Family Planning of Clallam County
Client Information for Informed Consent
THE RING — NuvaRing
Before using the ring, you need to know the possible advantages, disadvantages, risks, and warning signs to watch for. We have listed them here for you. Be sure to read the manufacturer’s information, too. We are happy to answer your questions.
Other methods of birth control are available. We will offer you information about their use, effectiveness, advantages, disadvantages, risks, and warning signs. You should read these materials, as well. Let us know if you have any questions about them.
You may notice some differences between the information the manufacturer provides and the information we provide. Please consult your clinician if you have questions about any difference you observe.
The ring is a combined hormone method of birth control. It is a small polyethylene vinyl acetate ring that is put in the vagina. It is kept in place for three weeks in a row and then removed for a ring-free week — three weeks in, one week out. The ring constantly releases two hormones into the bloodstream. They are similar to the estrogen and progesterone made by a woman’s body. They keep the ovaries from releasing eggs. They also thicken the cervical mucus so sperm cannot enter the uterus.
The ring is very effective if used correctly. Of every 100 women who use the ring, about eight will become pregnant the first year with typical use. Fewer than one out of 100 will become pregnant with perfect use.
The ring may be less effective if it is taken with certain drugs, especially some that are used to control seizures or treat certain mental illnesses or HIV/AIDS. Be sure to talk with your clinician if you take any other medicine — including herbs and over-the-counter medicine. Tell other clinicians you see that you are using the ring.
The ring offers no protection against sexually transmitted infections (STIs). Latex and female condoms are the best way for sexually active people to reduce the risk of STIs. Always use a condom if you or your partner has other sex partners.
Advantages of the Ring
• no medicine to take every day
• nothing to do right before sex to make it work
• ability to become pregnant should return quickly
Because the ring works like the pill, it probably offers the same non-contraceptive benefits:
• more regular periods • some protection against cancers of the ovaries
• fewer menstrual cramps and uterus
• less blood loss • decreased risk of PID (pelvic inflammatory disease)
• less iron deficiency anemia • decreased risk of ectopic pregnancy
• some protection against non-cancerous breast • less acne
tumors and ovarian cysts
Disadvantages of the Ring
• Some women may forget to insert and remove it on schedule.
Possible side-effects that usually clear up after two or three months include
• breast discomfort • vaginal irritation or infection
• headache • increased vaginal discharge
• nausea
Risks of using the Ring
Based on studies of the pill, it is believed that users of the ring have a slightly greater risk than non-users of developing certain serious problems that may cause death in rare cases, including
• blood clots in the legs that can travel to the lungs
• heart attack or stroke
• liver tumors
What are your annual chances of developing a blood clot compared to other women?
• Four out of 100,000 if you don’t use any hormonal birth control and are not pregnant.
• Ten to 30 out of 100,000 if you are taking the pill. May also be true for the ring.
• About 60 out of 100,000 if you become pregnant.
The more risk factors a woman has for heart disease, the greater the chance of developing certain serious health problems while using the ring. Risk factors include
• being older than 35 • high blood pressure
• tobacco use • high levels of cholesterol
• diabetes
Tell your clinician if you have any of these risk factors or conditions and about any other past or current medical problems or concerns you may have. Your clinician will help you to decide if the ring is right for you. Sometimes special tests or follow up may be needed.
The ring cannot be used by women who
• are 35 or older and use tobacco • have certain inherited blood-clotting disorders
• have controlled high blood pressure • have had serious liver disease
and use tobacco • have had cancer of the breast or liver
• have uncontrolled high blood pressure • have diabetes with vascular disease
• have had heart attack, angina, or stroke • have had migraine with aura
• have had serious heart valve problems
• will be on prolonged bed rest, for example
after major surgery
• have had blood clots in the veins or arteries
• are, or think they are, pregnant
Warning Signs — call the health center right away if you have
• sharp or crushing chest pain or coughing blood
• shortness of breath
• unusual swelling or pain in the legs or arms
• severe pain in the stomach or abdomen
• sudden severe headaches
• yellowing of the skin or eyes
• changes in the frequency, severity, or associated symptoms of your headache
• severe depression
• unusually heavy bleeding from the vagina
• aura — gradual onset, yet short-term, visual experience of arcing, bright, flashing zig-zag lines
• a new lump in the breast
• no period after having a period every month
Regular physical examinations for routine health care and for screening sexually transmitted infections and cancer are strongly recommended.
