, there is no official information about the possible negative consequences of using Nuvaring by underage girls. No special studies were organized to determine this fact.

Analyzes were conducted to determine the effects of the active compounds on bone mineral density. The duration of the program is two years. Nuvaring was compared with the results. A reasonable conclusion was made that there was no effect on bone density when choosing Nuvaring as a method of contraception.

Some have questioned what Nuvaring's withdrawal should look like. The manufacturer points out that no special measures are required. Consent with the treating doctor is only necessary if the ring was used against the background of fibroids. Otherwise, the woman simply stops using the contraceptive at any time of her own free will.

What happens in the body?

To understand why the previous periods are restored after Nuvaring, and for what reason they change during the period of use of the drug, one should delve into the logic of its influence on a woman. Hormonal compounds contained in a small ring are automatically injected daily into the surrounding tissues, affecting the reproductive system. They quickly reach target organs, minimize the unpleasant symptoms associated with eating tablets, since they do not have the same effect on the stomach and intestines as drugs intended for oral administration.

Etonogestrel, released from the ring, quickly penetrates the body, being adsorbed through the mucous membranes of the reproductive system. The highest concentration of the compound in the circulatory system is observed approximately seven days after administration of the drug. In blood plasma, the concentration changes gradually, although the limits are relatively small. The bioavailability of the active component is 100%, that is, higher than when used orally.

Ethinyl estradiol is the second hormonal compound contained in the ring and regularly injected in small doses into the female body. The highest level of concentration in the circulatory system is observed within three days from the start of use of the product. After three weeks, a slight decrease is observed, the process of decreasing the amount occurs smoothly. Bioavailability is estimated at 56%, which is approximately similar to tablets.

Special case

As stated above, the risk of encountering negative phenomena when using Nuvaring is higher if a woman belongs to certain groups of patients. For example, a number of dangers are associated with insufficient functioning of the renal and hepatic systems. There is no official information on how the circulation of the active compounds of a contraceptive in the body may change under such conditions. It is assumed that when liver functionality is impaired, the metabolism of sex hormones slows down and worsens.

When to use and when not to?

“Novaring” is intended for all modern women interested in preventing unwanted pregnancy through a reliable method associated with a minimum of unpleasant experiences. But the list of contraindications for the name is much wider than the indications. When using the ring by women belonging to the group of those for whom it is contraindicated, there is a high probability of a negative response from the body.

You should not install Nuvaring if you are hypersensitive or intolerant to any of the components used in the production of the product. This applies not only to the main compounds, but also to the excipients. You should not use Nuvaring if thrombosis or thromboembolism is diagnosed. This applies not only to the current moment, but also to the entire medical history. "Novaring" is not intended for persons whose condition suggests imminent thrombosis, as well as when determining a predisposition to it.

You should not use the Nuvaring contraceptive ring if you have focal migraines and the symptoms are neurological. This applies not only to the current moment, but also to the anamnesis. The ring is not intended for contraception in diabetics if vascular lesions are established; it is not suitable for patients with pancreatitis, malignant, benign neoplasms, bleeding of the genital organs, the cause of which cannot be determined. You should not use Nuvaring in case of severe liver diseases, during pregnancy and suspicion of conception, or when breastfeeding.

Possible, but carefully

There is an increased risk of side effects associated with the use of the Nuvaring ring by persons diagnosed with thrombophlebitis, heart valve disease, high blood pressure, diabetes, acute pathologies of the liver, kidneys, gallstones, systemic lupus, minor chorea, otosclerosis, which provoked depression of auditory function.

Description:

A modern combined hormonal contraceptive (ring) for intravaginal administration.

Manufacturer:

ORGANON (Netherlands)

Composition and release form

The vaginal ring is smooth, transparent, colorless or almost colorless, without major visible damage, with a transparent or almost transparent area at the junction.

Active ingredients: ethinyl estradiol 2.7 mg, etonogestrel 11.7 mg. Excipients: ethylene vinyl acetate copolymer (28% vinyl acetate), ethylene vinyl acetate copolymer (9% vinyl acetate), magnesium stearate.

Pharmacological action

Combined hormonal contraceptive drug for intravaginal use. Contains etonogestrel, which is a progestogen, a derivative of 19-nortestosterone, and ethinyl estradiol, which is an estrogen. The main mechanism of contraceptive action of the drug NuvaRing is inhibition of ovulation. The progestin component (etonogestrel) inhibits the synthesis of LH and FSH by the pituitary gland and, thus, prevents follicle maturation (blocks ovulation).

