The contraceptive ring as a method of hormonal contraception

pharmachologic effect

Hormonal contraceptive drug.

Etonogestrel is a progestogen that binds to progesterone receptors in target organs.

Ethinyl estradiol is an estrogen . The effect of the drug is ensured by a combination of various mechanisms, the most significant of which is the suppression of ovulation.

The use of the drug regulates the menstrual cycle , reducing pain during menstrual bleeding and its intensity. This reduces the likelihood of developing iron deficiency anemia .

The use of the drug reduces the risk of ovarian and endometrial cancer, the development of ovarian cysts , ectopic pregnancy , inflammation of the female reproductive system and benign pathologies of the mammary glands.

If the pregnancy ring was removed prematurely

Due to its dimensions, the vaginal ring is quite securely fixed in the vagina. But the ring may fall out in a number of situations, such as: incorrect insertion of a contraceptive, removal of a tampon, efforts accompanying constipation, intercourse, severe physical activity, structural anomalies of the reproductive system.

Sometimes it is enough to rinse the fallen ring under running lukewarm water and reinsert it into the vagina. In other cases, it is necessary to replace the ring with a new one and use additional contraceptives. The tactics for further action depend on:

1. The time period during which the ring was outside the body.
2. Week of the cycle in which the loss occurred.

• the protective effect of NuvaRing is not reduced if the time interval between the ring falling out and re-insertion does not exceed 3 hours;
• if the ring was outside the vagina for more than 3 hours in 1 or 2 weeks of use, the contraceptive effect may be reduced. The ring, previously washed under running water, can be reinstalled. During the next week after insertion of the ring, intercourse should be carried out using a condom;
• if NuvaRing was outside the vagina for more than 3 hours during the 3rd week of use, the protective effect may decrease. You will need to install a new ring, which can be inserted either as soon as possible (then there will be no withdrawal bleeding, but “spotting” may appear), or after waiting for menstrual-like bleeding, but no later than a week after the previous ring falls out. The second option is appropriate if there were no errors in use during the first weeks.
• In rare cases, the contraceptive may break. But the situation does not promise anything terrible: NuvaRing is designed in such a way that a violation of its integrity does not have a significant effect on the dosage of daily hormones released. The tactics for further action are similar to those described above, except that you will need to install a new ring.

Pharmacodynamics and pharmacokinetics

Etonogestrel is absorbed through the vaginal mucosa and its maximum concentration is reached after approximately 7 days. Bioavailability is about 100%, which is higher than with oral etonogestrel. The substance is metabolized in the liver and excreted in urine and bile. The half-life of metabolites is 6 days.

Ethinyl estradiol also penetrates the vaginal mucosa into the blood. The maximum concentration is reached after 3 days. Bioavailability is approximately 56% and is comparable to oral administration. Metabolized in urine and bile, the half-life is about 36 hours.

Contraindications

• arterial and venous thrombosis , thromboembolism and predisposition to them;
• heart defects with complications such as thrombosis;
• migraine;
• diabetes mellitus with vascular changes;
• pancreatitis;
• severe liver disease;
• malignant and benign liver tumors;
• hormone-dependent malignant tumors (breast and reproductive system);
• vaginal bleeding of unknown origin;
• pregnancy;
• hypersensitivity to any of the substances of the drug (active or auxiliary).

If any of these conditions occur, stop taking the drug immediately.

Prescribe the drug with caution in the following cases:

• a family history of venous or arterial thrombosis ;
• major surgical interventions and interventions on the lower extremities, prolonged immobilization;
• obesity with a body mass index over 30;
• thrombophlebitis;
• arterial hypertension;
• smoking (especially women over 35 years old);
• lipid metabolism disorders;
• heart defects;
• atrial flutter;
• diabetes;
• liver dysfunction;
• cholelithiasis;
• hemolytic-uremic syndrome;
• chorea;
• otosclerosis with hearing loss;
• systemic lupus erythematosus;
• angioedema;
• ulcerative colitis and Crohn's disease ;
• sickle cell anemia;
• porphyria;
• chloasma;
• cases of difficult use of the vaginal ring: severe chronic constipation , hernia of the bladder and rectum, cervical prolapse.

In case of exacerbation of diseases and deterioration of the condition, or if one of the above-mentioned conditions occurs for the first time, further questions about taking the drug must be resolved with a doctor.

Side effects

When used, the following side effects of Nuvaring may occur, occurring with varying frequencies.

• Infections: vaginal and urinary tract infections, cervicitis .
• Immune system: hypersensitivity.
• Metabolism: increased appetite and weight gain.
• Mental disorders: decreased sex drive, mood changes, depression .
• Nervous system: headache, dizziness , migraine .
• Visual organs: visual impairment.
• Cardiovascular system: increased blood pressure, thromboembolism , feeling of “hot flashes”.
• Digestive system: nausea, bloating, abdominal pain, diarrhea, constipation, vomiting.
• Skin: acne , itchy skin , rash .
• Musculoskeletal system: pain in the limbs and back, muscle spasms.
• Urinary system: dysuria , frequent urination.
• On the part of the reproductive system and mammary glands, side effects of the ring can manifest themselves as: engorgement and soreness of the mammary glands , genital itching, dysmenorrhea , vaginal discharge, amenorrhea , spotting during sexual intercourse, heavy menstruation, uterine bleeding, premenstrual syndrome, burning sensation in the vagina, painful sensations and discomfort in the vagina.
• General condition of the body: fatigue, swelling.

