The NuvaRing

NuvaRing is a brand of the vaginal ring. It is a soft plastic ring that you insert into your vagina, releasing hormones that prevent pregnancy. 

The NuvaRing is 5cm in diameter and clear in colour.

Vaginal rings are also known as contraceptive rings. The only available vaginal ring in the UK is NuvaRing. Another brand Annovera is available in the US.

The NuvaRing works to prevent pregnancy but does not protect against sexually transmitted diseases (STIs).

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The NuvaRing works by releasing artificial versions of the female hormones oestrogen and progesterone slowly into the bloodstream. These hormones work in three ways to prevent pregnancy:

1. stop your body releasing an egg each month which means there is nothing for sperm to reach
2. thicken the mucus in the cervix, which makes it harder for sperm to get through the cervix
3. thin the womb lining which makes it harder for a fertilised egg to implant itself

As it contains both oestrogen and progesterone, the NuvaRing is known as combined contraception. The doses it contains are smaller than other combined contraceptives, which means it is a low dose combined contraceptive.

How long does it take for the NuvaRing to work?

If you have regular periods and start using the NuvaRing in the first 5 days of your period, you will be protected immediately from pregnancy.

If you start using the NuvaRing at any other point in your cycle, you should use additional contraception for the first 7 days to be protected.

Talk to your doctor to understand when the NuvaRing will give you protection if you:

• have short or irregular cycles
• are switching from another contraception (except condoms)
• have taken emergency contraception in the last few weeks

How long does the NuvaRing last?

One NuvaRing lasts for 3 weeks. You then remove it and have 1 week without a vaginal ring before inserting the next one for a new cycle. The NuvaRing protects from pregnancy throughout these 4 weeks.

NuvaRing has a ‘best before’ date. Follow the instructions on how to store it safely and always check the date on the foil packet before you insert it.

How effective is the NuvaRing?

Studies have shown that the NuvaRing is >99% effective if used correctly. This means that less than 1 in 100 women get pregnant when using the NuvaRing correctly.

As with most contraceptives, in reality, there are times when the NuvaRing is not used correctly (for example, the new ring is not inserted at the right time). Studies have found that the effectiveness of NuvaRing is closer to 91% for typical use. This means that from 100 women using the NuvaRing regularly, 9 are likely to get pregnant.

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How to use a NuvaRing

You insert and remove the NuvaRing from the vagina like a tampon. There is no need for medical assistance.

The cycle is 4 weeks: 3 weeks with the NuvaRing inside your vagina and 1 week without it.  You should have a vaginal bleed during this week, similar to a period. This normally starts 2 to 3 days after you have removed the ring. You should always insert a new ring on time at the end of the 7 day break, even if you are still bleeding. 

How to insert the NuvaRing

1. Check the best before date on the NuvaRing you are about to use
2. Wash your hands
3. Chose a comfortable position: squatting, lying down or standing with one leg up are popular 
4. Take the NuvaRing out of its foil sachet
5. Hold the ring between your thumb and index finger and press the opposite sides together
6. Insert the NuvaRing into your vagina.
7. You should not feel anything once the NuvaRing is inside your vagina. If you feel uncomfortable, you may need to push the NuvaRing further into your vagina until it feels comfortable. 

Some women find inserting a NuvaRing into the vagina challenging. There are several ways to get help with this:

• ask your doctor or nurse to help you the first time
• use the patient information leaflet which has diagrams
• consider using the applicator included with the ring

How to remove the NuvaRing

After 3 weeks, you remove the NuvaRing on the same day of the week that you inserted it:

1. Chose a similar time of day to when you inserted the ring
2. Wash your hands
3. Find a comfortable position
4. Hook your index finger under the front rim of the ring or grasp the rim of the ring
5. Pull the ring out
6. Dispose of the NuvaRing using the resealable sachet in your household waste (do not flush it down the toilet)

If you can feel the NuvaRing inside your vagina but cannot remove it, get help from your doctor or nurse. 

What happens if I leave my NuvaRing in too long?