The Pearl index, an indicator reflecting the frequency of pregnancy in 100 women during a year of contraception, when using the drug NuvaRing is 0.96. The use of the drug reduces the pain and intensity of menstrual-like bleeding, reduces the frequency of acyclic bleeding and the likelihood of developing iron deficiency conditions. In addition, there is evidence of a reduced risk of endometrial and ovarian cancer with the use of the drug. NuvaRing does not reduce bone mineral density.

Indications for use

Intravaginal contraception (prevention of unwanted pregnancy) in women.

Directions for use

NuvaRing is inserted into the vagina once every 4 weeks. The ring is in the vagina for 3 weeks and then removed on the same day of the week on which it was placed in the vagina; after a week's break, a new ring is inserted. For example: if the NuvaRing ring was installed on Wednesday at approximately 10:00 pm, then it should be removed on Wednesday 3 weeks later at approximately 10:00 pm; on the following Wednesday a new ring is inserted.

Bleeding associated with discontinuation of the drug usually begins 2-3 days after removal of the NuvaRing and may not completely stop until a new ring is installed.

Start using Nuvaring

Hormonal contraceptives were not used in the previous menstrual cycle
NuvaRing should be administered on the first day of the cycle (i.e., the first day of menstruation). It is possible to install a ring on days 2-5 of the cycle, however, in the first cycle in the first 7 days of using the drug NuvaRing, additional use of barrier methods of contraception is recommended.

Switching from taking combined oral contraceptives

NuvaRing should be administered on the last day of the free interval in taking combined hormonal contraceptives (pills or patch). If a woman has been taking the combined hormonal contraceptive correctly and regularly and is confident that she is not pregnant, she can switch to using a vaginal ring on any day of her cycle. The duration of the interval in taking hormonal contraceptives should not exceed the recommended period.

Switching from progestin-only contraception (mini-pill, implant, or injectable contraception) or progestogen-releasing intrauterine device (IUD)

A woman taking the mini-pill can switch to using NuvaRing on any day (the ring is inserted on the day the implant or IUD is removed or on the day of the next injection). In all these cases, the woman should use a barrier method of contraception for the first 7 days after insertion of the ring.

After an abortion performed in the first trimester of pregnancy

You can start using NuvaRing immediately after an abortion. In this case, there is no need for additional use of other contraceptives. If the use of NuvaRing immediately after an abortion is undesirable, the ring should be used in the same way as if hormonal contraceptives were not used in the previous cycle. In the interval, the woman is recommended an alternative method of contraception.

After childbirth or abortion performed in the second trimester of pregnancy

The use of NuvaRing should begin within the 4th week after childbirth (if the woman is not breastfeeding) or abortion in the second trimester. If the use of NuvaRing is started at a later date, then additional use of barrier methods of contraception is necessary in the first 7 days of using NuvaRing. However, if sexual intercourse has already taken place during this period, you must first exclude pregnancy or wait until your first menstruation before starting to use the drug NuvaRing.

The contraceptive effect and cycle control may be impaired if the patient does not comply with the recommended regimen. To avoid loss of contraceptive effect in case of deviation from the regimen, you must follow the following recommendations.

Extending the break from using the ring

If you had sexual intercourse during a break from using the ring, pregnancy should be ruled out. The longer the break, the higher the likelihood of pregnancy. If pregnancy is ruled out, a new ring should be inserted into the vagina as quickly as possible. Over the next 7 days, an additional barrier method of contraception, such as a condom, can be used.

If the ring has been temporarily removed from the vagina

If the ring remains outside the vagina for less than 3 hours, the contraceptive effect will not decrease. The ring should be reinserted into the vagina as soon as possible.

If the ring was left outside the vagina for more than 3 hours during the first or second week of use, the contraceptive effect may be reduced. You should place the ring in your vagina as soon as possible. Over the next 7 days, you must use a barrier method of contraception, such as a condom. The longer the ring was outside the vagina and the closer this period is to the 7-day break in using the ring, the higher the likelihood of pregnancy.

If the ring was left outside the vagina for more than 3 hours during the third week of use, the contraceptive effect may be reduced. The woman should throw away this ring and choose one of two methods:
Immediately install a new ring. Please note that the new ring can be used for the next 3 weeks. In this case, there may be no bleeding associated with the cessation of the drug's effect. However, spotting or bleeding in the middle of the cycle is possible.

Wait for bleeding associated with the cessation of the drug's effect, and insert a new ring no later than 7 days after removing the previous ring. This option should only be chosen if the ring use regimen has not previously been violated during the first 2 weeks.

Extended use of the ring

If the drug NuvaRing was used for no more than a maximum period of 4 weeks, then the contraceptive effect remains sufficient. You can take a week's break from using the ring and then insert a new ring. If NuvaRing remains in the vagina for more than 4 weeks, the contraceptive effect may deteriorate, so pregnancy must be ruled out before inserting a new ring.

