What happened to my NuvaRing?

What happened to my NuvaRing and is this a common concern?

Q:        When my mother and I discussed NuvaRing, she said it wasn’t for her
because she would just “squeeze” it out. When I decided to go on the ring, at first I was paranoid and would check to make sure it was still in place every time I went to the bathroom. This month I finally let go of my paranoia and when I go to remove it on the appointed day, IT HAS DISAPPEARED!

I am not afraid of my vagina.  I have actually felt around and it is not in there. I have this weird paranoid feeling (like when you lose a tampon from your purse), that it will turn up on the floor or somewhere else for someone to find.

What probably actually happened?,  Is this a common problem? Should I be afraid to continue with this as my choice of birth control? I would hate to become one of those girls trying to estimate my ovulation when I realize AFTER I have sex, that the ring fell out and I am now pregnant.

I was not sexually active this month and I definitely put it in on schedule. I have the wrapper waiting for the ring to be disposed of properly. 

A:        Good morning.    

Everyone could understand your deep level of concern.  You finally let go of your paranoia about that NuvaRing coming out and when you went to remove it on the appointed day, it had disappeared.

 

Fortunately, in terms of your risk for an unintended pregnancy, you did not have intercourse during the month in question.  If you are going to continue to count on contraceptive rings you are going to need to check for the presence of the ring carefully.  This would definitely include checks before each act of intercourse.

 

One cause of rings coming out is sexual intercourse, but in your case, that was not the cause for you since you did not have sex during the month before your ring was found to be gone.  Rings have been known to expel at the time of a bowel movement.  Rings have come out when women remove a tampon, but that was not what happened in your case apparently.  Rings come out spontaneously during the night or during the day. 

 

Fortunately, expulsion of rings is not common.  Expulsions are no more common than 2-5% of women, but you are clearly in that percent, so you will need to check regularly if you continue to use rings as your contraceptive.

Below are several comments about your problem: 

Contraceptive Technology 19th edition

Chapter 12. Contraceptive Patch and Vaginal Contraceptive Ring

Kavita Nanda, MD, MHS

Expelled Rings

A woman may accidentally remove or expel her NuvaRing while removing a tampon, engaging in intercourse, or having a bowel movement. If the ring has been out of the vagina for less than 3 hours, no additional contraception is required. Instruct the woman to rinse the ring with lukewarm water and reinsert it as soon as possible. If a woman loses the NuvaRing, have her insert a new ring and then continue the regimen without alteration.

During the first or second week, if the NuvaRing is removed or expelled and has been out of the vagina for more than 3 hours, it may still be reinserted. However, advise her that an additional contraceptive method should be used for the next 7 days, and offer her emergency contraception if she has had unprotected intercourse.

If a women in her third week of ring use reports that NuvaRing has been out of her vagina for more than 3 hours, advise her to discard that ring. She can then choose one of two options:

  • Insert a new ring immediately to begin a new 3-week cycle.
  • Have a withdrawal bleed and insert a new ring no later than 7 days from when the last ring was removed/expelled. Advise the woman that this is an option only if the ring was used continuously for the preceding 7 days.

For either option, advise her to use an additional method of contraception until the new ring has been used continuously for 7 days.

To learn more about the advantages and disadvantages of NuvaRings, go to our website: www.managingcontraception.com and click on Choices.  You can also order this wonderful new educational book from our website or by calling 404-875-5001.  Do you have your copy yet?     

Reference:

Nanda K. Contraceptive patch and vaginal contraceptive rings IN Hatcher RA, Trussell J, Nelson AL, Cates W Jr. et al Contraceptive Technology 19th edition, pages 289-290: Ardent Media Inc. 2008