Hormonal nuvaring. Nuvaring: instructions for use of the hormonal ring. What to do if your period does not come during a week's break

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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Introduction

What is NuvaRing?

With NuvaRing you don’t need to limit your physical activity: you can safely engage in any sport, including running, swimming, and horse riding. During sexual relations, the ring is not felt at all by the partners and does not create any inconvenience.

The dimensions of the ring are the same for everyone: thickness - 4 mm, diameter - 54 mm. This size is suitable for every woman, regardless of her height, weight and age, as it is able to mold to the individual contours of the body.

NuvaRing is produced in the Netherlands in one single form: in the form of a ring. There are no NuvaRing tablets. NuvaRing 1 and NuvaRing 3 differ in the number of rings in the package (one ring or three).

Composition and principle of action

When the NuvaRing ring is inserted into the vagina, its shell heats up to the temperature of the human body (34-42 o) and becomes permeable to the hormones contained inside the ring. Released from under the membrane, hormones act directly on the uterus and ovaries. Other organs remain outside the influence of hormones.

The dose of hormones contained in NuvaRing is enough to suppress the maturation of the egg and its release from the ovary. As a result, pregnancy becomes impossible.

Advantages of the method

• Reliability and high efficiency of contraceptive action.
• Ease of use: replacement only once a month.
• The body is minimally affected by hormones due to their low dosage.
• Hormones act only locally, without putting unnecessary stress on the liver, stomach and intestines.
• A woman’s weight does not increase when using NuvaRing.
• The regularity of the menstrual cycle is restored (if it was disrupted). Menstruation becomes less painful.
• The use of NuvaRing reduces the risk of ovarian and uterine cancer.
• Ensuring a full, natural, harmonious sex life.
• Rapid restoration of ovulation and fertility (within 4-5 weeks after removal of the hormonal ring).
• If desired, a woman can keep the use of NuvaRing secret: the partner will not feel the presence of the ring in the vagina.

Disadvantages of the method

1. The method of contraception is psychologically unusual.
2. The presence of a fairly extensive list of contraindications.
3. NuvaRing, like other hormonal contraceptives, does not provide protection against sexually transmitted diseases, including AIDS (HIV infection).

Technique of use (how to insert NuvaRing)

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.

Application

After removing the ring, a 7-day break is required. On the 8th day, a new ring can be inserted.

If the patient has not previously used hormonal contraceptives, NuvaRing is administered, as mentioned above, between the 1st and 5th days of menstruation (no later than the 5th day).

If a woman switches to using NuvaRing after taking combined hormonal pills, the ring is inserted after a week-long break in contraception, on the day when she was supposed to start taking pills from the new package.

After taking the mini-pill, NuvaRing can be administered any day. After using intrauterine systems or implants - the next day after removing the IUD or implant. After injection contraception - on the day when the next injection is due.

In any case, during the first week of using NuvaRing it is recommended to additionally use a condom as a barrier method of contraception.

Use of NuvaRing after abortion or childbirth
If the abortion was performed in the first three months of pregnancy, NuvaRing can be administered immediately after the abortion. In this case, you do not need to use an additional condom.

If for some reason the hormonal ring was not inserted immediately after the abortion, you should wait until menstruation and insert NuvaRing from the 1st to the 5th day (plus using a condom for a week).

If the abortion took place in the second three weeks of pregnancy, then, just as after childbirth, you can start using NuvaRing only three weeks after the abortion. There is no need to use a condom.

If they want to introduce NuvaRing later than 21 days after childbirth or abortion, and during the intervening period there has been sexual intercourse, you need to wait until the first menstruation begins (to make sure there is no new pregnancy). Using a condom for a week is mandatory.

Break in use

• If NuvaRing was outside the vagina for less than three hours, the contraceptive effect of the hormones will not be interrupted. The ring should be returned to its place as soon as possible.
• If the hormonal ring is removed from the vagina for more than three hours, the contraceptive effect may be reduced. The ring, as in the previous case, must be immediately returned inside the vagina, and not removed from there for at least 7 days (plus the use of a condom for a week). Even if this episode occurred during the 3rd week of using NuvaRing, when the ring would soon have to be removed, you will have to extend the period of its use beyond 3 weeks (until 7 days have passed since the ring was returned to its place). Only then can the NuvaRing be removed and a new ring put in a week later.

Extended use

If NuvaRing remains in the vagina for more than 4 weeks, its contraceptive effect is reduced, and after removing the ring, a new one can be inserted only after making sure there is no pregnancy, i.e. waiting for the start of menstruation.

Menstruation and bleeding during and after NuvaRing use
cancellations

In some women, a break in the use of Nuvaring is not accompanied by bleeding. This option can be considered normal if the hormonal ring was used strictly according to the recommendations, and the absence of bleeding was noted once.

While NuvaRing is in the vagina, irregular, slight spotting may occur. It is also possible that there may be sudden onset of severe bleeding. Minor discharge does not require visiting a doctor, but with heavy bleeding you should urgently see a gynecologist.

Cancellation of NuvaRing

Pregnancy after stopping the contraceptive ring

Side effects

Side effects include the following symptoms:

• Reactions of the central nervous system - dizziness, headache, mood swings, anxiety.
• Reactions of the digestive organs - nausea, sometimes abdominal pain, diarrhea, vomiting.
• Reactions of the endocrine system - changes in body weight (weight gain or loss may be noted), some increase and engorgement

In this article you can read the instructions for use of the drug Nuvaring. Reviews of site visitors - consumers of this medicine, as well as the opinions of specialist doctors on the use of Nuvaring in their practice are presented. We kindly ask you to actively add your reviews about the drug: whether the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not stated by the manufacturer in the annotation. Analogues of Nuvaring in the presence of existing structural analogues. Use of a contraceptive hormonal ring to prevent pregnancy in women, as well as during pregnancy and breastfeeding. The likelihood of conception after using the drug. Compound.

Nuvaring- a combined hormonal contraceptive drug for intravaginal use. Contains etonogestrel, which is a progestogen, a derivative of 19-nortestosterone, and ethinyl estradiol, which is an estrogen.

The main mechanism of contraceptive action of the drug NuvaRing is inhibition of ovulation. The progestin component (etonogestrel) inhibits the synthesis of LH and FSH by the pituitary gland and, thus, prevents follicle maturation (blocks ovulation).

The Pearl index, an indicator reflecting the frequency of pregnancy in 100 women during a year of contraception, when using the drug NuvaRing is 0.96.

The use of the drug reduces the pain and intensity of menstrual-like bleeding, reduces the frequency of acyclic bleeding and the likelihood of developing iron deficiency conditions. In addition, there is evidence of a reduced risk of endometrial and ovarian cancer with the use of the drug. NuvaRing does not reduce bone mineral density.

Compound

Ethinyl estradiol + Etonogestrel + excipients.

Pharmacokinetics

Etonogestrel

Etonogestrel released from NuvaRing is rapidly absorbed by the vaginal mucosa. Absolute bioavailability is about 100%. Etonogestrel binds to serum albumin and sex hormone binding globulin (SHBG). Etonogestrel and its metabolites are excreted in urine and bile in a ratio of 1.7:1. T1/2 of metabolites is approximately 6 days.

Ethinyl estradiol

Ethinyl estradiol released from NuvaRing is rapidly absorbed by the vaginal mucosa. The absolute bioavailability is approximately 56%, which is comparable to the bioavailability of oral ethinyl estradiol. Ethinyl estradiol binds to serum albumin. Ethinyl estradiol is not excreted unchanged; its metabolites are excreted in urine and bile in a ratio of 1.3:1.

Indications

• contraception.

Release forms

Vaginal ring No. 1 and No. 3 (quantity per package).

Instructions for use and method of use

NuvaRing is inserted into the vagina once every 4 weeks. The ring is in the vagina for 3 weeks and then removed on the same day of the week on which it was placed in the vagina; after a week's break, a new ring is inserted. For example: if the NuvaRing ring was installed on Wednesday at approximately 10:00 pm, then it should be removed on Wednesday 3 weeks later at approximately 10:00 pm; on the following Wednesday a new ring is inserted.

