Instructions on Contraceptive Vaginal Ring

The contraceptive ring contains both estrogen and progestin. The contraceptive ring is 98 percent to 99 percent effective when used correctly.

BENEFITS:

• Fewer menstrual cramps and bleeding
• Improvement in acne
• Regular periods
• Weight neutral
• Less pain at ovulation
• Reduced PMS symptoms

DECREASED RISK OF:

• Ovarian or Endometrial cancer
• Benign breast tumors or ovarian cysts
• Ectopic pregnancy
• Anemia

RISKS/SIDE EFFECTS:

• Vaginal infections and irritation
• Vaginal discharge/discomfort
• Mood changes/depression (NuvaRing)
• Spotting between periods
• Nausea/Vomiting
• Breast tenderness
• Headaches
• Decreased milk supply (if breastfeeding)
• Worse acne (NuvaRing)
• Change in libido

Cigarette smoking increases the risk of serious cardiovascular side effects from combination oral contraceptive use. This risk increases with age and with heavy smoking (15 or more cigarettes per day) and is quite marked in women over 35 years of age. Women who use combination hormonal contraceptives, including NuvaRing, should be strongly advised not to smoke.

To decrease your chances of serious problems, you need to go to an emergency room, doctor, or clinic if you have any of the following symptoms:

A          Abdominal pain (severe)

C         Chest pain or shortness of breath

H         Headaches (severe)

E          Eye problems (blurred vision, flashing lights, or blindness)

S          Severe leg pain (calf or thigh)

ALTERNATIVES: You have received written information about the other methods of birth control. For situations of suspected contraception failure, emergency contraception is available and offers a second chance to reduce the risk of unintended pregnancy.

INSTRUCTIONS: You have received information about the vaginal ring and how to use it. The vaginal ring does not protect against STIs (sexually transmitted infections) and HIV.

DECISION TO STOP USING: You may stop using the vaginal ring at any time. A woman is most likely to become pregnant if she or her partner does not use a method of birth control.

QUESTIONS: You may ask questions about the ring at any time and may contact the clinic with further questions.

Before the use of either vaginal ring and during the use of ANNOVERA, store unused vaginal rings at room temperature and out of direct sunlight.

After use, do not flush vaginal rings down the toilet. One ANNOVERA vaginal ring is designed to be used for one year and should be stored in the provided case in between insertions.

Speak to your medical provider about the proper timing of initial insertion/use and if you will need to use a backup method for 7 days.

No special accuracy is required for ring placement; absorption is fine anywhere in the vagina.

With clean hands, press the sides of the ring together between the thumb and the first (index) finger.

Press and hold the sides of the vaginal ring together for easier insertion into the vagina.

Choose a position that is comfortable to you for insertion. Helpful positions to ease insertion may include squatting or standing with one leg up.

Gently insert the folded vaginal ring into the vagina and use your index finger to push the ring in as far as it goes. When properly inserted, the ring should be entirely in the vagina and behind the pelvic bone.

The date and time of insertion should be noted so that the ring can be removed 21 days later at about the same time

When it is due for removal, wash and dry your hands and choose the position that is most comfortable for you. Place one finger into the vagina to hook the vaginal ring and then gently pull downward to remove it. The used vaginal ring should be disposed of in the trash; do not flush in the toilet.

NUVARING: The vaginal ring is inserted into the vagina, left in place for 3 weeks (21 days), and then removed for a “ring-free” week (7 days). At the end of the “ring-free” week, a woman inserts a new vaginal ring. Speak to your medical provider about insertion and removal timing to determine if “continuous cycling” is right for you. If you leave the ring in your vagina longer than 4 weeks, remove the ring, contact your medical provider for further direction, and check if you are pregnant.

NUVARING: Ring removal during intercourse is not recommended; however, women who want to remove it during intercourse may do so without having to use a backup method as long as it is not removed for longer than three hours. If the vaginal ring is out of your body for more than three hours during the 3-week period, contact your medical provider for direction.

NUVARING: Ring breakage has occurred when using a vaginal lubricant or treatment for infection. Talk to your medical provider about vaginal products and Nuvaring before use.

ANNOVERA: The vaginal ring is inserted into the vagina, left in place for 3 weeks (21 days), and then removed for a “ring-free” week (7 days). At the end of the “ring-free” week, a woman inserts her same vaginal ring as used before. One vaginal ring is used for one year (13 cycles). See proper cleaning instructions below.

ANNOVERA: Ring removal during intercourse is not recommended; however, women who want to remove it during intercourse may do so without having to use a backup method as long as it is not removed for longer than two hours. If the vaginal ring is out of your body for more than two hours during the 3-week period, contact your medical provider for direction.

ANNOVERA: Do not use any vaginal lubricants that have silicone or oil in them. Water-based lubricants are ok to use.

ANNOVERA Cleaning Instructions: Wash the vaginal ring with mild soap and lukewarm water, pat it dry, and store in the case provided. At the end of the ring-free interval, the vaginal system should be cleaned prior to being placed back in the vagina for another 21 continuous days (3 weeks).

Why is my vaginal ring uncomfortable?
Although some women may be aware of the vaginal ring in the vagina, most women do not feel it once it is in place. If you feel discomfort, the vaginal ring is probably not inserted back far enough in the vagina. Remove and reattempt insertion to ensure the vaginal ring is pushed into the vagina far enough. Use your finger to push the vaginal ring further into your vagina gently There is no danger of the vaginal ring being pushed too far up in the vagina or getting lost. The vaginal ring can be inserted only as far as the end of the vagina, where the cervix (the narrow, lower end of the uterus) will block the vaginal ring from going any further. Your medical provider can ensure proper placement before leaving the clinic if you desire.