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With endometriosis, all kinds of treatment are used. This is done to eliminate pathology and prevent negative consequences. Ring Novairing belongs to hormonal contraceptives, has the ability to inhibit ovulation and prevents the occurrence of endometrioid cysts and endometriosis as well.

Can and why use NuvaRing for endometriosis?

During endometriosis, a pathological proliferation of uterine tissues occurs, as a result of which a woman has severe pain in the abdomen, her periods become abundant, and the reproductive function fades over time. NuvaRing successfully fights all of the listed symptoms, while additionally protecting the woman from unwanted pregnancy.

Introduction of NuvaRing

NuvaRing with the growth of endomeria is prescribed by a gynecologist after a thorough examination. You don't have to go to a doctor to get a contraceptive. You can do this yourself at home. To do this, you can sit down and spread your knees to the sides, stand up or lie down. The ring is compressed and placed in a convenient position in the vagina.

The introduction is carried out once a month, which is very convenient. If for any reason the contraceptive falls out, it is washed under water at room temperature and reinserted.

How to switch to NuvaRing after using COC?

If you need to make a transition from combined oral contraceptives to Novairing, then this must be done on the last day, when there is a break when taking the tablet form. If there is 100% certainty. That there is no pregnancy, you can insert the ring on any day of the menstrual cycle.

After a progestogen-containing contraceptive?

If a lady previously drank oral progestin pills or put an IUD, then the Novaring ring is allowed to be put on any day. A contraceptive is introduced after the previous implant is removed, or the OC is stopped.

Benefits of using during endometriosis

The considered contraceptive and endometriosis have a close relationship. Novairing helps to normalize PMS. The cycle is normalized, pains go away and uterine bleeding stops. Endometriosis stops, there is no further growth of pathological tissue.

This hormonal agent acts locally, is not absorbed into the bloodstream.

Contraindications

Contraindications include:

• arterial and venous thrombosis, thromboembolism;
• all kinds of violations cerebral circulation(angina pectoris, heart attacks, strokes, etc.);
• heart abnormalities;
• deficiency states for protein C, S, antithrombin Z;
• the presence of antiphospholipid antibodies, hyperhomocystenemia;
• serious liver pathologies (including the presence of neoplasms);
• the period of gestation and feeding of the child (the components included in NovaRing can partially pass into breast milk);
• systematic migraine attacks;
• neurasthenia;
• high blood pressure;
• history of diabetes mellitus, in which there are vascular lesions;
• pancreatitis;
• hypertriglyceridemia;
• the presence of various hormone-dependent formations of a malignant nature (for example, in the area of ​​the mammary gland);
• periodic or regular bleeding of an unexplained nature from the genitals;
• operations followed by a long recovery period;
• the age category of women who are over 35 years old and are heavy smokers (more than 15 cigarettes per day);
• individual intolerance to the components present in the preparation.

Relative contraindications for Novairing include the presence of:

• thrombotic lesions in close relatives;
• excessive body weight, tendency to obesity;
• varicose veins with thrombophlebitis;
• dyslipoproteinemia;
• uncomplicated diabetes mellitus;
• epileptic syndrome;
• pathologies associated with intestinal flora (ulcerative colitis, Crohn's disease);
• sickle cell anemia;
• chloasma;
• uterine fibroids;
• cystic fibrous mastopathy;
• prolapse of the genitals;
• hernia;
• systematic constipation;
• adhesions in the vaginal area;
• smoking;
• acute illness or exacerbation of a chronic one.

Before using this way treatment, it is necessary to undergo diagnostics at a medical center. Previously, the doctor examines the patient's history, excludes all contraindications and takes into account the risks. In the future, it is necessary to undergo examinations every six months, which minimize the occurrence of complications and undesirable consequences.

Side effects

• vaginal infections, in the form of vaginitis or candidiasis;
• cystitis;
• cervicitis;
• excessive and sharp increase in body weight;
• the occurrence of infections in the urinary tract;
• the appearance of an increased desire to eat;
• depressive conditions;
• lack of sexual desire;
• a sharp change in mood;
• headache;
• the presence of dizziness;
• loss of vision;
• the appearance of hot flashes;
• soreness in the abdomen;
• attacks of nausea and vomiting;
• flatulence and bloating;
• constipation or diarrhea;
• on the skin there are various kinds of rashes (acne, urticaria, eczema, alopecia, etc.);
• the appearance of itching on the skin and in the genital area;
• muscle cramps, soreness in the arms and legs;
• the presence of pain in the lumbar region, the pelvic region and abdomen;
• the mammary glands are swollen and sore;
• there are profuse altered discharge from the vagina;
• PMS syndrome;
• the woman gets tired quickly;
• there is swelling on the face, arms and legs;
• dryness and burning of the mucous membranes in the vagina and vulva are felt;
• during intercourse, the partner can feel a foreign body in the vagina and the woman herself feels it, even in Everyday life(but the latter is rarely observed);
• sometimes the NuvaRing ring falls out;
• in rare cases, the occurrence of menorrhagia, metrorrhagia, fibrocystic mastopathy, amenorrhea, dysmenorrhea and ectropion of the uterus is observed.

Read the instructions before using Novaring.

Mechanism of action for endometriosis

This product contains estrogen, which acts clearly on purpose, topically. The ring can gradually release the active ingredients, in the form of etonogestrel and ethinyl estradiol. These substances normalize the cycle, eliminate uterine bleeding and pain. The endometrium, in turn, does not grow further.

The positive effect of NoaRing

As mentioned above, this tool not only serves as a contraceptive, that is, it protects against sudden pregnancy, but also has a positive effect on the general condition of a woman. After installing the ring, the woman feels:

• decrease in pain;
• decrease in menstrual bleeding.

All of the above will be present only with a correctly established diagnosis and in the absence of contraindications. If any discomfort occurs, you should immediately tell your doctor about it, who will most likely cancel Novairing and prescribe another drug that will also be effective for endometriosis.

Where to buy and its cost

You can buy a Novaring ring at a pharmacy anywhere in Moscow. If there is no way to get out, you can order the drug online.

Keep in mind! Pharmacies are available in each clinic, so you can buy everything you need immediately after leaving the specialist's office.

We present to your attention several pharmacies with prices for Novaring, for comparison.

If we take into account all the information written above, we can conclude that the cost for Novaring varies. It depends on the number of rings in the package. average price No. 1 - 1,400 rubles, No. 3 - 3,500 rubles.

Sometimes the price of NovaRing differs if you buy online or directly from a pharmacist. The first option is more profitable.

NuvaRing is a hormonal ring that will not only save a woman from conception, but also prevent or eliminate endometriosis. It can be used only after consulting a doctor and examination.

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Pharmacodynamics. The NuvaRing ring contains etonogestrel and ethinyl estradiol. Etonogestrel is a progestogen derivative of 19-nortestosterone with a high affinity for progesterone receptors in target organs. Ethinylestradiol is an estrogen widely used in contraceptive drugs. The contraceptive effect of NovaRing is based on different mechanisms, the main one of which is inhibition of ovulation.
The Pearl index for the NuvaRing ring is 0.765. In addition to protecting against pregnancy, Novairing regulates the menstrual cycle, reduces the severity of pain, the intensity of bleeding (which reduces the risk of developing iron deficiency anemia). There is evidence of a reduced risk of endometrial cancer and ovarian cancer.
Pharmacokinetics.
Etonogestrel
Etonogestrel, released from the NuvaRing ring, is rapidly absorbed by the vaginal mucosa. The maximum concentration of etonogestrel in blood plasma (average 1700 pg / ml) is achieved approximately 1 week after the introduction of the ring. Then, after 3 weeks, the concentration slowly decreases to 1400 pg / ml. Absolute bioavailability is 100% (which is higher than when using oral contraceptives). Etonogestrel combines with serum albumin and globulin that bind sex hormones. The volume of distribution of etonogestrel is 2.3 L / kg body weight.
Etonogestrel is metabolized by hydroxylation and reduction to form sulfate and glucuronide conjugates. The rate of elimination of metabolites from blood plasma averages 3.5 l / h. The interaction of etonogestrel with ethinyl estradiol taken simultaneously has not been identified. Plasma concentration of etonogestrel is reduced in 2 stages. The half-life at the last stage is about 29 hours. Etonogestrel and its metabolites are excreted in the urine and bile in a ratio of 1.7: 1. The half-life of metabolites is about 6 days.
Ethinylestradiol
Ethinylestradiol, released from the NuvaRing ring, is rapidly absorbed by the vaginal mucosa. The maximum concentration in blood plasma (about 35 pg / ml) is reached approximately on the 3rd day after the introduction of the ring and decreases to 18 pg / ml after 3 weeks. The absolute bioavailability is 56%, which corresponds to the level of oral bioavailability of ethinylestradiol.
Ethinylestradiol is metabolized by aromatic hydroxylation to form hydroxylated and methylated metabolites. These metabolites are present both in a free state and as conjugates of glucuronides and sulfates. The effective ground clearance is approximately 35 l / h. Plasma ethinylestradiol levels decrease in 2 stages. The half-life at the last stage is characterized by significant individual differences with an average value of 34 hours. Ethinyl estradiol is not excreted unchanged. Ethinyl estradiol metabolites are excreted in the urine and bile in a ratio of 1.3: 1. The half-life of metabolites is 1.5 days.