Bleeding associated with discontinuation of the drug usually begins 2-3 days after removal of the NuvaRing and may not completely stop until a new ring is installed.

Hormonal contraceptives were not used in the previous menstrual cycle

NuvaRing should be administered on the first day of the cycle (i.e., the first day of menstruation). It is possible to install a ring on days 2-5 of the cycle, however, in the first cycle in the first 7 days of using the drug NuvaRing, additional use of barrier methods of contraception is recommended.

Switching from taking combined oral contraceptives

NuvaRing should be administered on the last day of the free interval in taking combined hormonal contraceptives (pills or patch). If a woman has been taking the combined hormonal contraceptive correctly and regularly and is confident that she is not pregnant, she can switch to using a vaginal ring on any day of her cycle.

The duration of the interval in taking hormonal contraceptives should not exceed the recommended period.

Switching from progestin-only contraception (mini-pill, implant, or injectable contraception) or progestogen-releasing intrauterine device (IUD)

A woman taking the mini-pill can switch to using NuvaRing on any day (the ring is inserted on the day the implant or IUD is removed or on the day of the next injection). In all these cases, the woman should use a barrier method of contraception for the first 7 days after insertion of the ring.

After an abortion performed in the 1st trimester of pregnancy

You can start using NuvaRing immediately after an abortion. In this case, there is no need for additional use of other contraceptives. If the use of NuvaRing immediately after an abortion is undesirable, the ring should be used in the same way as if hormonal contraceptives were not used in the previous cycle. In the interval, the woman is recommended an alternative method of contraception.

After childbirth or abortion performed in the 2nd trimester of pregnancy

Use of NuvaRing should begin within the 4th week after childbirth (if the woman is not breastfeeding) or abortion in the 2nd trimester. If the use of NuvaRing is started at a later date, then additional use of barrier methods of contraception is necessary in the first 7 days of using NuvaRing. However, if sexual intercourse has already taken place during this period, you must first exclude pregnancy or wait until your first menstruation before starting to use the drug NuvaRing.

The contraceptive effect and cycle control may be impaired if the patient does not comply with the recommended regimen. To avoid loss of contraceptive effect in case of deviation from the regimen, you must follow the following recommendations.

Extending the break from using the ring

If you had sexual intercourse during a break from using the ring, pregnancy should be ruled out. The longer the break, the higher the likelihood of pregnancy. If pregnancy is ruled out, a new ring should be inserted into the vagina as quickly as possible. Over the next 7 days, an additional barrier method of contraception, such as a condom, can be used.

If the ring has been temporarily removed from the vagina

If the ring remains outside the vagina for less than 3 hours, the contraceptive effect will not decrease. The ring should be reinserted into the vagina as soon as possible.

If the ring was left outside the vagina for more than 3 hours during the first or second week of use, the contraceptive effect may be reduced. You should place the ring in your vagina as soon as possible. Over the next 7 days, you must use a barrier method of contraception, such as a condom. The longer the ring was outside the vagina and the closer this period is to the 7-day break in using the ring, the higher the likelihood of pregnancy.

If the ring was left outside the vagina for more than 3 hours during the third week of use, the contraceptive effect may be reduced. The woman should throw away this ring and choose one of two methods:

1. Immediately install a new ring. Please note that 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's effect. However, spotting or bleeding in the middle of the cycle is possible.

2. Wait for bleeding associated with the cessation of the drug’s effect, and insert a new ring no later than 7 days after removing the previous ring. This option should only be chosen if the ring use regimen has not previously been violated during the first 2 weeks.

Extended use of the ring

If the drug NuvaRing was used for no more than a maximum period of 4 weeks, then the contraceptive effect remains sufficient. You can take a week's break from using the ring and then insert a new ring. If NuvaRing remains in the vagina for more than 4 weeks, the contraceptive effect may deteriorate, so pregnancy must be ruled out before inserting a new ring.

To change the time of onset of menstrual bleeding

To delay (prevent) menstrual-like withdrawal bleeding, you can insert a new ring without a week's break. The next ring must be used within 3 weeks. This may cause bleeding or spotting. Then, after the usual one-week break, you should return to regular use of NuvaRing.

To postpone the onset of bleeding to another day of the week, it may be recommended to take a shorter break from using the ring (for as many days as necessary). The shorter the interval between ring use, the higher the likelihood that there will be no bleeding after ring removal, and no bleeding or spotting will occur when the next ring is used.

Ring damage

In rare cases, ring rupture has occurred when using NuvaRing. The core of the NuvaRing ring is solid, so its contents remain intact, and the release of hormones does not change significantly. If the ring ruptures, it usually falls out of the vagina. If the ring ruptures, a new ring must be inserted.

Ring falling out

NuvaRing has sometimes been reported to fall out of the vagina, for example, when it was inserted incorrectly, when a tampon was removed, during sexual intercourse, or due to severe or chronic constipation. In this regard, it is advisable for a woman to regularly check the presence of the NuvaRing ring in the vagina.

Incorrect insertion of the ring

In very rare cases, women have inadvertently inserted NuvaRing into the urethra. When symptoms of cystitis appear, it is necessary to consider the possibility of incorrect insertion of the ring.

Rules for using NuvaRing

The patient can independently insert NuvaRing into the vagina. To insert the ring, a woman should choose the position that is most comfortable for her, for example, standing, raising one leg, squatting, or lying down. NuvaRing must be squeezed and inserted into the vagina until the ring is in a comfortable position. The exact position of NuvaRing in the vagina is not decisive for the contraceptive effect.

After insertion, the ring must remain in the vagina continuously for 3 weeks. If the ring was accidentally removed, it should be washed with warm (not hot) water and immediately inserted into the vagina.

To remove the ring, you can pick it up with your index finger or squeeze it between your index and middle fingers and pull it out of the vagina.

Side effect

• vaginal infection (candidiasis, vaginitis);
• cystitis, cervicitis, urinary tract infections;
• weight gain;
• increased appetite;
• depression;
• decreased libido;
• mood changes;
• headache;
• migraine;
• dizziness;
• visual impairment;
• tides;
• abdominal pain;
• nausea, vomiting;
• bloating;
• diarrhea;
• constipation;
• acne;
• alopecia;
• eczema;
• skin itching;
• skin rash;
• pain in the lumbar region;
• muscle spasms;
• pain in the limbs;
• dysuria;
• engorgement and tenderness of the mammary glands;
• genital itching;
• pelvic pain;
• vaginal discharge;
• amenorrhea;
• ectropion of the uterus;
• menorrhagia, metrorrhagia;
• premenstrual syndrome;
• dysmenorrhea;
• uterine spasm;
• burning sensation in the vagina;
• dryness of the vulva and vaginal mucosa;
• local reactions on the part of the penis (sensation of a foreign body by the partner during sexual intercourse, irritation of the penis with increased sensitivity to the components of the drug);
• prolapse of the vaginal ring;
• fatigue;
• malaise;
• stomach ache;
• swelling;
• sensation of a foreign body in the vagina.

Contraindications

• venous thrombosis (including a history), including deep vein thrombosis, pulmonary embolism;
• arterial thrombosis (including a history), including stroke, transient cerebrovascular accidents, myocardial infarction and/or precursors of thrombosis, including angina pectoris, transient ischemic attack;
• heart defects with thrombogenic complications;
• changes in blood parameters indicating a predisposition to the development of venous or arterial thrombosis, including resistance to activated protein C, antithrombin 3 deficiency, protein C deficiency, protein S deficiency, hyperhomocysteinemia and antiphospholipid antibodies (anticardiolipin antibodies, lupus anticoagulant);
• migraine with focal neurological symptoms;
• arterial hypertension (systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg);
• diabetes mellitus with vascular damage;
• pancreatitis incl. history, in combination with severe hypertriglyceridemia;
• severe liver diseases, until normalization of liver function indicators;
• liver tumors (including history);
• hormone-dependent malignant tumors (for example, breast cancer), known, suspected or in history;
• bleeding from the vagina of unknown etiology;
• pregnancy (including suspected);
• lactation period;
• surgical interventions followed by long-term immobilization;
• smoking (15 or more cigarettes per day) in women 35 years of age and older;
• hypersensitivity to the components of the drug.

