31.07.2014

Problems getting pregnant after using nuvaring

The NuvaRing costs between $15 and $80 per month and is a great choice for women who do not want to have to worry about a form of birth control every day. This means that a woman might experience a hard time getting pregnant for a little while, but those effects are only temporary.
The good news is that the temporary infertility that some women experience after discontinuing use of the NuvaRing is just that- temporary.
It’s important that women understand what to expect when stopping their use of the NuvaRing. If a woman wants to get pregnant after going off of the NuvaRing, a great option is to find a way to track ovulation using an ovulation predictor kit, basal body thermometer or another method. All of the information that we have right now indicates that there is no risk of long term infertility when using a NuvaRing. The NuvaRing is a relatively new and revolutionary method of birth control for women everywhere. The biggest secret to getting pregnant is knowing when you ovulateA (release an egg from your ovary).
To achieve maximum contraceptive effectiveness, NuvaRing must be used as directed [see Dosing and Administration (2.2)]. NuvaRing can be removed by hooking the index finger under the forward rim or by grasping the rim between the index and middle finger and pulling it out. After a one-week break, during which a withdrawal bleed usually occurs, a new ring is inserted on the same day of the week as it was inserted in the previous cycle. IMPORTANT: Consider the possibility of ovulation and conception prior to the first use of NuvaRing.
The woman may switch from her previous CHC on any day, but at the latest on the day following the usual hormone-free interval, if she has been using her hormonal method consistently and correctly, or if it is reasonably certain that she is not pregnant.
The woman may switch from the POP on any day; instruct her to start using NuvaRing on the day after she took her last POP. The woman may start using NuvaRing within the first five days following a complete first trimester abortion or miscarriage, and she does not need to use an additional method of contraception.
Start NuvaRing no earlier than four weeks after a second trimester abortion or miscarriage, due to the increased risk of thromboembolism. The use of NuvaRing may be initiated no sooner than four weeks postpartum in women who elect not to breastfeed, due to the increased risk of thromboembolism in the postpartum period.
Advise women who are breastfeeding not to use NuvaRing but to use other forms of contraception until the child is weaned.
If a woman begins using NuvaRing postpartum, instruct her to use an additional method of contraception, such as male condoms with spermicide, for the first seven days.
NuvaRing can be accidentally expelled, for example, while removing a tampon, during intercourse, or with straining during a bowel movement.
If the ring-free interval has been extended beyond one week, consider the possibility of pregnancy, and an additional method of contraception, such as male condoms with spermicide, MUST be used until NuvaRing has been used continuously for seven days. If NuvaRing has been left in place for longer than four weeks, instruct the woman to remove the ring, and rule out pregnancy. If the woman has not adhered to the prescribed regimen (NuvaRing has been out of the vagina for more than three hours or the preceding ring-free interval was extended beyond one week), consider the possibility of pregnancy at the time of the first missed period and discontinue NuvaRing use if pregnancy is confirmed.
If the woman has adhered to the prescribed regimen and misses two consecutive periods, rule out pregnancy. Pharmacokinetic data show that the use of tampons has no effect on the systemic absorption of the hormones released by NuvaRing. If feasible, stop NuvaRing at least four weeks before and through two weeks after major surgery or other surgeries known to have an elevated risk of thromboembolism, and during and following prolonged immobilization. Two epidemiologic studies1, 2, 3 that assessed the risk of VTE associated with the use of NuvaRing are described below.
In these studies, which were required or sponsored by regulatory agencies, NuvaRing users had a risk of VTE similar to COC users (see Table 1 for adjusted hazard ratios). The frequency of VTE in women using CHCs has been estimated to be 3 to 12 cases per 10,000 women-years. The risk of VTE is highest during the first year of CHC use and after restarting a CHC following a break of at least four weeks. Figure 1 shows the risk of developing a VTE for women who are not pregnant and do not use CHCs, for women who use CHCs, for pregnant women, and for women in the postpartum period.
Several epidemiology studies indicate that third generation oral contraceptives, including those containing desogestrel (etonogestrel, the progestin in NuvaRing, is the biologically active metabolite of desogestrel), may be associated with a higher risk of VTE than oral contraceptives containing other progestins. Do not use NuvaRing in women with liver disease such as acute viral hepatitis or severe (decompensated) cirrhosis of the liver [see Contraindications (4)]. NuvaRing is contraindicated in women with benign and malignant liver tumors [see Contraindications (4)].
