NuvaRing side effects and how to avoid them

Choosing a birth control method can be a difficult decision as there are so many options. Hormonal contraceptives are commonly used and one option is NuvaRing, a flexible birth control vaginal ring used to prevent pregnancy. Oral birth control pills are absorbed through the digestive tract however with NuvaRing the hormones are released directly into the bloodstream. Like other hormonal birth control methods, NuvaRing also increases the risk of serious blood clots, especially in women who have other risk factors, such as smoking. Let’s take a look at the adverse reactions associated with the NuvaRing and how to avoid them.

What is NuvaRing?

NuvaRing is a prescription birth control vaginal ring used to prevent pregnancy. It is a soft and flexible ring that is slightly larger than a 50-cent piece. You use it by inserting it into your vagina (following the patient information instructions that come with your NuvaRing ). Once inside you, NuvaRing releases two substances into your body that are man-made versions of the natural hormones estrogen and progestin, that stop you from getting pregnant.

How to use NuvaRing

NuvaRing is used in a 4-week cycle. You wear a NuvaRing for three weeks at a time, then you take it out for one week before you insert a new ring. During the one week that you do not wear a NuvaRing, you usually have your period. If used properly, NuvaRing is just as effective as the contraceptive pill, but you do not need to take it every day. The NuvaRing is simple to insert, similar to a tampon.

NuvaRing active ingredients

NuvaRing contains two active ingredients called ethinylestradiol and etonogestrel. Ethinylestradiol is a synthetic (man-made) version of the hormone estrogen that your body naturally produces. Etonogestrel is a synthetic version of the hormone progesterone produced naturally by your body.

Estrogen and progesterone are hormones that play a role in the female reproductive cycle. The ethinylestradiol and etonogestrel in NuvaRing have the same effects on your body as these natural hormones. They stop your ovaries from releasing an egg each month (ovulation). They can also change the lining of your womb (uterus), stopping a fertilized egg from attaching to it and developing. Finally, they can change the mucus created by your cervix (the opening of your womb), which can prevent sperm from entering your womb.

Dosing of NuvaRing

When placed in the vagina, each ring releases on average 0.120 mg/day of etonogestrel and 0.015 mg/day of ethinyl estradiol over a three-week period of use.

NuvaRing has an outer diameter of 54 mm and a cross-sectional diameter of 4 mm. It is made of ethylene-vinyl acetate copolymers and magnesium stearate and contains 11.7 mg etonogestrel and 2.7 mg ethinyl estradiol. NuvaRing is not made with natural rubber latex.

Side effects of NuvaRing

The most common side effects caused by NuvaRing include:

• Vaginal irritation
• Vaginal discharge
• Cervix irritation discomfort, and pain
• Breakthrough bleeding
• Problems with the ring slipping out, moving, and causing discomfort
• Migraine headaches
• Severe headaches
• Nausea (feeling sick)
• Vomiting (being sick)
• Breast tenderness or pain
• Painful menstrual periods
• Abdominal pain
• Acne
• Weight gain
• A fall in sexual desire (libido)
• Mood changes, including depression and thoughts of self-harm

In rare instances, NuvaRing can cause more serious side effects, including:

• Risk of developing blood clots, including serious blood clots that can cause deep vein thrombosis, pulmonary embolism, venous thromboembolism, vision loss, strokes, and heart attacks
• Severe allergic reactions to the medication cause skin rashes, hives, fever, and swelling in the face, mouth, and throat that can make it difficult to breathe
• Toxic shock syndrome – a potentially fatal condition caused by bacteria infecting your NuvaRing
• Liver problems, including liver tumors
• Gallbladder problems
• High blood pressure
• Problems caused by accidentally inserting your NuvaRing into your bladder
• Angioedema – inflammation of the lower layers of your skin and the tissue under your skin

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Boxed warning for NuvaRing

NuvaRing has an FDA (U.S. Food and Drug Administration) boxed warning for the risk of serious cardiovascular events from combination hormonal contraceptives in women over 35 years old who smoke.

Do not use NuvaRing if you smoke cigarettes and are over 35 years old. Smoking increases your risk of serious heart and blood vessel problems from combination hormonal contraceptives, including heart attack, blood clots, or stroke, which can be life-threatening.

Toxic Shock Syndrome (TSS)

A rare but potential side effect of NuvaRing is toxic shock syndrome a fatal condition. The condition is caused when bacteria get into the body and releases harmful toxins. It is associated commonly with tampon use in young women but it can affect women of any age.

When the NuvaRing is inserted into the vagina there is potential for bacteria to grow on the ring. This is why it is essential that it is removed after 3 weeks. The symptoms of TSS can start suddenly and get worse quickly, they include:

• Sudden high temperature
• A sunburn-like rash
• Muscle aches
• Vomiting
• Low blood pressure

Blood clots

This side effect relates to the black box warning associated with NuvaRing. Another serious side effect that can occur with NuvaRing is blood clots. Symptoms of a blood clot in the legs, lungs, eyes, heart, or brain are persistent leg pain, sudden shortness of breath, sudden partial or complete blindness, severe chest pain or pressure, sudden severe headaches, weakness or numbness in a limb, trouble speaking, or yellowing of the skin or eyeballs.