Indications for the use of the drug Novaring

Contraception.

The use of the drug Novaring

The NuvaRing ring is inserted into the vagina by a woman herself. The doctor should inform the woman how to insert and remove NuvaRing. To insert the ring, take a comfortable position: stand with your leg raised, sit down or lie down. Before insertion, the NuvaRing ring must be squeezed and inserted into the vagina so that it fits well. The exact position of the ring in the vagina is not decisive for the contraceptive effect.
From the moment of insertion, the ring should remain in the vagina constantly for 3 weeks. If the ring is accidentally removed (for example, when removing a tampon), it should be rinsed with cold or cool (but not hot) water and immediately reinserted into the vagina. NuvaRing should be removed after 3 weeks on the same day of the week when it was introduced. After a one-week break, a new ring must be inserted. The NuvaRing can be removed by hooking it with your index finger or holding the ring with your index and middle fingers. Bleeding associated with the cessation of the action of the drug usually begins 2-3 days after the removal of the NuvaRing and can continue until the day the next ring is inserted.
Start to use
If hormonal contraceptives have not been used during the previous menstrual cycle, NuvaRing must be administered between the 1st and 5th day of the cycle, but no later than the 5th day from the onset of menstruation, even if the bleeding has not yet ended. In the first 7 days of using Novairing, it is recommended to additionally use a condom.
Switching from combined oral contraceptives (CPC)
NuvaRing must be administered the next day after a break in taking the drug or after a period of taking placebo pills of the CPC course.
Switching from progestogen-only drugs (mini-pills, implant, or injection) or from a progestogen-releasing intrauterine system
A woman taking mini-pills can switch to the use of Novairing any day. When using an implant or intrauterine system that releases a progestogen, the transition is carried out on the day they are removed, and when using injections - on the day of the next scheduled injection. In all these cases, a woman should use an additional barrier method during the first 7 days.
After an abortion in the first trimester
You can start using the ring immediately after the abortion. There is no need for additional methods of contraception. If the use of NuvaRing immediately after an abortion is undesirable, you should adhere to the recommendations (see "If hormonal contraceptives were not used during the previous menstrual cycle").
After childbirth or abortion in the second trimester
Women are advised to start using the ring within the 4th week after childbirth or abortion in the second trimester. With a later use of the ring, it is recommended to additionally use the barrier method during the first 7 days of using NovaRing. With sexual intercourse during this period, before the introduction of NuvaRing, you must first exclude pregnancy or wait for the next menstruation.
Deviations from the recommended mode
Contraceptive effectiveness and menstrual control may be impaired if a woman does not adhere to the recommended regimen. To avoid a decrease in the effectiveness of contraception in case of violation of the regimen, the following recommendations should be adhered to.
When lengthening the break in use of the ring
In case of skipping ring replacement, the new ring should be inserted as early as possible and during the first 7 days, an additional barrier method of contraception (condom) should be used. If during the break in the use of the ring there was sexual intercourse, the risk of pregnancy should be assessed. The longer the break, the higher the risk of pregnancy.
With the temporary absence of a ring in the vagina
The NuvaRing ring should be constantly in the vagina for 3 weeks. Accidental removal and absence of the ring in the vagina for ≤3 hours does not affect the effectiveness of contraception. The ring should be reinserted as soon as possible, no later than after 3 hours. The absence of the ring in the vagina for 3 hours reduces the effectiveness of contraception. You should insert the ring as soon as possible and use a barrier method of contraception (condom) within 7 days from the time the ring is inserted into the vagina. If the first of these 7 days falls on the 3rd week of using the ring, Novairing should be used for longer than 3 weeks. Then the ring should be removed and a new one should be inserted after a week's break.
If the removal of the ring for a period of 3 hours took place during the 1st week of using the ring, the risk of pregnancy should be weighed.
With an increase in the period of use of the ring
The maximum period of using Novairing without losing the effectiveness of contraception is 4 weeks. You should take a week off from using the ring and then introduce a new one. Finding NovaRing in the vagina for 4 weeks reduces the effectiveness of contraception, and pregnancy should be excluded before the introduction of a new ring.
If the recommended regimen is violated and menstruation is delayed during the next break in using the ring, pregnancy should be excluded before the introduction of a new ring.
Change in the timing or delay of menstruation
To delay menstruation, a new ring should be inserted without a week break. The new ring should also be used for 3 weeks. During this period, a woman may experience slight or thick spotting. In the future, after the usual weekly break in the use of the ring, the regular use of NovaRing should be restored.
Changing the period of menstruation, moving it to another day of the week that does not coincide with the planned day of introduction of the ring should be by reducing the next break by required amount days. The shorter the previous break, the higher the risk of missing menstruation, the appearance of thick or light spotting during the next break.

Contraindications to the use of the drug Novaring

Venous thrombosis with / without pulmonary embolism at present or in history; arterial thrombosis (cerebrovascular accident, myocardial infarction) or precursors of thrombosis (angina pectoris or transient ischemic cerebrovascular accident), currently or in history; predisposition to venous or arterial thrombosis with or without the inclusion of such hereditary disorders as activated protein C (APC) resistance, antithrombin III deficiency, protein C deficiency, protein S deficiency, hyperhomocysteinemia, antiphospholipid antibodies (anticardiolipin antibodies, lupus anticoagulant). migraine with focal neurological symptoms; diabetes mellitus with vascular complications; pancreatitis or postponed pancreatitis, which is accompanied by hypertriglyceridemia; serious illnesses liver (until the liver function indicators return to normal values); liver tumor (benign or malignant; present or in history); hormone-dependent malignant tumors (diagnosed or suspected); vaginal bleeding of unknown etiology; diagnosed or probable pregnancy; lactation period; hypersensitivity to any component of the drug.
Use with caution in diabetes mellitus; obesity (body mass index 30 kg / m2); Hypertension (arterial hypertension); atrial fibrillation; heart valve disease; dyslipoproteinemia; diseases of the liver and gallbladder; Crohn's disease and ulcerative colitis; sickle cell anemia; systemic lupus erythematosus; hemolytic uremic syndrome; epilepsy; smoking over the age of 35; prolonged immobilization; extensive surgical interventions; fibrocystic breast disease; fibroids of the uterus; congenital hyperbilirubinemia (syndrome of Gilbert, Dubin-Johnson and Rotor); chloasma (avoid sun exposure and ultraviolet radiation); any condition in which the woman is unable to insert properly or may lose the ring; prolapse of the cervix; cystocele or rectocele, severe or chronic constipation.

Side effects of the drug Novaring

Adverse drug reactions reported in women using Novairing® are listed in the table below. The most appropriate term MedDRA (version 11.0) is attached to describe a specific adverse event.

Systems and organs	Frequent ≥ 1/100	Infrequent ≤1 / 100, ≥ 1/1000	Post Marketing (1)
Infections and invasions	Vaginal infection
The immune system			Increased sensitivity
Metabolism and eating disorders		Increased appetite
Mental disorders	Depression, decreased libido	Change of mood
The cardiovascular system		Blood to your face
Digestive system	Abdominal pain, nausea	Bloating, diarrhea, vomiting, constipation
Skin and subcutaneous tissue		Alopecia, eczema, itching, rashes	Hives
Musculoskeletal and connective tissue		Back pain, muscle cramps, limb pain
urinary system
Reproductive system and mammary gland	Soreness, itching of the female genitals, dysmenorrhea, pain in the small pelvis, vaginal discharge	Amenorrhea, discomfort in the mammary glands, enlargement of the mammary glands, cervical polyp, coital bleeding, dyspareunia, ectropia of the cervix, cystic fibrous mastopathy, menorrhagia, metrorrhagia, discomfort in the small pelvis, premenstrual syndrome, contractions of the muscles of the uterus, pain in the vagina bad smell from the vagina, vaginal pain, vulvovaginal discomfort, vulvovaginal dryness.	Diseases of the genital organ in men2
General disorders and disorders at the injection site		Fatigue, irritability, discomfort, edema, foreign body sensation
	Weight gain	Hypertension
Injuries and procedural complications	Discomfort during ring use, prolapse of the vaginal contraceptive ring	Complication when using a contraceptive ring, ring breakage

1) A list of adverse events based on a spontaneous report. The exact frequency cannot be determined.
2) Diseases of the genital organ in men (including reports of local reactions).