The drug should be prescribed with caution if any of the following disease conditions or risk factors are present; in such cases, the doctor must carefully weigh the benefit-risk ratio of using the drug NuvaRing:

• venous or arterial thrombosis (in siblings and/or parents);
• obesity (body mass index more than 30 kg/m2);
• dyslipoproteinemia;
• varicose veins (in combination with thrombophlebitis of the superficial veins);
• atrial fibrillation;
• diabetes;
• systemic lupus erythematosus;
• hemolytic-uremic syndrome;
• epilepsy;
• chronic inflammatory bowel diseases (Crohn's disease and ulcerative colitis);
• sickle cell anemia;
• congenital hyperbilirubinemia (Gilbert, Dubin-Johnson, Rotor syndromes);
• chloasma;
• uterine fibroids;
• fibrocystic mastopathy;
• conditions that make it difficult to use a vaginal ring: cervical prolapse, bladder hernia, rectal hernia, severe chronic constipation;
• adhesions in the vagina;
• smoking (less than 15 cigarettes per day) in women 35 years of age and older.

If the disease worsens, the condition worsens, or other risk factors appear, the woman should also consult a doctor and possibly discontinue the drug.

Use during pregnancy and breastfeeding

The use of NuvaRing is contraindicated during pregnancy, suspected pregnancy and lactation.

NuvaRing is contraindicated during breastfeeding. NuvaRing can affect lactation, reduce the amount and change the composition of breast milk. Small amounts of contraceptive steroids and/or their metabolites may be excreted in milk.

special instructions

Before prescribing or resuming the use of the drug NuvaRing, you should conduct a medical examination: analyze your medical history (including family history) and exclude pregnancy; measure blood pressure; conduct an examination of the mammary glands, pelvic organs, including cytological examination of smears from the cervix; conduct some laboratory tests to exclude contraindications and reduce the risk of possible side effects of the drug NuvaRing. The frequency and nature of medical examinations are carried out by a specialist, taking into account the individual characteristics of each woman, but at least once every 6 months.

The patient should read the instructions for use of the drug NuvaRing and follow all recommendations.

It should be kept in mind that NuvaRing does not protect against HIV infection (AIDS) and other sexually transmitted diseases.

Women aged 40 years and older, women with cervical intraepithelial neoplasia, as well as women who smoke at any age require additional consultation with a gynecologist before prescribing NuvaRing.

The effectiveness of the drug NuvaRing may decrease if the regimen is not followed.

While using NuvaRing, acyclic bleeding (spotting or sudden bleeding) may occur. If such bleeding is observed after regular cycles while using NuvaRing in accordance with the instructions, you should contact your gynecologist to conduct the necessary diagnostic tests, incl. to exclude a malignant tumor and pregnancy. A diagnostic curettage may be required.

Some women do not bleed after the ring is removed. If NuvaRing is used as directed, it is unlikely that the woman is pregnant. If the recommendations of the instructions are not followed and there is no bleeding after removing the ring, as well as if there is no bleeding in two cycles in a row, pregnancy must be excluded.

The most important risk factor for developing cervical cancer is infection with the human papillomavirus (HPV). Epidemiological studies have shown that long-term use of combined hormonal contraceptives further increases this risk, but the extent to which this is due to other factors remains unclear. The positive role of regular examinations of women by a gynecologist and the use of barrier methods of contraception are obvious. There is no information about an increased risk of developing cervical cancer in HPV-infected women using NuvaRing.

Studies have found a small increase in the relative risk (1.24) of developing breast cancer in women taking combined hormonal oral contraceptives, but this risk gradually decreases over 10 years after discontinuation of the drugs. Breast cancer is rare in women under 40 years of age, so the additional incidence of breast cancer in women who have received or continue to use combined oral contraceptives is small compared to the overall risk of developing breast cancer. There is evidence that women who have taken oral combined contraceptives have less breast cancer than women who have never used such medications. The possibility of the effect of the drug NuvaRing on the incidence of breast cancer is being studied.

In rare cases, benign liver tumors were observed in women taking combined oral contraceptives, and even more rarely, malignant ones. In some cases, these tumors led to the development of life-threatening bleeding into the abdominal cavity. If severe pain appears in the upper abdomen, liver enlargement, or signs of intra-abdominal bleeding in a woman using NuvaRing, a liver tumor should be excluded.

Although many women taking hormonal contraceptives experience a slight increase in blood pressure, clinically significant hypertension is rare. A direct connection between the use of hormonal contraceptives and the development of arterial hypertension has not been established. However, if, when using the drug NuvaRing, there is a constant increase in blood pressure, the patient should contact her gynecologist; in such cases, the ring should be removed, antihypertensive therapy should be prescribed and the issue of choosing the most acceptable method of contraception, incl. possible resumption of use of the drug NuvaRing.

Although estrogens and progestogens can influence peripheral insulin resistance and tissue tolerance to glucose, there is no evidence to support the need to change hypoglycemic therapy during the use of hormonal contraceptives. However, women with diabetes should be under constant medical supervision when using NuvaRing, especially in the first months of contraception.

The use of contraceptive steroids may affect the results of certain laboratory tests, including biochemical indicators of liver, thyroid, adrenal and kidney function, plasma levels of transport proteins (for example, corticosteroid binding globulin and sex hormone binding globulin), lipid/lipoprotein fractions, carbohydrate metabolism parameters and indicators of coagulation and fibrinolysis. Indicators, as a rule, vary within normal values.

Serious surgery (including on the lower extremities) is a contraindication to the use of the drug. In case of planned surgery, it is recommended to stop using the drug at least 4 weeks in advance, and resume no earlier than 2 weeks after complete restoration of motor activity.

Women predisposed to the development of chloasma should avoid exposure to sunlight and ultraviolet radiation while using NuvaRing.

The extent of exposure and possible pharmacological effects of ethinyl estradiol and etonogestrel on the glans mucosa and skin of the penis have not been studied.

Impact on the ability to drive vehicles and operate machinery

Considering the pharmacodynamic properties of the drug NuvaRing, its effect on the ability to drive a car and use complex equipment is not expected.

Drug interactions

Interactions between hormonal contraceptives and other drugs may lead to the development of acyclic bleeding and/or contraceptive failure.

There may be an interaction with drugs that induce microsomal enzymes, which can lead to increased clearance of sex hormones.

The effectiveness of NovaRing may be reduced with the simultaneous use of antiepileptic drugs (phenytoin, phenobarbital, primidone, carbamazepine, oxcarbazepine, topiramate, felbamate), anti-tuberculosis drugs (rifampicin), antimicrobial drugs (ampicillin, tetracycline, griseofulvin), possibly antiviral drugs (ritonavir) and medicines containing St. John's wort.

When treating any of the listed drugs, a woman should temporarily use a barrier method of contraception in combination with the drug NuvaRing or choose another method of contraception. When treating with drugs that induce liver enzymes, a barrier method (condom) should be used during treatment and for 28 days after discontinuation of such drugs.

If concomitant therapy is to be continued after 3 weeks of ring use, the next ring should be administered immediately without the usual interval.

During treatment with antibiotics (excluding amoxicillin and doxycycline), it is necessary to use a barrier method of contraception (condom) during treatment and for 7 days after their discontinuation. If concomitant therapy is to be continued after 3 weeks of ring use, the next ring should be administered immediately without the usual interval.

As a result of pharmacokinetic studies, no effect on the contraceptive effectiveness and safety of the drug NuvaRing when used simultaneously with antifungals and spermicides was identified. When combined with suppositories and antifungal agents, the risk of ring rupture increases slightly.

