NuvaRing

Authors: Meghan Joslyn, Dana Erickson, Nicole Austreng, and Abbie Holig

NuvaRing is a birth control option that is administered monthly. When used as directed, it can be as effective as an oral contraceptive and more convenient as it does not need to be taken daily.

History

When Did Nuvaring Begin?

October 3, 2001
The FDA approved Nuvaring (4).

Who Founded the Product?

Schering-Plough (Organon) company in the Netherlands founded Nuvaring (3).

Marketing

1st marketed in the USA in July 2002 (5).

Structure

Chemical structure (3)

Etonogestrel & Ethinyl Estradiol

chem_structure

Components: a progestin, etonogestrel and an estrogen, ethinyl estradiol
The NuvaRing is a flexible ring about 2” in diameter that you insert vaginally once a month. Once inside, NuvaRing releases a continuous low dose of hormones to prevent pregnancy.
What is the Nuvaring ring made of?
- NuvaRing is a nonbiodegradable, flexible, transparent, colorless to almost colorless, combination contraceptive vaginal ring containing two active hormones (6).

Function

How Nuvaring Effects Women & How it Works:

NuvaRing is an estrogen/progestin birthcontrol ring that is inserted into the vagina once every four weeks. The ring is left in for three weeks and is taken out for menstruation. A new ring is inserted after the fourth week (6).

Insertion, Removal, & Complications:

A common question women ask about NuvaRing is “How exactly do you put it in?”

NuvaRing is a small, flexible ring that is inserted very simply.

Insertion: After washing and drying hands, the index finger and thumb are used to squeeze the sides together and inserted into the vagina as far in as it can be placed.
Placement: Once inserted into a comfortable position, the NuvaRing expands to fit the size of your vagina. (If it feels uncomfortable after insertion, it can be moved around inside the vagina until it feels correct. Most women who use NuvaRing say that they barely ever notice they have it in, but some women are aware of it during the first 21 days of use and during sexual intercourse. Some women even expel it during intercourse, bowel movements, or while removing a tampon.) (6)

Removal: To remove NuvaRing, simply hook the index finger under the forward rim of the ring, or grasp it with the index and middle fingers, pull it out, and dispose of it in a trash receptacle, not a toilet. When using NuvaRing, only use one ring at a time because overdose can lead to nausea, vomiting, and vaginal bleeding (6).

Why women use Nuvaring:

Compared to other forms of birth control, NuvaRing is inserted once a month, provides low doses of estrogen and progestin, it is easy to use, doesn’t need to be fitted by a clinician, and is 99% effective (6).

Problems with Nuvaring

Possible side effects of NuvaRing include:

vaginal infections, irritation, and secretion
headaches
weight gain
nausea

Side effects noted when NuvaRing is used as a hormonal birth control method:

chart

Graph 1. Data from study "Cycle Control, Tolerability, Efficacy, and Acceptability of the Vaginal Contraceptive Ring, NuvaRing; Results of Clinical Experience in Germany" (1).

Side effects also place NuvaRing users at a risk for:

heart attacks
blood clots
gallbladder disease
breast cancer
reproductive organ cancer
high blood pressure
liver tumors
defects of lipid metabolism (cause inflammation of the pancreas)

Current Problems

Women should discuss NuvaRing with their doctor before using it if they have any of the following conditions (2):

Circulation Problems
Gallbladder, Heart, Kidney, or Liver Disease
Migraines
High Blood Pressure
Breast Cancer
Heavy Smoker
Vaginal Bleeding
Pregnant (may be pregnant)
Have not yet menstruated

During a study called "Cycle Control, Tolerability, Efficacy, and Acceptability of the Vaginal Contraceptive Ring, NuvaRing; Results of Clinical Experience in Germany," 5823 women were surveyed and their reponses are displayed in the graph below (1).

graph2

Graph 2. Response Classifications: Satisfaction with NuvaRing, Continued Use of NuvaRing, and Recommendation of NuvaRing to Others.

NuvaRing is a monthly form of birth control that is 99% effective when used correctly. There are many forms of birth control available today, however the NuvaRing is a slightly different option that delivers hormones directly into the vagina.

Information Sources:

(1) "Cycle Control, Tolerability, Efficacy, and Acceptability of the Vaginal Contraceptive Ring, NuvaRing; Results of Clinical Experience in Germany." European Journal of Contraception & Reproductive Health Care, March 2008. Vol. 13 Issue 1, p31-38.

(2) "Ethinyl Estradiol and Etonogestrel." Lex-PALS Drug Guide, Nov 2009. p1-1.

(3) Faundes, A. "Pros and cons of vaginal rings for contraceptive hormone delivery." American Journal of Drug Delivery, 2004, 2 (4): 241-50.

(4) "Human Pharmaceutical." Schering-Plough, Schering-Plough Corporation, 2009. Web. 21 Oct 2009. <http://www.schering-plough.com/products/human-prescription.aspx#1>.

(5) "NME Drug and New Biologic Approvals in 2001." FDA U.S Food and Drug Administration, U.S. Department of Health & Human Services. Web. 21 Oct. 2009. <http://www.fda.gov/Drugs/DevelopmentApprovalProcess/HowDrugsareDevelope
dandApproved/DrugandBiologicApprovalReports/NMEDrugandNewBiologicApprovals
/ucm081684.htm> .

(6) "Nuvaring." Nuvaring. Organon Oss: The Netherlands. Web. 21 Oct. 2009. <http://www.nuvaring.com/Consumer/index.asp>.

**All hand-drawn pictures were done by Meghan Joslyn.