Special instructions for the use of the drug Novaring

Special warnings and special precautions.
In the event of any of the conditions / risk factors listed below, the benefits or risks of further use of the Novairing drug should be considered in each specific woman and discussed with the patient before she decides to use this drug. In case of exacerbation, intensification or the first manifestations of any of these conditions, a woman should consult a doctor. The doctor determines the need to use the drug Novairing. All the data below are based on epidemiological data obtained with the use of combined oral contraceptives. There are no epidemiological data obtained with the vaginal method of using hormones, but warnings are considered acceptable when using the drug NovaraRing.

1. Circulatory disorders

• Epidemiological studies suggest a link between COC use and an increased risk of arterial and venous thrombosis and thromboembolic diseases such as myocardial infarction, stroke, deep venous thrombosis and pulmonary embolism. These phenomena are rare.
• The use of any combined oral contraceptive pill by women increases the risk of developing venous thromboembolism (VTE) compared with those who do not take COCs. The risk of developing venous thromboembolism is especially high in the first year of using the PDA. This increased risk is less than the risk of VTE associated with pregnancy, which is estimated at 6 per 10,000 pregnancies. VTE ends fatally in 1-2% of cases.
  It is not known how NuvaRing affects the risk of VTE in comparison with other combined hormonal contraceptives.
• Thrombosis that occurs in other blood vessels, such as hepatic, mesenteric, renal, cerebral or retinal veins and arteries, has been reported very rarely in women using COCs. Not general opinion about whether the occurrence of these cases is associated with the use of PDAs.
• Symptoms of venous or arterial thrombotic events may include: uncharacteristic one-sided pain in the lower extremities and / or swelling; sudden severe pain in chest, regardless of whether she gives to the left hand; sudden dyspnea; a sudden attack of coughing; any unusual, severe, prolonged headache; sudden partial or complete loss of vision; diplopia; slurred speech or aphasia; vertigo; collapse with or without focal seizure; weakness or severe numbness on one side or one part of the body; impaired coordination of movements; symptoms of an "acute" abdomen.
• The risk of venous thromboembolism is increased due to:
  age;
  burdened family history (the presence of siblings or parents of venous or arterial thromboembolism in relatively early age). If there is a suspicion of a hereditary predisposition, the woman should be referred for consultation with a specialist before deciding on the use of a PDA;
  prolonged immobilization, significant surgical interventions, various surgical interventions on the lower extremities or severe injuries. In these cases, it is recommended to stop taking the drug (in the case of a planned operation, at least four weeks) and not to resume it within two weeks after complete remobilization;
  obesity (body mass index is more than 30 kg / m2);
  also in the presence of superficial thrombophlebitis and varicose veins. There is no consensus on the possible role of these conditions in the etiology of venous thrombosis.
• The risk of arterial thromboembolism is increased due to:
  - age;
  - smoking (the more a person smokes and the older he is, the greater the risk, especially in women over 35);
  - dyslipoproteinemia;
  - obesity (body mass index ≤30 kg / m2);
  - AH (arterial hypertension);
  - migraine;
  - heart valve disease;
  - atrial fibrillation;
  - a burdened family history (for example, arterial thrombosis in a brother / sister or parents at a relatively early age). If a hereditary predisposition is suspected, the woman should be referred to a specialist for advice before deciding on the use of hormonal contraception.
• Biochemical factors that may indicate a hereditary or acquired predisposition to venous or arterial thrombosis include resistance to activated protein C (APC), hyperhomocysteinemia, antithrombin III deficiency, protein C deficiency, protein S deficiency, antiphospholipid antibodies (anticardiol-coagulation antibodies) ...
• Other pathological conditions that have been associated with undesirable circulatory effects, including diabetes mellitus, SLE, hemolytic uremic syndrome, chronic inflammatory bowel disease (Crohn's disease and ulcerative colitis), and sickle cell anemia.
• It is necessary to consider the increased risk of thromboembolism in the postpartum period (see section "Use during pregnancy or lactation").
• An increase in the frequency or intensity of migraine while taking a PDA (which may precede a cerebrovascular disorder) may be the reason for the immediate discontinuation of PDA intake.

2. Tumors

• The highest risk factor for cervical cancer is persistent human papillomavirus (HPV) infection. Epidemiological studies have shown that long-term use of COCs may contribute to an increased risk of cervical cancer, but it is not clear how this relates to mixed effects, for example, an increase in the frequency of cervical examinations and a variety of sexual behaviors, including the use of barrier contraceptives and casual association. It is not known how this effect relates to NovaRing.
• A meta-analysis of 54 epidemiological studies showed that there is a slight increase in the relative risk (RR = 1.24) of developing breast cancer in diagnosed women who are this moment use a PDA. The high risk gradually decreases over the course of 10 years after the discontinuation of the use of PDAs. Since breast cancer rarely occurs in women under 40 years of age, the number of breast cancer diagnoses in those who have now or previously used COCs is small compared to the overall risk of developing breast cancer. Breast cancer diagnosed in women is generally less advanced clinically than cancer diagnosed in people who have never used COCs. The increased risk model that is observed may be due to the early diagnosis of breast cancer in women using COCs, the biological effects of COCs, or a combination of both.
• In women who use COCs, benign liver tumors and very rarely malignant liver tumors have been reported rarely. In isolated cases, these tumors were the cause of life-threatening intra-abdominal bleeding. Thus, it is necessary to consider a liver tumor in the differential diagnosis if women who use NuvaRing experience severe pain in the upper abdomen, enlargement of the liver, or signs of intra-abdominal bleeding.

3. Other conditions

• When using PDAs in women with hypertriglyceridemia or with a family history of it, there is a possible risk of developing pancreatitis.
• Although mild increases in blood pressure have been reported in many women who take hormonal contraceptives, clinically significant increases are rare. The exact relationship between the use of hormonal contraceptives and hypertension (arterial hypertension) has not been established. However, if persistent clinically significant hypertension (arterial hypertension) develops during the use of the Novairing drug, the doctor should suspend the use of the ring for a while and treat hypertension (arterial hypertension). The use of the drug Novairing can be resumed if blood pressure norms are reached with the help of antihypertensive therapy.
• The occurrence or worsening of the following conditions during pregnancy and the use of hormonal contraceptives have been reported, but the evidence for a relationship in their use is inconclusive: jaundice and / or pruritus associated with cholestasis; the formation of gallstones; porphyria; SLE; hemolytic uremic syndrome; chorea; herpes during pregnancy; hearing loss associated with otosclerosis; hereditary angioedema.
• Acute or chronic abnormalities of liver function may require discontinuation of the use of Novairing, until the normalization of liver function indicators. Recurrence of cholestatic jaundice and / or pruritus associated with cholestasis that first occurred during pregnancy or previous use of sex steroids requires discontinuation of ring use.
• Estrogens and progestogens can affect peripheral insulin resistance and impaired glucose tolerance, and there is no need to change the treatment regimens for diabetic patients who use hormonal contraception. However, for women with diabetes mellitus, there should be careful medical supervision during the use of NovaRing, especially in the first months of use.
• In connection with the use of hormonal contraceptives, a worsening of Crohn's disease and ulcerative colitis have been reported.
• Chloasma can occur intermittently, especially in women with a history of pregnant chloasma. Women who are prone to chloasma are advised to avoid sun exposure or exposure to ultraviolet radiation while taking NuvaRing.