There may also be discomfort and discomfort in the vagina.

Reviews from doctors

Zhilina Margarita Viktorovna, gynecologist:

“I consider this method of intrauterine contraception to be the safest. The contraceptive Nuvaring effectively has a contraceptive effect and is not capable of damaging the integrity of the vaginal tissues.”

Bogdanova Tatyana Igorevna, gynecologist:

“For a woman, the Nuvaring vaginal ring does not cause discomfort unless adverse reactions occur. But not every man can tolerate the sensation of a foreign object.”

Instructions for use Nuvaring rings (Method and dosage)

The ring is inserted once every 4 weeks into the vagina, where it remains for 21 days and then is removed. A new ring is introduced after a break of 7 days.

On the 2-3rd day after removal of the ring, bleeding begins, which is associated with the cessation of the effect of the drug.

If hormonal contraceptives , the Nuvaring contraceptive ring is administered on the first day of menstruation. It is possible to install it up to the 5th day of the cycle, but in this case it is recommended to use a condom for the first week of using the drug.

When switching from combined oral contraceptives, the ring is administered on the last day of the interval between taking hormonal contraceptives. If you take a combined hormonal contraceptive correctly and regularly and are confident that you are not pregnant, you can insert a vaginal ring on any day of the cycle.

When switching from a mini-pill , you can start using the ring on any day (on the day the IUD is removed or on the day of the next injection). In such cases, it is necessary to use barrier contraceptives for 1 week.

The instructions for Nuvaring allow the use of the ring immediately after an abortion performed in the first trimester of pregnancy.

After an abortion in the second trimester or childbirth, use can begin in the 4th week after the abortion or childbirth.

The contraceptive effect may be impaired if the regimen and rules of use are not followed.

If there was sexual intercourse during a break in using the ring, pregnancy must be ruled out.

When the ring ruptures, the release of hormones does not change. In this case, the ring usually falls out of the vagina. It needs to be replaced with a new one.

Rules for using Nuvaring

The ring can be inserted into the vagina yourself. For insertion, you need to choose a comfortable position - standing, with one leg raised, squatting or lying down. In this case, the ring must be squeezed and inserted into the vagina.

To remove the ring, squeeze it with your index and middle fingers and remove it from the vagina.

Characteristics

The pharmacological form is a flexible ring made of latex, which contains two active components: estrogen and gestagen. Therefore, NuvaRing is a combined hormonal contraceptive with a predominantly local mechanism of action. The gestagen is etonogestrel, and the group of estrogens is ethinyl estradiol - synthetic analogues of the natural hormones of the female body. The diameter of the ring is 5.4 cm, and its thickness is only 4 mm. These sizes are suitable for most women, which is ensured by the flexibility of the shape and its adjustment to the individual characteristics of the genital organs.

The effects of the contraceptive ring are due to the action of the active substances included in its composition.

Etonogestrel and ethinyl estradiol bind to the corresponding receptors, thereby blocking the local effects of natural hormones - estrogens and progesterone. This is mainly manifested in the suppression of ovulation and inhibition of secretory transformation of the endometrium.

As soon as the ring is inserted into the vagina, its shell takes on the temperature of the human body, becoming permeable to the substances inside. The medicinal components are contained in low doses; they act primarily on the uterus and ovaries, without affecting other systems and organs. Based on the mechanism of action of etonogestrel and ethinyl estradiol, conceiving a child becomes impossible. The egg does not mature and remains in the follicle, and the thin mucous membrane of the uterus prevents implantation of the embryo.

Interaction

An interaction may occur, manifested in the onset of acyclic bleeding, with the following drugs: barbiturates , carbamazepine , phenytoin , rifampicin , oxcarbazepine , topiramate , felbamate , St. John's wort preparations. During treatment with these drugs and for 1 month after stopping therapy, a condom should be used.

When treating with antibiotics ampicillin and tetracyclines, you should use a condom during treatment and for 1 week after stopping the antibiotic, since the effectiveness of contraceptives that contain ethinyl estradiol .

The use of suppositories with antifungal drugs slightly increases the risk of ring damage and rupture.

The use of hormonal contraceptives may cause changes in the metabolism of other drugs, and their concentration in plasma or peripheral tissues may increase ( cyclosporine ) or decrease ( lamotrigine ).

