Nuva Ring, Ringing in' a contraceptive revolution

Laura Csortan, TV personality, Sydney

Laura Csortan, 30, has been using NuvaRing for the past few months. This is her story.

What types of contraceptives have you used in the past and what are your thoughts on them?
I've used the Pill in the past. But having to remember to take it everyday and keep to this routine, especially with my travel commitments, was difficult to do.

What type of contraceptives do you prefer?
I prefer contraceptives that are discreet and easy to use.

How would you describe using NuvaRing?
I'd describe NuvaRing as simple and easy to use, discreet and hassle free. You put it in once every three weeks and you don't have to worry about it.

Why have you decided to use NuvaRing?
I've decided to use NuvaRing because of the reasons above. Also, it allows busy, active women like myself to not have to worry about contraception for a change. It's more than 99 per cent effective. It's got a lower dose of oestrogen than the lowest dose oral pill and it puts me in control of my cycle.

How do you feel about using NuvaRing?
I don't even know I'm using it, and that's the beauty of it. I insert it once every three weeks and then take it out. I can't feel it, I can't see it. It's a no-brainer!

What was your experience when on the Pill?
When I was on the Pill I had to obviously take it every day, and if I missed a day, I wasn't covered. With traveling and crossing time zones, I found it particularly difficult to work out when to take the Pill. When visiting countries like Bali, I'd often get a stomach ache and couldn't keep my food down, let alone the Pill. So I had no contraceptive cover then. I also experienced a lot of headaches on the Pill, was hungry all the time and gained weight.

How often did you forget to take the Pill?
I was OK with the Pill. But when I went on inter-State trips at little notice, I'd rush out the door with only one bag and arrive only to find that I'd forgotten to bring the Pill. It was such a hassle to have to go to see a doctor to get a prescription for the Pill and then to pick it up.

What benefits do you think NuvaRing has over the Pill?
NuvaRing is discreet, it's just once a month, it has a lower dose of oestrogen than the lowest dose oral Pill and therefore less potential side-effects than the Pill. It can't fall out of your bag and you don't need to remember to take it every day, because it's already in place. It places you in control of your contraception.

What is your experience with NuvaRing to date?
I've found NuvaRing exceptionally easy to use. It's so discreet that I forget about it. I've had no side effects from it, given it's low dose of oestrogen. It's fantastic.

Have you gained any weight using NuvaRing?
I have not gained any weight using NuvaRing. I think as women we tend to fluctuate anyway at the beginning of our cycles and after. But I'd definitely have to say no.

How easy is it to insert and remove NuvaRing?
It's really easy to insert NuvaRing and just as easy to remove it. I was actually quite surprised by this.

How do you remember to remove and re-insert NuvaRing?
I remember to remove and reinsert NuvaRing by visiting a website that sends you a personalized SMS to remind you of when to remove and reinsert the ring. Also, in the NuvaRing pack, there are stickers that you can place in your diary that act as a reminder.

Does NuvaRing fall out?
NuvaRing hasn't fallen out on me and I'm quite active. So I guess the answer is no.

What do you like most about NuvaRing?
What I like most about NuvaRing is that it's discreet and so easy to use. You insert it once a month and you're covered. Also, there are very little side effects given its low dose of oestrogen.

What is your advice to other women about using contraception?
My advice to women on contraception is to use it. Australia has one of the highest rates of unplanned pregnancies in the Developed World, so I really think it's important to use contraception and to choose one that's right for you.

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NuvaRing is Australia's first once-a-month, low dose, flexible, non-absorbent, self-administered, combined hormonal vaginal ring that is used to prevent pregnancy. It contains hormones that are similar to the Pill and offers:

More than 99% effectiveness. It is as reliable as the Pill

Convenience and ease of use. It only requires contraceptive action once-a-month

A low dose of oestrogen (just 15 micrograms a day)

Lower exposure to hormones and related side-effects

Steady hormone levels - avoids hormonal "peaks and troughs" seen with the Pill

Exceptional cycle control - less breakthrough bleeding than with the Pill

Well tolerated with minimal side effects

High acceptability among women former Pill users prefer its convenience and ease of use

A woman has complete control of her contraception - it does not need to be fitted and is easily self-administered

Discreet method


Contraception has come full circle today with the launch of Australia's first, once-a-month, low dose, combined hormonal contraceptive ring.