If a woman has any of the following conditions, she will not be able to correctly insert NuvaRing or may lose the ring: cervical prolapse, cystocele and / or rectocele, severe or chronic constipation.
It has very rarely been reported that NuvaRing was accidentally injected into the urethra and possibly ended up in the bladder. Thus, it is necessary to consider the possibility of incorrect placement of the ring in the differential diagnosis in case of symptoms of cystitis.
During the use of the NovaRing drug, women can sometimes experience vaginitis. There is no evidence that the effectiveness of NovaRing is affected by the treatment of vaginitis or that the use of NovaRing affects the effectiveness of treatment of vaginitis (see Section Interaction with other medicinal products and other types of interactions.).
It was very rarely reported that the ring had grown into the vaginal mucosa, which required the intervention of a specialist doctor.
Medical supervision
Before using or resuming the use of NuvaRing, a doctor's consultation is necessary with a thorough collection of anamnestic data and a medical examination. In the future, the doctor's examination should be repeated at least once a year with blood pressure measurement, examination of the mammary glands, abdominal and pelvic organs, cytological examination of the cervix and appropriate laboratory tests.
The patient should be informed that the use of NuvaRing does not protect against HIV infection (AIDS) and other sexually transmitted diseases.
Decreased efficiency
The effectiveness of NovaRing may decrease in case of non-compliance with the regimen of use or while taking certain medications.
Worsening control of the menstrual cycle
During the use of the drug NovaRing may experience (minor or heavy) bleeding. If irregular bleeding occurs after previous regular cycles during the use of NovaRing in accordance with the recommended regimen, non-hormonal causes should be considered and an adequate diagnosis should be prescribed to exclude pregnancy or malignant tumor, which may include curettage.
In some women, during a break in the use of the ring, bleeding may not be observed. If NuvaRing was used in accordance with the recommendations given in the section "Dosage and Administration", then the possibility of pregnancy is small. However, if NovaRing was used without following such recommendations before the first case of no bleeding during the period without using the ring, or if there are no bleeding twice in a row, pregnancy should be excluded before continuing to use the drug NovaRing.
Ring damage
In very rare cases, it has been reported about the disconnection of the NuvaRing ring during use (see Section Interaction with other medicinal products or other types of interactions). Since the core of the NovaRing preparation is solid, its contents remain intact and will not significantly affect the release of hormones. If the ring is disconnected, it may fall out. If the drug NuvaRing is damaged, the woman should discard the ring and replace it with a new one.
Deleting
Reportedly, the NuvaRing can be removed if the ring was incorrectly inserted, when a tampon is removed, during coitus, or in cases of severe and chronic constipation. Therefore, a woman is advised to regularly check for the presence of Novairing in the vagina. If NuvaRing is accidentally deleted, the woman should follow the instructions.
The effect of ethinyl estradiol and etonogestrel on men
The extent and possible pharmacological effect of ethinyl estradiol and etonogestrel on sexual partners by absorption through the mucous membrane of the male genital organ has not been studied.
Use of the drug during pregnancy or lactation
Pregnancy is a contraindication for the use of NovaRing. When pregnancy occurs, the ring should be removed.
Estrogens can reduce the amount and composition of breast milk. It is not recommended to use NuvaRing during breastfeeding (until the baby is completely weaned).
NuvaRing does not affect concentration and ability to drive vehicles.

Drug interactions Novaring

Interactions between hormonal contraceptives and other medications can cause irregular bleeding and / or lack of contraceptive effect.
Hepatic metabolism: Interactions can be observed with drugs that induce microsomal enzymes that can lead to an increase in sex hormone metabolism (for example, phenytoin, phenobarbital, primidone, carbamazepine, rifampicin, oxcarbazepine, topiramate, felbamate, ritonavir, and griseofulvin drugs ).
Women taking any of these drugs should temporarily use a barrier method of contraception in addition to the use of NovaRing or choose another method of contraception. When using drugs that induce microsomal enzymes, a barrier method of contraception should be used during the course of using such drugs and for another 28 days after stopping their use.
If the course of therapy with concomitant drugs exceeds 3 weeks, during which the ring is used, the next one should be administered immediately, without the usual one-week break.
The contraceptive effect of the drug may also decrease with the simultaneous administration of certain antibiotics, for example, penicillins and teracycline. The mechanism of this effect has not been identified. In studies of pharmacokinetic interaction, oral administration of amoxicillin (875 mg, 2 times a day) or doxycillin (200 mg on the first day, followed by 100 mg per day) for 10 days of use of the NovaRing preparation does not significantly affect the pharmacokinetics of etonogestrel and ethinyl estradiol (EE ). Women who are taking antibiotics (other than amoxilin and doxycycline) need to use a barrier method of contraception for up to 7 days after discontinuation. If the concomitant drug intake exceeds 3 weeks of the ring cycle, a new ring must be inserted immediately, without taking the usual break before using the next ring.
According to pharmacokinetic data, intravaginally administered antimycotics and spermicides do not affect the contraceptive efficacy and safety of NovaRing. During the concomitant use of antimycotic suppositories, the risk of ring disconnection may be slightly higher.
Hormonal contraceptives can affect the metabolism of others medicines... Accordingly, the concentration in blood plasma and tissues can both increase (for example, cyclosporine) and decrease (for example, lamotrigine).
The directions for use of concomitant medicinal products should be followed to determine potential interactions.
The use of contraceptive steroids can interfere with the results of some laboratory tests, including biochemical indicators of liver, thyroid, adrenal and kidney function, plasma protein levels (for example, the level of globulin, which binds corticosteroids, and globulin, which binds sex hormones), lipid fractions and lipoproteins, indicators of carbohydrate metabolism, coagulation and fibrinolysis. Such changes usually remain within the normal laboratory values.
Interaction with tampons.
Pharmacokinetic data show that the use of tampons does not affect the systemic absorption of hormones that NovaRing secretes. In rare cases, NuvaRing can be removed when the tampon is removed.

Overdose of the drug Novaring, symptoms and treatment

The occurrence of serious and dangerous complications in overdose have not been reported. In case of an overdose, nausea, vomiting may occur, in young women - spotting from the vagina. There is no antidote. Treatment in case of overdose is symptomatic.

Storage conditions of the drug Novaring

In its original packaging at a temperature of 2-8 ° C.

List of pharmacies where you can buy Novaring:

• Saint Petersburg

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The Novaring ring is relatively the new kind local hormonal contraception, increasingly used by modern women. On the pharmaceutical market, there is the only manufacturer of this contraceptive - N. o. Organon (Netherlands). The lack of competition and ease of use explains the high cost of the drug.

The Novaring hormonal ring is a combined contraceptive agent based on estrogen and gestagen, the contraceptive effect of which is mainly due to the suppression of ovulation.

Mechanism of action

The Novaring contraceptive ring is a transparent product made of vinyl acetate, which contains 2 types of hormones: etonogestrel and ethinyl estradiol. In addition to the contraceptive effect, the hormonal ring has a therapeutic effect on the female reproductive system.

Sex hormones that are secreted from the Novaring vaginal ring, under the influence of body temperature, penetrate into the tissues of the vagina. The maximum increase in the concentration of hormones in the blood is noted 3-7 days after the introduction of the contraceptive into the vagina. Over the course of 3 weeks, the concentration of active substances gradually decreases. The bioavailability of etonogestrel exceeds that with oral administration of the drug.

Numerous reviews of women who used the Novaring vaginal ring indicate the effectiveness of the contraceptive and the therapeutic effect. As a result of ongoing studies, a decrease in the incidence of breakthrough bleeding, often observed with the use of oral hormonal contraception, has been noted. This action of the drug reduces the risk of developing anemia as a result of monthly blood loss and significantly improves the woman's condition. There is evidence of a decrease in the likelihood of the formation of oncological processes in the organs of the reproductive system after using the Novaring ring.

It should be noted that the contraceptive does not protect a woman from sexually transmitted diseases, despite the thickening of cervical mucus under the influence of sex hormones. Structural changes in vaginal secretions only prevent the occurrence of inflammatory processes, provided that sexual hygiene is observed.

The effectiveness of the Novaring ring depends on adherence to the manufacturer's recommendations when using it. The vaginal ring, inserted into the vagina, under the influence of body temperature takes a comfortable position corresponding to the anatomical features of the organ.

With increased physical activity, improper administration, chronic constipation, hernias, removal of a hygienic tampon, the ring may fall out of the vagina. Therefore, it is necessary to observe precautions in such situations. A woman should regularly check for the presence of a ring in her vagina in order to ensure a reliable contraceptive effect.

The period of hormonal changes in the body when using this contraceptive does not exclude additional consultation with a gynecologist and a diagnostic examination of the body before starting therapy.

The complex of standard measures preceding hormone therapy includes:

• examination on a gynecological chair;
• confirmation of the absence of pregnancy (pharmacy test or blood test for hCG);
• blood pressure measurement;
• taking a smear for further cytological and bacteriological examination;
• general and biochemical blood tests;
• blood clotting test (coagulogram or hemostasiogram).

Consultation with a gynecologist-endocrinologist will prevent the appearance of hormone-dependent neoplasms in the reproductive organs, breasts, uterine bleeding, exacerbation of chronic diseases, deterioration of the general condition against the background of the use of contraceptive hormones.

Terms of use

The vaginal method of using synthetic sex hormones allows you to achieve a higher bioavailability of active substances, compared with oral administration and a transdermal patch.

This type of contraception is convenient because a woman uses a hormonal agent on her own and can remove it at any time. For the correct administration of the contraceptive, it is advisable to choose the most comfortable position (as when using a hygienic tampon). To insert the ring into the vagina, you just need to bend it with your fingers.

A sufficient concentration of hormones is present for 1 month from the date of administration. After a three-week stay of the ring in the vaginal cavity, it is removed. The next copy is used in a similar way after a one week break.

