Constant Spotting on Continuous Birth Control Nuvaring

Who should not use NuvaRing?

Do not use NuvaRing if you:

• Smoke and are over 35 years old
• Have or have had blood clots in your arms, legs, eyes, or lungs
• Have an inherited problem with your blood that makes it clot more than normal
• Have had a stroke
• Have had a heart attack
• Have certain heart valve problems or heart rhythm problems that can cause blood clots to form in the heart
• Have high blood pressure that medicine can't control
• Have diabetes with kidney, eye, nerve, or blood vessel damage
• Have certain kinds of severe migraine headaches with aura, numbness, weakness, or changes in vision, or have any migraine headaches if you are over age 35
• Take any Hepatitis C drug combination containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir. This may increase levels of the liver enzyme "alanine aminotransferase" (ALT) in the blood
• Have unexplained vaginal bleeding
• Are pregnant or think you may be pregnant. NuvaRing is not for pregnant women
• Have or have had breast cancer or any cancer that is sensitive to female hormones
• Are allergic to etonogestrel, ethinyl estradiol or any of the ingredients in NuvaRing. See the list of ingredients in NuvaRing in the Patient Information.

Hormonal birth control methods may not be a good choice for you if you have ever had jaundice (yellowing of the skin or eyes) caused by pregnancy or related to previous use of hormonal birth control.

Tell your health care provider if you have ever had any of the conditions listed above. Your health care provider can suggest another method of birth control.

What should I tell my health care provider before using NuvaRing?

Before you use NuvaRing tell your health care provider if you:

• Have any medical conditions
• Smoke
• Are pregnant or think you are pregnant
• Recently had a baby
• Recently had a miscarriage or abortion
• Have a family history of breast cancer
• Have or have had breast nodules, fibrocystic disease, an abnormal breast x-ray, or abnormal mammogram
• Use tampons and have a history of toxic shock syndrome
• Have been diagnosed with depression
• Have had liver problems including jaundice during pregnancy
• Have or have had elevated cholesterol or triglycerides
• Have or have had gallbladder, liver, heart, or kidney disease
• Have diabetes
• Have a history of jaundice (yellowing of the skin or eyes) caused by pregnancy (also called cholestasis of pregnancy)
• Have a history of scanty or irregular menstrual periods
• Have any condition that makes the vagina become irritated easily
• Have or have had high blood pressure
• Have or have had migraines or other headaches or seizures
• Are scheduled for surgery. NuvaRing may increase your risk of blood clots after surgery. You should stop using NuvaRing at least 4 weeks before you have surgery and not restart it until at least 2 weeks after your surgery.
• Are scheduled for any laboratory tests. Certain blood tests may be affected by hormonal birth control methods.
• Are breastfeeding or plan to breastfeed. Hormonal birth control methods that contain estrogen, like NuvaRing, may decrease the amount of milk you make. A small amount of hormones from NuvaRing may pass into your breast milk. Consider another non-hormonal method of birth control until you are ready to stop breastfeeding.
• Have (or have ever had) an allergic reaction while using NuvaRing, including hives, swelling of the face, lips, tongue, and/or throat causing difficulty in breathing or swallowing (anaphylaxis and/or angioedema)

Tell your health care provider about all medicines and herbal products you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Some medicines and herbal products may make hormonal birth control less effective, including, but not limited to:

• Certain anti-seizure medicines (such as barbiturates, carbamazepine, felbamate, oxcarbazepine, phenytoin, rufinamide and topiramate).
• Medicine to treat fungal infections (griseofulvin)
• Certain combinations of HIV medicines (such as nelfinavir, ritonavir, darunavir/ritonavir, (fos)amprenavir/ritonavir, lopinavir/ritonavir and tipranavir/ritonavir)
• Certain hepatitis C (HCV) medicines (such as boceprevir and telaprevir)
• Non-nucleoside reverse transcriptase inhibitors (such as efavirenz and nevirapine)
• Medicine to treat tuberculosis (such as rifampicin and rifabutin)
• Medicine to treat high blood pressure in the vessels of the lung (bosentan)
• Medicine to treat chemotherapy-induced nausea and vomiting (aprepitant)
• St John's wort

Use an additional barrier contraceptive method (such as a male condom with spermicide) when you take medicines that may make NuvaRing less effective. Since the effect of another medicine on NuvaRing may last up to 28 days after stopping the medicine, it is necessary to use the additional barrier contraceptive method for that long to help prevent you from becoming pregnant. While using NuvaRing, you should not use certain female barrier contraceptive methods such as a vaginal diaphragm, cervical cap or female condom as your back-up method of birth control because NuvaRing may interfere with the correct placement and position of a diaphragm, cervical cap or female condom.

