Instructions for NuvaRing
The NuvaRing is a great new option for birth control. It is similar to the birth control pill because it contains estrogen and progestin, the two female hormones. Like the pill, it prevents you from having an egg released from your ovaries. Unlike the pill, you do not have to remember to take it every day. You simply insert a ring into your vagina and leave it there for 21 to 24 days. On the fourth week you remove it for 4 to 7 days, during which time you will have a period. The following week you start the whole process all over again. If used correctly, the ring is about 99% effective in preventing pregnancy.
Getting Started on the NuvaRing
- If you did not use a hormonal contraceptive the past month (i.e. the pill, the patch):
- Counting the first day of your period as day 1, insert your first NuvaRing between day 1 and day 5 of the cycle (even if you have not finished bleeding on day 5). Use an extra form of birth control (condom, spermicide) for the first week of the first month.
- If you are switching from the pill or the patch:
- Insert NuvaRing anytime during the first 7 days after the last active pill or your last patch and no later than the day you would have started your last pill or patch. No extra birth control is needed.
- If you are switching from the Depo shot, the mini-pill, or the IUD:
- Mini-pill: start using NuvaRing on any day for the month. Do not skip any days between your last pill and the first day on NuvaRing.
- Depo-Provera shot: start using NuvaRing on the day when your next injection is due.
- IUD: start using NuvaRing on the same day you have your IUD removed.
- Your provider may also suggest the “Quick Start” method. Using this method, a ring can be inserted in the day of your office visit, after a negative pregnancy test.
Use an extra form of birth control for the first week of the first month for any of the above situations.
How do you insert NuvaRing?
- Remove the NuvaRing from its foil packet and pinch its opposite sides between your thumb and index finger.
- Choose a position you are most comfortable with (i.e. lying down, squatting, or standing with one leg up). Gently push the pinched NuvaRing into your vagina. The exact position that you insert it is not important as long as it feels comfortable. If it is not comfortable, gently push if further into your vagina. NuvaRing cannot be pushed too far and will not go into your uterus or get lost.
- Keep the NuvaRing in place for 21 to 24 days, as directed by your provider.
- On the fourth week, remove the ring for a total of 4 to 7 days (as directed by your provider), during which time you will have your period.
- To remove the ring simply insert your index finger into your vagina and hook it around the front rim of the ring. Pull downward and out.
- Insert a new ring on day 5 or 8 (depending on which “period” cycle you are on) at about the same time even if you are still having a period. For example, if you took your ring out at 9:00 am on Sunday, you should put a new one in around 9:00 am the next Sunday.
Your provider may also suggest continuous cycling on the NuvaRing. With this method, you change to a new ring monthly, for 3 to 4 months, and have a period at the end with this interval. Cycling in this fashion decreases your total number of periods to 3 to 4 a year.
What if a NuvaRing falls out?
If your ring should fall out and has been out for 3 hours or less, you should still be protected from pregnancy. Wash the ring with lukewarm water and reinsert it as soon as you can.
If you have lost the ring, you must insert a new one. If it has been out of the vagina for more than 3 hours, you may not be protected from pregnancy, so a backup method must be used for 1 week.
While it is rare for the ring to fall out, this can happen if it is inserted improperly and with straining and constipation of the bowels. Make sure you are getting plenty of fiber and fluids in your diet to avoid this situation. Women who have a prolapsed (dropped) uterus may have more trouble with the ring slipping out. If this happens often, inform your healthcare provider.
What if the NuvaRing is left in the vagina too long?
If the ring has been left in the vagina for 4 weeks or less, remove it and insert a new one at your normally scheduled time. No backup method of birth control is necessary.
If the ring has been left in the vagina for more than 4 weeks, you may not be protected from pregnancy. Check a home pregnancy test. If it is negative, insert a new ring and use a backup method of birth control for one full week.
Side effects of the NuvaRing
Side effects of the NuvaRing are similar to those of the birth control pill and include the following:
- Breast tenderness
- Mild headaches
- Nausea at first (eat small frequent meals)
- Breakthrough bleeding in the first several cycles
- Vaginal irritation
- Vaginal discharge
- Moodiness
Like the pill, the ring contains estrogen. This hormone can increase the risk of blood clots, heart attack, and stroke. This risk is greater if you are a smoker and are over 35 years of age. If you are using these hormones, you should stop smoking.
Serious side effects that could indicate a blood clot or other adverse effect are referred to as the “ACHES” symptoms:
- Abdominal pain
- Chest pain
- Headaches
- Eye disturbances
- Severe leg pain
Call our office immediately if you should have any of these symptoms.
What else do I need to know?
The NuvaRing can be stored at room temperature as long as it is not above 86 degrees or in direct sunlight.
Spermicide will not alter the effects of the ring. Vaginal medications and lubricants are also safe to use. You should not douche while using the ring (or at any other time, for that matter!) You should not use a diaphragm as your backup method, since this may dislodge the ring.
Call our office if you have any other questions.