To change the time of onset of menstrual bleeding

To delay (prevent) menstrual-like withdrawal bleeding, you can insert a new ring without a week's break. The next ring must be used within 3 weeks. This may cause bleeding or spotting. Then, after the usual one-week break, you should return to regular use of NuvaRing.

To postpone the onset of bleeding to another day of the week, it may be recommended to take a shorter break from using the ring (for as many days as necessary). The shorter the interval between ring use, the higher the likelihood that there will be no bleeding after ring removal and no bleeding or spotting will occur when the next ring is used.

Ring damage

In rare cases, ring rupture has occurred when using NuvaRing. The core of the NuvaRing ring is solid, so its contents remain intact, and the release of hormones does not change significantly. If the ring ruptures, it usually falls out of the vagina. If the ring ruptures, a new ring must be inserted.

Ring falling out

NuvaRing has sometimes been reported to fall out of the vagina, for example, when it was inserted incorrectly, when a tampon was removed, during sexual intercourse, or due to severe or chronic constipation. In this regard, it is advisable for a woman to regularly check the presence of the NuvaRing ring in the vagina.

Incorrect insertion of the ring

In very rare cases, women have inadvertently inserted NuvaRing into the urethra. When symptoms of cystitis appear, it is necessary to consider the possibility of incorrect insertion of the ring.

Rules for using NuvaRing

The patient can independently insert NuvaRing into the vagina. To insert the ring, a woman should choose the position that is most comfortable for her, for example, standing, raising one leg, squatting, or lying down. NuvaRing must be squeezed and inserted into the vagina until the ring is in a comfortable position. The exact position of NuvaRing in the vagina is not decisive for the contraceptive effect.

After insertion, the ring must remain in the vagina continuously for 3 weeks. If the ring was accidentally removed, it should be washed with warm (not hot) water and immediately inserted into the vagina.

To remove the ring, you can pick it up with your index finger or squeeze it between your index and middle fingers and pull it out of the vagina.

Side effect

The following side effects may occur when using Nuvaring:

System-organ class	Often (? 1/100)	Uncommon (< 1/100, ? 1/1000)	Rarely (< 1/1000)
Infections and infestations	Vaginal infection (candidiasis, vaginitis)	Cystitis, cervicitis, urinary tract infections
Immune system			Hypersensitivity
Metabolic disorders	Weight gain	Increased appetite
Mental disorders	Depression, decreased libido	Mood changes
From the nervous system	Headache, migraine	Dizziness
From the side of the organ of vision		Visual impairment
From the cardiovascular system		"Tides"
From the digestive system	Abdominal pain, nausea	Bloating, diarrhea, vomiting, constipation
From the skin		Alopecia, eczema, itchy skin	Skin rash
From the musculoskeletal system		Pain in the lumbar region, muscle spasms, pain in the limbs
From the urinary system		Dysuria, urgency, pollakiuria
From the reproductive system	Engorgement and tenderness of the mammary glands, genital itching in women, pelvic pain, vaginal discharge	Amenorrhea, cervical polyps, contact (during sexual intercourse) spotting (bleeding), dyspareunia, ectropion of the uterus, fibrocystic mastopathy, menorrhagia, metrorrhagia, premenstrual syndrome, dysmenorrhea, uterine spasm, burning sensation in the vagina, dryness of the vulva and mucous membrane vagina.	Local reactions on the part of the penis (sensation of a foreign body by the partner during sexual intercourse, irritation of the penis with increased sensitivity to the components of the drug)
	Vaginal ring prolapse	Rupture (damage) of the ring, fatigue, malaise, abdominal pain, swelling, sensation of a foreign body in the vagina

Contraindications for use

Venous thrombosis (including a history), including deep vein thrombosis, pulmonary embolism;
- arterial thrombosis (including a history), including stroke, transient cerebrovascular accidents, myocardial infarction and/or precursors of thrombosis, including angina pectoris, transient ischemic attack;
- heart defects with thrombogenic complications;
- changes in blood parameters indicating a predisposition to the development of venous or arterial thrombosis, including resistance to activated protein C, antithrombin III deficiency, protein C deficiency, protein S deficiency, hyperhomocysteinemia and antiphospholipid antibodies (anticardiolipin antibodies, lupus anticoagulant);
- migraine with focal neurological symptoms;
- arterial hypertension (systolic blood pressure? 160 mm Hg. or diastolic blood pressure? 100 mm Hg.);
- diabetes mellitus with vascular damage;
- pancreatitis incl. history, in combination with severe hypertriglyceridemia;
- severe liver diseases, until normalization of liver function indicators;
- liver tumors (including in history);
- hormone-dependent malignant tumors (for example, breast cancer), established, suspected or in history;
- bleeding from the vagina of unknown etiology;
- pregnancy (including suspected);
- lactation period;
- surgical interventions followed by long-term immobilization;
- smoking (15 or more cigarettes per day) in women 35 years of age and older;
- hypersensitivity to the components of the drug.

