Can anyone help me with some questions about Nuva-Ring contraceptives

[WilliamPitt]

Short version: when my girlfriend went on the pill for the first time several years ago, the standard-issue orthotrycicline they gave her scrambled her badly. The hormone levels were too much, so she went off the stuff. After we started dating two years ago, her gyno recommended Yaz as a good alternative because it has less of a hormonal impact, and it was great. The hormonal impact was minimal, it worked, and all was fine.

Ten months ago, she was diagnosed with MS, and last April had a flare-up worrisome enough for her doctors to get her on low daily doses of an anti-siezure medication. That did the trick as far as the MS problem went, but this particular anti-siezure medicine had one nifty side-effect: it totally annihilates the effectiveness of orally-taken contraceptives.

Nuva Ring, according to her gyno, will be only marginally affected by the anti-siezure stuff, because it delivers hormones locally instead of body-wide. As far as contraception goes, the Nuva seems a solid choice to replace the now-useless Yaz.

But my girlfriend has heard of side-effects and/or problems with the Nuva that I haven't been able to find documented on the web. I'm wondering if anyone here knows anything on the matter, and can point me in the right direction. She'll ask her gyno during her next appointment, but isn't usually wild about calling/speaking to doctors unless she has to...mostly because she has to several times a month, and it isn't her favorite pastime, if ya get me.

So...I'll be grateful for anything you can tell me. Cheers.

[Schema Thing]

1. why you wanna kill da babies?

:weeps for Will Pitts seed pairings:

[WilliamPitt]

2. Every sperm is sacred...

:)

[godai]

3. Still could have the same drug interaction potential

The advantage of Nuvaring is primarily the once a month use, instead of a pill everyday. The same types of drugs are involved. As you can see from the following, the potential drug interaction with anticonvulsants remains for Nuvaring. This interaction involves lowering the levels of the contraceptive drugs by a chemical interaction caused by the anticonvulsant. Nuvaring was not specifically studied for this interaction. The wording is general for the types of contraceptive drugs involved.

While Nuvaring delivers the drugs locally, the drugs are circulated body-wide (see the graph, figure 1, in the link). Are the drug levels effected when an anticonvulsant is also used? The document ion suggests, possibly.

Your girlfriend should discuss this with her doctor. Maybe the doctor has some specific information which would make Nuvaring a good choice. But, the precaution listed for Nuvaring does suggest that the contraceptive drug levels might be reduced.

My experience is with FDA, specifically with drug interactions such as this.



From the Nuvaring information:

"Contraceptive effectiveness may be reduced when hormonal contraceptives
are co-administered with some antifungals, anticonvulsants, and
other drugs that increase metabolism of contraceptive steroids. This could
result in unintended pregnancy or breakthrough bleeding. Examples
include barbiturates, griseofulvin, rifampin, phenylbutazone, phenytoin,
carbamazepine, felbamate, oxcarbazepine, topiramate, and modafinil.
Women may need to use an additional contraceptive method when taking
such medications."

http://www.nuvaring.com/Authfiles/Images/309_76063.pdf

[WilliamPitt]

5. We're 100% informed on side-effects regarding her MS meds

I'm thinking of more general side-effects that would/might affect everyone,

Thanks for the link, tho.

[ben_meyers]

4. Why not just get a vasectomy and spare her the grief?

How is it that sensitive caring males don't want to take responsibility and would rather expose the women to all the danger?

[WilliamPitt]

6. Because we want to have children.

Find me a male contraceptive pill that works and I'll take it, even if it causes me to grow horns and hooves.

Oh, and hey...thanks. :eyes:

[Fire_Medic_Dave]

7. How is it that sensitive caring liberals jump to conclusions and denigrate other liberals?

Really not much need to be an ass here, after all it is their decision. Will, sorry about your girlfriend and the MS diagnosis, you may want to have the children discussion a little sooner rather than later or at least discuss it with her doctors.

David

[WilliamPitt]

9. "the children discussion"

...has happened many times, and will happen many times again. The only certainty is that pregnancy now is not an option, 100% for health reasons. We know the score, but have a ways to travel together before kids can be seriously considered.

Thanks, bro.

[Fire_Medic_Dave]

10. Hope all goes well.

Sounds like a wise decision.

David

[MountainLaurel]

8. Here are a few info sources

LiveJournal community on birth control: NuvaRing

MedlinePlus (from the National Library of Medicine)

Planned Parenthood

Go Ask Alice, from Columbia University

the FDA

NuvaRing Side Effects Web site. which mainly deals with a lawsuit against the manufacturers

Problems I've heard from women who have used it mainly have had to do with it causing them to bleed like a motherfucker, gain weight, and have mood swings. All of which are side effects of any sort of hormonal contraception.