Some medicines and grapefruit juice may increase the level of ethinyl estradiol in your blood if used together, including:

• The pain reliever acetaminophen
• Ascorbic acid (vitamin C)
• Medicines that affect how your liver breaks down other medicines (such as itraconazole, ketoconazole, voriconazole, fluconazole, clarithromycin, erythromycin and diltiazem)
• Certain HIV medicines (atazanavir/ritonavir and indinavir)
• Non-nucleoside reverse transcriptase inhibitors (such as etravirine)
• Medicines to lower cholesterol such as atorvastatin and rosuvastatin

Hormonal birth control methods may interact with lamotrigine, a medicine used for seizures. This may increase the risk of seizures, so your health care provider may need to adjust your dose of lamotrigine.

Women on thyroid replacement therapy may need increased doses of thyroid hormone.

Ask your health care provider if you are not sure if you take any of the medicines listed above. Know the medicines you take. Keep a list of them to show your health care provider and pharmacist when you get a new medicine.

What are the possible risks and side effects of NuvaRing?

Blood clots:

Like pregnancy, combination hormonal birth control methods increase the risk of serious blood clots (see graph below), especially in women who have other risk factors, such as smoking, obesity, or age greater than 35. This increased risk is highest when you first start using a combination hormonal birth control method or when you restart the same or different combination hormonal birth control method after not using it for a month or more. Talk with your health care provider about your risk of getting a blood clot before using NuvaRing or before deciding which type of birth control is right for you.

In some studies of women who used NuvaRing, the risk of getting a blood clot was similar to the risk in women who used combination birth control pills.

Other studies have reported that the risk of blood clots was higher for women who use combination birth control pills containing desogestrel (a progestin similar to the progestin in NuvaRing) than for women who use combination birth control pills that do not contain desogestrel.

It is possible to die or be permanently disabled from a problem caused by a blood clot, such as heart attack or stroke. Some examples of serious blood clots are blood clots in the:

• Legs (deep vein thrombosis)
• Lungs (pulmonary embolus)
• Eyes (loss of eyesight)
• Heart (heart attack)
• Brain (stroke)

To put the risk of developing a blood clot into perspective: If 10,000 women who are not pregnant and do not use hormonal birth control are followed for one year, between 1 and 5 of these women will develop a blood clot. The figure below shows the likelihood of developing a serious blood clot for women who are not pregnant and do not use hormonal birth control, for women who use hormonal birth control, for pregnant women, and for women in the first 12 weeks after delivering a baby.

Likelihood of Developing a Serious Blood Clot (Venous Thromboembolism [VTE])

*CHC = combination hormonal contraception **Pregnancy data based on actual duration of pregnancy in the reference studies. Based on a model assumption that pregnancy duration is 9 months, the rate is 7 to 27 per 10,000 woman-years.

Call your health care provider right away if you have:

• Leg pain that does not go away
• Sudden shortness of breath
• Sudden blindness, partial or complete
• Severe pain or pressure in your chest
• Sudden, severe headache unlike your usual headaches
• Weakness or numbness in an arm or leg, or trouble speaking
• Yellowing of the skin or eyeballs

Other serious risks include:

• Toxic Shock Syndrome (TSS). Some of the symptoms are much the same as the flu, but they can become serious very quickly. Call your health care provider or get emergency treatment right away if you have the following symptoms:

• Sudden high fever
• Vomiting
• Diarrhea
• A sunburn-like rash
• Muscle aches
• Dizziness
• Fainting or feeling faint when standing up

• Allergic reaction, including hives, swelling of the face, lips, tongue, and/or throat causing difficulty in breathing or swallowing (anaphylaxis and/or angioedema)
• Liver problems, including liver tumors
• High blood pressure
• Gallbladder problems
• Accidental insertion into bladder
• Symptoms of a problem called angioedema if you already have a family history of angioedema