The drug should be prescribed with caution if any of the following disease conditions or risk factors are present; in such cases, the doctor must carefully weigh the benefit-risk ratio of using the drug NuvaRing:

Venous or arterial thrombosis (in siblings and/or parents);
- obesity (body mass index more than 30 kg/m2);
- dislipoproteinemia;
- varicose veins (in combination with thrombophlebitis of the superficial veins);
- atrial fibrillation;
- diabetes mellitus;
- systemic lupus erythematosus;
- hemolytic-uremic syndrome;
- epilepsy;
- chronic inflammatory bowel diseases (Crohn's disease and ulcerative colitis);
- sickle cell anemia;
- congenital hyperbilirubinemia (Gilbert, Dubin-Johnson, Rotor syndromes);
- chloasma;
- uterine fibroids;
- fibrocystic mastopathy;
- conditions that make it difficult to use a vaginal ring: cervical prolapse, bladder hernia, rectal hernia, severe chronic constipation;
- adhesions in the vagina;
- smoking (less than 15 cigarettes per day) in women 35 years of age and older.

If the disease worsens, the condition worsens, or other risk factors appear, the woman should also consult a doctor and possibly discontinue the drug.

Although a cause-and-effect relationship has not been convincingly proven, caution should be exercised when prescribing NovaRing if the following conditions/diseases have previously developed or worsened during the use of any other hormonal contraceptives or previous pregnancy: jaundice and/or itching associated with cholestasis, formation of gallstones, porphyria, Sydenham's chorea, herpes of pregnancy, otosclerosis with hearing loss, (hereditary) angioedema.

Recurrence of cholestatic jaundice and/or cholestasis with itching, which was observed during pregnancy or previous use of sex hormones, is grounds for discontinuing the use of NuvaRing.

Use of NuvaRing during pregnancy and breastfeeding

The use of NuvaRing is contraindicated during pregnancy, suspected pregnancy and lactation. NuvaRing is contraindicated during breastfeeding. NuvaRing can affect lactation, reduce the amount and change the composition of breast milk. Small amounts of contraceptive steroids and/or their metabolites may be excreted in milk.

Use for liver dysfunction

NuvaRing is contraindicated in severe liver diseases (until normalization of function indicators).

Special instructions

Before prescribing or resuming the use of the drug NuvaRing, you should conduct a medical examination: analyze your medical history (including family history) and exclude pregnancy; measure blood pressure; conduct an examination of the mammary glands, pelvic organs, including cytological examination of smears from the cervix; conduct some laboratory tests to exclude contraindications and reduce the risk of possible side effects of the drug NuvaRing. The frequency and nature of medical examinations are carried out by a specialist, taking into account the individual characteristics of each woman, but at least once every 6 months.

The patient should read the instructions for use of the drug NuvaRing and follow all recommendations.

It should be kept in mind that NuvaRing does not protect against HIV infection (AIDS) and other sexually transmitted diseases.

Women aged 40 years and older, women with cervical intraepithelial neoplasia, as well as women who smoke at any age require additional consultation with a gynecologist before prescribing NuvaRing.

The effectiveness of the drug NuvaRing may decrease if the regimen is not followed.

While using NuvaRing, acyclic bleeding (spotting or sudden bleeding) may occur. If such bleeding is observed after regular cycles while using NuvaRing in accordance with the instructions, you should contact your gynecologist to conduct the necessary diagnostic tests, incl. to exclude a malignant tumor and pregnancy. A diagnostic curettage may be required.

Some women do not bleed after the ring is removed. If NuvaRing is used as directed, it is unlikely that the woman is pregnant. If the recommendations of the instructions are not followed and there is no bleeding after removing the ring, as well as if there is no bleeding in two cycles in a row, pregnancy must be excluded.

The most important risk factor for developing cervical cancer is infection with the human papillomavirus (HPV). Epidemiological studies have shown that long-term use of combined hormonal contraceptives further increases this risk, but the extent to which this is due to other factors remains unclear. The positive role of regular examinations of women by a gynecologist and the use of barrier methods of contraception are obvious. There is no information about an increased risk of developing cervical cancer in HPV-infected women using NuvaRing.

Studies have found a small increase in the relative risk (1.24) of developing breast cancer in women taking combined hormonal oral contraceptives, but this risk gradually decreases over 10 years after discontinuation of the drugs. Breast cancer is rare in women under 40 years of age, so the additional incidence of breast cancer in women who have received or continue to use combined oral contraceptives is small compared to the overall risk of developing breast cancer. There is evidence that women who took oral combined contraceptives have less breast cancer than women who have never used such medications. The possibility of the effect of the drug NuvaRing on the incidence of breast cancer is being studied.

