Vaginal Contraceptive Ring

Vaginal Contraceptive Ring (NuvaRing or Annovera)

What is it?

The vaginal contraceptive ring is a flexible, latex free ring that is inserted by a woman into her vagina. The ring releases a continuous low dosage of the synthetic hormones estrogen and progestin over a three week period. A new ring is inserted every month. You will need a prescription from a health care provider to get the ring.

Annovera is the brand name of a vaginal contraceptive ring that is reusable and lasts for a year. It is softer and thicker than the monthly ring.

How does it work?

The ring prevents ovulation. The ring may also thicken the cervical mucus and thin the lining of the uterus. The ring is inserted by the user and remains in the vagina for 3 weeks. The ring is then removed for one week during which bleeding will occur. A new ring is used each month.

How effective is the ring?

The ring is as effective as oral contraceptives. When used perfectly, it is 99.7% effective. But people are not perfect, so for most users it is about 92% effective.

How do I get started?

Your health care provider will help you decide the best time to start the ring based on your menstrual cycle and your previous birth control method. You may need to use condoms for 7 days after starting the ring.

The ring is gently pushed inside the vagina with your finger much like inserting a tampon. If you feel discomfort, try pushing it deeper into your vagina. Most women don’t feel the ring once it is in place. The ring does not have to be in a specific place in the vagina for it to be effective. Once in place, keep the ring in for 3 weeks. You don’t have to remove the ring when you have sex.

What are the advantages unique to the ring?

The woman does not have to take a pill every day.
It is monthly rather than daily routine.

What are the disadvantages unique to the ring?

Possible vaginal discharge and irritation
Some women dislike placing and removing the ring
It does not protect you from sexually transmitted infections
It's effectiveness hasn't been evaluated in women with a BMI >29

What are the side effects of the ring?

The most common side effects reported by ring users are:

vaginal infections and irritation
vaginal discharge
headache
nausea
changes in your period

If you have side effects that cause you discomfort after 2-3 months, ask your provider about a different birth control method.

What are possible complications?

Use of ring may cause elevated blood pressure, migraines, gall bladder problems, and very rarely a benign liver tumor.

Hormones increase the risk of blood clots in veins and arteries. The risk of a blood clot is extremely small in young, healthy women. The highest risk is seen in older women who smoke. However, pregnancy causes an even greater risk of blood clots than does using a hormonal birth control method. Clots in the veins can cause thrombophlebitis (mostly in the leg) and pulmonary embolism (a blood clot that travels to the lungs.) Clots in arteries cause heart attacks or strokes. Know the warning signs of these problems (see below) and get medical evaluation immediately.

We advise women to quit smoking if they want to use the ring.

Call your physician/clinician if you have:

A—Abdominal pain (severe) that cannot be explained
C—Chest pain (severe or sudden) or shortness of breath
H—Unusual or suddenly severe headaches with dizziness or vomiting
E—Eye problems (blurred vision, flashing lights or blindness)
S—Severe leg pain, one-sided weakness or numb-ness (calf or thigh)

What should I do if the ring slips out?

The ring may slip out when removing a tampon, straining during a bowel movement, or having intercourse. If the ring does slip out, follow the directions below:

Rinse NuvaRing with cool-to-lukewarm (not hot) water and reinsert it as soon as possible, within 3 hours at the latest. You should still be protected from pregnancy. If you’ve lost the ring, insert a new NuvaRing and continue on the same schedule you had been following.

Contraceptive effectiveness may have been reduced, so you might not be protected from pregnancy. Reinsert the ring as soon as possible and use an extra method of birth control, such as condoms, until you have used the ring for 7 days in a row.

Throw the ring away and choose 1 of the 2 options below:

Insert a new ring immediately. This begins the next 3-week use period. You may not have a period but you may experience breakthrough spotting or bleeding.
Have your period and insert a new ring no later than 7 days from the time the previous ring was removed or expelled. This option should be chosen only if the ring was used continuously for the preceding 7 days.

In addition, in order to prevent pregnancy, you must use a barrier method, such as condoms, until you have used the ring again for 7 days in a row.

If the ring slips out repeatedly, please consult your health care provider.

If the ring has been left in your vagina for up to 1 extra week (4 weeks total or less), you will still remain protected from pregnancy. Remove the ring for 1 week and reinsert a new one if using NuvaRing, Annovera is rinsed and reinserted for a year. If the ring has been left in place for more than 4 weeks, you may not be protected from pregnancy and you should do a pregnancy test.

Will my partner or I feel the ring during intercourse?

During intercourse, some sexual partners may feel the ring in the vagina. However, in clinical studies, 9 of 10 (90%) couples did not find this to be a problem.

You should tell your health care providers about any medications that you use, including over the counter medications, herbal remedies, vitamins, and the ring.

Vaginal Contraceptive Ring