NuvaRing drug interactions

NuvaRing can interact with other medications, particularly:

• Any other contraceptives
• Any antiviral medications taken to treat an HIV infection, including ritonavir, atazanavir, indinavir, saquinavir, or nelfinavir
• Any antiviral medications taken to treat a hepatitis C infection, including boceprevir or telaprevir
• Any other antiviral medications taken to treat another viral infection
• Any antibiotics taken to treat a bacterial infection, including rifampicin, clarithromycin, or telithromycin
• Any antifungal medications taken to treat a fungal infection, including ketoconazole and itraconazole
• Any medications taken to lower cholesterol levels, including atorvastatin or rosuvastatin
• Any anticonvulsant medications taken to reduce the chances of you having seizures, like carbamazepine, phenobarbital, or phenytoin
• Any thyroid replacement therapies
• A medicine called bosentan, taken to treat high blood pressure in the vessels of the lung
• A medicine called aprepitant, taken to treat chemotherapy-induced nausea and vomiting
• A medicine called acetaminophen, taken to relieve pain
• Ascorbic acid (vitamin C)
• A herbal supplement called St John’s wort

NuvaRing warnings & precautions

Do not drink grapefruit juice, eat grapefruit or eat anything that contains grapefruit when using NuvaRing, as grapefruit contains an ingredient that can affect how NuvaRing works.

NuvaRing is not suitable for everyone. Don’t use a NuvaRing if you:

• Are allergic to the active ingredients ethinylestradiol and etonogestrel
• Are allergic to any of the other ingredients in NuvaRing (you can find these listed in the leaflet which comes with the medication)
• Have any unusual vaginal bleeding
• Have ever had a heart attack
• Have ever had a stroke
• Have or have had blood clots in your body
• Have an inherited condition that increases your risk of blood clots
• Have a heart valve problem or heart rhythm problem that can cause blood clots in your heart
• Smoke any tobacco products and are over 35 years old (this puts you at an increased risk of blood clots)
• Have or have ever had breast cancer, cancer of the womb (uterus), or another cancer that is sensitive to female hormones
• Have high blood pressure that’s not controlled by medicine
• Have diabetes with kidney, eye, nerve, or blood vessel damage
• Have liver disease
• Get severe migraines with visual auras or get mild to severe migraines and are over 35 years old
• Think you may be pregnant
• Are not a woman that can get pregnant
• Are under 18 years of age

Talk to your doctor before taking NuvaRing if you:

• Are taking any of the medications that could interact with NuvaRing (see the section above)
• Smoke any tobacco products
• Have recently been pregnant, have given birth, have had a miscarriage, or an abortion
• Are breastfeeding or are planning to breastfeed
• Have a family history of breast cancer
• Have or have had breast nodules, fibrocystic disease, an abnormal breast x-ray, or an abnormal mammogram
• Have ever had toxic shock syndrome
• Have any liver problems, including jaundice during pregnancy
• Have ever had heart disease
• Have ever had liver disease
• Have ever had kidney disease
• Have ever had gallbladder disease
• Have ever had high blood pressure
• Have ever had a seizure
• Have ever had a migraine
• Have diabetes
• Have a history of missed or irregular menstrual periods
• Have ever been diagnosed with depression
• Are due to have any form of surgery, including a dental procedure
• Are due to have any form of laboratory test, such as a blood test, as NuvaRing can affect the results of some tests

How to avoid NuvaRing side effects

1. Read the patient information for NuvaRing use

When used as directed by your healthcare professional NuvaRing has been shown to be very effective. Your chance of getting pregnant depends on how well you follow the directions for using NuvaRing. The better you follow the directions, the less chance you have of getting pregnant.

Follow the instructions on how to insert a NuvaRing thoroughly and seek help from your doctor if you are unsure. The patient leaflet will show you a step-by-step guide on the correct way to insert NuvaRing. It is possible to accidentally insert the NuvaRing into your bladder. If you have pain during or after insertion and you cannot find NuvaRing in your vagina, call your health care provider right away.

2. Discuss medical history

Discussing your medical history with your healthcare provider is important to help them understand how well NuvaRing will work for you. Give a complete list of all the prescription drugs, including over-the-counter meds, supplements, medical conditions you may have, and if you smoke. Talking with your doctor will allow them to pick up any drug interactions with NuvaRing and help manage any possible side effects.

3. Pay attention to your body

Paying attention to how your body feels when taking NuvaRing is important. As mentioned earlier in the blog, blood clots and TSS are a risk with NuvaRing. If you experience any of the symptoms associated with these serious side effects seek medical help urgently.

Due to NuvaRing entering your bloodstream directly it can bring on a more powerful reaction. It is important that you learn which symptoms are dangerous so you can treat them quickly with medical advice and attention.

Talk to your doctor straight away if you start to experience any side effects of NuvaRing when taking it, or if you feel the medication is not working for you.

5. Store NuvaRing correctly

Store NuvaRing at room temperature for up to 4 months after you receive it. Throw NuvaRing away if the expiration date on the label has passed. Do not store NuvaRing above 86°F (30°C) and avoid direct sunlight. To dispose of NuvaRing place the used NuvaRing in the re-closable foil pouch and throw it away in your household trash. Do not flush your used NuvaRing down the toilet.