Hormonal contraceptives can cause disruption of the metabolism of other drugs. Accordingly, their concentrations in plasma and tissues may increase (for example, cyclosporine) or decrease (for example, lamotrigine).

To exclude possible interactions, it is necessary to study the instructions for use of other drugs.

The use of tampons does not affect the effectiveness of NuvaRing. In rare cases, the ring may be accidentally removed when removing the tampon.

Analogues of the hormonal contraceptive Novaring

The drug Nuvaring has no structural analogues of the active substance.

Analogs by pharmacological group (estrogens and gestagens in combinations):

• Angelique;
• Anteovin;
• Belara;
• Dailla;
• Desmoulins;
• Jess;
• Divina;
• Eura;
• Janine;
• Genetten;
• Zoely;
• Individual;
• Claira;
• Klimadinon;
• Klymen;
• Klimonorm;
• Cliogest;
• Lindinet 20;
• Lindinet 30;
• Logest;
• Marvelon;
• Mercilon;
• Midiana;
• Microgynon;
• Novinet;
• Non-Ovlon;
• Ovidon;
• Regulon;
• Rigevidon;
• Silest;
• Triaclim;
• Trigestrel;
• Triquilar;
• Trisequence;
• Femaflor;
• Femoden;
• Femoston;
• Eviana;
• Egestrenol;
• Yarina;
• Yarina Plus.

If there are no analogues of the drug for the active substance, you can follow the links below to the diseases for which the corresponding drug helps, and look at the available analogues for the therapeutic effect.

- a hormonal contraceptive, the intravaginal administration of which leads to inhibition of the synthesis of hormones - and LH, inhibition of ovulation, obstruction of follicle maturation, thereby blocking ovulation and the onset of unexpected pregnancy.

Taking into account the Pearl index, the possible pregnancy after using this contraceptive does not exceed 0.96%. The drug will not affect the decrease in bone density, but can reduce the frequency of acyclic menstrual bleeding and the development of iron deficiency anemia.

Compound

The ring for insertion into the vagina contains:

• ethinyl estradiol (2.7 mg), etonogestrel (11.7 mg), as 2 active ingredients;
• ethylene copolymer, vinyl acetate copolymer, and magnesium stearate as essential excipients.

Release form

Nuvaring is a clear ring for vaginal insertion. It has no special color and is placed in a waterproof bag. Packaging form: packs with 1-3 rings and attached instructions for use.

Effect of the drug

Blocking ovulation occurs thanks to 2 active components in the composition of Nuvaring - estrogen and progesterone, as binders with natural receptors in the female body, having a complex effect on the target organ:

If you use Nuvaring constantly, you will experience:

• regulation of menstrual cycles;
• reduction of spasms, pain syndromes, bleeding;
• obstacle to the development of permissible ectopic pregnancy, ovarian, breast, and endometrial cancer.

With Nuvaring, the components are evenly distributed throughout the tissues of the vaginal mucosa and almost completely absorbed into the systemic bloodstream.

Indications for use

The drug is an excellent and safe contraceptive and is considered the best contraceptive for women of reproductive age.

It has a low-dose combined hormonal effect, promotes:

• preventing the release of an egg from the ovary;
• protection against unwanted pregnancy;
• normalization of menstruation;
• reduction of painlessness, acyclic manifestations.

Nuvaring can be used for uterine fibroids if, of course, according to indications, the tumor has stopped growing.

Although you should first consult your doctor about the advisability of using contraception. Also, the course of the disease improves with endometriosis as the hormonal ring is used.

With the arrival of menstruation, patients begin to lose significantly less blood, pain decreases and the endometrial uterine layer is restored.

Action of Nuvaring– soft and gentle, therefore it does not lead to the failure of systems and organs, and the active ingredients, when they come into contact with the mucous layer of the uterus, begin to have a local therapeutic effect.

Safe days calendar

1st day of last menstruation

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

January February March April May June July August September October November December

Average cycle length

20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35

Duration of menstruation

2 3 4 5 6 7 8 9 10

Contraindications

In some cases, the use of rings is unacceptable and is contraindicated for medical reasons.

Studies have not been conducted on the use of Nuvaring for girls under 18 years of age, so its safety and effectiveness have not been established. It is not recommended to use the device in early adolescence. If, out of ignorance, it was still used, then if unpleasant symptoms appear, you should urgently stop the drug and consult a doctor.

A contraceptive should be used with caution, after first assessing the possible risks and benefits:

If these diseases worsen and the condition worsens sharply, then you need to stop the drug and consult a specialist.

Side effects

Side effects after using Nuvaring are rare, but cases have been reported:

Side effects often occur when Nuvaring is taken with other hormonal drugs in combination, when allergies, acne, decreased libido, and vomiting may occur.

Instructions for use Nuvaring rings

You can insert the ring into the vagina with your own hands and in the comfort of your home.

It's easy to do, just:

If you violate the rules and mode of application, the effectiveness of the impact will be greatly underestimated.

On a note! If the ring is accidentally broken, the concentration of released hormones should not change. Usually a damaged ring falls out immediately. In this case, it is advisable to immediately replace it with a new one.

Terms of use

If the ring falls out

IMPORTANT! It happens that the drug suddenly falls out due to improper use or as a result of combined removal with a tampon. In this case, you can rinse with warm water and put it back on. If necessary, you can change the arrival time of menstruation, for example, shorten the break by using the device for the required number of days.

Use of oral contraceptives

If you have previously used oral contraceptives, then switching to the ring should be done on the last, 7th day of the intermediate interval between courses.

In this case, women are advised to first make sure that there is no pregnancy and only then start taking Nuvaring correctly, regularly, starting on any day of the cycle.

After childbirth and abortion

If, for medical reasons, using the device during an abortion is undesirable, then you can choose a different method of contraception in the interval between menstrual cycles.

During the postpartum period or after surgery (abortion), the use of Nuvaring should be started from the 4th week. If you had sexual intercourse during the first 7 days, then it is advisable to check first to see if there is any pregnancy, then, if it is ruled out, wait for the arrival of menstruation and start using the drug again.

In addition, while using contraception, women should not neglect the following rules and recommendations:

When using a hormonal contraceptive, it is not recommended to violate the frequency and exceed the time period of 3 weeks. If mini-pills have been used previously, the contraceptive ring should be inserted immediately the next day or wait a 7-day break using additional barrier methods.

Dosage

It is recommended to use the ring once a month by inserting it on the 1st day of menstrual bleeding. If there was no use of hormonal contraception in the previous menstrual cycle, then Nuvaring can be started on days 2-5 of the cycle.

The ring stays in the vagina for 3 weeks.

Falling out or deliberate removal should not be prolonged. It is not necessary to change the drug to a new one. If it is in intact condition, then it is enough to rinse with warm water and re-introduce it within the next three hours.

Overdose

Doctors do not indicate an overdose when using the drug, even if it remains in the vagina for more than three weeks.

In some cases, nausea, vomiting, and minor bleeding from the vagina may occur, but this is observed exclusively in girls using the drug for the first time.

Interaction with other drugs

The effect of the drug may be reduced if you take certain medications at the same time:

1. If it is necessary to carry out concomitant therapy, then when taking Nuvaring you should first consult a doctor, so as not to get adverse reactions later.
2. A number of drugs may well lead to acyclic bleeding. Should not be taken together. Ring rupture is also possible when taken simultaneously with the antifungal “Spermicide”.
3. If used in conjunction with suppositories, in order to avoid unpleasant consequences from interaction, it is important to study the instructions before using other vaginal contraceptives.

Tampons and pads will not have a negative impact and will not affect the effect when Nuvaring is administered, although it happens that the ring is removed accidentally, together with the removal of the tampon.

Use during pregnancy and breastfeeding

Nuvaring is designed to protect the female body from unwanted pregnancy.