NuvaRing, a self-administered contraceptive ring which is inserted internally, is being hailed a revolution by the medical fraternity, who have keenly anticipated its arrival "Down Under".

The soft, flexible, non-absorbent plastic ring is slightly larger than a fifty cent piece and is easily inserted by the woman herself.

According to Prof Gab Kovacs, National Medical Director of Monash IVF, Melbourne and a pioneer of IVF in Australia, NuvaRing contains half the dose of the female hormone oestrogen of the commonly used oral Pill, and is the result of a rigorous 20 year development process.

"NuvaRing is suitable as a first choice of contraception for any Australian woman of reproductive age seeking a simple, once-a-month, low dose, convenient, discreet and highly effective, combined hormonal contraceptive.

"NuvaRing is just as effective (99.3%)1 as the most commonly used oral contraceptive Pill, although it contains only half the dose of oestrogen.2 It is also reliable3, well-tolerated1,4 and provides excellent cycle control5, said Prof Kovacs.

GP and reproductive health advocate, Dr Sally Cockburn, aka "Dr Feelgood", says that NuvaRing offers women a new choice in contraception.

"Because of its steady release of hormones directly into the bloodstream, NuvaRing provides great cycle control, helping to avoid the hormonal peaks and troughs common to the Pill."

Research shows that nearly half of all Australian women do not take the Pill correctly6 and most unplanned pregnancies are the result of inconsistent or incorrect use of this form of contraception.7

"Because NuvaRing only needs to be changed once-a-month, this helps to reduce the chance of contraceptive failure due to human error, such as forgetting to take the Pill," Dr Cockburn said.

According to Dr Edith Weisberg, New South Wales representative, Sexual Health and Family Planning Australia: "Today there's an array of contraceptive options available in a variety of shapes, sizes and formulas to accommodate modern women, all of which share a common goal - to prevent pregnancy.

"NuvaRing represents an important advance to this range of non-daily contraceptives available.

"This new contraceptive is likely to appeal to women who want greater control. Those who are uncomfortable using more invasive contraceptives, such as implants or intrauterine devices, and would prefer a modern contraceptive that involves little action on their behalf, are likely to find NuvaRing appealing," Dr Weisberg said.

NuvaRing works by releasing combined hormones that prevent ovulation. Most commonly used oral contraceptives provide a daily oestrogen dose of 30 to 35 micrograms8, in comparison to NuvaRing's 15 micrograms of oestrogen.9 Because the hormones enter the body slowly and steadily through the vaginal wall, directly into the bloodstream, this allows lower dosing than seen with the Pill.

Each NuvaRing is self-inserted for three weeks at a time, for use during one menstrual cycle or period only. After three weeks, a woman removes the ring and commences a ring-free week, during which her period usually occurs. A new ring can then be inserted one week later (week four).9

"A woman who is comfortable inserting a tampon will be fine with the notion of NuvaRing," said Dr Cockburn.

"She simply inserts the small, clear, plastic ring into her vagina. As long as the ring has been inserted properly and pushed in toward the back, upper area, a woman won't feel it and it can't get lost. The ring then relaxes and conforms to the woman's contours and her pelvic floor muscles help to keep it discreetly in place."

Unlike tampons which are highly absorbent, NuvaRing is a smooth, non-absorbent plastic ring that does not cause infection in the vagina or unpleasant odours.10

According to Prof Kovacs, "The ring not only helps to regulate a woman's cycle (making irregular bleeding unlikely), but it can also lead to shorter, lighter bleeding in the hormone-free (ring-free) week.

"NuvaRing can also be used at the same time as spermicides, antifungal agents and tampons, none of which will affect hormonal absorption. However, most women experience their period during the ring-free week and do not need to use tampons while NuvaRing is inserted.

Dr Cockburn says: "NuvaRing can even be left in during sex and most guys won't even notice that it's there.