NuvaRing is contraindicated in women with uncontrolled hypertension or hypertension with vascular disease [see Contraindications (4)]. An increase in blood pressure has been reported in women using CHCs and this increase is more likely in older women and with extended duration of use. NuvaRing may not be suitable for women with conditions that make the vagina more susceptible to vaginal irritation or ulceration. Some women are aware of the ring on occasion during the 21 days of use or during intercourse, and sexual partners may feel NuvaRing in the vagina.
Women with hypertriglyceridemia, or a family history thereof, may be at an increased risk of pancreatitis when using CHCs. If a woman using NuvaRing develops new headaches that are recurrent, persistent, or severe, evaluate the cause and discontinue NuvaRing if indicated.
Consider discontinuation of NuvaRing in the case of an increased frequency or severity of migraine during CHC use (which may be prodromal of a cerebrovascular event) [see Contraindications (4)]. Unscheduled bleeding (breakthrough or intracyclic) bleeding and spotting sometimes occur in women using CHCs, especially during the first three months of use. If the patient has adhered to the prescribed regimen and misses two consecutive periods, rule out pregnancy.
Some women may experience amenorrhea or oligomenorrhea after discontinuing CHC use, especially when such a condition was pre-existent. There have been reports of inadvertent insertions of NuvaRing into the urinary bladder, which required cystoscopic removal. Extensive epidemiological studies have revealed no increased risk of birth defects in women who have used oral contraceptives prior to pregnancy. Carefully observe women with a history of depression and discontinue NuvaRing use if depression recurs to a serious degree. NuvaRing is contraindicated in women who currently have or have had breast cancer because breast cancer is a hormonally-sensitive tumor [see Contraindications (4)]. A woman who is using NuvaRing should have a yearly visit with her healthcare provider for a blood pressure check and for other indicated healthcare.
There is little or no increased risk of birth defects in women who inadvertently use CHCs during early pregnancy. The administration of CHCs to induce withdrawal bleeding should not be used as a test for pregnancy.
NuvaRing has not been studied in postmenopausal women and is not indicated in this population. The pharmacokinetic profile of etonogestrel and ethinyl estradiol during use of NuvaRing is shown in Figure 2.


The pharmacokinetic parameters of etonogestrel and ethinyl estradiol were determined during one cycle of NuvaRing use in 16 healthy female subjects and are summarized in Table 3. The use of tampons had no effect on serum concentrations of etonogestrel and ethinyl estradiol during use of NuvaRing [see Dosage and Administration (2.5)]. Based on pooled data from the three trials, 2,356 women aged < 35 years completed 23,515 evaluable cycles of NuvaRing use (cycles in which no back-up contraception was used).
For the Dispenser: When NuvaRing is dispensed to the user, place an expiration date on the label.
Cigarette smoking increases the risk of serious cardiovascular events from use of NuvaRing, and women who are over 35 years old and smoke should not use NuvaRing.
The increased risk of VTE compared to non-users of CHCs is greatest after initially starting a CHC or restarting (following a 4-week or greater CHC-free interval) the same or a different CHC.
NuvaRing does not protect against HIV infection (AIDS) and other sexually transmitted infections.
The proper usage of NuvaRing and what to do if she does not comply with the labeled timing of insertion and removal. The need to use a barrier method of contraception when the ring is out for more than three continuous hours until NuvaRing has been used continuously for at least seven days. Use a back-up or alternative method of contraception when enzyme inducers are used with NuvaRing. Women who start NuvaRing postpartum and have not yet had a normal period should use an additional non-hormonal method of contraception for the first seven days. NuvaRing (NEW-vah-ring) is a flexible birth control vaginal ring used to prevent pregnancy. Your chance of getting pregnant depends on how well you follow the directions for using NuvaRing.
Based on the results of a US clinical study, approximately 1 to 3 women out of 100 women may get pregnant during the first year they use NuvaRing.
The following chart shows the chance of getting pregnant for women who use different methods of birth control. 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.
Use an additional birth control method (such as a male condom with spermicide) when you take medicines that may make NuvaRing less effective.
Read the Instructions for Use at the end of this Patient Information that comes with your NuvaRing for information about the right way to use NuvaRing. After your 1 week (7 days) break, you should insert a new NuvaRing on the next Monday at 8:00 am.
While using NuvaRing, you should not use a vaginal diaphragm as your back-up method of birth control because NuvaRing may interfere with the correct placement and position of a diaphragm. Use of spermicides or vaginal yeast products will not make NuvaRing less effective at preventing pregnancy.
