Nuva Ring

You will also receive a copy of the FDA-approved information pamphlet provided by the NuvaRing® manufacturer. You should read this and the other information you are given. Please ask questions about anything you do not understand.

Description
NuvaRing® is a form of contraception. Since it works in the same way that birth control pills work, most of the benefits, risks and side effects are considered to be the same for both methods. But we know less about its effects than we know about the effects of the Pill. Research studies with NuvaRing® users are continuing.

NuvaRing® is a polyethylene vinyl acetate ring that is about 2 1/s inches in diameter. The Ring contains the hormones estrogen and progestin -specifically, a progestin called Etonogestrel. These hormones are similar to those produced by a woman's body. The hormones flow slowly from the Ring into your bloodstream. They work to prevent pregnancy by keeping eggs from being released by the ovaries. Although no studies have yet been published, it is assumed that with typical use NuvaRing® will be more effective than the Pill. In early studies of this new contraceptive, the pregnancy rate of users was less than 1 per 100 women.

You should not use the Ring if you have reason to think you might be pregnant.

Benefits

Since the Ring works like combination birth control pills do, it is likely that women who use the Ring will receive many of the same non-contraceptive benefits as Pill users. These include:

• Predictable, regular menstrual cycles;
  
• Decreased menstrual cramps and blood loss;
  
• Less iron deficiency anemia;
  
• Less acne;
  
• Some protection from non-cancerous breast tumors and ovarian cysts;
  
• Some protection from ovarian and uterine lining cancer;
  
• Decreased risk of infection of the pelvis (PID);
  
• Decreased risk of ectopic pregnancies.

In addition, You do not need to remember to take a pill everyday. You only need to remember to remove the Ring after week 3 and to insert another ring one week later;

When you stop using the Ring because you want to have a baby, your ability to become pregnant should return quickly.

Risks

NuvaRing® users may have a slightly greater chance than non-users of hormonal contraception of developing certain serious problems that may cause death in rare cases. This is based on studies of women who use birth control pills. These serious problems include:

• Blood clots in the legs that can travel to the lungs;
  
• Stroke;
  
• Heart attack;
  
• Liver tumors.

The chances of developing serious health problems increase with age over 35 years old, and when certain other health risk factors are present, such as:

• Smoking more than 15 cigarettes a day;
  High blood pressure;
  
• High levels of blood cholesterol or fat;
  
• Diabetes.

You should not use the Ring if you have had, now have, or develop in the future:

• High risk for a heart attack;
  
• A heart attack, angina, or certain types of stroke;
  
• Serious problems of your heart valves;
  
• Blood clots in the veins or arteries;
  
• Serious liver disease;
  
• Cancer of the breast, uterus, or liver;
  
• Migraine with aura;
  
• Prolonged bedrest, for example after major surgery;
  
• Yellow jaundice that occurred with a prior pregnancy or with birth control pill use.

You may need special tests if you have certain medical conditions that could get worse while using the Ring.

Because NuvaRing® is a new method of birth control we must take information obtained from studies of the Pill and apply it to the Ring. The risk to life and health is greater from pregnancy than from birth control pill use. Only for a woman age 35 or older who smokes more than 15 cigarettes per day or who has certain other medical conditions does the Pill carry a higher risk than pregnancy. This is probably true for NuvaRing® as well.

ADDITIONAL WARNINGS specifically about the progestin Etonogestrel.

NuvaRing® contains the progestin Etonogestrel (a form of the progestin desogestrel which is contained in some kinds of birth control pills).

Because NuvaRing® is a new method of birth control we must take information gotten from studies of the Pill and apply it to the Ring. Some of those studies have shown that there is a small increase in the risk of getting blood clots in the veins of the legs or lungs of women using birth control pills containing desogestrel compared to birth control pills containing other types of progestins. No one knows for sure if this increased risk of getting blood clots is the same for women who use NuvaRing® but it is important that you know about the possibility.

What are your chances of developing a blood clot compared to other women?

The chance of getting these blood clots if you are not using any hormonal birth control and are not pregnant is 4 per 100,000 women per year.
If you are taking birth control pills containing other progestin hormones (levonorgestrel or norethindrone), the chance of getting these blood clots is 10-15 in 100,000 women per year.
For a woman currently using a pill containing desogestrel, the chance of getting these blood clots would be 20-30 in 100,000 women per year. (This may be the same for the Ring.)
On the other hand, for any woman who becomes pregnant, the chance of getting these blood clots is about 60 per 100,000 women per year.

What else increases your risk of developing a blood clot?

• Inheriting one or more weaknesses in the blood clotting system that raise the chance of abnormal clotting;
  
• Past history of having any kind of blood clots;
  
• Smoking (the more you smoke, the higher the risk);
  
• Increased weight, especially very overweight;
  
• Less activity, such as being in bed for long periods of time after injury or surgery, or very long airplane flights;
  
• Getting older(over age 35);
  
• Taking any medications or street drugs that increase the tendency to clot.

You should watch for the following danger signals and report any to a clinician immediately:

• sharp or crushing chest pain or coughing blood;
  
• shortness of breath;
  
• unusual swelling or pain in the legs or arms;
  
• sudden severe headaches;
  
• changes in the frequency, severity, or associated symptoms of your headache;
  
• eye problems such as blurred or double vision or loss of vision;
  
• severe pain in the stomach or abdomen;
  
• yellowing of the skin or eyes;
  
• severe depression;
  
• unusually heavy bleeding from the vagina;
  
• lump in the breast;
  
• no period after having a period every month.

Short term side effects from your use of NuvaRing® may include:

• headache;
  
• increased vaginal discharge;
  
• vaginal irritation or infection;
  
• nausea.

Special Instructions

If you are using NuvaRing® correctly (3 weeks in, 1 week out) and you miss two periods in a row, it is possible that you may be pregnant. You need to call your clinician. If you have tested positive for pregnancy and the Ring is in place, you should remove it immediately and notify your clinician.

There may be less protection from pregnancy when NuvaRing® is used with certain drugs, especially those used to control seizures. The hormones in NuvaRing® may also have an effect on certain other medications you may be taking. You should talk to your clinician about what to do if you take any other medicine with the Ring.

If oil-based vaginal anti-fungal medications (for yeast infections) are used while NuvaRing® is in place, the hormone levels released into the blood may increase. This will not reduce the effectiveness of NuvaRing®. If you are using oil-based vaginal medications on a regular basis or for more than several days in a row, you should discuss this with your clinician.

There should be no changes in hormone levels or contraceptive effectiveness when a water-based product like a sexual lubricant is used in the vagina along with NuvaRing®.

Using NuvaRing® does not protect against sexually transmitted infections and some infections can cause sterility. If you or your partner has other sexual partners, you should also use latex condoms to prevent infections, even though you are using NuvaRing®.

Stay Healthy

Regular physical examinations for routine health care and for screening for sexually transmitted infections and for cancer are strongly recommended.

This document is for informational purposes only and is not intended to constitute medical advice, diagnosis, or treatment.