The Novaring ring is administered according to a strictly defined scheme so that the effectiveness of the hormonal agent remains high for a month:

1. If a woman uses this type of contraception for the first time, then it is better to start from the first day of the onset of menstruation. However, the option from 2 to 5 days of menstruation is also acceptable, subject to additional barrier protection in the form of a condom or contraceptive suppositories (cream). The vaginal ring should be at least three weeks old, and after a week's break, a new one is inserted. The appearance of blood discharge is a sign that the drug is losing its contraceptive property.
2. After previous hormonal contraception in the form of systemic drugs (pills or transdermal patch), the transition to Novaring is carried out at any time, provided that the permissible hormone-free period of time (7 days) is observed.
3. When switching from microdosed oral drugs, hormonal injections, an intrauterine device, implants, according to the instructions, the Novaring ring should be inserted immediately after the end of the previous contraceptive (on the last day of the interval between cycles). Otherwise, you will need to use a condom or spermicidal suppository for at least 7-10 days.
4. If a woman had an abortion before 12 weeks, the Novaring ring should be inserted immediately after surgery, otherwise additional local contraception or an alternative method of preventing unwanted pregnancy will be required.
5. V postpartum period gynecologists advise using Novaring no earlier than one month after delivery in case of refusal to breastfeed the child. If during this period there was coitus, you need to make sure that there is no pregnancy. A clear confirmation that a woman is not pregnant will be the first menstruation. If the discharge is insignificant, and there are doubts, you can seek advice from a gynecologist. If you want to use a pregnancy test, you should remember that after delivery, the chorionic gonadotropin hormone is still present in the female body, which affects the test result. When breastfeeding a baby, Novaring is not used.
6. After spontaneous removal of the ring from the vagina (for example, with increased physical activity), it must be washed with water and reinserted. When rinsing the ring, make sure that the water is not hot, otherwise you will need to introduce a new copy.
7. In the absence of no more than 3 hours in the first or second week of the menstrual cycle, you can not worry about the loss of the contraceptive properties of the drug. If the ring was missing in the vagina in the third week of the cycle for more than 3 hours, a new contraceptive should be introduced without waiting for withdrawal bleeding. If the mode of using the Novaring ring was not violated during the cycle, you can wait for withdrawal bleeding and introduce a new contraceptive 7 days later according to the usual scheme.
8. Sometimes Novaring can be used without interruption in administration. For example, if you want to postpone your period, doubting the effect of the drug, errors in use. If these are isolated cases, then there is no particular reason for excitement. However, repeated violation of the scheme of use specified in the instructions significantly increases the risk of side effects, hormonal imbalance. It is not recommended to use the Novaring ring for more than 3 consecutive months without interruption.
9. Taking antibacterial and antifungal drugs requires additional barrier contraception to maintain the maximum contraceptive effect. Against the background of prolonged antibacterial or antifungal therapy, it may be necessary to use local remedies to prevent pregnancy.
10. Pregnant women are not prescribed Novaring. It is not recommended to use it during lactation due to the penetration of contraceptive hormones into breast milk.

Novaring has no analogues, but hormonal agents containing a combination of estrogens and gestagens have a similar effect:

• Logest;
• Kliogest;
• Klayra;
• Klymene;
• Silest;
• Yarina.

In what cases is a contraceptive contraindicated?

Like any hormonal drug, the Novaring vaginal ring has contraindications and restrictions for use:

1. young age (puberty);
2. diseases of the circulatory system (arterial and venous thrombosis);
3. genetic factor of predisposition to thrombosis of veins and arteries;
4. heart diseases;
5. diabetes;
6. complex surgical intervention (a break of at least one month);
7. severe headache (suspected migraine);
8. hormone-dependent neoplasms in the reproductive organs and mammary glands;
9. pregnancy or suspicion of it;
10. lactation period;
11. severe diseases of the gastrointestinal tract (pancreatitis, pathology of the liver and biliary tract, etc.);
12. hypertension;
13. prolapse of the cervix;
14. chronic constipation;
15. hernia of the organs of the excretory system;
16. bleeding from the vagina.

Novaring can have a negative effect on the body with improper use or individual intolerance to synthetic hormones.

Side effects

• acute inflammatory processes in the vagina (dysbiosis, vaginitis, thrush);
• itching of the vagina;
• infection of the urinary tract (urethritis,);
• lower abdominal pain;
• painful sensations in the chest;
• headache;
• swelling of the limbs;
• hypertension;
• decreased libido;
• painful menstrual discharge;
• increased appetite;
• a rapid increase in body weight;
• local allergy to vinyl acetate;
• general allergic reaction of the body to synthetic hormones.

If any of the listed symptoms appear, you should consult a gynecologist-endocrinologist or related specialists if you have a history of systemic diseases.

The contraceptive property of Novaring depends on the rules for using the vaginal ring, the individual characteristics of the organism. Diagnostics of the body, the study of hormonal levels, timely consultations with a gynecologist, endocrinologist, mammologist prior to hormone therapy will reduce the risk of side effects not only in the presence of systemic diseases, but also in order to prevent their occurrence.

Thank you

The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. A specialist consultation is required!

Introduction

Doctors around the world are trying to create funds contraception as convenient as possible for women, safe, comfortable to use. Therefore, from time to time, new, unfamiliar ones appear in pharmacies. contraceptives; how to use them is not very clear. Currently in Russia, such contraceptives include a hormonal ring Novairing(although women all over the world have been using this tool for over a decade). We will try to give as complete an understanding of this method of contraception as possible.

What is NuvaRing?

NuvaRing is a contraceptive in the form of an elastic, smooth, transparent ring inserted into a woman's vagina and remaining there for three weeks. Inside the female body, the ring changes its shape, taking the optimal position in accordance with the individual characteristics of the physique. The flexible, soft ring does not cause any uncomfortable sensations, and does not remind of itself in any way.

With NovaRing, you do not need to limit your physical activity: you can safely engage in any sport, including jogging, swimming, horse riding. During sexual relations, the ring is not felt by partners at all, and does not create inconvenience.

The dimensions of the ring are the same for everyone: thickness - 4 mm, diameter - 54 mm. This size is suitable for every woman, regardless of her height, weight and age, as it is able to adapt to the shape of the individual body contours.

NovaRing is produced in the Netherlands in one single form: in the form of a ring. NovaRing tablets do not exist. NovaRing 1 and NovaRing 3 differ in the number of rings in the package (one ring or three).

Composition and principle of action

Shell contraceptive ring consists of antiallergic material. Under the shell in the NuvaRing ring is a minimum dose of two female sex hormones (estrogen and progestogen). This dose is even less than that found in any of the micro-dose birth control pills.

When the NuvaRing ring is inserted into the vagina, its shell heats up to a temperature human body(34-42 o) and becomes permeable to hormones contained within the ring. Released from under the membrane, hormones act directly on the uterus and ovaries. Other organs remain outside the sphere of influence of hormones.

The dose of hormones contained in NovaRing is enough to suppress the maturation of the egg and its release from the ovary. As a result, pregnancy becomes impossible.

Method advantages

• Reliability and high efficiency of contraceptive action.
• Ease of use: replacement only once a month.
• The body is minimally affected by hormones due to their low dosage.
• Hormones act only locally, without exerting unnecessary stress on the liver, stomach and intestines.
• A woman's weight does not increase when using Novairing.
• The regularity of the menstrual cycle is restored (if it has been violated). Menstruation becomes less painful.
• The use of NuvaRing reduces the risk of ovarian and uterine cancer.
• Providing a full, natural, harmonious sex life.
• Rapid recovery of ovulation and fertility (within 4-5 weeks after removal hormonal ring).
• If desired, a woman can keep the use of NuvaRing secret: the partner will not feel the presence of the ring in the vagina.

Disadvantages of the method

The disadvantages include only three factors:

1. The method of protection is psychologically unusual.
2. The presence of a fairly extensive list of contraindications.
3. NuvaRing, like other hormonal contraceptives, does not provide protection against sexually transmitted diseases, including AIDS (HIV infection).

Technique of use (how to insert NuvaRing)

The woman inserts the contraceptive ring into the vagina on her own, choosing a comfortable position for this: lying down, squatting, or standing, leaning her back against the wall and raising one leg. The introduction of the ring is performed during menstruation (on the 1st - 5th day). Hands should be washed clean. NuvaRing should be squeezed with your fingers, reducing its diameter, and inserted as deep as possible into the vagina. The smooth ring slides into the body unhindered. If you feel uncomfortable after doing this, adjust the ring with your fingers. Once in the correct position, it will become imperceptible. It does not matter where exactly the NuvaRing is fixed in the vagina: an indicator of correct insertion is the absence of discomfort.

Once the contraceptive ring is inserted, it is not removed for three weeks. If the NuvaRing is accidentally removed (for example, together with a tampon), it is washed with warm water and returned to its original place.

When the time comes to remove the hormone ring, it is gently pulled out by hooking it with the index finger or between the middle and index fingers.

Application

The action of one NovaRing ring is designed for the duration of one menstrual cycle. The ring placed inside the vagina is removed on the 22nd day after insertion. In order not to get lost in the calculations, remember: remove the ring on the same day of the week on which it was introduced (introduced on Wednesday - remove after three weeks on Wednesday; introduced on Friday - remove after three weeks on Friday). It is better, of course, to mark in advance the day of introduction and the day of removal in the calendar.

After removing the ring, a 7-day break is required. On the 8th day, you can enter a new ring.