In rare cases, benign liver tumors were observed in women taking combined oral contraceptives, and even more rarely, malignant ones. In some cases, these tumors led to the development of life-threatening bleeding into the abdominal cavity. If severe pain appears in the upper abdomen, liver enlargement, or signs of intra-abdominal bleeding in a woman using NuvaRing, a liver tumor should be excluded.

Although many women taking hormonal contraceptives experience a slight increase in blood pressure, clinically significant hypertension is rare. A direct connection between the use of hormonal contraceptives and the development of arterial hypertension has not been established. However, if, when using the drug NuvaRing, there is a constant increase in blood pressure, the patient should contact her gynecologist; in such cases, the ring should be removed, antihypertensive therapy should be prescribed and the issue of choosing the most acceptable method of contraception, incl. possible resumption of use of the drug NuvaRing.

Although estrogens and progestogens can influence peripheral insulin resistance and tissue tolerance to glucose, there is no evidence to support the need to change hypoglycemic therapy during the use of hormonal contraceptives. However, women with diabetes should be under constant medical supervision when using NuvaRing, especially in the first months of contraception.

The use of contraceptive steroids may affect the results of certain laboratory tests, including biochemical parameters of liver, thyroid, adrenal and kidney function, plasma levels of transport proteins (for example, corticosteroid binding globulin and sex hormone binding globulin), lipid/lipoprotein fractions, carbohydrate metabolism parameters and indicators of coagulation and fibrinolysis. Indicators, as a rule, vary within normal values.

Serious surgery (including on the lower extremities) is a contraindication to the use of the drug. In case of planned surgery, it is recommended to stop using the drug at least 4 weeks in advance, and resume no earlier than 2 weeks after complete restoration of motor activity.

Women predisposed to the development of chloasma should avoid exposure to sunlight and ultraviolet radiation while using NuvaRing.

The extent of exposure and possible pharmacological effects of ethinyl estradiol and etonogestrel on the glans mucosa and skin of the penis have not been studied.

Impact on the ability to drive vehicles and operate machinery

Considering the pharmacodynamic properties of the drug NuvaRing, its effect on the ability to drive a car and use complex equipment is not expected.

Overdose

Serious consequences of an overdose of hormonal contraceptives have not been described. Suggested symptoms: nausea, vomiting, slight vaginal bleeding in young girls.

Treatment: carry out symptomatic therapy. There are no antidotes.

Drug interactions

Interactions between hormonal contraceptives and other drugs may lead to the development of acyclic bleeding and/or contraceptive failure. There may be an interaction with drugs that induce microsomal enzymes, which can lead to increased clearance of sex hormones.

The effectiveness of NovaRing may be reduced with simultaneous use of antiepileptic drugs (phenytoin, phenobarbital, primidone, carbamazepine, oxcarbazepine, topiramate, felbamate), anti-tuberculosis drugs (rifampicin), antimicrobial drugs (ampicillin, tetracycline, griseofulvin), possibly antiviral drugs (ritonavir) and medicines containing St. John's wort.

When treating any of the listed drugs, a woman should temporarily use a barrier method of contraception in combination with the drug NuvaRing or choose another method of contraception. When treated with drugs that induce liver enzymes, a barrier method (condom) should be used during treatment and for 28 days after discontinuation of such drugs.

If concomitant therapy is to be continued after 3 weeks of ring use, the next ring should be administered immediately without the usual interval.

During treatment with antibiotics (excluding amoxicillin and doxycycline), it is necessary to use a barrier method of contraception (condom) during treatment and for 7 days after their discontinuation. If concomitant therapy is to be continued after 3 weeks of ring use, the next ring should be administered immediately without the usual interval.

As a result of pharmacokinetic studies, no effect on the contraceptive effectiveness and safety of the drug NuvaRing when used simultaneously with antifungals and spermicides was identified. When combined with suppositories and antifungal agents, the risk of ring rupture increases slightly.

Hormonal contraceptives can cause disruption of the metabolism of other drugs. Accordingly, their concentrations in plasma and tissues may increase (for example, cyclosporine) or decrease (for example, lamotrigine).

To exclude possible interactions, it is necessary to study the instructions for use of other drugs.

The use of tampons does not affect the effectiveness of NuvaRing. In rare cases, the ring may be accidentally removed when removing the tampon.

Storage conditions and periods

NuvaRing should be stored out of the reach of children at a temperature of 2° to 8°C (in the refrigerator).

Hormonal contraceptive for intravaginal use.