If you need more info, PM me and I can send you results from some medical databases I can access from work (I have experience as a medical librarian though that's not my gig right now)

[Heddi]

11. I'm a nurse, and I've used Nuva Ring for about 4 years

previously I was on Depo, and I loved it but it started making me feel...funky. Sex? wat dat?

Anyhow, so I went to my Dr and I needed something that would work, that wouldn't require a daily dose of anything (my problem with the pill was that it would be Wednesday, the last pill i took would be on Sunday, so every day was Plan B day in the Heddi Household :) ), and that I could get rid of quickly if I didn't like it.

As far as problems, I personally haven't had any. That's not to say that they don't exist, but they're pretty much the same side effects that other BC's have: possible irregular periods, possible heavier periods, possible lighter periods, possible absent periods, pregnancy, vaginal dryness, and increased risk of blood clots and certain gynecological cancers, esp if she smokes and esp if she smokes and is above 35.

Nuva isn't affected by meds like oral Bc's are because they are absorbed instead of ingested. Still, there is question in the medical community if some of the stronger antibiotics don't decrease the effectiveness of injected, implanted contraceptives. Right now, the consensus is that they DON'T affect the contraceptive nature of the device. However, I think it's incorrect to say that the hormones are delivered "locally"--they are absorbed by the vessels in the vaginal wall and travel through the blood stream in that manner, rather than being absorbed by the vessels in the digestive tract. It is still a systemic medication, meaning, the hormones are in the blood. They are at lower levels, though, than ingested pills because the ring is constantly releasing small amounts of hormones 24 hours a day, as opposed to one hunk of hormone that you take once a day. The hormones aren't just hanging out in the vagina, they're in the blood stream just like the pill is, but there's much less of it there at any given point in time. A more "uniform" amount of it, if you will.

That's why the anti-seizure drugs won't have a risk of complications like they do with the pill. The amount of hormone is much smaller, and therefore less of a risk of reacting or being deactivated by her other medication. This is true with other meds that affect BC's, like antibiotics.

I like the Nuva Ring. Some insurance co's will let you get 3 months at a time. You keep them in the fridge until it's time to use one. You leave it in for 3 weeks, out for 1 week. They even come with little stickers to put on the calendar to remind you 'Out' and "in".

My insurance now makes me get it by the month which is a real pain, but what the hell am I gonna do?

For me, it's about $15-$20 a month, regardless of whether you get it once a month, or once every three months.

The ring fits inside the vagina. Contrary to the way the pictures show, it's not supposed to lay flat against the cervix. That, I think, is physically impossible.

She will take it out of the package, squeeze it into an oval, and insert it as far into the vagina as she can. It just hangs out there, and my husband *rarely* knows if I'm using one or not. He can only feel it occasionally, and only if he's trying to. Ahem.

I find it's easiest to insert when sitting on a toilet or in the shower, and kind of squatting down, kind of (kind of) like putting in a tampon.

To take it out, I find that it's easiest in the shower as well, again, kind of squatting. Removing is a bit more....interesting than inserting. I have found that using a finger to "hook" it while bearing down kind of pushes it forward a bit and you can hook it with your finger and pull it out. Sometimes it takes more than one hook-n-push, but it comes out.

Also, the nice thing is that if she had to remove it for any reason, it's effective as long as it's reinserted within 3 hours after being removed. So say that you found that you could feel it inside of her and that made sex unpleasurable, she could remove it before sex and put it back in after sex and as long as it's within a 3 hour window, it is still effective.

As far as periods, I had none on Depo and loved that. I do have periods on Nuva Ring, and they're no worse or better than they are naturally. They are very predicitable, however, and I can pinpoint within a day of when it will start and when it will end. That's nice, and I actuall find that they last a shorter amount of time than they did when I was on the pill. However, that was upwards of 12 years ago and bodies do change over time in that regard.

If she smokes, tell her not to. IF she smokes and uses nuva ring and starts having leg or chest pain, or difficulty breathing, tell her to remove the ring immediately and call 911. It could be a blood clot and they have been implicated in blood clots.

Good luck!

[Warpy]

12. Other than the usual set of side effects from hormonal contraception

I haven't found any others for the Nuva Ring, although vaginal irritation and/or increased discharge would certainly seem to be troublesome ones for a few women, most likely linked to an allergy to one of the components of the ring.

In any case, it's worth a trial.