If the patient has not previously used hormonal contraceptives, NuvaRing is introduced, as mentioned above, between the 1st and 5th days of menstruation (no later than the 5th day).

If a woman switches to using Novairing after taking combined hormonal pills, the ring is inserted after a week's break in contraception, on the day when the pills from the new package should have started.

After taking mini-pills, NovaRing can be administered any day. After using intrauterine systems or implants - the next day after removing the IUD or implant. After injection contraception - on the day the next injection is due.

In any case, during the first week of using Novairing, it is recommended to additionally use a condom as a barrier method of contraception.

Application of NuvaRing after an abortion or childbirth
If the abortion was performed in the first three months of pregnancy, NuvaRing can be administered immediately after the abortion. In this case, you do not need to use a condom additionally.

If, for some reason, the hormonal ring was not inserted immediately after the abortion, you should wait for menstruation and insert NuvaRing from the 1st to the 5th day (plus using a condom for a week).

If an abortion took place in the second three weeks of pregnancy, then, just like after childbirth, you can start using NuvaRing only three weeks after the abortion. You do not need to use a condom.

If NuvaRing wants to be introduced later than 21 days after childbirth or abortion, and sexual intercourse took place in the past period, you need to wait for the start of the first menstruation (to make sure there is no new pregnancy). It is imperative to use a condom for a week.

Break in application

If a woman, for any reason, violates the Novairing regimen and takes a break from using the contraceptive ring for more than 7 days, the contraceptive effect may be lost. The longer the break, the greater the risk of an unwanted pregnancy. To prevent this from happening, the following recommendations must be followed:
1. With an extended break in the use of NuvaRing, you need to insert a new ring into the vagina as soon as possible (plus using a condom for a week).
2. If the ring was removed by accident, 2 scenarios are possible:

• If NuvaRing has been outside the vagina for less than three hours, the contraceptive effect of hormones will not be interrupted. Put the ring back in place as soon as possible.
• If the hormonal ring has been removed from the vagina for more than three hours, the contraceptive effect may be reduced. The ring, as in the previous case, must be urgently returned to the inside of the vagina, and not removed from there for at least 7 days (plus using a condom for a week). Even if this episode occurred during the 3rd week of using NuvaRing, when it would soon be necessary to remove the ring, it will be necessary to extend the period of its use for more than 3 weeks (until 7 days have passed since the ring was returned to its place). Only then can the NuvaRing be removed, and a new ring can be put in a week later.

Extended use

If a woman forgot to take out NuvaRing on time, and the ring was inside the vagina for 3 to 4 weeks, the contraceptive effect persists. The ring is removed as usual and a new one is inserted after a week.

In the event that NuvaRing's stay in the vagina lasts more than 4 weeks, its contraceptive effect decreases, and after removing the ring, a new one can be inserted only after making sure that there is no pregnancy, i.e. waiting for the onset of menstruation.

Menstruation and bleeding during the use of NuvaRing, and after it
canceling

A break in the use of NuvaRing in most women causes bleeding associated with the cessation of hormonal exposure. Bleeding starts 2-3 days after extraction
the contraceptive ring, and may stop after the introduction of a new ring (but maybe even earlier).

In some women, a break in the use of Novaring is not accompanied by bleeding. This option can be considered the norm if the hormonal ring was used strictly according to the recommendations, and the absence of bleeding was noted once.

While NovaRing is in the vagina, irregular, minor spotting bleeding may appear. A sudden onset of heavy bleeding is also possible. Minor discharge does not require a visit to a doctor, and with severe bleeding, an urgent need to see a gynecologist.

Cancellation of NuvaRing

Cancellation of NuvaRing does not require any special preparation. The contraceptive ring is simply removed when you decide to stop contraception.

Pregnancy after lifting the contraceptive ring

After removing the NuvaRing ring, the effect of hormones on female body... The ovulation process is restored, i.e. maturation of a normal egg. Within 4-5 weeks after the cancellation of Novairing, conception and full-fledgedness may occur, normal pregnancy... There are no consequences after using the vaginal ring.

Side effects

When using the NovaRing hormonal ring side effects are quite rare. Usually, these phenomena occur at the beginning of using the product, and soon disappear on their own, without requiring treatment.

Side effects include the following symptoms:

• Central nervous system reactions - dizziness, headache, mood swings, anxiety.
• Reactions of the digestive system - nausea, sometimes abdominal pain, diarrhea, vomiting.
• Endocrine system reactions - changes in body weight (weight gain or loss may occur), some increase and engorgement

Novaring: instructions for use and reviews

Novairing is a combined hormonal contraceptive for intravaginal use.

Release form and composition

Dosage form NovaRing - vaginal ring: transparent, smooth, almost colorless or colorless, without visible significant damage, at the junction - a transparent or almost transparent area (1 pc. In sealed aluminum foil bags, in a cardboard box 1 or 3 bags) ...

• Etonogestrel - 11.7 mg;
• Ethinylestradiol - 2.7 mg.

Auxiliary components: ethylene and vinyl acetate copolymer (28% vinyl acetate), magnesium stearate, ethylene and vinyl acetate copolymer (9% vinyl acetate).

Pharmacological properties

Pharmacodynamics

Novairing is a hormonal combined contraceptive that contains ethinyl estradiol and etonogestrel. Etonogestrel is a progestogen (19-nortestosterone derivative) that binds with high affinity to progesterone receptors localized in target organs. Ethinylestradiol belongs to estrogens and is widely used in the production of contraceptive drugs.

The contraceptive effect of NovaRing is due to a combination of various factors, the most important of which is the suppression of ovulation.

The results of clinical studies indicate that the Pearl index (a parameter showing the frequency of pregnancy when 100 women were observed for 1 year while using contraception) in patients aged 18-40 years for this drug was 0.96 when statistical analysis of all randomized participants (PT analysis) and 0.64 (95% CI ranged from 0.35 to 1.07) in the analysis of participants who completed them according to the protocol (PP analysis). These results were similar to the values ​​of Pearl indices, determined during comparative studies of combined oral contraceptives (COCs), which included drospirenone / ethinyl estradiol (3 / 0.3 mg) or levonorgestrel / ethinyl estradiol (0.15 / 0.03 mg) ...

Against the background of the use of NovaRing rings, the cycle normalizes (it becomes more regular), and the intensity and soreness of menstrual bleeding decreases, which reduces the incidence of iron deficiency states. There is evidence that the use of this drug reduces the risk of ovarian and endometrial cancer.

Over the course of 1 year, 1000 women who used Novaring and COCs, which include levonorgestrel / ethinylestradiol (0.15 / 0.03 mg), compared bleeding patterns. The results of the study confirmed that when using NuvaRing, the frequency of spotting bleeding or breakthrough bleeding was significantly reduced compared with COCs. Also, cases in which bleeding was observed only during a break in the use of a contraceptive, occurred much more often in women who used vaginal rings.

A comparative study of the effects of NuvaRing and a non-hormonal intrauterine device, carried out for 2 years, did not reveal a clinically significant effect on bone mineral density in women.

Pharmacokinetics

Etonogestrel

Etonogestrel, which is released from the vaginal ring, is rapidly absorbed through the vaginal mucosa. Its maximum concentration in blood plasma is approximately 1700 pg / ml and is reached on average 1 week after the ring is inserted. The level of the substance in the blood plasma changes in a small range and gradually decreases to approximately 1600 pg / ml after 1 week, 1500 pg / ml after 2 weeks and 1400 pg / ml after 3 weeks after starting the drug. Absolute bioavailability reaches 100%, which exceeds the bioavailability when taking etonogestrel orally. The results of measuring the concentrations of this active substance inside the uterus and in the cervical region confirm that the determined values ​​of the concentrations of etonogestrel in patients using Novairing and patients taking COCs, which contain 0.02 mg of ethinyl estradiol and 0.15 mg of desogestrel, were comparable.

Etonogestrel binds to sex hormone binding globulin (SHBG) and plasma albumin. The apparent volume of distribution of the substance is 2.3 l / kg.

The biotransformation of etonogestrel is carried out through the known pathways of sex hormone metabolism. The apparent clearance of blood plasma is approximately 3.5 l / h. There is no direct interaction of etonogestrel with ethinyl estradiol taken simultaneously.

The plasma level of etonogestrel decreases in two phases. The terminal phase is characterized by a half-life of approximately 29 hours. Etonogestrel and its metabolites are excreted through the kidneys and intestines with bile in a quantitative ratio of approximately 1.7: 1. For metabolites, the half-life is about 6 days.