Drug: NuvaRing ®
Active substance: ethinylestradiol, etonogestrel
ATX code: G02BB01
KFG: Hormonal contraceptive for intravaginal administration
Reg. number: P No. 015428/01
Registration date: 12/25/03
Owner reg. cred.: ORGANON N.V. (Netherlands)

DOSAGE FORM, COMPOSITION AND PACKAGING

Vaginal ring smooth, transparent, colorless or almost colorless, without major visible damage, with a transparent or almost transparent area at the junction.

Excipients: ethylene vinyl acetate copolymer (28% vinyl acetate), ethylene vinyl acetate copolymer (9% vinyl acetate), magnesium stearate, purified water.

1 piece - aluminum foil bag (1) - cardboard boxes.

The description of the drug NuvaRing is based on the officially approved instructions for use.

PHARMACOLOGICAL ACTION

Hormonal contraceptive for intravaginal use containing estrogen - ethinyl estradiol and gestagen - etonogestrel. Etonogestrel, a 19-nortestosterone derivative, binds to progesterone receptors in target organs.

The contraceptive effect of the drug NuvaRing is based on various mechanisms, the most significant of which is inhibition of ovulation. The Pearl index of the drug NuvaRing is 0.765.

In addition to the contraceptive effect, the drug NuvaRing has a positive effect on the menstrual cycle. With its use, the cycle becomes more regular, menstruation is less painful, with less bleeding, which in turn can help reduce the frequency of iron deficiency conditions. In addition, there is evidence of a reduced risk of endometrial and ovarian cancer.

PHARMACOKINETICS

Etonogestrel

Suction

Etonogestrel released from NuvaRing is rapidly absorbed by the vaginal mucosa. The etonogestrel Cmax of approximately 1700 pg/ml is achieved approximately one week after ring insertion. Serum concentrations are subject to slight fluctuations and slowly reach a level of 1400 pg/ml after 3 weeks. Absolute bioavailability is about 100%.

Distribution

Etonogestrel binds to serum albumin and sex hormone binding globulin (SHBG). V d etonogestrel 2.3 l/kg.

Metabolism

Etonogestrel is metabolized by hydroxylation and reduction to form sulfate and glucuronide conjugates. Serum clearance is about 3.5 l/h.

Removal

The decrease in serum etonogestrel concentrations is biphasic. T1/2?-phase is about 29 hours. Etonogestrel and its metabolites are excreted in urine and bile in a ratio of 1.7:1. T 1/2 of metabolites is about 6 days.

Ethinyl estradiol

Suction

Ethinyl estradiol released from NuvaRing is rapidly absorbed by the vaginal mucosa. C max is about 35 pg/ml, achieved by 3 days after insertion of the ring and decreases to 18 pg/ml after 3 weeks. Absolute bioavailability is approximately 56%, which is comparable to oral bioavailability.

Metabolism

Ethinyl estradiol is initially metabolized by aromatic hydroxylation to form a variety of hydroxylated and methylated metabolites, which are present both in the free state and as glucuronide and sulfate conjugates. Serum clearance is about 3.5 l/h.

Removal

The decrease in serum ethinyl estradiol concentration is biphasic. T1/2?-phase is characterized by large individual differences, and, on average, is about 34 hours. Ethinyl estradiol is not excreted unchanged; its metabolites are excreted in urine and bile in a ratio of 1.3:1. T1/2 of metabolites is about 1.5 days.

INDICATIONS

Contraception.

DOSING REGIME

NuvaRing is inserted into the vagina once every 4 weeks. The ring is placed in the vagina for 3 weeks and then removed on the same day of the week on which it was placed in the vagina. After a week's break, a new ring is inserted. Bleeding associated with discontinuation of the drug usually begins 2-3 days after removal of the NuvaRing and may not completely stop until the next ring needs to be used.

Hormonal contraceptives were not used in the previous menstrual cycle

NuvaRing should be administered between the 1st and 5th day of the menstrual cycle, but no later than the 5th day of the cycle, even if the woman has not completed menstrual bleeding. During the first 7 days of the first cycle of NuvaRing use, additional use of barrier methods of contraception is recommended.

Switching from taking combined oral contraceptives

NuvaRing should be administered no later than the day following the interval in taking the drug. If the combined oral contraceptive also contains inactive tablets (placebo), then NuvaRing should be administered no later than the day following the taking of the last placebo tablet.

Switching from progestin-only contraception (mini-pill, implant, or injectable contraception) or progestogen-releasing intrauterine device (IUD)

NuvaRing should be administered on any day (if the patient took mini-pills), on the day of removal of the implant or IUD, and with injectable contraception - on the day when the next injection is necessary. In all these cases, an additional barrier method of contraception should be used during the first 7 days of using NuvaRing.