Instructions for Use
THE RING
When to Use the Ring
Your clinician will advise you when to start using the ring — usually during the first five days of your next period. The ring fits easily in your vagina and is worn for three weeks. It is removed after three weeks of continuous use. That’s when your menstrual period should start. Insert a new ring after one ring-free week.
How to Insert the Ring
It is easy to insert the ring. Use your fingers to press the sides of the ring together and gently push it into your vagina. It will work properly no matter what position it is in.
Expiration Date
Always check the expiration date on the ring package before inserting the ring. Unused rings should be stored at room temperature out of direct sunlight until the expiration date. A ring inserted after the expiration date may not be fully effective.
If you take the ring out of your vagina or if it slips out by itself
• Wash the ring with lukewarm or cool water and put it back in as soon as possible.
• You could become pregnant if the ring stays out of your vagina for more than three hours.
• Use backup contraception for seven days in a row if the ring is out for more than three hours in a row.
If your ring-free interval has been longer than one week
• You could become pregnant.
• You may want to take a pregnancy test.
• You must use backup contraception for seven days in a row when you restart with a new ring.
If you leave the ring in your vagina for longer than you should
• up to four weeks from insertion
• Remove the ring.
• Take a ring-free week.
• Insert a new ring after the ring-free week.
• for more than four weeks
• Remove the ring.
• You may become pregnant.
• You may want to take a pregnancy test.
• When you restart with a new ring, you must use backup contraception for seven days in a row.
If back-up contraception is needed
Do not use a vaginal barrier method of birth control. The ring could interfere with correct placement of the contraceptive sponge, diaphragm, Lea’s Shield, or FemCap. Latex condoms and/or spermicide are good choices for backup protection.
Removing and Discarding the Ring
Remove the ring three weeks after insertion on the same day of the week as it was inserted and at about the same time.
Hook your index finger under the forward rim or hold the rim between your index and middle fingers and gently pull it out. It may be easier to remove if you gently bear down — as if having a bowel movement — as you remove it.
Be sure to put the used ring in the foil pouch and throw it away. Used rings still contain some active hormones. Using the foil pouch protects children who might otherwise play with a used ring. It also reduces the chance of estrogen seeping into the soil and water supply. Use the foil packet. Do not flush rings down the toilet.
When to Expect Your Period
Most women who use the ring bleed sometime in the ring-free week — the fourth week. You still may be bleeding — usually spotting — when its time to insert the new ring. Insert the new ring, even if you are still bleeding in order to stay protected against pregnancy.
If You Miss Your Period
If you use the ring correctly (three weeks in, one week out, then a new ring) and you miss two periods in a row, it is possible that you may be pregnant. You need to call your clinician. If you know you are pregnant, remove the ring immediately, and notify your clinician.
If You Are Taking Other Medications
The ring may be less effective if it is taken with certain drugs, especially some that are used to control seizures or treat certain mental illnesses or HIV/AIDS. Be sure to talk with your clinician if you take any other medicine — including herbs and over-the-counter medicine. Tell other clinicians you see that you are using the ring.
The regular use of oil-based vaginal anti-fungals (medicine for yeast infections) while the ring is in place may increase the level of hormones released into the blood. This may also be true of oil-based lubricants. Neither will reduce the effectiveness of the ring.
Water-based products, such as lubricants, have no effect on the ring.
FYI — Emergency Contraception
Mistakes happen. That’s why it’s important to remember that emergency contraception pills can reduce the risk of unintended pregnancy. They work best when started as soon as possible within 120 hours of unprotected intercourse. Contact your clinician for more information.
2/09 4 of 4 FPCC 5.08