Ethinylestradiol

When released from the vaginal ring, ethinyl estradiol is rapidly absorbed through the vaginal mucosa. Its peak concentration in blood plasma is approximately 35 pg / ml and is reached 3 days after the ring is inserted, after which it gradually decreases to 19 pg / ml after 1 week and 18 pg / ml after 2-3 weeks after the start of use. The absolute bioavailability is approximately 56% and is comparable to that when ethinyl estradiol is taken orally. In accordance with the results of determining the concentrations of this active substance inside the uterus and in the cervical region, the measured values ​​of the concentrations of ethinylestradiol were comparable in patients taking oral contraceptives containing 0.02 mg of ethinyl estradiol and 0.15 mg of desogestrel, and patients using NovaRing. The content of ethinyl estradiol in the body was studied during a comparative randomized study of the drug NovaRing (when the ring is inserted into the vagina per day, 0.015 mg of ethinyl estradiol is released into the vagina), COC (levonorgestrel / ethinyl estradiol; 0.03 mg of ethinyl estradiol is released per day) and a transdermal patch (ethinyl estradiol); day 0.02 mg of ethinylestradiol is released) during one cycle in healthy women... It was found that the systemic exposure of ethinylestradiol for a month for the Novaring vaginal rings was statistically significantly weaker than for COCs and a patch: the AUC indicator was 10.9 ng h / ml compared to 22.5 and 37.4 ng h / ml for COC and patch, respectively.

Ethinyl estradiol is characterized by non-specific binding to albumin in blood plasma. The apparent volume of distribution is approximately 15 l / kg.

Ethinylestradiol is metabolized by aromatic hydroxylation. Its biotransformation leads to the formation of a large number of methylated and hydroxylated metabolites. They circulate in the blood either in free form or in the form of glucuronide and sulfate conjugates. The apparent ground clearance is approximately 35 l / h.

The concentration of ethinyl estradiol in the blood plasma decreases in a biphasic manner. In the terminal phase, the elimination half-life varies widely, and the median is approximately 34 hours. Ethinylestradiol is not excreted unchanged. Its metabolites are excreted through the kidneys and intestines with bile in an approximate ratio of 1.3: 1. For metabolites, the half-life is 1.5 days on average.

The pharmacokinetics of NuvaRing rings when used in healthy adolescent girls who have not reached the age of 18 and who have already begun menstruation have not been studied. The effect of liver and kidney diseases on the pharmacokinetic parameters of the drug has not been sufficiently studied, however, in patients with liver dysfunctions, a deterioration in the metabolism of sex hormones is allowed. The pharmacokinetics of NovaRing in representatives of various ethnic groups has not been specifically studied.

Indications for use

According to the instructions, NovaRinga is indicated for intravaginal contraception.

Contraindications

• Multiple or severe risk factors for arterial or venous thrombosis: hereditary predisposition (presence of thrombosis, cerebrovascular accident or myocardial infarction in the next of kin at a young age), damage to the valvular apparatus of the heart, arterial hypertension, atrial fibrillation, obesity (body mass index more than 30 kg per 1 m 2), extensive trauma and / or surgery, smoking over the age of 35, prolonged immobilization;
• Arterial and venous thrombosis, thromboembolism, including pulmonary embolism, deep vein thrombosis, cerebrovascular disorders, myocardial infarction (including a history);
• Propensity to develop arterial or venous thrombosis, including hereditary diseases such as antithrombin III deficiency, resistance to activated protein C, protein C deficiency, protein S deficiency, antiphospholipid antibodies (lupus anticoagulant, antibodies to cardiolipin) and hyperhomocysteinemia;
• Transient ischemic attacks, angina pectoris and other pathologies preceding thrombosis (including a history);
• Migraine with focal neurological symptoms (including history);
• Pancreatitis (including history) with concomitant severe hypertriglyceridemia;
• Benign or malignant neoplasms of the liver (including history);
• Severe liver pathology;
• Diabetes mellitus with vascular lesions;
• Suspected or diagnosed malignant hormone-dependent tumors (including genitals, mammary glands);
• The period of pregnancy or suspicion of it;
• Vaginal bleeding of unknown etiology;
• Breastfeeding period;
• Hypersensitivity to drug substances.

The efficacy and safety of NovaRing's use by patients under the age of 18 has not been established.

If symptoms of any of the above conditions occur, the drug should be discontinued immediately.

The appointment of Novairing should be done with extreme caution (after a careful assessment of the balance of benefits and risks of contraception): in the presence of risk factors for the development of thromboembolism and thrombosis, including cardiac arrhythmias, arterial hypertension, heart valve disease, hereditary predisposition (the presence of thrombosis, myocardial infarction or cerebral blood circulation in close relatives at a young age), obesity, smoking, dyslipoproteinemia, migraine without focal neurological symptoms, serious surgical interventions, prolonged immobilization; patients with dyslipoproteinemia, thrombophlebitis of superficial veins, controlled arterial hypertension, valvular heart disease, diabetes mellitus without vascular complications, cholelithiasis, acute or chronic liver dysfunction, porphyria, hemolytic uremic syndrome, systemic lupus erythematosus, hearing loss, against a background of chorea (Sydenham's chorea), angioedema (hereditary) edema, sickle cell anemia, chronic inflammatory bowel pathologies (ulcerative colitis, Crohn's disease), chloasma; with pathologies that make it difficult to use the vaginal ring (hernia of the bladder and / or rectum, prolapse of the cervix, chronic severe constipation), with pruritus and / or jaundice against the background of cholestasis.

In the event of the appearance / exacerbation of any of these conditions or deterioration of health, you should consult a doctor.

Instructions for the use of NovaRing: method and dosage

The NovaRing contraceptive ring is used by insertion into the vagina. The procedure is performed once every 4 weeks, in a prone position, standing (lifting the leg bent at the knee) or squatting. By squeezing the ring, it is inserted into the vagina and placed in a comfortable position, the accuracy of the location does not affect the effectiveness of contraception.

In the absence of hormonal contraception in the previous menstrual cycle, the ring is inserted on the first day of menstrual bleeding. After 3 weeks, on the day of the week and at about the same time that the ring was installed, it is removed. During the absence of the ring, menstrual bleeding occurs, which occurs 2-3 days after removal. The new ring is injected after one week off on the set day of the week, even if the withdrawal bleeding has not ended.

If the use of NovaRing is started from the second to the fifth day of the menstrual cycle, during the first 7 days it is necessary to additionally use barrier contraceptives.

When switching from combined oral contraceptives, the ring is recommended to be inserted on the last day of the break between the cycles of use or on any day of the cycle, but subject to regular intake of the previous combined hormonal agent and complete confidence in the absence of pregnancy.

When switching from progestogenic contraceptives, the contraceptive ring can be inserted on the day the implant or the hormone-containing intrauterine system is removed, the next injection, or on any day after using the mini-pill. In each of these cases, during the first 7 days of use, the use of additional barrier methods of contraception is required.

After an abortion in the first trimester of pregnancy, the NuvaRing ring can be inserted immediately after the operation without resorting to additional contraceptives.

The introduction of the ring is recommended within the fourth week after an abortion in the II trimester of pregnancy or childbirth (in the absence of breastfeeding). At a later period of initiation of use, it is recommended to use additional condoms during sexual intercourse during the first 7 days of hormonal contraception.

If, after childbirth or abortion, the woman has had sexual intercourse, then before the introduction of the ring, it is necessary to confirm the absence of pregnancy or insert the ring at the beginning of the menstrual cycle.

After insertion, the ring must be kept in the vagina for 3 weeks. If accidentally removed, so as not to interfere with the contraceptive effect, it should be rinsed with warm water and placed in the vagina within the next 3 hours.

If the period of the absence of the ring in the established place exceeds 3 hours in the first or second week of use, then it is recommended to use additional barrier contraceptives after inserting it into the vagina for the next 7 days.

If accidental removal occurred in the third week of use, and the ring was missing for more than 3 hours, then the risk of violation of the contraceptive effect is very high. In this case, the dropped ring should be discarded and one of the following actions should be chosen.

A new ring can be inserted immediately and must be worn for the next 3 weeks. Menstrual bleeding may not occur, the risk of spotting spotting or breakthrough bleeding in the middle of a new cycle increases.

The next option can be selected only if there are no violations in the mode of using the ring during the first 2 weeks. He suggests waiting for withdrawal bleeding and inserting a new ring no later than 1 week after the removal of the previous ring.

If a woman had sexual intercourse during the week's break, then pregnancy must be excluded before the introduction of a new ring. In the absence of pregnancy and after the introduction of NuvaRing, it is necessary to use additional barrier contraceptives during the first 7 days.

The contraceptive property of the ring remains sufficient for up to 4 weeks. If the ring is not removed for more than 4 weeks, then there is a risk of pregnancy, since the contraceptive effect has been exhausted. Therefore, you need to make sure that there is no pregnancy before the next introduction of NuvaRing.

To delay withdrawal bleeding, the next ring should be inserted on the first day of the intended break and used within 3 weeks. During this period, the appearance of spotting and breakthrough bleeding is possible. Then you should follow the usual regimen of regular use of the ring.

To postpone the onset of withdrawal bleeding to another day of the week, the ring should be removed not on the set day of the week, but later, reducing the interruption in use. It should be borne in mind that the shorter the break, the greater the risk of the absence of menstrual bleeding and the appearance of spotting in the next cycle of using the ring.