The drug should not be used once pregnancy occurs, as soon as it is known.

In this condition, it is important to stop contraception in a timely manner, despite the absence of cases of detecting defects in newborns.

Nuvaring is administered topically, into the vagina, and is considered a safe drug, but it is not advisable to use it while breastfeeding. The active ingredients will negatively affect lactation and reduce the production of breast milk.

It is known that metabolites and steroids are excreted in breast milk, although a negative impact on the health of children has not been proven.

Reception for children

The use of Nuvaring for children and adolescents is undesirable, since safety has not been studied or proven.

special instructions

Analogs

There are no drugs known today that are similar in effect and composition to Navarng.

Taking into account the pharmacological group, the combination of estrogens and gestagens, the following can be considered analogues:1476 rub.

You can buy a Nuvaring device through an online pharmacy on the website - wer.ru for 1307 RUR, to Europharm – for 3699 rub.

Among the methods of pregnancy planning, great importance is given to the prevention of unwanted conception. For this purpose, various means of contraception are used: condoms, pills, IUDs. But there are also quite exotic pharmacological forms, for example, a vaginal contraceptive ring called NuvaRing (or Nova Ring). Many women are hearing about this for the first time, so it is necessary to pay attention to the features, method of use, indications and limitations of this remedy.

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.

Distribution in the body

Substances contained in the ring are actively released from it and absorbed through the vaginal mucosa. They enter the bloodstream, where they reach maximum concentrations after about three days (ethinyl estradiol) and a week (etonogestrel) from the start of use. Bioavailability is high, comparable to the use of tablet contraceptives. Once in the blood plasma, the active substances bind to proteins (mainly albumin) and in this form are transported to target organs. Metabolism occurs in the liver, the half-life of drugs ranges from 29 to 36 hours, and excretion from the body is carried out by the kidneys (with urine) and intestines (with bile).

Indications

The NuvaRing ring is used as routine contraception. But it also has medicinal properties, which makes it possible to use this pharmacological form for some gynecological diseases. We are talking about menstrual dysfunction, when the cycle is irregular and periods are painful.

When using a ring to prevent unwanted conception, you can be confident in its reliability and high effectiveness. The probability of pregnancy occurring within a year of using a contraceptive does not exceed 0.9. This is a high rate, comparable to taking hormonal pills. But besides this, the NuvaRing ring has other advantages:

• Ease of use (replacement is carried out once a month).
• A predominantly local effect on the genital organs is provided.
• There is no chance of weight gain.
• The menstrual cycle is normalized.
• The risk of cancer of the uterus and ovaries is reduced.
• The ring does not affect sensations during sexual intercourse.
• Rapid resumption of fertility (4 weeks after extraction).

A wide list of positive qualities should increase patients' adherence to this method of contraception. But, compared to other means of contraception, it also has a number of disadvantages. Firstly, using a ring is quite unusual for a woman. Secondly, it does not protect against sexually transmitted infections (unlike a condom). And thirdly, there are many contraindications and restrictions for using NuvaRing.

As a contraceptive, the ring has many advantages. But there are certain disadvantages that limit its use.

Usage

Before using the ring, a woman should consult a gynecologist. The doctor will conduct an examination, based on the results of which he will tell whether she can use such a contraceptive. The specialist should explain how and when it is best to administer it and what can be expected in the long term.

Acting according to the instructions, a woman can easily install the NuvaRing ring herself. To do this, she must first choose a suitable position: lying on her back, squatting or standing with her leg raised. Squeezing the contraceptive with two fingers, she inserts it. The position of the ring in the vagina should be comfortable, and the contraceptive effect does not depend on its accuracy.

The time when you start using the ring is important. The optimal timing of administration is determined by several factors:

• No other contraceptives were used on the first day of the menstrual cycle.
• After taking combined estrogen-gestagen drugs (tablets or patches) - on the last day of the interval between their administration.
• Switching from monocomponent gestagenic agents - at any time of the cycle.
• With early abortion - immediately after termination of pregnancy.
• In the postpartum period or during an abortion in the second trimester - after 1 month.

The ring remains in the vagina for 3–4 weeks. Use beyond this period reduces the contraceptive effect. If the NuvaRing falls out spontaneously, it must be reinserted as soon as possible. If the ring was in the external environment for more than 3 hours, then its effect also decreases. In the intervals between installing a contraceptive, as well as in the first 7 days of its use, you should use an additional means in the form of a condom (after childbirth or abortion, this is not necessary).

Side effects

The NuvaRing contraceptive ring has a number of side effects. They occur with varying frequency and not in all women. Much depends on the individual characteristics of the body. The following side effects may occur while using the ring:

• Gynecological: inflammatory processes (cervicitis), vaginal discharge, itching, burning and dryness in the vagina, scanty bleeding (including contact and acyclic), discomfort during sexual intercourse, ectropion, cervical polyps; swelling and tenderness of the mammary glands, mastopathy.
• Urological: cystitis, dysuric disorders (frequent urge).
• Digestive: nausea, loss of appetite, abdominal pain, flatulence, constipation.
• Neuropsychiatric: migraine headaches, visual disturbances, dizziness, weakness and fatigue, irritability, decreased libido, depression.
• Skin-allergic: itching, pinpoint rash, urticaria, acne.
• Vascular: sensation of heat, thrombotic conditions.

In addition to the effects due to the content of active components, the ring may simply fall out of the vagina, rupture, or cause discomfort due to the shape itself. But to keep the risk of any side effects minimal, it should be used only after consulting a doctor and undergoing an appropriate examination. Compliance with all recommendations and requirements of the instructions will minimize adverse events.

The use of the NuvaRing ring may be associated with various unpleasant symptoms. But their likelihood can be reduced by strictly observing all conditions of use.

Restrictions and contraindications

Like any medication, the ring with etonogestrel and ethinyl estradiol has certain limitations that make the use of NuvaRing impossible or extremely undesirable. All such conditions must be taken into account by the doctor at the examination stage.

The contraceptive in question has a number of contraindications. The instructions for the NuvaRing contraceptive ring indicate that it should not be used in the following cases:

• Thrombotic conditions, including predisposition to them.
• Associated migraine (combined with neurological disorders).
• Diabetes complicated by angiopathy.
• Severe liver pathology (including oncology).
• Hormone-sensitive gynecological tumors.
• Metrorrhagia with unknown cause.
• Pregnancy (confirmed and probable).
• Individual hypersensitivity to the components of the ring.

It is necessary to treat conditions such as hypertension, dyslipidemia, heart defects, systemic connective tissue diseases, inflammatory bowel disease, and sickle cell anemia with caution. Some restrictions relate to difficulties when introducing a contraceptive into the vagina, which can be observed with uterine prolapse, constipation, rectal diverticula, hernial protrusions of the bladder wall.

special instructions

If pregnancy develops while using NuvaRing, the ring will have to be removed immediately. Studies confirming the safety of local combined contraceptives for the fetus are insufficient to definitively say that there are no undesirable consequences. You should also not use this method while breastfeeding your baby. The effectiveness of the ring in adolescent girls is unknown.

In women using combinations of estrogens and progestins as contraceptives, cases of increased blood pressure have been reported, but a direct relationship between these events has not yet been established. With proper use of antihypertensive drugs, this effect is neutralized. There are indications of the effect of the active substances included in the ring on carbohydrate tolerance. But this does not require any changes in glucose-lowering therapy.

The components of NuvaRing may have a certain effect on the results of some laboratory tests: liver tests, thyroid and adrenal hormones, kidney function indicators, lipid spectrum, coagulogram. But all changes are within the reference values. The use of tampons does not affect the effectiveness of the ring.

If, while using the drug in question, a woman experiences any symptoms described as side effects or other alarming symptoms, she should immediately consult a doctor. Mild reactions do not require removal of the ring, but in some cases you should still stop using it and switch to other contraceptives.

Every woman should remember about contraindications and other restrictions that could become an obstacle to using NuvaRing.

