Columbus county Health Department Policy and Procedure on
Transdermal System-Nuva Ring
-Policy Title:
Contraceptive Transdermal System-Nuva Ring
Program Area:
Family Planning
Policy Identifier:
(optional)
Approval Date:
Effective Date:
6/15/2009
Revision
Date(s):
3/24/04
5/20/09
Approved by:
Kim Smith RN, BSN, MSHCA, Health Director
Approved by:
Mary Cherry OB/GYN Nurse Practitioner, Pattie Strickland OB/GYN Nurse Practitioner
Purpose:
To provide a varied selection of birth control measures with education so the patient will be able to
make an informed decision on the type of birth control that meet their needs.
Definitions:
Columbus County Health Department will provide a variation in contraceptive measures which
includes Transdermal Contraception (Nuva Ring) in an effort to prevent unplanned or unwanted
pregnancies.
Responsibilities:
Family Planning/ Obstetric Family Nurse Practitioners and Maternal Child Coordinator.
Procedures:
For patient direction, staff intervention, and follow up see the “New/Annual Visit
Procedure” or “Method Return”
How does the Nuva Ring Work?
The Ring is placed in the vagina where it releases synthetic female hormones,
estrogen and progestin. These hormones are absorbed through the vagina into
your blood system which changes your body's normal hormonal balance so that no
egg is released from the ovaries and the woman cannot become pregnant.
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Columbus county Health Department Policy and Procedure on
Transdermal System-Nuva Ring
INSTRUCTIONS FOR USE
1. The Ring should be started on Day 1-5 of the menstrual cycle or the 1st-5th day after
your period starts.
2. Use your fingers to press the sides of the ring together and gently push it into your
vagina. Push the Ring up high in the vagina.
3. The Ring is left in place in the vagina for 3 weeks. Do not remove the Ring for
intercourse.
4. After 3 weeks, remove the vaginal ring for 7 days. During this break, you will
experience withdrawal bleeding, your period.
5. Remove by hooking the rim of the Ring with your finger and pulling out.
6. Place the used Ring in the foil pouch or a plastic bag and discard. Do not flush the
Ring down the toilet.
7. After the 7 day break, insert a new Ring to begin the cycle again. Insert the new
Ring on the same day of the week you inserted the previous Ring, even if you have
not finished your period.
8. Unused Rings should be stored at room temperature and out of direct sunlight.
WHAT TO DO IF THE RING FALLS OUT
1. Wash the Ring with lukewarm or cool water and put the Ring back in as soon as
possible.
2. You could become pregnant if the Ring is out of your vagina for more than 3 hours,
you may need emergency contraception. If needed Contact the Nurse Practitioner
at Columbus County Health Department @ 910-640-6615
3. Use back-up contraception for 7 days if the Ring is out of your vagina for more than
3 hours.
WHAT TO DO IF YOU LEAVE THE RING IN LONGER THAN 3 WEEKS
Up to 4 weeks:
1. Remove the Ring.
2. Take a Ring-free week.
3. Insert a new Ring after the Ring-free week
More than 4 weeks:
1. Remove the Ring.
2. Take a Ring-free week. If you have a normal menses, insert a new Ring after
the Ring-free week. You must use a back-up contraceptive for 7 days.
3. If you do not have a normal menses, you may be pregnant and will need a
pregnancy test BEFORE you restart the Ring.
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Columbus county Health Department Policy and Procedure on
Transdermal System-Nuva Ring
WHAT TO DO IF THE RING-FREE WEEK HAS BEEN LONGER THAN ONE WEEK:
1. It is possible that you could become pregnant. If you have not had a normal menses
you will need a pregnancy test.
2. Use a back-up contraceptive until you have determined if you are pregnant.
3. Restart with a new Ring once determined not pregnant.
POSSIBLE PROBLEMS:
Call the health department, your physician or seek emergency care if you have any of the
following symptoms:
A – Severe Arm or leg pain, or unusual swelling
C – Severe or crushing Chest pain, shortness of breath or coughing up blood
H – Severe, sudden Headache or increase in frequency of severe headaches
E – Sudden loss of vision or blurred vision (Eyes)
S – Severe Stomach pain
If you are having regular periods and miss your period, call the health department,
you may be pregnant.
REFILLS:
Remind the patient to call the health department when she opens her last Ring to make
an appointment for more supplies or for her annual exam. Only the patient can pick up
her Ring, do not send a friend or relative. We have NO WALK-INS for refills.
BACK-UP CONTRACEPTION and STD PROTECTION:
1. The Ring gives NO PROTECTION to STD’s. Use condoms for protection.
2. Mistakes happen. It is important to remember that Emergency Contraception Pills
can reduce the risk of unintended pregnancy. They work best when started as soon
as possible, within 72 hours of unprotected intercourse. Discuss this with clinic staff
for more information
Laws and Rules:
Reference(s):
http://www.cmdhd.org/fp/fpring.htm Central Michigan District Health Department.
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