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To achieve a contraceptive effect, NuvaRing® should be used according to the instructions.

A woman can independently insert the vaginal ring of NuvaRing® into the vagina.

The doctor should inform the woman how to insert and remove the NuvaRing® vaginal ring. To insert a ring, a woman should choose a comfortable position, for example, standing, lifting one leg, squatting or lying down. The NuvaRing® vaginal ring should be compressed and inserted into the vagina until the ring is in a comfortable position. The exact position of the ring in the vagina is not critical for the contraceptive effect.

After the introduction (see subsection "How to start using NuvaRing®"), the ring should be kept in the vagina continuously for 3 weeks. A woman should regularly check whether it remains in the vagina. If the ring was accidentally deleted, then follow the instructions in "What to do if the ring was temporarily removed from the vagina".

The NuvaRing® vaginal ring should be removed after 3 weeks on the same day of the week when the ring was inserted into the vagina. After a one-week break, a new ring is inserted (for example, if the NuvaRing® vaginal ring was placed on Wednesday at about 22.00, then it should be removed to the medium after 3 weeks at about 10 pm Next time, a new ring is inserted). To remove the ring, it must be picked up by the index finger or squeezed the index and middle finger and pulled out of the vagina. The used ring should be placed in a bag (keep out of reach of children and pets) and discarded. The bleeding associated with the cessation of the NuvaRing® drug usually begins 2-3 days after the removal of the NuvaRing® vaginal ring and may not completely stop before the new ring is inserted.

How to start using NuvaRing®?

In the previous cycle, hormonal contraceptives were not used

The drug NuvaRing® should be entered on the first day of the cycle (ie on the first day of menstruation). It is possible to install the ring on the 2nd-5th days of the cycle, however, in the first cycle, in the first 7 days of NuvaRing®, additional use of barrier methods of contraception is recommended.

Transition from combined hormonal contraceptives

A woman should insert the NuvaRing® vaginal ring on the last day of the usual interval between cycles in taking combined hormonal contraceptives (tablets or patches).

If a woman correctly and regularly took a combined hormonal contraceptive and is sure that she is not pregnant, she can switch to using the vaginal ring on any day of the cycle. In no case should the recommended non-hormonal interval of the previous method be exceeded.

Transition from preparations containing only progestogen (mini-pili, progestin-based oral contraceptives, implants, injectable forms or hormone-containing intrauterine systems - IUDs)

A woman taking mini-pills or progestin-only oral contraceptives may switch to NuvaRing® on any given day. The ring is inserted on the day of removal of the implant or IUD. If a woman received injections, the NuvaRing® drug is started on the day that the next injection should be made. In all these cases, a woman should use the barrier method of contraception within the first 7 days after the introduction of the ring.

After abortion in the first trimester

A woman can enter the ring right after the abortion. In this case, she does not need additional contraceptives. If the application of NuvaRing® immediately after the abortion is undesirable, it is necessary to follow the recommendations given in the subsection "In the previous cycle, hormonal contraceptives have not been used." In the interval, a woman is recommended an alternative method of contraception.

After childbirth or after an abortion in the second trimester

A woman is recommended to enter the ring not earlier than 4 weeks after childbirth (if she does not breast-feed) or abortion in the second trimester. If the ring is installed at a later date, an additional barrier method is recommended for the first 7 days. However, if sexual intercourse has already taken place, before pregnancy NuvaRing® is used, it is necessary to exclude pregnancy or wait for the first menstruation.

Deviations from the recommended mode

Contraceptive effect and cycle control may be impaired if the woman does not follow the recommended regimen. To avoid reducing the contraceptive effect, the following recommendations should be followed.

What should I do in case of an extended break in the application of the ring?

If during interruption in the application of the ring there were sexual contacts, pregnancy should be excluded. The longer the break, the higher the probability of pregnancy. With the exception of pregnancy, a woman should insert a new ring into the vagina as soon as possible. For the next 7 days, an additional barrier method of contraception, for example, a condom, should be used.

What if the ring was temporarily removed from the vagina?

The ring should be constantly in the vagina for 3 weeks. If the ring was accidentally removed, it should be rinsed with cold or slightly warm (not hot) water and immediately inserted into the vagina.