If you leave your NuvaRing in place for between 3 and 4 weeks, you will still be protected from pregnancy. Start your 1 week off from the ring as soon as you remember and insert a new ring as normal after 7 days.

If it has been longer than 4 weeks, use additional contraception and insert a new ring as soon as possible without having a ring free week. You shouldtalk to your doctor or pharmacist about whether you need emergency contraception. 

What happens if my NuvaRing slips out?

If your NuvaRing slips out, you should rinse it in lukewarm water (do not use hot water) and reinsert it. Whether or not you are protected from pregnancy depends on how long it has been out and how many weeks the ring has been in place:

• less than 48 hours out of the vagina:: you will still be protected as long as you used the ring correctly in the 7 days before your ring free week. This is during week 1 or in the last 7 days of week 2 or 3.
• more than 48 hours out of the vagina in the 1st week: use a condom for the first 7 days that the NuvaRing has been reinserted and speak to your doctor or pharmacist about getting emergency contraception if you has sex without a condom.
• more than 48 hours out of the vagina in the 2nd or 3rd week: emergency contraception isn't needed if you’ve used the ring as instructed for the past 7 days. Use additional contraception for 7 days and if it’s less than 48 hours until you are due to remove your ring, skip yourring free break and insert a new ring instead. 

Does the NuvaRing hurt?

The NuvaRing does not hurt if it is in place correctly. If you feel discomfort, try changing its position in your vagina.

Can I feel the NuvaRing during sex?

If the NuvaRing is inserted correctly you cannot feel it during sexual intercourse.

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As with all medicines, the NuvaRing can cause side effects, but not everyone will get them. For those who do get side effects, their severity and impact will vary between individuals.

Seek immediate medical attention if you are experiencing signs of:

• an allergic reaction: wheezing and breathing difficulties, swelling, sneezing, itchy eyes
• a possible blood clot: sharp chest pain, sudden breathlessness, coughing or coughing up blood, swelling, redness and cramping in an arm or leg

Common side effects affect up to 1 in 10 women and include:

• vaginal discomfort or the ring falling out
• stomach pain and feeling sick
• yeast infection (thrush)
• low mood
• low sex drive
• pain in the pelvis, breast or head
• acne
• changes to periods

Uncommon side effects may affect up to 1 in 100 women and include:

• feeling tired or unwell
• dizziness or disturbed vision
• issues with peeing, including bladder or urinary tract infection
• issues during intercourse including pain, bleeding or partner feeling the ring
• vaginal infection
• hair loss, eczema, itching, rash or hives
• extra fluid in the body (oedema) 
• increased blood pressure 
• increased appetite 
• muscle spasms or pain in legs or arms 
• fibrocystic breast disease (cysts in the breasts which may become swollen or painful)
• issues with the cervix such as inflammation or polyps (growths in the cervix)
• diarrhoea or vomiting

If you develop any migraine symptoms, unexpected changes to your bleeding pattern or breasts, or any unmanageable side effects whilst using NuvaRing, contact your doctor.

Risks of the NuvaRing

All combined contraceptives create a slightly higher risk of developing blood clots and certain cancers.

What is the risk of developing a blood clot while using the NuvaRing?

Out of 10000 women who are not using a combined contraceptive, about 2 develop a blood clot. These figures change to between 5 and 12 for women using the NuvaRing. 

The risk of developing a blood clot while using a NuvaRing is low, but the following are examples of conditions that can increase it:

• having a BMI of over 35
• being a smoker aged 35 and over
• having recently given birth
• immediate family members with blood clots under the age of 45
• being off your feet for a long time because of injury or illness
• having a medical condition that increases your risk of blood clots

Always tell your doctor your complete medical and familial history when they are prescribing contraception, so they can be sure you are using the safest method for you.

What is the risk of developing cancer while using the NuvaRing?

There has been limited research into the risk of developing cancer while using the NuvaRing. Taking the combined contraceptive pill can slightly increase your risk of getting breast and cervical cancer and slightly decrease the risk of getting ovarian and womb cancers. As the combined contraceptive pill has the same hormones as the NuvaRing,  the risks are likely to be similar for the NuvaRing.

