NuvaRing - msdonline.com.au

NuvaRing™ and you
Your questions answered
If you have any questions related to the
use of your NuvaRing, please talk to your
Doctor or Healthcare Professional
References 1. NUVARING Product Information, MSD, 19 September 2011. 2. NUVARING Consumer Medicine Information, MSD, September 2011. Merck Sharp & Dohme
(Australia) Pty Limited, Level 4, 66 Waterloo Road, North Ryde NSW 2113. Copyright ©
2012 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co. Whitehouse Station,
NJ, USA. All rights reserved. WOMN-1021706-0027. First issued February 2012.
1-302476021
Contents
What is NuvaRing?
4
Can my partner use condoms while I use NuvaRing?
14
How does NuvaRing work?
5
Will NuvaRing affect my period?
15
What levels of hormones are used in NuvaRing?
5
Will I experience irregular bleeding with NuvaRing?
15
How do I start using NuvaRing?
6
Can I use tampons while using NuvaRing?
15
How do I know NuvaRing is in the right spot?
8
What should I do if…?
16
What do I do once I’ve inserted NuvaRing?
9
Are there side effects associated with the
use of NuvaRing?
18
Does NuvaRing affect my weight?
18
Can I take other medications while using NuvaRing?
18
What if I decide I want to have a baby?
19
How do people who have used NuvaRing
feel about it?
19
How do I remember when to remove and insert
a new NuvaRing?
10
Can NuvaRing break, get lost or fall out?
11
How hygienic is NuvaRing?
12
How easy is it to remove NuvaRing?
13
Does NuvaRing interfere with having sex?
14
After you have read this booklet you should also read the Consumer Medicine
Information for NuvaRing. A copy is provided in every NuvaRing packet. You can
also obtain a copy from your Pharmacist or from MSD.
Your Doctor has prescribed NuvaRing as your method of contraception. This booklet
contains some questions and answers which will help you to understand NuvaRing.
3
What is NuvaRing?
How does NuvaRing work?
NuvaRing is a contraceptive ring that you insert into your vagina
once every month. Once inserted, NuvaRing steadily releases a
low dose of hormones that prevent pregnancy. NuvaRing, like
the pill, makes your period predictable and provides good cycle
control but unlike the pill, you don’t have to remember to take it
every day.
NuvaRing is a combined hormonal contraceptive which
contains oestrogen and progestogen. These hormones
are released from the ring gradually and are absorbed
continuously into the bloodstream through the wall of the
vagina. They work primarily by preventing ovulation, which
means that the ovaries do not release an egg.
NuvaRing is made of clear, flexible plastic, so once it’s
inserted it takes on the shape of your vagina. NuvaRing is made
of non-absorbent, inert material so it therefore won’t
interfere with the lubrication of your vagina.
4
What levels of hormones are used in NuvaRing?
NuvaRing releases approximately 15 micrograms of
oestrogen and 120 micrograms of progestogen per day.
Each NuvaRing gradually releases a consistent low dose
of hormones daily during the three weeks in which you
use it.
5
How do I start using NuvaRing if
previously I have been using...?
…a non-hormonal
method of
contraception
…a progestogenonly mini pill
6
How do I start using NuvaRing...?
Start NuvaRing
on Day 1
Day 1 = First day of
menstrual bleed
No barrier
method required
(e.g. condom)
Start NuvaRing
between Day 2
and Day 5
Add barrier method
of contraception
for 7 days
Start NuvaRing
any day
Add barrier method
of contraception
for 7 days
…a progestogenonly implant
or intrauterine
system (IUS)
Start NuvaRing
on the same day
as you remove
the implant/IUS
Add barrier method
of contraception
for 7 days
…a progestogenonly injection
Start NuvaRing
on the same day
as the next
injection is due
Add barrier method
of contraception
for 7 days
…a combined oral
contraceptive pill
Start NuvaRing
on the day
following the last
placebo tablet
No barrier
method required
(e.g. condom)
…if I am starting
NuvaRing after
having a baby
…if I am starting
NuvaRing after a
miscarriage or
an abortion
Please discuss with
your Doctor who
will advise you
…if I am starting
NuvaRing when
I have had irregular
cycles or no bleeding
Please discuss the correct
time to insert NuvaRing
with your Doctor.
7
How do I know NuvaRing is in the right spot?