If the ring remained outside the vagina for less than 3 hours, then its contraceptive effect does not decrease. A woman should enter the ring as soon as possible into the vagina (no later than 3 hours).
If the ring was outside the vagina for more than 3 hours during the first or second week of use, the contraceptive effect may decrease. A woman should enter the ring as quickly as possible into the vagina. During the next 7 days, it is necessary to use the barrier method of contraception, for example, a condom. The longer the ring was outside the vagina and the closer this time to a 7-day break in the application of the ring, the higher the probability of pregnancy.
If the ring was outside the vagina for more than 3 hours in the third week of use, then the contraceptive effect may decrease. A woman should throw this ring and choose one of the following two methods.
Immediately install a new ring. Note: The new ring can be used for the next 3 weeks. In this case, there may be no bleeding associated with the cessation of the drug. However, smearing bleeding or bleeding in the middle of the cycle is possible.
Wait for bleeding associated with the cessation of the drug, and introduce a new ring no later than 7 days after the removal of the previous ring. Note: this option should be selected only if the mode of application of the ring during the first two weeks is not violated.
What to do in case of prolonged use of the ring?

If the drug NuvaRing® was applied no more than a maximum period of 4 weeks, then the contraceptive effect remains sufficient. A woman can make a week break in applying the ring, and then introduce a new ring.

If the NuvaRing® vaginal ring remained in the vagina for more than 4 weeks, the contraceptive effect may worsen, so before the introduction of a new ring, pregnancy should be excluded.

If a woman does not follow the recommended scheme of application and after a week break in the application of the ring does not bleed, then before the introduction of a new ring, pregnancy should be excluded.

How to move or delay the onset of menstrual bleeding?

To delay the menstrual-like withdrawal bleeding, a woman can introduce a new ring without a one-week break. The next ring should be used within 3 weeks. In this case, spotting spotting or bleeding may occur. After a normal week-long break, the woman returns to the regular use of NuvaRing®.

To transfer the onset of bleeding to another day of the week, a woman can be recommended to take a shorter break in applying the ring (for as many days as necessary). The shorter the break in the application of the ring, the higher the probability of no bleeding that occurs after removal of the ring and the occurrence of bleeding or spotting spotting during the application of the next ring.

Children

The safety and efficacy of NuvaRing® for girls under the age of 18 years have not been studied.

Mechanism of action

NuvaRing® is a hormonal combination contraceptive containing ethonogestrel and ethinylestradiol. Etonogestrel is a progestogen (a derivative of 19-nortestosterone), which binds with high affinity to the receptors of progesterone in target organs. Ethinyl estradiol is an estrogen and is widely used for the manufacture of contraceptives.

The contraceptive effect of NuvaRing® is due to a combination of various factors, the most important of which is suppression of ovulation.

Efficiency

In clinical studies, it was found that the Perl index (an indicator reflecting the frequency of pregnancy in 100 women during 1 year of contraception) in women aged 18 to 40 years for NuvaRing® was 0.96 (95% CI: 0.64 -1.39) and 0.64 (95% CI: 0.35-1.07) in a statistical analysis of all randomized participants (ITT-analysis) and analysis of the participants of the studies that completed them according to the protocol (PP-analysis), respectively. These values ​​were similar to the Perl index values ​​obtained from comparative studies of combined oral contraceptives (COCs) containing levonorgestrel / ethinylestradiol (0.150 / 0.030 mg) or drospirenone / ethinyl estradiol (3 / 0.30 mg).

Against the background of NuvaRing®, the cycle becomes more regular, the pain and intensity of menstrual bleeding decreases, which helps to reduce the frequency of development of iron deficiency states. There is evidence of a reduction in the risk of endometrial and ovarian cancer when the drug is used.

The nature of bleeding

A comparison of the characteristics of the bleeding pattern over a period of one year in 1,000 women using NuvaRing® and COC containing levonorgestrel / ethinylestradiol (0.150 / 0.030 mg) showed a significant reduction in the frequency of breakthrough bleeding or spotting bleeding with NuvaRing® as compared to COOK. In addition, the frequency of cases when bleeding occurred only during a break in the use of the drug was significantly higher among women using NuvaRing®.

Effect on bone mineral density

A comparative two-year study of the effect of NuvaRing® (n = 76) and non-hormonal intrauterine device (n = 31) showed no effect on bone mineral density in women.

Children

The safety and efficacy of NuvaRing® for girls under the age of 18 years have not been studied.