If the ring is damaged (broken), it should be replaced with a new one.

To remove the ring, hook it with your index finger and pull it out of the vagina, then discard it, first placing it in a bag.

Side effects

• Genitals and mammary glands: often - itching of the external genital organs, painful withdrawal bleeding, vaginal discharge, pain in the pelvic region, tenderness and engorgement of the mammary glands; infrequently - absence of menstrual bleeding, enlargement of the mammary glands, discomfort in the mammary glands and / or in the pelvic region, lumps in the mammary glands, spotting (bleeding) during intercourse, painful intercourse, cervical polyps, cervical ectropion, acyclic bleeding, profuse withdrawal bleeding, fibrocystic breast disease, burning sensation and / or soreness inside the vagina, premenstrual-like syndrome, vaginal odor, dryness and discomfort of the vulva and vaginal mucosa; the frequency is unknown - galactorrhea, local reactions in the partner on the part of the penis, such as pain, bruising, hyperemia, abrasions;
• Immune system: frequency unknown - hypersensitivity;
• Infections and invasions: often - vaginal infection; infrequently - cystitis, cervicitis, urinary tract infections;
• Metabolism: often - an increase in body weight; infrequently - increased appetite;
• Digestive system: often - nausea, abdominal pain; infrequently - vomiting, bloating, constipation, diarrhea;
• Mental disorders: often - decreased libido, depression; infrequently - mood changes;
• Organ of vision: infrequently - visual impairment;
• Nervous system: often - headache, migraine; infrequently - hypesthesia, dizziness;
• Cardiovascular system: infrequently - hot flashes, increased blood pressure (BP); rarely - venous thromboembolism;
• Skin: often acne; infrequently - itching, alopecia, rash, eczema; frequency unknown - urticaria;
• Urinary system: infrequently - pollakiuria, dysuria, urge to urinate;
• Musculoskeletal system: infrequently - muscle spasms, pain in the back and / or limbs;
• General ailments: infrequently - irritability, fatigue, painful condition, edema;
• Others: often - discomfort during the use of the vaginal ring, prolapse of the vaginal ring; infrequently - difficulties in application, damage (rupture) of the ring, sensation of a foreign body.

In addition, against the background of the use of NovaRing, it is possible to develop cholecystitis, pancreatitis, cerebrovascular disorders, chloasma, benign and malignant liver tumors, and a change in insulin resistance.

In hereditary forms of angioedema, combined hormonal contraceptives can cause or aggravate symptoms of angioedema.

Overdose

Cases of complications leading to serious health consequences and associated with an overdose of NuvaRing have not been described. Symptoms include minor vaginal bleeding in young women, nausea, and vomiting. There are no specific antidotes. In this case, symptomatic therapy is prescribed.

special instructions

The appointment of NovaRing is indicated only after excluding pregnancy and a complete gynecological examination (including mammary glands, pelvic organs, cytological examination of cervical smears), measuring blood pressure, carrying out some laboratory research, excluding contraindications. During the period of using the contraceptive ring, a woman should undergo a medical examination at least once every six months.

In case of exacerbation or appearance of symptoms of diseases, deterioration of health, a woman should consult a doctor for advice.

The use of NovaRing can cause circulatory disorders and, as a result, cause the development of deep vein thrombosis, pulmonary embolism, arterial thrombosis and complications associated with these pathologies, sometimes with a risk of death.

In extremely rare cases, women taking complex hormonal contraceptives develop thrombosis of the veins and arteries of the liver, mesenteric vessels, cerebral vessels, retina, kidneys and other blood vessels, although the connection with the use of NovaRing has not been precisely established.

Symptoms of arterial or venous thrombosis may include: severe sudden chest pain with possible return to the left arm, prolonged and intense headaches, an attack of coughing or shortness of breath, acute abdomen, sudden weakness or severe numbness of one side or any part of the body, movement disorders, double vision, sudden loss of vision (partial or complete), aphasia, dizziness, the appearance of unilateral edema and / or pain in the lower limb, local fever, discoloration of the skin or hyperemia, collapse with or without a focal epileptic seizure.

Risk factors that can cause venous thrombosis and embolism may be: age, family history of thrombosis, obesity (body weight index more than 30 kg per 1 m 2), prolonged immobilization, major surgical interventions, any leg surgery, serious injuries, possibly varicose veins and thrombophlebitis of superficial veins.

The use of NuvaRing should be discontinued 4 weeks before the planned operation and resumed only when motor activity is fully restored after 2 weeks.

In addition to age, obesity and heredity, factors of the possible occurrence of complications of arterial thromboembolism can be: heavy smoking (especially in women after 35 years), dyslipoproteinemia, migraine, atrial fibrillation, arterial hypertension, valvular heart disease.

If in a family history (close relatives of the patient: parents in their youth, brothers, sisters) there is a predisposition to thrombosis, it is impossible to start using any hormonal contraceptives without consulting a specialist.

Unwanted circulatory disorders can occur with biochemical predisposition factors for venous or arterial thrombosis (hyperhomocysteinemia, resistance to activated protein C, protein C deficiency, antithrombin III deficiency, antibodies to phospholipids, protein S deficiency), with diabetes mellitus, hemolytic systemic uremic syndrome lupus erythematosus, chronic inflammatory diseases intestines, sickle cell anemia, in the postpartum period.

An increase in the frequency or severity of migraines while taking hormonal contraceptives may cause their cancellation.

According to epidemiological studies, the risk of developing tumors with prolonged use of hormonal oral contraceptives increases. How much this is associated with the use of NuvaRing has not been established, since the diagnosis of a tumor in this category of patients may be associated with more frequent observations with a doctor.

With the use of the drug, the development of benign or malignant liver tumors is possible, which can cause life-threatening bleeding into the abdominal cavity. Therefore, in the differential diagnosis of diseases in women taking hormonal contraceptives, it is necessary to take into account the possibility of a liver tumor with existing signs of intra-abdominal bleeding, acute pain in the upper abdomen or an enlarged liver.

The use of NuvaRing can cause a slight increase in blood pressure; with a pronounced constancy of this pathology, one should consider the feasibility of further hormonal contraception.

In case of recurrence of cholestatic jaundice, which first occurred during pregnancy or previously taken sex steroids, the development of acute or chronic liver dysfunctions, Novairing must be canceled.

If a woman has diabetes mellitus, constant medical supervision is necessary, especially in the first cycles of using the drug.

The cause of incorrect insertion or frequent prolapse of the ring may be existing pathologies: a hernia of the bladder and / or rectum, prolapse of the cervix, severe chronic constipation.

In case of an unexpected appearance of symptoms of cystitis, the correct insertion of the ring should be checked.

The effectiveness of NovaRing may decrease if the regimen of use is violated or the simultaneous use of other drugs.

If acyclic bleeding occurs during the use of the ring, you should consult a gynecologist to exclude pregnancy or organic pathology.

If there is no withdrawal bleeding after removing the ring for two cycles in a row, you should consult a doctor.

When conducting laboratory tests, the health worker should be informed about the use of contraceptive hormonal drugs.

The contraceptive ring does not protect against sexually transmitted diseases, including HIV infection (AIDS).

The effect of NuvaRing on the ability to drive vehicles and mechanisms has not been established.

Application during pregnancy and lactation

NuvaRing is designed to prevent pregnancy. If a woman wants to stop using the ring in order to become pregnant, conception should be postponed until the natural cycle is restored, as this will help to determine the date of conception and childbirth as accurately as possible.

Installation of a vaginal ring during pregnancy is contraindicated. In the case of a diagnosed pregnancy, it must be removed immediately. Extensive epidemiological studies do not confirm the presence of an increased risk of congenital malformations in children born to women who took COCs before pregnancy, as well as teratogenic effects in cases where women took contraceptives for early dates pregnancy, not yet knowing about it. However, at the moment it is not known whether this applies to the drug Novairing. A clinical study conducted in a small group of patients showed that, despite the introduction of a ring into the vagina, the level of sex hormones that have a contraceptive effect when using Novaring is similar to that when taking other COCs. Pregnancy outcomes in women using the drug during a clinical trial have not been described.

The use of NovaRing rings during lactation is contraindicated. The active components of the contraceptive can affect the production of breast milk, changing its composition and reducing its amount. Contraceptive sex hormones and / or their metabolites can be excreted in breast milk in small concentrations, but there is no evidence of their negative impact on the health of children.

Drug interactions

If necessary, concomitant therapy against the background of the use of a contraceptive ring, it is necessary to consult a doctor in order to avoid the development of unwanted adverse reactions.

Analogs

NovaRing's analogues are: Janine, Logest, Midiana, Novinet, Yarina.

Terms and conditions of storage

Store at 2-8 ° C. Keep out of the reach of children.

Shelf life is 3 years.