Interaction

Estrogen-progestin contraceptives, including NuvaRing, may interact with other medications. Acceleration of metabolism, and therefore a decrease in the contraceptive effect, can be observed with parallel administration of inducers of microsomal oxidation in the liver. Such drugs include barbiturates, rifampicin, carbamazepine, ritonavir, and preparations based on St. John's wort. The effect of the ring is inhibited by taking antibiotics from the group of ampicillin and tetracycline. Therefore, the patient should inform the doctor about all medications taken.

The NuvaRing ring is a highly effective hormonal contraceptive. Due to its form, it has a predominantly local effect on the genitals. There are other positive qualities that contribute to the widespread use of the ring. But it can only be used in strict accordance with medical recommendations and instructions. This allows you to minimize the risk of adverse events and achieve a stable result.

Pharmacodynamics. The NuvaRing contains etonogestrel and ethinyl estradiol. Etonogestrel is a progestogen, a derivative of 19-nortestosterone, which has a high affinity for progesterone receptors in target organs. Ethinyl estradiol is an estrogen widely used in contraceptives. The contraceptive effect of NuvaRing is based on different mechanisms, the main one of which is inhibition of ovulation.
The Pearl Index for the NuvaRing ring is 0.765. In addition to protecting against pregnancy, NuvaRing regulates the menstrual cycle, reduces the severity of pain and the intensity of bleeding (which reduces the risk of developing iron deficiency anemia). There is evidence of a reduced risk of developing endometrial and ovarian cancer.
Pharmacokinetics.
Etonogestrel
Etonogestrel, released from the NuvaRing ring, is quickly absorbed by the vaginal mucosa. The maximum plasma concentration of etonogestrel (average 1700 pg/ml) is achieved approximately 1 week after insertion of the ring. Then after 3 weeks the concentration slowly decreases to 1400 pg/ml. Absolute bioavailability is 100% (which is higher than when using oral contraceptives). Etonogestrel combines with serum albumin and sex hormone binding globulin. The volume of distribution of etonogestrel is 2.3 l/kg body weight.
Etonogestrel is metabolized by hydroxylation and reduction to form sulfate and glucuronide conjugates. The rate of elimination of metabolites from blood plasma is on average 3.5 l/h. There was no interaction of etonogestrel with concomitantly taken ethinyl estradiol. The concentration of etonogestrel in the blood plasma decreases in 2 stages. The half-life at the last stage is about 29 hours. Etonogestrel and its metabolites are excreted in urine and bile in a ratio of 1.7:1. The half-life of metabolites is about 6 days.
Ethinyl estradiol
Ethinyl estradiol, released from the NuvaRing ring, is quickly absorbed by the vaginal mucosa. The maximum concentration in blood plasma (about 35 pg/ml) is reached approximately on the 3rd day after insertion of the ring and decreases to 18 pg/ml after 3 weeks. The absolute bioavailability is 56%, which corresponds to the level of bioavailability of ethinyl estradiol when taken orally.
Ethinyl estradiol is metabolized by aromatic hydroxylation to form hydroxylated and methylated metabolites. These metabolites are present both in the free state and as conjugates of glucuronides and sulfates. The effective clearance is approximately 35 l/h. The level of ethinyl estradiol in the blood plasma decreases in 2 stages. The half-life at the last stage is characterized by significant individual differences with an average value of 34 hours. Ethinyl estradiol is not excreted unchanged. Ethinyl estradiol metabolites are excreted in urine and bile in a ratio of 1.3:1. The half-life of metabolites is 1.5 days.

Indications for use of the drug Nuvaring

Contraception.

Use of the drug Nuvaring

The NuvaRing ring is inserted into the vagina by the woman herself. The doctor should inform the woman how to insert and remove NuvaRing. To insert the ring, take a comfortable position: stand with your leg raised, sit down or lie down. Before insertion, the NuvaRing ring must be compressed and inserted into the vagina so that it fits well. The exact position of the ring in the vagina is not decisive for the contraceptive effect.
From the moment of insertion, the ring should remain in the vagina continuously for 3 weeks. If the ring is accidentally removed (for example, when removing a tampon), it should be rinsed with cold or cool (not hot) water and immediately reinserted into the vagina. NuvaRing should be removed after 3 weeks on the same day of the week when it was inserted. After a week's break, a new ring must be inserted. The NuvaRing can be removed by lifting it with your index finger or holding the ring between your index and middle fingers. Bleeding associated with discontinuation of the drug usually begins 2-3 days after NuvaRing is removed and may continue until the day the next ring is inserted.
Getting started
If hormonal contraceptives were not used during the previous menstrual cycle, NuvaRing must be administered between the 1st and 5th day of the cycle, but no later than the 5th day from the start of menstruation, even if the bleeding has not stopped yet. During the first 7 days of using NuvaRing, it is recommended to additionally use a condom.
Switching from combined oral contraceptives (COCs)
NuvaRing must be administered the next day after a break in taking the drug or after a period of taking placebo tablets in a COC course.
Switching from progestogen-only medications (mini-pill, implant, or injection) or from a progestogen-releasing intrauterine system
A woman taking the mini-pill can switch to NuvaRing any day. When using an implant or intrauterine system that releases progestogen, the transition occurs on the day of its removal, and when using injections, on the day of the next scheduled injection. In all of these cases, the woman should use an additional barrier method during the first 7 days.
After an abortion in the first trimester
You can start using the ring immediately after an abortion. There is no need for additional methods of contraception. If the use of NuvaRing immediately after an abortion is undesirable, you should follow the recommendations (see “If hormonal contraceptives were not used during the previous menstrual cycle”).
After childbirth or abortion in the second trimester
Women are recommended to start using the ring during the 4th week after childbirth or abortion in the second trimester. If the ring is used later, it is recommended to additionally use the barrier method during the first 7 days of using NuvaRing. If you have sexual intercourse during this period, before introducing NuvaRing, you must first rule out pregnancy or wait until the next menstruation.
Deviations from the recommended regime
The effectiveness of contraception and control of the menstrual cycle may be impaired if a woman does not adhere to the recommended regimen. To avoid a decrease in the effectiveness of contraception if the regimen is violated, the following recommendations should be followed.
When extending the break in using the ring
If you miss a ring replacement, a new ring should be inserted as soon as possible and a barrier method of contraception (condom) should be additionally used for the first 7 days. If you had sexual intercourse during the break from using the ring, the risk of pregnancy should be assessed. The longer the break, the higher the risk of pregnancy.
If there is a temporary absence of a ring in the vagina
The NuvaRing ring should be kept in the vagina continuously for 3 weeks. Accidental removal and absence of a ring in the vagina for ≤3 hours does not affect the effectiveness of contraception. The ring should be reinserted as quickly as possible, no later than after 3 hours. The absence of the ring in the vagina for 3 hours reduces the effectiveness of contraception. You should insert the ring as soon as possible and use a barrier method of contraception (condom) for 7 days from the time the ring is inserted into the vagina. If the first of these 7 days falls on the 3rd week of using the ring, NuvaRing should be used for longer than 3 weeks. Then the ring should be removed and a new one inserted after a week's break.
If the ring is removed for a period of 3 hours during the 1st week of using the ring, the risk of pregnancy should be weighed.
As the period of use of the ring increases
The maximum period of use of NuvaRing without loss of contraceptive effectiveness is 4 weeks. You should take a week's break from using the ring and then insert a new one. Keeping NuvaRing in the vagina for 4 weeks reduces the effectiveness of contraception, and pregnancy should be ruled out before inserting a new ring.
If the recommended regimen is violated and menstruation is delayed during the next break in using the ring, pregnancy should be ruled out before introducing a new ring.
Change in timing or delay of menstruation
To delay menstruation, a new ring should be inserted without a week's break. The new ring should also be used for 3 weeks. During this period, a woman may experience light or thick bleeding. In the future, after the usual one-week break from using the ring, regular use of NuvaRing should be resumed.
Changing the period of menstruation, moving it to another day of the week that does not coincide with the planned day of insertion of the ring, should be done by shortening the next break by the required number of days. The shorter the previous break, the higher the risk of no menstruation, or the appearance of thick or light bleeding during the next break.