What do I do once I’ve inserted NuvaRing?
NuvaRing is as easy to insert as a tampon. Simply squeeze
NuvaRing between your thumb and forefinger and push it
backwards high into the vagina until it feels comfortable
(see drawing). You may find that squatting, lying down or
raising one leg helps you to slide it into place.
Once you have NuvaRing in place, there’s no need to do
anything for 3 weeks, since it sits comfortably in your vagina,
steadily releasing hormones into your bloodstream.
You don’t need to clean or check NuvaRing, or remove
it for sex. You will not have a period while NuvaRing is in
place, but if you have any breakthrough bleeding you can
still insert a tampon.
After three weeks, you remove and discard NuvaRing.
Then one week later, insert a new NuvaRing. During the
week you do not have NuvaRing inserted, you will usually
have a period.
Squeeze NuvaRing until it’s flat
Push NuvaRing into your vagina
until it feels comfortable
NuvaRing is correctly inserted if you cannot feel it. If you
can still feel NuvaRing after you’ve inserted it, just push it a
little further into your vagina. If you have any problems with
insertion, please speak to your Doctor.
8
9
How do I remember when to remove and
insert a new NuvaRing?
Inside each NuvaRing pack there is a Consumer Medicine
Information leaflet. In the back of this leaflet is a page of stickers
which you can place in your diary or calendar to remind you to
insert or remove NuvaRing.
October
Insert Sunday night
1st Oct 10pm
X
Remove Sunday night
22nd October 10pm
X
Insert new ring Sunday
night 29th October 10pm
X
Can NuvaRing break, get lost or fall out?
NuvaRing is flexible, but sturdy. It very rarely breaks. If you
notice that your ring has broken, discard that ring and replace
it with a new ring as soon as possible and use the new ring
until the original ring was due to be removed. It does not
decrease in size or dissolve at all inside your vagina.
NuvaRing has been specially designed and made to mould to
the shape of your vagina so that it stays in place once inserted.
As is the case with tampons, it cannot be ‘lost’ in your body as
the entrance to your uterus (womb) is too small for NuvaRing
to pass through. The muscles at the bottom
of your vagina keep it in position
so it is very unlikely to fall
out or be pushed out.
If you would like to receive a SMS message to your
mobile phone to remind you to insert and remove
NuvaRing, you should visit the following website
www.moderncontraception.com.au (password: modern).
10
11
How hygienic is NuvaRing?
How easy is it to remove NuvaRing?
NuvaRing is made of smooth non-absorbent plastic,
so there are no crevices or pockets in which bacteria
can grow. The ring itself is odourless. There is no need
to clean NuvaRing at any time during the three weeks
it sits in your vagina.
NuvaRing is easy to remove. You can either hook the ring
with your index finger, or grab it between your index and
middle finger and gently withdraw it (see drawing).
You may be worried because you have heard that leaving
a tampon in place for too long may cause toxic shock
syndrome. This should not happen with NuvaRing
because it’s non-absorbent, so it is quite safe to leave
it in place for three weeks.
NuvaRing doesn’t interfere with the normal functioning
of your vagina, so you should not notice any changes in
your normal discharge.
NuvaRing does not protect you against sexually
transmitted infections (STIs). You should take the
usual precautions to prevent STIs.
12
NuvaRing can be removed
by hooking the index finger
under the ring or grasping
the ring between the index
and middle finger and
pulling out.
You should remove NuvaRing three weeks after insertion,
at about the same time of the day. So, if you inserted
NuvaRing at 7:00am on a Tuesday, you should remove
it at about 7:00am on the Tuesday three weeks later.
13
Does NuvaRing interfere with having sex?
Will NuvaRing affect my period?
NuvaRing should not interfere with sex or your ability to reach
an orgasm. When NuvaRing is in place, it sits at the top of your
vagina, on the vaginal wall where there are very few nerve
endings. That’s why you can’t feel it.
NuvaRing can regulate your cycle and can lead to lighter
bleeding and less painful periods in the hormone-free
(ring-free) week.
It’s very unlikely that your partner will be able to feel
NuvaRing during sex. Most couples report not noticing it
at all. There’s no need to remove NuvaRing before you
have sex because it’s designed to stay in the vagina for
three weeks and is not affected by how often or how
vigorously you have sex.
