What is NuvaRing?NuvaRing is a flexible combined contraceptive vaginal ring that is used to prevent pregnancy by preventing ovulation.
What is the most important information I should know about NuvaRing?NuvaRing does not protect against HIV infection (AIDS) and other sexually transmitted diseases (STDs) such as chlamydia, genital herpes, genital warts, gonorrhea, hepatitis B, and syphilis.
Cigarette smoking increases the risk of serious cardiovascular side effects when you use combination oral contraceptives. This risk increases even more if you are over age 35 and if you smoke 15 or more cigarettes a day. Women who use combination hormonal contraceptives, including NuvaRing, are strongly advised not to smoke.
To make sure NuvaRing works properly, you must follow a strict schedule for insertion and removal. Each ring should be inserted and left in place for exactly three weeks, then removed. Exactly one week after removal, a new ring should be inserted for the following three weeks. Always insert and remove NuvaRing on the same day of the week, at approximately the same time of day.
Don't use a diaphragm as back-up contraception with NuvaRing, because it interferes with the correct placement and position of the diaphragm.
Do not breastfeed while using NuvaRing. Some of the medicine may pass through the milk to the baby and could cause yellowing of the skin (jaundice) and breast enlargement in your baby. NuvaRing could also decrease the amount and quality of your breast milk.
Go for an annual checkup while on the ring so your doctor can evaluate how you are doing, especially if you have high blood pressure or high cholesterol.
Who should not take NuvaRing?NuvaRing is not indicated for use in women who have not yet had their period. Do not use NuvaRing if you have any of the following conditions: pregnancy or suspected pregnancy; a history of blood clots in your legs, lungs (pulmonary embolism), or eyes; chest pain (angina pectoris); a history of heart attack or stroke; severe high blood pressure; diabetes with complications of the kidneys, eyes, nerves or blood vessels; obesity; headaches with neurological symptoms; known or suspected breast cancer or cancer of the lining of the uterus, cervix or vagina (now or in the past); unexplained vaginal bleeding (until a diagnosis is reached by your doctor); jaundice during pregnancy or during past use of birth control medications of any kind; liver tumors or active liver disease; heart valve or heart rhythm disorders associated with blood clots formation; need for a long period of bed rest following major surgery; an allergic reaction to any of the components of NuvaRing.
Women older than 65 years should not use NuvaRing.
If you have developed serious depression during or prior to therapy, stop using NuvaRing at once and speak to your doctor to determine if the depression is drug-related.
Do not use NuvaRing if you smoke, especially if you smoke more than 15 cigarettes per day and are over the age of 35.
What should I tell my doctor before I take the first dose of NuvaRing?Tell your doctor about all prescription, over-the-counter, and herbal medications you are taking before beginning treatment with NuvaRing. Also, talk to your doctor about your complete medical history, especially if you have any of the following conditions: a family history of breast cancer, breast nodules, fibrocystic disease, an abnormal breast x-ray, or abnormal mammogram, diabetes, high blood pressure, high cholesterol or triglycerides, headaches or epilepsy (seizures), mental depression, gallbladder, liver, heart or kidney disease, scanty or irregular menstrual periods, major surgery (You may need to stop using NuvaRing for a while to reduce your chance of getting blood clots), any condition that makes the vagina get irritated easily, prolapsed (dropped) uterus, dropped bladder (cystocele), or rectal prolapse (rectocele), severe constipation, and history of toxic shock syndrome.
What is the usual dosage?The information below is based on the dosage guidelines your doctor uses. Depending on your condition and medical history, your doctor may prescribe a different regimen. Do not change the dosage or stop taking your medication without your doctor's approval.
Adults: NuvaRing is inserted in the vagina once a month. It stays in the vagina continuously for three weeks. It must be removed exactly 21 days after insertion. A new ring is inserted precisely seven days later.
The time to start use of NuvaRing depends on your previous contraceptive program:
If you did not use a hormonal contraceptive in the past month: Count the first day of your menstrual period as Day 1. Insert the first ring between day 1 and Day 5 of the cycle, even if you are still bleeding on Day 5. During the first cycle, use an extra method of birth control such as male condoms or spermicide for the first seven days of ring use.
If you are switching from a combination birth control pill: Insert NuvaRing any time during the first seven days after the last tablet and no later than the day you would have started a new pill cycle. No extra birth control method is needed.
If you are switching from a progestin-only contraceptive: When you are switching from a progestin-only contraceptive, use an extra method of birth control, such as male condoms or spermicide, for the first seven days after inserting NuvaRing.
If you are switching from the "mini-pill": Start using NuvaRing on any day of the month. Do not skip days between your last pill and first day of NuvaRing use.
If you are switching from a progestin implant (Norplant): Start using NuvaRing on the same day you have your implant removed.