After an abortion performed in the first trimester of pregnancy

You can start using NuvaRing immediately after an abortion. In this case, there is no need for additional use of other contraceptives. If the use of NuvaRing immediately after an abortion is undesirable, the ring should be used in the same way as if hormonal contraceptives were not used in the previous cycle.

After childbirth or abortion performed in the second trimester of pregnancy

Use of NuvaRing should begin within the 4th week after childbirth or abortion. If the use of NuvaRing is started at a later date, then additional use of barrier methods of contraception is necessary in the first 7 days of using NuvaRing. However, if sexual intercourse has already taken place during this period, you must first exclude pregnancy or wait until your first menstruation before starting to use NuvaRing.

The contraceptive effect and cycle control may be impaired if the patient violates the recommended regimen. To avoid loss of contraceptive effect in case of deviation from the regimen, you must follow the following recommendations:

In case extended break in the use of the ring You should place the new ring in your vagina as soon as possible. Additionally, over the next 7 days it is necessary to use a barrier method of contraception. If you have had sexual intercourse during a break from using the ring, you should consider the possibility of pregnancy. The longer the break, the higher the risk of pregnancy.

In case the ring was accidentally removed and remained outside the vaginaless than 3 hours, the contraceptive effect will not decrease. The ring should be reinserted into the vagina as soon as possible. If the ring is left outside the vagina for more than 3 hours, the contraceptive effect may be reduced. The ring should be placed in the vagina as soon as possible, after which it should remain in the vagina continuously for at least 7 days, and a barrier method of contraception should be additionally used during these 7 days. If the ring was outside the vagina for more than 3 hours during the third week of its use, then its use should be extended beyond the prescribed three weeks (until the end of 7 days after reinsertion of the ring). After this, the ring should be removed and a new one placed after a week break. If removal of the ring from the vagina for a period of more than 3 hours occurs during the first week of using the ring, the possibility of pregnancy should be considered.

In case extended use of the ring, but not longer than 4 weeks, the contraceptive effect remains. You can take a week's break and then place a new ring. If NuvaRing has been in the vagina for more than 4 weeks, the contraceptive effect may decrease, and pregnancy must be excluded before using a new NuvaRing ring.

If the patient does not adhere to the recommended regimen and then does not experience bleeding caused by ring removal during a week-long break from using the ring, pregnancy must be ruled out before using a new vaginal ring.

To delay the onset of menstruation, you can start using the new ring without a week's break. The next ring should also be used for 3 weeks. This may cause bleeding or spotting. Then, after the required one-week break, you should return to regular use of NuvaRing.

To shift the onset of menstruation to another day of the week from the day that falls according to the current scheme of using the ring, you can shorten the upcoming break in using the ring for as many days as necessary. The shorter the break in using the ring, the higher the likelihood of no bleeding occurring after ring removal, and the occurrence of untimely bleeding or spotting during the use of the next ring.

Rules for using NuvaRing

The patient can independently insert NuvaRing into the vagina. To insert the ring, a woman should choose the position that is most comfortable for her, for example, standing, raising one leg, squatting, or lying down. NuvaRing must be squeezed and inserted into the vagina until the ring is in a comfortable position. The exact position of NuvaRing in the vagina is not decisive for the contraceptive effect of the ring.

After insertion, the ring must remain in the vagina continuously for 3 weeks. If it is accidentally removed (for example, when removing a tampon), the ring should be rinsed with warm water and immediately placed in the vagina. To remove the ring, you can pick it up with your index finger or squeeze it between your index and middle fingers and pull it out of the vagina.

SIDE EFFECTS of NuvaRing

From the side of the central nervous system: headache, migraine, depression, emotional lability, dizziness, anxiety, feeling tired.

From the digestive system: nausea, abdominal pain, diarrhea, vomiting, decreased libido.

From the endocrine system: increase or decrease in body weight.

From the reproductive system: vaginal discharge (“leucorrhoea”), vaginitis, cervicitis, pain, tension and enlargement of the mammary glands, dysmenorrhea.

From the urinary system: urinary tract infections (including cystitis).

Local reactions: prolapse of the ring, feeling of discomfort during sexual intercourse in women and men, sensation of a foreign body in the vagina.

CONTRAINDICATIONS NuvaRing

Venous or arterial thrombosis/thromboembolism (including a history);

Risk factors for thrombosis (including history);

Migraine with focal neurological symptoms;

Diabetic angiopathy;

Pancreatitis (including a history) in combination with a high degree of hypertriglyceridemia (LDL concentration more than 500 mg/dL);

Severe liver diseases (until normalization of function indicators);

Liver tumors (benign or malignant, including history);

Hormone-dependent malignant tumors (established or suspected, for example, tumors of the genital organs or mammary glands);

Vaginal bleeding of unknown etiology;

Pregnancy or suspicion of it;

Lactation period;

Hypersensitivity to the components of the drug.