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 healthcare provider to be sure you are not pregnant. Your healthcare provider should examine you at least 1 time a year to see if you have any signs of side effects from using NuvaRing.
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. 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.
Other side effects seen with NuvaRing include allergic reaction, hives, breast discharge, and penis discomfort of the partner (such as irritation, rash, itching). Place the used NuvaRing in the re-closable foil pouch and properly throw it away in your household trash out of the reach of children and pets. Women who use hormonal birth control methods may have a slightly higher chance of getting cervical cancer. When you use NuvaRing you may have bleeding and spotting between periods, called unplanned bleeding.
Read these Instructions for Use before you start using NuvaRing and each time you get a refill.
It is a small flexible ring that is inserted into the vagina once per month for three weeks in order to prevent pregnancy. The hormones from the NuvaRing (much like birth control pills) can build up in your system and can lead to something known as “temporary infertility” when those methods are discontinued. For most women, temporary infertility after discontinuing NuvaRing only lasts about 2 to 3 months. There is no indication that use of a NuvaRing causes any sort of long time fertility damage. Taking a few months for ovulation to return to normal is to be expected with NuvaRing, however, if a woman goes much longer than that without having her periods or ovulation cycles return to normal, it is probably a good idea to see a doctor. Some women, especially those who had irregular menstrual periods before NuvaRing, might find that their periods take a very long time to come back to normal, as in six months or more. NuvaRing is a great birth control option for many women, and getting pregnant after it is usually a breeze. When you stop taking birth control pills, you might have trouble getting pregnant right away. Clinically proven to dramatically increase your chances of conception and help you get pregnant fast from the very first use. Usually, it takes four to ten months but it can take up to two years from the date of your last shot before you can get pregnant. The withdrawal bleed usually starts on Day 2-3 after removal of the ring and may not have finished before the next ring is inserted. NuvaRing may also be started on Days 2-5 of the woman's cycle, but in this case a barrier method, such as male condoms with spermicide, should be used for the first seven days of NuvaRing use in the first cycle. If use of NuvaRing is not started within five days following a first trimester abortion or miscarriage, the woman should follow the instructions for "No Hormonal Contraceptive Use in the Preceding Cycle." In the meantime, she should be advised to use a non-hormonal contraceptive method. If she has not yet had a period, consider the possibility of ovulation and conception occurring prior to initiation of NuvaRing.
NuvaRing should be removed and the woman should insert a new ring after a one-week ring-free interval. If pregnancy is ruled out, NuvaRing may be restarted, and an additional method of contraception, such as male condoms with spermicide, MUST be used until a new NuvaRing has been used continuously for seven days. Stop NuvaRing use if there is unexplained loss of vision, proptosis, diplopia, papilledema, or retinal vascular lesions. The risk of postpartum thromboembolism decreases after the third postpartum week, whereas the risk of ovulation increases after the third postpartum week.
A large prospective, observational study, the Transatlantic Active Surveillance on Cardiovascular Safety of NuvaRing (TASC), investigated the risk of VTE for new users, and women who were switching to or restarting NuvaRing or COCs in a population that is representative of routine clinical users. Although the absolute VTE rates are increased for users of CHCs compared to non-users, the rates associated with pregnancy are even greater, especially during the post-partum period (see Figure 1). To put the risk of developing a VTE into perspective: If 10,000 women who are not pregnant and do not use CHCs are followed for one year, between 1 and 5 of these women will develop a VTE.


Based on a model assumption that pregnancy duration is nine months, the rate is 7 to 27 per 10,000 WY.
TSS has been associated with tampons and certain barrier contraceptives, and, in some cases the NuvaRing users were also using tampons. For women with well-controlled hypertension, monitor blood pressure and stop NuvaRing use if blood pressure rises significantly. Women with a history of pregnancy-related cholestasis may be at an increased risk for CHC-related cholestasis.
If bleeding persists or occurs after previously regular cycles, check for causes such as pregnancy or malignancy. If the patient has not adhered to the prescribed dosing schedule, consider the possibility of pregnancy at the time of the first missed period and take appropriate diagnostic measures.
Assess for ring insertion into the urinary bladder in NuvaRing users who present with persistent urinary symptoms and are unable to locate the ring.