If you are switching from an injectable contraceptive (Depo-Provera): Start using NuvaRing on the day when your next injection is due.
If you are switching from a progestin intra-uterine device (IUD): Start using NuvaRing on the same day you have your IUD removed.
Following a first trimester abortion or miscarriage: If you start using NuvaRing within five days after a complete first-trimester abortion or miscarriage, you do not need to use an extra method of contraception. If more than five days have passed, proceed as you would if you had not used a hormonal contraceptive for the past month.
Following a second trimester abortion or miscarriage: You may start using NuvaRing 4 weeks after a complete second trimester abortion or miscarriage.
Following delivery: If you choose not to breastfeed your child, you may start using NuvaRing four weeks after a complete delivery. It is recommended to use an extra form of contraception such a male condoms or spermicide for the first seven days. If you choose to breastfeed your child, do not use NuvaRing. Instead, use other forms of contraception until the child is weaned.
How should I take NuvaRing?Start NuvaRing on the first day of your cycle (the first day of your period). You may start it on Days 2-5 as well. This medication does not work immediately, so make sure to use other contraception (such as condoms) during the first seven days of NuvaRing use.
See the Patient Information that accompanies your NuvaRing for detailed instructions on the proper way to insert and remove the ring.
After removing the ring, place the used ring in the foil pouch it came in and dispose of it in the garbage, away from children and pets. Do not discard in the toilet.
Your menstrual period will usually start 2 to 3 days after the ring is removed and may not have finished before it's time to insert the next ring. For continued pregnancy protection, you need to insert the new ring exactly 1 week after the old one was removed, even if your period has not stopped.
What should I avoid while taking NuvaRing?Do not smoke or breastfeed while using NuvaRing.
What are possible food and drug interactions associated with NuvaRing?If NuvaRing is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining NuvaRing with any of the following: acetaminophen, antibiotics such as ampicillin and tetracycline, anticonvulsants, antifungals, atorvastatin, clofibrate, cyclosporine, HIV drugs known as protease inhibitors, morphine, phenylbutazone, prednisolone, rifadin, certain herbal products (St. John's wort), temazepam, theophylline, and vitamin C.
What are the possible side effects of NuvaRing?Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking this drug.
Side effects may include: abdominal cramps, allergic rash, bloating, blood clots, high blood pressure, breakthrough bleeding and spotting, breast secretions, change in menstrual flow, changes in the breast such as tenderness or enlargement, dark pigmentation of the skin, decreased milk production in nursing mothers, depression, emotional instability, gallbladder disease, headaches, heart attack, stroke (risk is greater in women over age of 35, high blood pressure, and smokers), intolerance to contact lenses, liver disease, liver tumors, migraine headaches, missed periods, nausea, problems with the ring, sinus inflammation, stroke, swelling, temporary infertility after discontinuing NuvaRing, upper respiratory tract infections, vaginal inflammation or discharge, vision problems, vomiting, weight gain or loss, yeast infections, yellow tint to the skin
Can I receive NuvaRing if I am pregnant or breastfeeding?NuvaRing should not be used during pregnancy or while nursing.
What should I do if I miss a dose of NuvaRing?In Weeks 1 and 2, if NuvaRing slips out, you'll still be protected against pregnancy provided the ring is replaced within 3 hours. You can use the old ring (after rinsing it with cool or lukewarm water) or insert a new ring. Remove the ring according to your original schedule.
If you're unable to replace the ring within 3 hours, insert it as soon as possible and use an additional method of birth control for seven days.
In Week 3, if NuvaRing has been out for more than 3 hours, discard the ring and follow one of the two options listed: 1)Insert a new ring immediately, which will begin the next three-week period (some spotting and bleeding may occur); 2)If spotting/bleeding occur, insert a new ring no later than seven days after the first one was removed (choose this option only if you used the ring for a full seven days the first time).
Make sure to use other barrier methods for the first 7 days of ring use.
If you forget and leave the ring in place for an extra week, remove it, take a one-week break, and reinsert a new one on Day 7. If you leave the ring in place for more than four weeks you may not be adequately protected against pregnancy.
If you miss a menstrual period, you should check to be sure you are not pregnant if any of the following circumstances apply: if NuvaRing was out of the vagina for more than 3 hours during the three weeks of ring use; if you waited longer than one week to insert a new ring after removing the old one; if you followed the instructions but miss two periods in a row; or if you have left NuvaRing in place for longer than four weeks.
If the ring has been out for more than 3 hours, or the ring-free week interval was greater than seven days, and a period was missed, pregnancy should be considered.
How should I store NuvaRing?Store at room temperature. Pay attention to the expiration date on the label. Do not use past four months from the date you received the ring.
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