WITH caution the drug should be prescribed for diabetes mellitus, obesity (body mass index over 30 kg/m2), arterial hypertension, atrial fibrillation, heart valve disease, dyslipoproteinemia, liver or gallbladder diseases, Crohn's disease or ulcerative colitis, sickle cell anemia, SLE, hemolytic uremic syndrome, epilepsy, smoking in combination with age over 35 years, with prolonged immobilization, major surgical interventions, fibrocystic mastopathy, uterine fibroids, congenital hyperbilirubinemia (Gilbert, Dubin-Johnson and Rotor syndrome), chloasma (avoid exposure to ultraviolet rays) , as well as conditions that make it difficult to use a vaginal ring (cervical prolapse, bladder hernia, rectal hernia, severe chronic constipation).

PREGNANCY AND LACTATION

The use of NuvaRing is contraindicated during pregnancy, suspected pregnancy and lactation.

SPECIAL INSTRUCTIONS

Before prescribing NuvaRing, you should collect a detailed medical history of the patient and conduct a medical examination, taking into account contraindications and precautions. During the period of use of NuvaRing, the examination should be repeated at least once a year. The frequency and list of studies should be selected individually for each patient, but in any case, special attention should be paid to blood pressure control, examination of the mammary glands, abdominal and pelvic organs, including cytological examination of the cervix and relevant laboratory tests.

The effectiveness of NuvaRing may be reduced if the regimen is not followed or if other drugs are used concomitantly.

If it is necessary to use drugs that may affect the contraceptive effect of the ring while using NuvaRing, you should use a barrier method of contraception in addition to using NuvaRing or choose another method of contraception. When taking inducers of microsomal liver enzymes while using NuvaRing, you should use a barrier method of contraception during the course of taking concomitant medications and for 28 days after stopping them. When taking antibiotics simultaneously (excluding rifampicin and griseofulvin), the barrier method should be used for at least 7 days after stopping the course of antibacterial therapy. If the course of therapy with concomitant medications continues beyond 3 weeks of ring use, the next ring is placed immediately, without a week's break.

The use of contraceptive steroids may affect the results of certain laboratory tests, including biochemical parameters of liver, thyroid, adrenal and kidney function, plasma levels of transport proteins (for example, corticosteroid binding globulin and sex hormone binding globulin), lipid/lipoprotein fractions, parameters carbohydrate metabolism and indicators of coagulation and fibrinolysis. Indicators, as a rule, vary within normal values.

During pregnancy or taking oral hormonal contraceptives, conditions such as gestational herpes, hearing loss, Sydenham's chorea (minor chorea), and porphyria may occur.

The patient should be informed that NuvaRing does not protect against HIV infection (AIDS) and other sexually transmitted diseases.

While using NuvaRing, irregular bleeding may occur (minor discharge or sudden bleeding).

Some women do not experience any bleeding caused by ring removal while they are not using the ring. If NuvaRing is used as directed, it is unlikely that the woman will be pregnant. If you deviate from the recommended regimen and there is no bleeding from drug withdrawal, or if there is no bleeding 2 times in a row, pregnancy should be excluded.

The extent of exposure and possible pharmacological effects of ethinyl estradiol and etonogestrel on sexual partners through absorption through the skin of the penis have not been studied.

OVERDOSE

Cases of overdose are unknown.

Alleged symptoms: nausea, vomiting, vaginal bleeding.

Treatment: carry out symptomatic therapy. There are no antidotes.

DRUG INTERACTIONS

Interactions between hormonal contraceptives and other medications may result in breakthrough bleeding and/or loss of contraceptive effect.

With simultaneous use of NuvaRing with drugs that induce microsomal liver enzymes (phenytoin, phenobarbital, primidone, carbamazepine, rifampicin, oxcarbazepine, topiramate, felbamate, ritonavir, griseofulvin, St. John's wort), the metabolism of sex hormones is increased and the contraceptive effect of NuvaRing is reduced.

The effectiveness of NuvaRing may also be reduced when taking certain antibiotics, such as penicillins and tetracyclines, at the same time. These drugs reduce the enterohepatic circulation of estrogens, resulting in decreased ethinyl estradiol concentrations.

The effect on the contraceptive effect and safety of NuvaRing of antifungal drugs and spermicides prescribed intravaginally is unknown.

No direct interactions have been observed between etonogestrel and co-administered ethinyl estradiol.

CONDITIONS OF VACATION FROM PHARMACIES

The drug NuvaRing is available with a prescription.

CONDITIONS AND DURATION OF STORAGE

NuvaRing should be stored out of the reach of children at a temperature of 2° to 8°C. Shelf life - 3 years.