When you think of family planning methods, you probably think of pills that you take daily or injections that you get every few months. But have you heard of a small, flexible ring that you wear inside the vagina? This is also a very effective family planning method. Today, let's talk about this vaginal ring, the `Vaginal Ring`. In Sri Lanka, you may have heard of it under the brand name `NuvaRing`.
Simply put, what is this vaginal ring?
This is a small ring made of flexible, transparent plastic used for family planning by women. It contains two types of hormones. They are estrogen and progestin. To be precise, it contains the drugs `Etonogestrel` and `Ethinyl Estradiol`.
When you insert this ring into your vagina, it releases these hormones into your body in a very gentle, controlled manner. Together, these two hormones do two main things:
1. Prevents Ovulation: Stops the monthly release of an egg from a woman's ovaries. Without an egg, pregnancy cannot occur.
2. Thickening of the cervical mucus: The mucus at the entrance to the uterus is thickened, making it difficult for sperm to swim into the uterus.
This is how this ring protects you from pregnancy.
Things you need to tell your doctor before using this medicine:
This ring is not suitable for everyone. So when you talk to your doctor, be sure to mention any of the conditions below. This is very important for your safety.
| Type of medical condition | Situations you should report |
|---|---|
| Heart and blood vessel problems | High blood pressure, heart disease or recent heart attack, stroke, blood clots in the blood vessels, high cholesterol or triglyceride levels. |
| Cancer | If you have or have had breast, cervical, uterine, ovarian or liver cancer. |
| Other medical conditions | Diabetes, liver disease, kidney disease, gallbladder disease, migraine headaches, lupus (SLE), Protein C/S deficiency. |
| Lifestyle and other matters | If you are a smoker (especially over 35), have recently given birth, had an abortion, are about to undergo surgery, or have unusual vaginal bleeding. |
| Pregnancy and allergies | If you are pregnant or trying to become pregnant, if you are breastfeeding, or if you have allergies to hormones or other medications or foods. |
How exactly do you use this ring?
The method of using this is very simple, but it is very important to follow the procedure exactly.
1. 3 weeks in, 1 week out: Insert the ring into the vagina as directed by your doctor. This should remain in place for 3 weeks (21 days) .
2. Removal: After exactly 3 weeks, remove the ring on the same day you inserted it (e.g., if you inserted it on Sunday, then on Sunday after 3 weeks).
3. One week break: You will need to be ring-free for the next week (7 days) . During this time, you will have your period (withdrawal bleeding).
4. Inserting a new ring: Exactly one week after the break, on the same day as the previous ring was removed (in our example, the following Sunday), you should insert a new ring .
For example, if you feel like your ring has come off, or if you're unsure if it's still there, check it out right away. If you don't know how long it's been out, you could be at risk of pregnancy. Take a pregnancy test at that time and talk to your doctor.
What do you do if you put the ring on too late, or if it falls off?
The success of this method depends on how well you keep up with this cycle. If you miss the day you should have inserted the ring, or if it has been out for a few hours, your protection against pregnancy may be reduced. Call your doctor right away for advice. It is also wise to use an additional form of birth control, such as condoms, until he or she tells you to.
Things not to use with this ring (Drug Interactions)
Other medications you take can interact with the hormones in this ring, reducing its effectiveness or increasing side effects. So tell your doctor about all medications, vitamins, and herbal products you take.
| Don't use these names together! | |
|---|---|
| Avoid using this ring with certain medications for Hepatitis C (such as Dasabuvir; ombitasvir; paritaprevir; ritonavir), vaginal lubricants containing oil or silicone. | |
| Tell your doctor if you are taking these medications. | |
| Medicines for infections | Antibiotics and antifungals such as Rifampin and Griseofulvin. |
| Medicines for epilepsy/ seizures | Such as Carbamazepine, Phenytoin, Topiramate. |
| Medicines for HIV/AIDS | Some antiviral drugs. |
| Herbal products | St. John's wort. |
| Other | Acetaminophen (Paracetamol), Warfarin, diabetes medications, thyroid hormones, and many other medications. |
*This list is not complete. So please inform your doctor about everything you are taking.*
Things to be careful about when using
- Avoid smoking: Smoking is very dangerous if you are using this type of hormonal birth control. Smoking greatly increases your risk of blood clots and stroke, especially if you are over 35.
- Medical checkups: Visit your doctor on time and get checkups. Don't skip things like breast exams and Pap smears.
- Sexually transmitted diseases:
- Skin spots: Some women may develop brown spots (cholasma) on their face. This condition can worsen with sun exposure. So, protect yourself from the sun and use sunscreen.
- Overdose: If for any reason you suspect an overdose, immediately go to the National Poisons Information Centre at the National Hospital or the Emergency Treatment Unit (ETU) of the nearest hospital.
- The vaginal ring is a cyclical birth control method that is inserted for 3 weeks, removed for a week, and then a new one is inserted.
- Although this protects against pregnancy, it does not provide any protection against sexually transmitted diseases (STIs), including HIV.
- If you are a smoker and over the age of 35, your risk of blood clots is very high. Avoid smoking completely.
- Tell your doctor about all medications, vitamins, and herbal products you are taking.
- Seek immediate medical attention if you experience any serious side effects such as severe chest pain, difficulty breathing, leg swelling, or severe headache.
- If the ring falls out or you forget to insert it on the scheduled date, consult your doctor immediately.
The most important thing is that this ring only protects you from pregnancy. It does not protect you from sexually transmitted infections (STIs) such as HIV (AIDS). It is essential to use a barrier method such as condoms.
What are the expected side effects?
Like any medicine, this one can have side effects. Some are serious, some are common.
| Serious side effects that should be reported to the doctor immediately | |
|---|---|
| Symptoms of a blood clot | Leg pain, swelling, redness, difficulty breathing, chest pain. |
| Symptoms of a Stroke | Sudden numbness or weakness in the face, arm, or leg, difficulty speaking, severe headache, change in vision. |
| Liver problems | Pain in the upper right abdomen, yellowing of the skin or eyes, dark urine, pale stools. |
| Other serious symptoms | Allergic reactions (skin rash, itching, swelling of the face/lips), worsening migraines, depression, vaginal pain, abnormal discharge, symptoms of Toxic Shock Syndrome (TSS) with fever. |
| Side effects that are common but should be reported to the doctor if they persist | |
|---|---|
| Breast pain or tightness | Nausea |
| Irregular menstrual cycles or spotting | Slight weight gain |
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