Technique of use (how to insert NuvaRing)

The woman inserts the contraceptive ring into the vagina on her own, choosing a comfortable position for this: lying down, squatting, or standing, leaning her back against the wall and raising one leg.
The ring is inserted during menstruation (on the 1st – 5th day). Hands must be washed clean. NuvaRing should be squeezed with your fingers, reducing its diameter, and inserted as deep as possible into the vagina. The smooth ring will slide inside the body without hindrance. If you feel uncomfortable after this, adjust the ring with your fingers. Once in the correct position, it will become imperceptible. It doesn’t matter where exactly the NuvaRing is fixed in the vagina: an indicator of correct insertion is the absence of discomfort. After insertion of the contraceptive ring, it is not removed for three weeks. If NuvaRing is accidentally removed (for example, together with a tampon), it is washed with warm water and returned to its original place.

When the time comes to remove the hormonal ring, it is carefully pulled out by hooking it with the index finger or pinched between the middle and index fingers.

special instructions

Taking hormonal contraceptives may be associated with the development of venous and arterial thrombosis .

Possible symptoms of thrombosis are:

• pain and swelling in one leg;
• sudden intense chest pain;
• shortness of breath or paroxysmal cough
• dizziness , intense headaches;
• sudden loss of vision or double vision;
• speech disorders;
• sudden weakness or numbness on one side or part of the body;
• movement disorders.

If there are signs of thrombosis, stop taking hormonal contraceptives immediately and consult a doctor.

The reason to stop taking hormonal contraceptives should be an increase in the severity of migraine and the frequency of attacks.

Women with hypertriglyceridemia have an increased risk of developing pancreatitis.

If you are predisposed to developing chloasma, you should avoid exposure to ultraviolet radiation and the sun while using the ring.

The use of the drug may cause acyclic bleeding in the form of spotting or bleeding that occurs suddenly.

What if I take a break for more than 7 days?

If you do not insert the ring after 7 days, you should insert it when possible and use additional methods of contraception for a week.

If a woman decides to become pregnant and no longer use protection, she should simply remove the vaginal contraceptive. After the last removal, reproductive function is fully restored within a month.

Like any medicine, the vaginal ring has its drawbacks. And the most significant thing is the presence of a large number of contraindications, as when taking any type of hormonal drugs.

Using a contraceptive ring does not protect against sexually transmitted infections. When using it, it is desirable to have one reliable sexual partner.

Another disadvantage is the psychological aspect. It takes time for a woman to get used to this type of contraceptive protection.

Analogs

Matches by level 4 ATX code:
Patentex Oval N

Nonoxynol

Erotex

Septefril

Benatex

Pharmatex

There are analogues for the pharmacological group, which includes combined oral contraceptives : Zhanin , Logest , Midiana , Novinet , Yarina .

What is better Jess, Mirena, Yarina or Nuvaring?

Jess, Mirena, Yarina and Novaring
Jess and Yarina are combined oral contraceptives. Mirena is an intrauterine device.

All contraceptives are used for the same purpose, but they are suitable for each woman differently and the comfort/discomfort from them is also different.

Have you used the contraceptive Nuvaring and was it effective?

Reviews of the Nuvaring ring

Many women turn to the medical forum with questions about using the Nuvaring ring. Reviews from doctors about Nuvaring are mostly considered to be a reliable and effective remedy with a minimum number of side effects. None of the reviews mentioned the occurrence of unwanted pregnancy while taking the drug. The hormonal ring is widely used by gynecologists for endometriosis as a factor that inhibits the development of the disease. Some women report side effects such as vaginal discomfort, weight gain and headaches.

Composition and release form

The contraceptive Nuvaring is made in the form of a vaginal ring.

Nuvaring vaginal ring

The concentration of ethinyl estradiol in it is 2.7 mg, and etonogestrel is 11.7 mg.

The composition also includes additional substances in the form of:

1. Ethylene copolymer.
2. Vinyl acetate copolymer.
3. Magnesium stearate.

Nuvaring price, where to buy

The price of the Nuvaring hormonal ring is about 1000 rubles. for 1 piece Buy a pack of 3 pieces in Moscow. possible for 2800 rubles. In Ukraine, the average cost of one ring is 220 UAH.

The average price in pharmacies in Minsk is 182,200 BYN. rub.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine

ZdravCity

• Nuvaring vaginal ring 15mcg+120mcg/day 3 pcs.Organon
  RUB 3,641 order
• Nuvaring vaginal ringOrganon

  RUB 1,423 order

Pharmacy Dialogue

• NuvaRing vaginal ring. (No. 1)Organon

  RUB 1,328 order

• NuvaRing vaginal ring. (No. 3)Organon

  RUR 3,670 order

Europharm* 4% discount using promo code medside11

• Nuvaring vaginal ring ORGANON

  RUB 1,599 order

• Nuvaring vaginal ring N3ORGANON

  RUR 3,980 order

show more

Indications for use

The birth control contraceptive Nuvaring is primarily intended to protect against pregnancy.

Contraceptive effect of the hormonal ring

The Nuvaring vaginal ring is often prescribed by doctors for endometriosis. They also treat uterine fibroids when their size is small and surgery can be avoided.