The most common side effects of NuvaRing are:

• Tissue irritation inside your vagina or on your cervix
• Headache (including migraine)
• Mood changes (including depression, especially if you had depression in the past). Call your health care provider immediately if you have any thoughts of harming yourself.
• NuvaRing problems, including the ring slipping out or causing discomfort
• Nausea and vomiting
• Vaginal discharge
• Weight gain
• Vaginal discomfort
• Breast pain, discomfort, or tenderness
• Painful menstrual periods
• Abdominal pain
• Acne
• Less sexual desire

Some women have spotting or light bleeding during NuvaRing use. If these symptoms occur, do not stop using NuvaRing. The problem will usually go away. If it doesn't go away, check with your health care provider.

Other side effects seen with NuvaRing include breast discharge; vaginal injury (including pain, discomfort, and bleeding) associated with broken rings; and penis discomfort of the partner (such as irritation, rash, itching).

Less common side effects seen with combination hormonal birth control include:

• Blotchy darkening of your skin, especially on your face
• High blood sugar, especially in women who already have diabetes
• High fat (cholesterol, triglycerides) levels in the blood

There have been reports of the ring becoming stuck to the vaginal tissue and having to be removed by a healthcare provider. Call your healthcare provider if you are unable to remove your NuvaRing.

Tell your health care provider about any side effect that bothers you or that does not go away. These are not all the possible side effects of NuvaRing. For more information, ask your health care provider or pharmacist. Call your health care provider for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

How effective is NuvaRing?

When used as directed, NuvaRing has been shown to be 98% effective, just like the pill. 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.

How should I use NuvaRing?

Use NuvaRing exactly as your health care provider tells you to use it.

• NuvaRing is used in a 4-week cycle.

• Insert 1 NuvaRing in the vagina and keep it in place for 3 weeks (21 days). Regularly check that NuvaRing is in your vagina (for example, before and after intercourse) to ensure that you are protected from pregnancy.
• Remove the NuvaRing for a 1-week break (7 days). During the 1-week break (7 days), you will usually have your period. Note: Insert and remove NuvaRing on the same day of the week and at the same time:

• For example, if you insert your NuvaRing on a Monday at 8:00 AM, you should remove it on the Monday 3 weeks later at 8:00 AM.
• After your 1-week break (7 days), you should insert a new NuvaRing on the next Monday at 8:00 AM.

• While using NuvaRing, you should not use certain female barrier contraceptive methods such as a vaginal diaphragm, cervical cap or female condom as your back-up method of birth control because NuvaRing may interfere with the correct placement and position of a diaphragm, cervical cap or female condom.
• Use of spermicides or vaginal yeast products will not make NuvaRing less effective at preventing pregnancy.
• Use of tampons will not make NuvaRing less effective or stop NuvaRing from working.
• If NuvaRing has been left inside your vagina for more than 4 weeks (28 days), you may not be protected from pregnancy and you should see your health care provider to be sure you are not pregnant. Until you know the results of your pregnancy test, you should use an extra method of birth control, such as male condoms with spermicide, until the new NuvaRing has been in place for 7 days in a row.
• Do not use more than 1 NuvaRing at a time. Too much hormonal birth control medicine in your body may cause nausea, vomiting, or vaginal bleeding.

Will NuvaRing dissolve?

No. NuvaRing is non-biodegradable so it will not dissolve. It releases a low dose of hormones into your body over the course of 3 weeks. After that time, you need to remove it, take a week off from NuvaRing, and insert a new one 7 days after removal.

How do I insert and remove NuvaRing?

NuvaRing is easy to insert and remove:

• Manual insertion: After washing and drying your hands, remove NuvaRing from the foil pouch. Keep the foil pouch for proper disposal of the ring after use. Holding NuvaRing between your thumb and index finger, press the sides together while lying down, squatting, or standing with one leg up—whatever is most comfortable for you. Gently push the folded ring into your vagina. If you feel discomfort after inserting NuvaRing (etonogestrel/ethinyl estradiol vaginal ring), slide it farther in until it feels comfortable. Once inserted in the vagina, there is no risk of NuvaRing being pushed too far up or getting lost. Some women have accidently inserted NuvaRing into their bladder. If you have pain during or after insertion and you cannot find NuvaRing in your vagina, call your health care provider right away. Regularly check that NuvaRing is in your vagina (for example, before and after intercourse) to ensure you are protected from pregnancy.