Will I experience irregular bleeding with NuvaRing?
Can my partner use condoms while I use NuvaRing?
Condoms can be used while using NuvaRing. Sometimes the
use of condoms is recommended since NuvaRing does not
protect you from STIs and HIV.
Irregular bleeding is unlikely with NuvaRing. NuvaRing provides
a predictable bleeding pattern; nearly all women experience
normal withdrawal bleed during the ring-free week. A few
women experience irregular bleeding – either breakthrough
bleeding or spotting – during the three weeks that the ring is
being used. Speak to your Doctor if you experience irregular
bleeding.
Can I use tampons while using NuvaRing?
Yes, you can use tampons while using NuvaRing.
However, most women experience their withdrawal bleed
during the ring-free week and do not need to use tampons
while NuvaRing is inserted. Be careful not to remove
the ring when removing a tampon.
14
15
What should I do if...?
...NuvaRing is accidentally expelled or removed?
If you have deviated from the recommended regimen and you do not have your
expected period in the first normal ring-free interval, you may be pregnant.
Contact your doctor before you insert a new NuvaRing.
If NuvaRing is
outside the vagina
for more than
3 hours during the
first and second
week.
Rinse NuvaRing in cold/lukewarm water
(Do not use soap) and then re-insert, but
ALSO use a barrier method of contraception
for 7 days.
NuvaRing should be used at least 7 days
continuously after this event.
If NuvaRing has
been out of the
vagina for more
than 3 hours
during the 3rd week
of the three-week
use period,
contraceptive
efficacy may be
reduced. The
woman should
discard that ring,
and one of the
following two
options should
be chosen:
Insert a new ring immediately.
If NuvaRing is
outside the vagina
for less than
3 hours
16
...I forgot to remove NuvaRing after 3 weeks?
If NuvaRing has
been left in place
continuously for
more than 3 but
less than 4 weeks
Remove the NuvaRing and have a ring-free
interval of one week and then insert a new
NuvaRing
If NuvaRing has
been left in place
continuously for
more than 4 weeks
Remove the ring and consult your doctor and
ALSO use a barrier method of contraception
until you have consulted your doctor
Note: Inserting a new ring will start the next three-week
use period. The woman may not experience a
withdrawal bleed from her previous cycle. However,
breakthrough spotting or bleeding may occur.
Consult your Doctor to exclude pregnancy
...I forgot to insert a new NuvaRing for my next cycle
(after the 7 day ring free period)?
Have a withdrawal bleed and insert a new ring
no later than 7 days (7x24 hours) from the time
the previous ring was removed or expelled.
If you have not had
intercourse during
the ring free period
Insert a new
NuvaRing and
ALSO use a barrier
method of
contraception
for 7 days
If you have had
intercourse during
the ring free period
Consult your doctor
and ALSO use a
barrier method of
contraception until
you have consulted
your doctor
Note: This option should only be chosen if the ring was
used continuously for the preceding 7 days.
Rinse NuvaRing in cold/lukewarm water
(Do not use soap) and then re-insert as
soon as possible
Consult your
doctor to exclude
pregnancy
17
Are there side effects associated
with the use of NuvaRing?
NuvaRing is well tolerated, although some side effects have
been reported. They include acne and oestrogen-related side
effects such as breast tenderness, nausea and mood swings.
A minority of women experience vaginal symptoms such as
irritation and increased vaginal discharge.
Does NuvaRing affect my weight?
Both weight-gain and weight-loss have been reported in a
minority of women.
Can I take other medications
while using NuvaRing?
Some medications can affect the reliability
of NuvaRing and vice versa. You should
inform your Doctor of all medications
you are taking before you start, or while
you are using NuvaRing.
What if I decide I want to have a baby?
If you decide you want to fall pregnant, you can stop
NuvaRing at any time. Most women ovulate 12 days after ring
removal with a quick return to their baseline state of fertility.
It is generally recommended that you wait until you have
had a natural period before trying to conceive. This helps you
calculate when the baby will be due.
How do people who have used NuvaRing
feel about it?
Acceptability of NuvaRing was assessed in the two large
efficacy and safety studies. The large majority of users felt that
the ring could easily be inserted (97%) or removed (98%). Male
discomfort during sexual intercourse was reported by 2% of
clinical trial subjects.1
18
19