"While NuvaRing prevents pregnancy however, condoms are still needed to protect against sexually transmitted infections (STIs)."

Like the Pill, some oestrogen-related side-effects have been reported with NuvaRing's use. NuvaRing does not commonly affect weight.11

"Surprisingly, despite NuvaRing's low oestrogen dose, it's unlikely for a woman to experience breakthrough bleeding or spotting," said Dr Cockburn.

Laura Csortan, a Sydney-based personality who spent many years globetrotting as a TV travel reporter, has welcomed the introduction of NuvaRing.

"Like many women today who lead busy lifestyles and are always on the run, the convenience of a once-a-month, low dose contraceptive is very attractive. Having to remember to take the Pill each day is now history with NuvaRing.

"Being able to rely on a simple, discreet and effective contraceptive while crossing time zones that is not compromised by tummy upset or sickness, will also provide women with peace of mind," said Ms Csortan.

The introduction of NuvaRing may also help to address Australia's very high prevalence rate of unplanned pregnancies, which is the second highest among developed countries world-wide.12 Recent research estimates that 84,460 induced abortions were performed in Australia in 2003, which represents an annual abortion rate of 19.7 per 1,000 women.13 Twenty per cent of Australian women aged 45-50 years have had at least one induced abortion performed in their lifetime.14

NuvaRing comes in a foil sachet which can be stored before use at room temperature below 30 degrees Celsius for up to four months. A used ring should be replaced in its sachet and properly disposed of in a waste bin and not flushed down the toilet.9

Consumer Medicine Information leaflets contained in each NuvaRing pack include a page of stickers for a woman to place in her diary as a reminder to insert or remove the ring. Women whom have been prescribed NuvaRing can also visit www.moderncontraception.com.au to register to receive an SMS to their mobile, as a reminder of when to insert and remove the ring.

NuvaRing contains the hormones etonogestrel and ethinylestradiol that are impregnated in the ring. It is available today from Doctors or local Family Planning clinics nation-wide on private prescription (non-PBS) at a cost of $25-$28 for one cycle - which is comparable to other low dose, private, oral contraceptive Pills. Before use all patients should check with their Doctor to ensure that they are suitable for this method.

NuvaRing has won the Time award for Best Invention of the Year for Health in the US (2001), the Best Prescription Drug of the Year in Spain (2004), the Therapeutic Innovation of the Year in Gynaecology in France (2004) and has consistently been voted Gynaecologists' Choice of Most Innovative Product in Germany.

NuvaRing is manufactured by Organon NV and distributed in Australia by Organon (Australia) Pty Ltd. Organon is a renowned global biopharmaceutical company committed to improving the health and quality of human life.

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References
1. Roumen FJME et al. Human Reproduction 2001 16: 469-475.
2. Timmer CJ et al. Clin Pharmacokinet 2000 39(3): 233-242.
3. Bjarnadottir, RI et al. Am J Obstet Gynecol 2002 186:389-395.
4. Dieben TOM et al. Obstet Gynecol 2002 100: 585-593.
5. Oddsson K et al. Human Reproduction 2005 20: 557-562.
6. National Newspoll study conducted in April 1996 by telephone among a representative sample of 483 women aged 18-44.
7. Bajos et al. Human Reproduction 2003: vol 18m, No 5: 994-999.
8. van den Heuvel MW et al. Contraception 2005 72: 168-174.
9. Australian Approved NuvaRing Product Information.
10. Archer, D et al. 2002. Jones Institute of Reproductive Medicine, VA Ctr for Reproductive Health Research and Policy, CA Organon Inc, NJ.
11. Milson L et al. Human Reproduction 2006 21: 2304-2311.
12. Henshaw SK et al. Int Family Planning Perspect 1999 25 (Suppl): S30-S38.
13. Chan, A and Sage, L. Medical Journal of Australia 2005: 182 99): 447-452.
14. Research Institute for Gender and Health 1997.
Organon (Australia) Pty Ltd is a signatory to the Code of Medicines Australia. Further information on this Code is available from the company.