Studies also do not suggest a teratogenic effect, particularly in so far as cardiac anomalies and limb reduction defects are concerned, when taken inadvertently during early pregnancy. Women with a tendency to chloasma should avoid exposure to the sun or ultraviolet radiation while using NuvaRing.
Epidemiologic studies and meta-analyses have not found an increased risk of genital or non-genital birth defects (including cardiac anomalies and limb-reduction defects) following exposure to low dose CHCs prior to conception or during early pregnancy. The bioavailability of ethinyl estradiol after vaginal administration is approximately 56%, which is comparable to that with oral administration of ethinyl estradiol. The ring should be replaced in this reclosable sachet after use and discarded in a waste receptacle out of the reach of children and pets. If pregnancy is planned or occurs during treatment with NuvaRing, instruct the patient to discontinue NuvaRing use. Rule out pregnancy in the event of amenorrhea if NuvaRing has been out of the vagina for more than three consecutive hours, if the ring-free interval was extended beyond one week, if the woman has missed a period for two or more consecutive cycles, and if the ring has been retained for longer than four weeks.
Smoking increases your risk of serious cardiovascular side effects (heart and blood vessel problems) from combination hormonal contraceptives (CHCs), including death from heart attack, blood clots or stroke.
Hormonal birth control methods that contain estrogen, like NuvaRing, may decrease the amount of milk you make.
Continue back-up birth control for 28 days after stopping the medicine to help prevent you from becoming 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. Like pregnancy, combination hormonal birth control methods increase the risk of serious blood clots (see following graph), especially in women who have other risk factors, such as smoking, obesity, or age greater than 35. 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. 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.
Consider a visit with your healthcare provider for a pre-pregnancy checkup before you stop using NuvaRing. Working together with ObGyn physicians in her own practice, she has over 20 years experience in women's health, pregnancy and childbirth. However, when going off of the NuvaRing birth control method, many women worry about whether or not it will cause infertility when they stop using it.
If you are still experiencing infertility problems after a couple of months of stopping the use of NuvaRing, you should seek the help and advice of a doctor.
However, when you are considering NuvaRing as your birth control choice, keep in mind that there might be some temporary infertility after going off of NuvaRing. And now for a limited time, Try a FREE starter pack today & receive 20 FREE pregnancy tests and a FREE Digital BBT Thermometer! For this reason, CHCs, including NuvaRing, should not be used by women who are over 35 years of age and smoke. In order to maintain contraceptive effectiveness, the new ring must be inserted exactly one week after the previous one was removed even if menstrual bleeding has not finished. If pathology and pregnancy are excluded, bleeding irregularities may resolve over time or with a change to a different CHC. The serum etonogestrel and ethinyl estradiol concentrations observed during three weeks of NuvaRing use are summarized in Table 2. The serum ethinyl estradiol concentrations observed during three weeks of NuvaRing use are summarized in Table 2. 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.
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. You can ask your pharmacist or healthcare provider for information about NuvaRing that is written for health professionals. 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. In fact, it even says so on the NuvaRing website, that you can have some temporary infertility after stopping the ring. You might have an underlying health condition that is contributing to your trouble getting pregnant. NuvaRing can be rinsed with cool to lukewarm (not hot) water and reinserted as soon as possible, but at the latest within three hours. If a woman discovers that her NuvaRing has disconnected, she should discard the ring and replace it with a new ring.
Co-administration of vaginal miconazole nitrate and NuvaRing increases the serum concentrations of etonogestrel and ethinyl estradiol by up to 40% [see Clinical Pharmacology (12.3)]. In case of suspected overdose, all NuvaRing rings should be removed and symptomatic treatment given.
The box on the bottom of the chart shows the chance of getting pregnant for women who do not use birth control and are trying to get pregnant. Talk with your healthcare provider about your risk of getting a blood clot before using NuvaRing or before deciding which type of birth control is right for you.
If NuvaRing is lost, a new vaginal ring should be inserted and the regimen should be continued without alteration. For women using COCs that did not contain the progestins desogestrel (DSG) or gestodene (GSD), VTE incidence was 8.9 per 10,000 WY. Counsel women to use an alternative method of contraception or a back-up method when enzyme inducers are used with NuvaRing, and to continue back-up contraception for 28 days after discontinuing the enzyme inducer to ensure contraceptive reliability. Within one to two months, ovulation should have returned and you should be able to get pregnant normally. A lot of women say that they do experience irregular periods and long cycles after going off of the NuvaRing.



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Comments to «Problems getting pregnant after using nuvaring»

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