Birth Control Vaginal Ring (NuvaRing)

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  What Is the Vaginal Ring?

  The vaginal ring is a small, flexible ring a woman inserts into her vagina once a month to prevent pregnancy. It is left in place for three weeks and taken out for the remaining week each month. The vaginal ring is commonly called NuvaRing, its brand name.

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  How Does the Vaginal Ring Work?

  Like other methods of birth control, NuvaRing releases hormones. Hormones are chemicals made in our bodies. They control how different parts of our bodies work.

  The hormones in NuvaRing are the same hormones as in the birth control pill — estrogen and progestin.
  
  The hormones work by keeping a woman’s ovaries from releasing eggs — ovulation. Pregnancy cannot happen if there is no egg to join with sperm. The hormones in NuvaRing also prevent pregnancy by thickening a woman’s cervical mucus. The mucus blocks sperm and keeps it from joining with an egg.
  
  

  The hormones also thin the lining of the uterus. In theory, this could prevent pregnancy by keeping a fertilized egg from attaching to the uterus.

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  How Effective Is the Vaginal Ring?

  Effectiveness is an important and common concern when choosing a birth control method. The vaginal ring is very effective. It works best when a woman inserts it, keeps it in place for three weeks, takes it out for one week, and then inserts a new ring. That keeps the correct level of hormone in a woman’s body.

  • Less than 1 out of 100 women will get pregnant each year if they always use NuvaRing as directed.
  • About 8 out of 100 women will get pregnant each year if they don’t always use NuvaRing as directed.

  Certain medicines and supplements may make NuvaRing less effective. These include

  • the antibiotic rifampin — other antibiotics do not make the ring less effective
  • certain medicines that are taken by mouth for yeast infections
  • certain HIV medicines
  • certain anti-seizure medicines
  • St. John's wort

  Keep in mind the ring doesn’t protect against sexually transmitted infections. Use a latex or female condom to reduce the risk of infection.

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  How Safe Is the Vaginal Ring?

  Most women can use NuvaRing safely. But all medications have some risks, so safety is a concern when choosing a birth control method. Certain conditions increase the risk of serious side effects. Talk with your health care provider about your health and whether NuvaRing is likely to be safe for you.
  
  There are many other methods of birth control that may be safe for you if you cannot use the ring. Read about other methods to find one that may be right for you.

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  What Are the Benefits of the Vaginal Ring?

  Using the vaginal ring is safe, simple, and convenient. There is nothing to do right before having sex. Some women say it improves their sex lives because it helps them feel more spontaneous.
  
  Many women who use the vaginal ring have more regular, lighter, and shorter periods. And a woman’s ability to become pregnant returns quickly when use of the ring is stopped.

  Because the ring works like the pill, it probably offers the same benefits. These health benefits may include some protection against

  • acne
  • bad menstrual cramps
  • breast growths that are not cancer
  • ectopic pregnancy
  • endometrial and ovarian cancers — protection increases with each year of use
  • iron deficiency anemia
  • ovarian cysts
  • pelvic inflammatory disease, which often leads to infertility when left untreated
  • premenstrual symptoms, including headaches and depression

  The ring can be used to control when and how often you have your period. It can also be used continuously — without a monthly break — to eliminate monthly periods.

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  What Are the Disadvantages of the Vaginal Ring?

  Many of us like to weigh the benefits against the risks of taking a medicine. Now that you’re familiar with the benefits, let’s look at the possible disadvantages.

  Because NuvaRing works like the pill, it probably carries the same possible disadvantages.

  Possible Side Effects of the Vaginal Ring

  Some women may have undesirable side effects while using NuvaRing. But many women adjust to it with few or no problems.
   
  Some of the most common side effects usually clear up after two or three months. They include

  • bleeding between periods
  • breast tenderness
  • nausea and vomiting

  NuvaRing may also cause more long-lasting side effects. It may cause increased vaginal discharge, vaginal irritation, or infection. The hormones in NuvaRing may change a woman’s sexual desire.
  
  It’s important that you find a method that won’t make you feel sick or uncomfortable. If you continue to experience side effects after using the vaginal ring for three months, talk with your health care provider.
  
  After ring use is stopped, it usually takes one or two months for a woman’s periods to return to the cycle she had before using it. Once in a while, a woman may have irregular or absent periods. This may go on for as long as six months after stopping. This is more likely if her periods were irregular before using the ring.
  
  Regularly using oil-based medicines in the vagina for yeast infections while the ring is in place may increase the level of hormones released into the blood. This will not reduce the effectiveness of the ring. The effect of using these types of yeast infection medications with the vaginal ring long-term is unknown. Talk with your health care provider if you need long-term treatment for yeast infections while you are using the ring.