Contraindications to the use of the drug Nuvaring

Venous thrombosis with/without pulmonary embolism currently or in history; arterial thrombosis (cerebrovascular accident, myocardial infarction) or precursors of thrombosis (angina pectoris or transient ischemic cerebrovascular accident) currently or in history; predisposition to venous or arterial thrombosis with or without the inclusion of such hereditary disorders as activated protein C resistance (APC), antithrombin III deficiency, protein C deficiency, protein S deficiency, hyperhomocysteinemia, antiphospholipid antibodies (anticardiolipin antibodies, lupus anticoagulant). migraine with focal neurological symptoms; diabetes mellitus with vascular complications; pancreatitis or previous pancreatitis, which is accompanied by hypertriglyceridemia; severe liver disease (until liver function indicators return to normal values); liver tumor (benign or malignant; present or in history); hormone-dependent malignant tumors (diagnosed or suspected); vaginal bleeding of unknown etiology; diagnosed or probable pregnancy; breastfeeding period; hypersensitivity to any component of the drug.
Use with caution in diabetes mellitus; obesity (body mass index 30 kg/m2); AH (arterial hypertension); atrial fibrillation; heart valve diseases; dyslipoproteinemia; diseases of the liver and gall bladder; Crohn's disease and ulcerative colitis; sickle cell anemia; systemic lupus erythematosus; hemolytic uremic syndrome; epilepsy; smoking over the age of 35; prolonged immobilization; extensive surgical interventions; fibrocystic mastopathy; uterine fibroids; congenital hyperbilirubinemia (Gilbert, Dubin-Johnson and Rotor syndrome); chloasma (avoid sun exposure and ultraviolet radiation); any of the conditions in which the woman will not be able to properly insert or may lose the ring; cervical prolapse; cystocele or rectocele, severe or chronic constipation.

Side effects of the drug Nuvaring

Adverse drug reactions reported in women using NuvaRing® are listed in the table below. The most appropriate MedDRA term (version 11.0) to describe the specific adverse event is appended.

1) List of adverse events based on spontaneous report. It is impossible to determine the exact frequency.
2) Diseases of the genital organ in men (including reports of local reactions).

Special instructions for the use of the drug Nuvaring

Special warnings and special precautions.
If any of the following conditions/risk factors occur, the benefits or risks of continued use of NuvaRing should be considered for each individual woman and discussed with the patient before she decides to use this drug. In case of exacerbation, intensification or first manifestations of any of these conditions, a woman should consult a doctor. The doctor determines the need to use the drug NuvaRing. All data given below are based on epidemiological data obtained from the use of combined oral contraceptives. There are no epidemiological data obtained from the vaginal method of using hormones, but warnings are considered acceptable when using the drug NuvaRing.

1. Circulatory disorders

• Epidemiological studies suggest an association between COC use and an increased risk of arterial and venous thrombosis and thromboembolic diseases such as myocardial infarction, stroke, deep venous thrombosis and pulmonary embolism. These phenomena occur rarely.
• Women using any combined oral contraceptives increases the risk of developing venous thromboembolism (VTE) compared to those not taking COCs. There is a particularly high risk of developing venous thromboembolism in the first year of using COCs. This increased risk is less than the pregnancy-associated risk of VTE, which is estimated to be 6 per 10,000 pregnancies. VTE is fatal in 1-2% of cases.
  It is unknown how NuvaRing affects the risk of VTE compared to other combined hormonal contraceptives.
• Very rarely, thrombosis has been reported to occur in other blood vessels, such as the hepatic, mesenteric, renal, cerebral or retinal veins and arteries, in women using COCs. There is no general consensus on whether these cases are related to the use of COCs.
• Symptoms of venous or arterial thrombotic cases may include: uncharacteristic unilateral lower extremity pain and/or swelling; sudden severe pain in the chest, regardless of whether it radiates to the left arm; sudden dyspnea; sudden attack of coughing; any unusual, severe, prolonged headache; sudden partial or complete loss of vision; diplopia; slurred speech or aphasia; vertigo; collapse with or without focal epileptic seizure; weakness or severe numbness on one side or part of the body; impaired coordination of movements; symptoms of an “acute” abdomen.
• The risk of venous thromboembolism increases due to:
  age;
  family history (presence of venous or arterial thromboembolism in siblings or parents at a relatively early age). If there is a suspicion of a hereditary predisposition, the woman should be referred for consultation with a specialist before making a decision about the use of COCs;
  prolonged immobilization, significant surgical interventions, various surgical interventions on the lower extremities or severe injuries. In these cases, it is recommended to stop taking the drug (in case of planned surgery, at least four weeks in advance) and not to resume it for two weeks after complete remobilization;
  obesity (body mass index more than 30 kg/m2);
  also in the presence of superficial thrombophlebitis and varicose veins. There is no consensus on the possible role of these conditions in the etiology of venous thrombosis.
• The risk of arterial thromboembolism increases due to:
  - age;
  - smoking (the more a person smokes and the older he is, the greater the risk, especially in women over 35 years old);
  - dislipoproteinemia;
  - obesity (body mass index ≤30 kg/m2);
  - AH (arterial hypertension);
  - migraine;
  - heart valve diseases;
  - atrial fibrillation;
  - a burdened family history (for example, arterial thrombosis in a brother/sister or parents at a relatively early age). If a hereditary predisposition is suspected, the woman should be referred to a specialist for advice before deciding to use hormonal contraception.
• Biochemical factors that may indicate hereditary or acquired predisposition to venous or arterial thrombosis include activated protein C (APC) resistance, hyperhomocysteinemia, antithrombin III deficiency, protein C deficiency, protein S deficiency, antiphospholipid antibodies (anticardiolipin antibodies, lupus anticoagulant) .
• Other medical conditions that have been associated with adverse circulatory effects include diabetes mellitus, SLE, hemolytic uremic syndrome, chronic inflammatory bowel disease (Crohn's disease and ulcerative colitis), and sickle cell disease.
• The increased risk of thromboembolism in the postpartum period should be considered (see section "Use during pregnancy or lactation").
• An increase in the frequency or intensity of migraine while taking COCs (which may precede cerebrovascular accident) may be a reason for immediate discontinuation of COC use.

2. Tumors

• The highest risk factor for developing cervical cancer is persistent infection with the human papillomavirus (HPV). Epidemiological studies have suggested that long-term use of COCs may contribute to an increased risk of cervical cancer, but the extent to which this is related to confounding effects, such as increased frequency of cervical screening and variation in sexual behavior, including barrier contraceptive use and causal associations, is unclear. It is unknown how this effect relates to NuvaRing.
• A meta-analysis of 54 epidemiological studies found that there was a small increase in the relative risk (RR = 1.24) of developing breast cancer in diagnosed women who were currently using COCs. The high risk gradually decreases over 10 years after stopping the use of COCs. Because breast cancer rarely occurs in women under 40 years of age, the number of breast cancer diagnoses among current or former COC users is small compared with the overall risk of developing breast cancer. Breast cancer diagnosed in women is generally less advanced clinically than cancer diagnosed in people who have never used COCs. The pattern of increased risk observed may be due to the early diagnosis of breast cancer in women who used COCs, the biological effects of COCs, or a combination of both factors.
• Benign liver tumors and very rarely malignant liver tumors have been rarely reported in women who use COCs. In isolated cases, these tumors caused intra-abdominal bleeding that threatened life. Therefore, liver tumor should be considered in the differential diagnosis if women who use NuvaRing experience severe upper abdominal pain, liver enlargement, or signs of intra-abdominal bleeding.