For more information, see Inserting NuvaRing or refer to the Patient Information.

• Removing NuvaRing: Remove the ring 3 weeks (21 days) after insertion on the same day of the week it was inserted at about the same time. After washing and drying your hands, hook your index finger under the forward rim or hold the rim between your index and middle fingers. Gently pull out NuvaRing. Place the used NuvaRing in the re-sealable foil pouch and dispose of it in a waste receptacle out of the reach of children and pets. Do not throw it in the toilet. Your menstrual period will usually start 2 or 3 days after the ring is removed and may not have finished before the next ring is inserted. To continue to have pregnancy protection, you must insert a new ring 1 week (7 days) after the last one was removed even if your period has not stopped.

For more information, see Removing NuvaRing or refer to the Patient Information.

When can I start using NuvaRing?

It is important to consult with your health care provider to make sure you are not pregnant before starting NuvaRing.

When you start using NuvaRing depends on your current birth control situation. Talk to your health care provider and read the Prescribing Information for more details. Also read some basic directions on how to start NuvaRing.

What does NuvaRing feel like when it is in?

Although some women may be aware of NuvaRing in the vagina, most women can't feel NuvaRing once it's in place. NuvaRing may move around slightly within your vagina. This is normal. If you do feel discomfort, NuvaRing is probably not fully inserted. In that case, just use your finger to gently push the NuvaRing as far as you can into your vagina.

Rest assured, there is no danger of NuvaRing being pushed too far up in the vagina or getting lost. The cervix (the narrow, lower end of the uterus) will block NuvaRing from going any farther. NuvaRing can accidentally slip out of the vagina while removing a tampon, during intercourse, or straining during a bowel movement.

Some women have accidentally inserted NuvaRing into their bladder. If you have pain during or after insertion and you cannot find NuvaRing in your vagina, call your health care provider right away.

Will my partner or I feel NuvaRing during intercourse?

During intercourse, some sexual partners may feel NuvaRing in the vagina. However, in clinical studies 9 out of 10 (90%) partners did not find this to be a problem.

Does NuvaRing protect against sexually transmitted diseases (STDs)?

No. As with other hormonal birth control methods, NuvaRing does not protect against HIV infection (AIDS) or other sexually transmitted infections.

Do hormonal birth control methods cause cancer?

Hormonal birth control methods do not seem to cause breast cancer. However, if you have breast cancer now or have had it in the past, do not use hormonal birth control, including NuvaRing, because some breast cancers are sensitive to hormones.

Women who use hormonal birth control methods may have a slightly higher chance of getting cervical cancer. However, this may be due to other reasons such as having more sexual partners.

What should I do if my NuvaRing comes out of my vagina?

NuvaRing can slip or accidentally come out of (be expelled from) your vagina during sexual intercourse, bowel movements, use of tampons, or if it breaks.

• NuvaRing may break, causing the ring to lose its shape. If the ring stays in your vagina, this should not lower NuvaRing's effectiveness at preventing pregnancy.

• If NuvaRing breaks and slips out of your vagina, throw the broken ring in your household trash out of the reach of children and pets.
• Insert a new NuvaRing. (See Inserting NuvaRing.)

• You should pay attention when removing a tampon to be sure that your NuvaRing is not accidentally pulled out.

• Be sure to insert NuvaRing before inserting a tampon.
• If you accidentally pull out your NuvaRing while using tampons, rinse your NuvaRing in cool to lukewarm (not hot) water and insert it again right away.

• NuvaRing can be pushed out of (expelled from) your vagina, for example, during sexual intercourse or during a bowel movement.

• If the expelled ring has been out of your vagina for less than 3 hours, rinse the expelled NuvaRing in cool to lukewarm (not hot) water and insert it again right away.
• If the expelled NuvaRing has been out of your vagina for more than 3 continuous hours:

  During Weeks 1 and 2, you may not be protected from pregnancy. Reinsert the ring as soon as you remember. Use another birth control method, such as male condoms with spermicide, until the ring has been in place for 7 days in a row.