What does the NuvaRing do to periods?

Using a combined contraceptive such as a NuvaRing can impact your periods. 

Regulating the hormones in your system can make your periods less heavy and painful. It is also possible to have spotting between your periods while using the NuvaRing, especially when you are first using it and your body is adjusting to the new hormonal regime. If the bleeding is heavy or continues for more than a few days or happens after the first 3 months of using NuvaRing, seek medical advice.

Does the NuvaRing cause acne?

The NuvaRing does not usually cause acne. Using a combined contraceptive can help with acne as it regulates the level of hormones in your system, preventing flare-ups. However, some women find certain hormonal contraceptives can make their acne worse. 

Does the NuvaRing cause weight gain?

There is no scientific evidence to prove that taking combined contraception increases or decreases your weight. 

Does the NuvaRing cause migraines?

One of the side effects of the NuvaRing can be headaches. These usually clear up within a couple of months of using the NuvaRing. 

The NuvaRing is not known to cause migraines, but women who get migraines with aura should not use the NuvaRing. If you get migraines with aura, your risk of a stroke is already higher than average and using the NuvaRing increases your risk again.

If you develop migraine symptoms whilst using NuvaRing contact your GP who will recommend an alternative contraceptive method.

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The NuvaRing is safe for most women to use. However, certain health conditions mean you cannot use the NuvaRing:

allergies to ethinylestradiol or etonogestrel, or any of the other ingredients in the NuvaRing

• pregnancy or suspected pregnancy
• recently given birth
• BMI over 35
• smoke and are over 35
• a history of high blood pressure 
• history of blood clots, stroke or heart attack or  heart disease
• diabetes that has caused damage to the kidneys, eyes, nerves or blood vessels
• history of headaches known as migraines with aura
• liver disease or tumours in the liver
• taking certain medications which can interact with NuvaRing
• breast cancer or any cancer that is sensitive to female hormones
• vaginal bleeding that is unexplained
• a complicated organ transplant
• any conditions that increase your risk of blood clots
• gallstones
• a vaginal prolapse
• NuvaRing can interact with certain medications. Tell your doctor if you are taking medication but especially for any of the following conditions:
• epilepsy
• tuberculosis
• HIV infection
• Hepatitis C
• high blood pressure
• depression
• antifungals
• emergency contraception

Your doctor can advise you on other forms of contraception if the NuvaRing is not safe for you to use.

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You need a prescription to use the NuvaRing. 

You can get it for free on the NHS through your doctor or a sexual health clinic. Some sexual health clinics do not provide the NuvaRing so it’s worth checking when you make your appointment.

If you already have a prescription from your doctor for the NuvaRing, you can buy it online from a registered online pharmacy. It usually costs around £40 to £50 for three months’ supply. 

Due to the shelf life of the NuvaRing, the maximum prescription you will be given is 4 months.

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• Combined contraceptive pill NHS [accessed 18 March 2022]
• Examining the efficacy, safety, and patient acceptability of the combined contraceptive vaginal ring (NuvaRing®) NCBI [accessed 18 March 2022]
• FRSH Clinical Guidance on Quick Starting Contraception FRSH [accessed 18 March 2022]
• Hormonal Contraceptive Options for Women With Headache: A Review of the Evidence NCBI [accessed 18 March 2022]
• NuvaRing NuvaRing.com [accessed 18 March 2022]
• NuvaRing EMC [accessed 18 March 2022]
• Vaginal Ring NHS [accessed 18 March 2022]
• file:///Users/drclairgrainger/Downloads/fsrh-ceu-recommended-actions-after-incorrect-use-of-chc-march-2020-amended-jul-2021-%20(2).pdf (accessed 21/3/22)
• file:///Users/drclairgrainger/Downloads/fsrh-guideline-combined-hormonal-contraception-2020%20(1).pdf (accessed 21/3/22)
• file:///Users/drclairgrainger/Downloads/fsrh-ukmec-summary-september-2019%20(16).pdf (accessed 21/3/22)

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