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03.04.2015

Nuvaring stop period, help to sleep music - Review

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The NuvaRing releases the hormones estrogen and progesterone (the same as in the birth control pill) which prevent the release of an egg from the ovary (ovulation). You can decide whether or not you want to have your period when you are using the NuvaRing. Conventional Use: Some doctors and the instructions that come with the NuvaRing may recommend that you leave it in for 21 days and then take a seven day break, which will cause your period to come. Continuous Use: You can also simply leave the NuvaRing inside for 28-31 days and then change it without a break. If it is during the first or second week of using the NuvaRing: reinsert it and use a backup method (like condoms) until the NuvaRing has been in for a full seven days.
If it is during the third week of using the NuvaRing: you can either 1) insert a new ring immediately and begin a new cycle as if you are just starting a new ring (ie. If you took your NuvaRing out to have a period and forgot to put the next one in after 3-4 days, you are still protected if the NuvaRing has not been out for more than 7 days. 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. IMPORTANT: Consider the possibility of ovulation and conception prior to the first use of NuvaRing. 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).
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)]. 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. 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)]. If the patient has adhered to the prescribed regimen and misses two consecutive periods, rule out pregnancy. There have been reports of inadvertent insertions of NuvaRing into the urinary bladder, which required cystoscopic removal.


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. 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.
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.
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 okay to skip your period when you are using hormonal contraception because the lining of the uterus does not grow as much and does not need to shed every month. Many women therefore leave their NuvaRing in for 25 days and then take a three day break before putting their new one in, or 24 days with it in and four days out.
Change your NuvaRing on the 28th day (every 4 weeks) or on the same day each calendar month, putting the new one in immediately after you remove the old one. There is no increased risk of vaginal infection with Nuvaring use and the ring does not cause weight gain. 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.
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).
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.
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. Women with a tendency to chloasma should avoid exposure to the sun or ultraviolet radiation while using NuvaRing. 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. 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. In actual use an average of 8 women out of 100 get pregnant in a year using the NuvaRing as their only form of contraception. The Nuvaring will not make it harder to get pregnant or have children in the future -when you stop using the ring your fertility will return very quickly. For this reason, CHCs, including NuvaRing, should not be used by women who are over 35 years of age and smoke. 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.
You can also insert the NuvaRing on the day following a surgical abortion, even though the aftercare instructions might be to not put anything inside the vagina for a week. If you do remove the ring for intercourse, do not leave it out of the vagina for more than 3 hours in any 24-hour period. 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.
Consider another non-hormonal method of birth control until you are ready to stop breastfeeding.
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 you do not like having irregular spotting, you may want to take a three or four day break every second or third month, which will make it more like having a period. Many women find their periods get lighter and less painful, and this can be helpful with anemia (low iron).
If NuvaRing is lost, a new vaginal ring should be inserted and the regimen should be continued without alteration.
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. Otherwise, just continue to use the ring, changing every 28-31 days, and the spotting will eventually stop. If you want to stop using the NuvaRing, talk to someone first to lessen the chance of pregnancy. If you have extra NuvaRings, you can store them at room temperature (25 degrees C) for up to 4 months, but it is best to store them in the refrigerator especially in hot weather.



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