  During Week 3, do not reinsert the NuvaRing that has been out of your vagina; but throw it away in your household trash away from children and pets. Use another birth control method, such as male condoms with spermicide, until the new NuvaRing has been used for 7 days in a row, following one of the two options below:

  Option 1. Insert a new ring right away to start your next 21 day NuvaRing use cycle. You may not have your regular period but you may have spotting or vaginal bleeding.

  Option 2. Insert a new ring no later than 7 days from the time the previous ring was removed or expelled. During this time, you may have your period.

Note: You should only choose to do option 2 if you used NuvaRing for 7 days in a row, prior to the day that your previous NuvaRing was accidently removed or expelled.

• If NuvaRing was out of the vagina for an unknown amount of time, you may not be protected from pregnancy. Perform a pregnancy test prior to inserting a new ring and consult your health care provider.

Can NuvaRing get lost inside of me?

No. Rest assured that once inserted in the vagina, there is no risk of NuvaRing being pushed too far up or getting lost. There have been some reports of women accidentally inserting NuvaRing into their bladder. If you are experiencing pain during or after insertion and you cannot find your NuvaRing in your vagina, call your health care provider right away.

What should I do if I keep NuvaRing in for too long?

• If you leave NuvaRing in your vagina for up to 4 weeks (28 days) you will still be getting pregnancy protection. Remove your old NuvaRing for 1 week (7 days) and insert a new NuvaRing 1 week (7 days) later.
• If you leave NuvaRing in your vagina longer than 4 weeks (28 days), remove the ring and check to make sure you are not pregnant. If you are not pregnant, insert a new NuvaRing.

You must use another birth control method, such as male condoms with spermicide, until the new NuvaRing has been used for 7 days in a row.

What should I do if the ring disconnects?

NuvaRing may break, causing the ring to lose its shape. If the ring stays in your vagina, this should not lower the effectiveness of NuvaRing at preventing pregnancy. If NuvaRing breaks and slips out of your vagina, throw the broken ring in your household trash out of the reach of children and pets and immediately insert a new ring.

Can I use a tampon when using NuvaRing?

Use of tampons will not reduce the contraceptive efficacy of NuvaRing. Insert NuvaRing before inserting a tampon. You should pay particular attention when removing a tampon to be sure that the ring is not accidentally pulled out. If this should occur, simply rinse the ring in cool to lukewarm (not hot) water and immediately reinsert it.

Can I use vaginal medications when using NuvaRing?

Use of spermicides or vaginal yeast products will not reduce the contraceptive efficacy of NuvaRing.

What happens if I miss a period when I'm using NuvaRing (etonogestrel/ethinyl estradiol vaginal ring)?

Some women miss periods on hormonal birth control, even when they are not pregnant. Consider the possibility that you may be pregnant if:

• You miss a period and NuvaRing was out for more than 3 hours during the 3 weeks of ring use
• You miss a period and waited longer than 1 week to insert a new ring
• You have followed the instructions and you miss 2 periods in a row
• You have left NuvaRing in place for longer than 4 weeks

If you know or suspect you are pregnant, do not use NuvaRing. See your health care provider as soon as possible.

What should I know about my period when using NuvaRing?

When you use NuvaRing you may have bleeding and spotting between periods, called unplanned bleeding. Unplanned bleeding may vary from slight staining between menstrual periods to breakthrough bleeding, which is a flow much like a regular period. Unplanned bleeding occurs most often during the first few months of NuvaRing use, but may also occur after you have been using NuvaRing for some time. Such bleeding may be temporary and usually does not indicate any serious problems. It is important to continue using the ring on schedule. If the unplanned bleeding or spotting is heavy or lasts for more than a few days, you should discuss this with your health care provider.

Can I overdose when using NuvaRing?

Do not use more than one NuvaRing at a time. Too much hormonal birth control medicine in your body may cause nausea, vomiting, or vaginal bleeding.

Is it all right to use NuvaRing after the expiration date?

No. Before inserting NuvaRing, always check the expiration date on the label. Do not insert if the expiration date has passed. Store NuvaRing at room temperature for up to 4 months after you receive it and throw it away if the expiration date on the label has passed.

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Source: https://www.nuvaring.com/frequently-asked-questions/

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