3. Other states

• When using COCs in women with hypertriglyceridemia or a family history of it, there may be a risk of developing pancreatitis.
• Although slight increases in blood pressure have been reported in many women taking hormonal contraceptives, clinically significant increases are rare. The exact relationship between the use of hormonal contraceptives and hypertension (arterial hypertension) has not been established. However, if persistent clinically significant hypertension (arterial hypertension) develops while using NuvaRing, the doctor should stop using the ring for a while and treat the hypertension (arterial hypertension). The use of the drug NuvaRing can be resumed if blood pressure levels are achieved with the help of antihypertensive therapy.
• The occurrence or worsening of the following conditions has been reported during pregnancy and the use of hormonal contraceptives, but the evidence for an association with their use is inconclusive: jaundice and/or pruritus associated with cholestasis; formation of gallstones; porphyria; SCV ; hemolytic uremic syndrome; chorea; herpes during pregnancy; hearing loss associated with otosclerosis; hereditary angioedema.
• Acute or chronic liver dysfunction may require discontinuation of the drug NuvaRing until liver function indicators normalize. Recurrence of cholestatic jaundice and/or pruritus associated with cholestasis that first occurred during pregnancy or previous use of sex steroids requires discontinuation of ring use.
• Estrogens and progestogens can affect peripheral insulin resistance and impaired glucose tolerance, and there is no need to change the treatment regimen of diabetic patients who use hormonal contraception. However, women with diabetes should be closely monitored while using NuvaRing, especially in the first months of use.
• Worsening of Crohn's disease and ulcerative colitis has been reported in association with the use of hormonal contraceptives.
• Chloasma may occur periodically, especially in women with a history of chloasma during pregnancy. Women who are prone to chloasma are advised to avoid exposure to the sun or exposure to ultraviolet radiation while taking NuvaRing.

If a woman has any of the following conditions, she may not be able to insert the NuvaRing correctly or may lose the ring: cervical prolapse, cystocele and/or rectocele, severe or chronic constipation.
Very rarely, NuvaRing has been reported to be accidentally inserted into the urethra and possibly end up in the bladder. Therefore, the possibility of ring misplacement should be considered in the differential diagnosis if symptoms of cystitis occur.
While using the drug NuvaRing, women may sometimes experience vaginitis. There is no evidence that the effectiveness of the drug NuvaRing is affected by the treatment of vaginitis or that the use of the drug NuvaRing affects the effectiveness of the treatment of vaginitis (see Section Interaction with other drugs and other types of interactions.).
Very rarely, it was reported that the ring grew into the vaginal mucosa, which required the intervention of a specialist doctor.
Medical supervision
Before using or resuming the use of NuvaRing, it is necessary to consult a doctor with a thorough collection of anamnestic data and a medical examination. In the future, the doctor’s examination should be repeated at least once a year with blood pressure measurement, examination of the mammary glands, abdominal and pelvic organs, cytological examination of the cervix and relevant laboratory tests.
The patient should be informed that the use of NuvaRing does not protect against HIV infection (AIDS) and other sexually transmitted diseases.
Reduced efficiency
The effectiveness of NuvaRing may decrease if the regimen is not followed or if certain medications are taken simultaneously.
Deterioration of menstrual cycle control
While using the drug NuvaRing, (minor or heavy) bleeding may be observed. If irregular bleeding occurs after previous regular cycles while using NuvaRing in accordance with the recommended regimen, non-hormonal causes should be considered and adequate diagnostics should be instituted to rule out pregnancy or malignancy, which may include curettage.
Some women may not experience any bleeding during a break from using the ring. If NuvaRing was used in accordance with the recommendations given in the “Method of administration and dosage” section, then the possibility of pregnancy is low. However, if NuvaRing was used without following such recommendations before the first case of absence of bleeding during the period without using the ring, or if there were no bleedings twice in a row, pregnancy should be excluded before continuing to use the drug NuvaRing.
Ring damage
In very rare cases, the NuvaRing ring has been reported to come loose during use (see Section Interactions with other medicinal products or other types of interactions). Since the core of the NuvaRing drug is solid, its contents remain intact and will not significantly affect the release of hormones. If the ring becomes disconnected, it may fall out. If NuvaRing is damaged, the woman should throw away the ring and replace it with a new one.
Removal
NuvaRing may reportedly be removed if the ring is not inserted correctly, when removing a tampon, during coitus, or in cases of severe and chronic constipation. Therefore, a woman is recommended to regularly check for the presence of NuvaRing in the vagina. If NuvaRing is accidentally removed, the woman should follow the instructions.
The effect of ethinyl estradiol and etonogestrel on men
The extent and possible pharmacological effects of ethinyl estradiol and etonogestrel on sexual partners through absorption through the mucous membrane of the male genital organ have not been studied.
Use of the drug during pregnancy or breastfeeding
Pregnancy is a contraindication for the use of NuvaRing. If pregnancy occurs, the ring should be removed.
Estrogens can reduce the amount and change the composition of breast milk. It is not recommended to use NuvaRing during breastfeeding (until the baby is completely weaned).
NuvaRing does not affect concentration or the ability to drive.

Drug interactions Nuvaring

Interactions between hormonal contraceptives and other medications may cause irregular bleeding and/or a lack of contraceptive effect.
Hepatic metabolism: Interactions may occur with drugs that induce microsomal enzymes that can lead to increased metabolism of sex hormones (eg, phenytoin, phenobarbital, primidone, carbamazepine, rifampicin, oxcarbazepine, topiramate, felbamate, ritonavir, griseofulvin and preparations containing St. John's wort ).
Women taking any of these drugs should temporarily use a barrier method of contraception in addition to using NuvaRing or choose another method of contraception. When using drugs that induce microsomal enzymes, a barrier method of contraception should be used during the course of using such drugs and for another 28 days after stopping their use.
If the course of concomitant drug therapy exceeds the 3 weeks during which the ring is used, the next one should be administered immediately, without the usual one-week break.
The contraceptive effect of the drug may also be reduced when taking certain antibiotics at the same time, for example, penicillins and teracyclines. The mechanism of this effect has not been identified. In pharmacokinetic interaction studies, oral administration of amoxicillin (875 mg, twice daily) or doxycycline (200 mg on the first day, followed by 100 mg daily) for 10 days of NuvaRing did not significantly affect the pharmacokinetics of etonogestrel and ethinyl estradiol (EE). ). Women taking antibiotics (except amoxilin and doxycycline) should use a barrier method of contraception for up to 7 days after stopping. If concomitant drug use exceeds 3 weeks of the ring cycle, a new ring must be inserted immediately without taking the usual break before using the next ring.
According to pharmacokinetic data, intravaginally administered antimycotic agents and spermicides do not affect the contraceptive effectiveness and safety of the drug NuvaRing. During concomitant use of antimycotic suppositories, the risk of ring dislocation may be slightly higher.
Hormonal contraceptives may affect the metabolism of other drugs. Accordingly, the concentration in blood plasma and tissues can either increase (for example, cyclosporine) or decrease (for example, lamotrigine).
Directions for use of concomitant medications should be followed to identify potential interactions.
The use of contraceptive steroids may affect the results of some laboratory tests, including biochemical indicators of liver, thyroid, adrenal and kidney function, plasma protein levels (for example, levels of corticosteroid binding globulin and sex hormone binding globulin), lipid fractions and lipoproteins, indicators of carbohydrate metabolism, coagulation and fibrinolysis. Such changes usually remain within normal laboratory values.
Interaction with tampons.
Pharmacokinetic data show that the use of tampons does not affect the systemic absorption of hormones released by NuvaRing. In rare cases, NuvaRing may be removed when the tampon is removed.

Overdose of the drug Nuvaring, symptoms and treatment

No serious or dangerous complications have been reported from overdose. In case of an overdose, nausea, vomiting may occur, and in young women, bleeding from the vagina. There is no antidote. Treatment in case of overdose is symptomatic.

Storage conditions for the drug Nuvaring

In original packaging at a temperature of 2-8 °C.

List of pharmacies where you can buy Nuvaring:

• Saint Petersburg