  Serious Side Effects of the Vaginal Ring

  Many women have concerns about the possible risks of taking hormones in birth control. Serious problems do not occur often.
  
  Women who use birth control with estrogen — like NuvaRing —have a slightly greater chance of certain serious problems than nonusers. The most serious — in very rare cases — may be fatal. These include heart attack, stroke, or having a blood clot in the legs, lungs, heart, or brain.
  
  Other rare risks include developing high blood pressure, liver tumors, gallstones, or yellowing of the skin or eyes (jaundice). The risk for these problems increases if you

  • are age 35 or older
  • are very overweight
  • have certain inherited blood-clotting disorders
  • have diabetes
  • have high blood pressure
  • have high cholesterol
  • need prolonged bed rest
  • smoke

  Serious problems usually have warning signs. Report any of these signs to your health care provider as soon as possible:

  • a new lump in your breast
  • a sudden very bad headache
  • achy soreness in the leg
  • aura — seeing bright, flashing zigzag lines, usually before a very bad headache 
  • bad pain in your abdomen or chest 
  • headaches that are different, worse, or happen more often than usual
  • no period after having a period every month
  • trouble breathing
  • yellowing of the skin or eyes

  The Vaginal Ring and Breast Cancer You may have heard claims linking the hormones in the vaginal ring to breast cancer. The most recent literature suggests that the use of these hormones in birth control has little, if any, effect on the risk of developing breast cancer.

  See the insert from NuvaRing for more information about possible side effects.

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  How Do I Get the Vaginal Ring? How Much Do Vaginal Rings Cost?

  First, you’ll need to get a prescription. Visit a Planned Parenthood health center, a clinic, or a private health care provider for a prescription. Your health care provider will discuss your medical history with you, check your blood pressure, and give you any other medical exam that you may need. If you need an exam, it may cost about $35–$250. You won’t need a fitting from a health care provider — NuvaRing only comes in one size that fits all women.
  
  NuvaRing may be purchased with a prescription at a drugstore or clinic. It costs about $15–$50 a month.
  
  Medicaid and private health insurance may cover the vaginal ring. Family planning clinics usually charge less than private health care providers.

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  How Do I Use the Vaginal Ring?

  Most women find that NuvaRing is very easy to use. Insert one new ring into your vagina and keep it in place for three weeks in a row. Then remove it for one week — three weeks in, one week out. Insert a new ring after one week.

  Here are some more specific details about using the ring:

  • Store your unused rings at room temperature and out of direct sunlight.
  • Check the expiration date of each ring package before insertion.
  • Count the first day of your menstrual period as "day one." Your health care provider will tell you when to start using the ring — usually during the first five days of your cycle.
  • Wash your hands with soap and water.
  • Use your fingers to press the sides of the ring together. 
  • Gently push the ring into your vagina.
  • The exact position of the ring doesn’t matter.
  • There’s no need to remove the ring during vaginal intercourse.
  • Remove it in three weeks on the same day of the week that it was inserted.
  • Hook your finger under the forward rim and gently pull it out of the vagina.
  • Wrap it up in the original foil wrapper, and throw it out in the trash — do not flush. Used rings still contain some hormones. Using the foil wrapper protects children who might play with a used ring. It also reduces the chance that hormones will get into the soil and water supply.
  • After one week without the ring, insert a new one — on the same day of the week that the previous one was inserted in your last cycle.

  During the one-week break, you will usually have your period. You may still be bleeding when it is time to insert a new ring. This is normal, too. But the vaginal ring must be inserted on the same day of the week as it was inserted in the last cycle, or you could get pregnant.

  

  Some women use the ring every day without a one-week break to keep from getting their periods. They simply replace the ring every three weeks with a new ring. If you use the ring continuously, it is normal to have spotting or bleeding the first six months. It may get less over time. Some women stop having any bleeding at all. This is normal and will not harm your body. 

  Helpful Tips About Using the Vaginal Ring The ring will work best if you always remember to insert the ring and take it out at the right time. But many women forget from time to time. The key to protecting yourself from an unplanned pregnancy is knowing what to do if you make a mistake or if the ring slips out of your vagina. A missed period does not always mean you are pregnant, especially if you have used the ring correctly. Even though the chance of pregnancy is very low, you may want to take a pregnancy test if you miss two periods in a row. Talk with your health care provider if you have any questions or concerns while using the ring. There is a very slight chance that you will become pregnant even if you use the ring as directed. It is unlikely that using the ring during early pregnancy will increase the risk of birth defects. If you decide you want to become pregnant, stop using NuvaRing. It’s possible to get pregnant right after stopping. It usually takes about one or two months for your period to return to the cycle you had before using the ring.