NuvaRing out for 1/2 hour longer than it ought to have been... looking for advice and experiences.

June 26, 2007 10:09 PM

NuvaRing out for 1/2 hour longer than it ought to have been... looking for advice and experiences.

NuvaRing users:

We are looking for reassurance and personal experiences from women who use the ring, and/or clinicians or docs that are familiar with the action and pharmacokinetics of the ring.

So. The ring came out during sex, and was reinserted three-and-a-half-hours afterwards.

The literature that is supplied with the ring states that if the ring is out for more than three hours, contraceptive efficacy may be compromised. How much?

NuvaRing releases a combination of estrogen and progestin, providing a sort of threefold defense against pregnancy-- one, it prevents ovulation. two, it thins the uterine lining, forestalling implantation of a fertilized egg, and three, it thickens cervical mucus, making it more difficult for semen to get past the cervix.

Is ~30 minutes over really long enough to allow progestin levels to drop to a point at which ovulation would occur? I imagine that the 3 hour limit is fairly arbitrary; the assumption being that 3 hours is completely safe, but anything over that increases one's chances.

This occurred on the 16^th day into the cycle, though from what we understand of the action of the ring, it's moot, as ovulation is completely suppressed.

We have posted to the nuva_ring lj, vaginapagina lj, spoken to a clinician at Planned Parenthood (who are usually fairly helpful, but this one was completely off with her facts regarding the official time limit re: length of time out), and gotten a lot of conflicting information, from "oh, don't worry about it, I'm sure you'll be fine, don't bother with Plan B, to "well, it depends.. would a pregnancy be devastating right now, or not?". PP provided a dose of "Plan B", but we're wary of using it having heard some horror stories of really bad reactions.

If anyone can provide peer-reviewed studies or statistical papers on exactly how quickly the efficacy drops after the three-hour mark, that would help too.

We're really just looking to assuage our nervousness.

posted by exlotuseater to health & fitness (12 comments total)

I'm sorry I can't answer your question. But personally? In any situation like this I would consider picking up some emergency contraception just to be sure and to ease your mind. Good luck.
posted by loiseau at 10:17 PM on June 26, 2007

I know nothing about the Nuvaring, but I do have experience with emergency contraception and with pregnancy scares.

Plan B might make you a little sick. Getting pregnant almost certainly will, plus you'll end up with a baby when all's said and done unless you terminate the pregnancy.

All forms of contraception are subject to failure. And all women and their partners should be prepared to face the consequences of that, whether it's to use emergency contraception, abort, or carry a pregnancy to term.

If I were you and if I were not prepared to carry a pregnancy, I'd take the Plan B. Indeed, when I was you, I did. I'm now the mother of two children and I still keep Plan B in the top of the medicine cabinet.
posted by padraigin at 10:39 PM on June 26, 2007 [1 favorite]

I've used emergency contraception. It did make me feel sick for about a day, but the peace of mind was well worth it. I doubt you are going to find a definitive answer for the half hour gap.
posted by happyturtle at 11:44 PM on June 26, 2007

Have you tried phoning the hotline? 1-877-NUVARING

They might want to avoid lawsuits though and will probably repeat the 3 hour rule.
posted by robofunk at 12:59 AM on June 27, 2007

If this helps to reassure you, my experience with emergency contraception was just fine, and was similar to others above. I felt sick to my stomach on and off for a day, and then felt absolutely fine. And felt very relieved that there was no chance I could be pregnant.

The ER doc who prescribed it was a judgmental jerk full of scary tales about the possible side effects. I wish I had told him to stuff it, to be honest. Women should not be scared away from using emergency contraception--it's there for emergencies and overall it is very safe.

Good luck and I hope you get some more answers on the Nuvaring question.
posted by hurdy gurdy girl at 1:29 AM on June 27, 2007

You are fine. If you'd been wearing it more than a week before it came out, you haven't ovulated - you could just has well have started your week out right then.

Now, what you have to be careful about is that it must remain in at least a full week before you go for your break week. That is, a long pause now could set the clock ticking, making your break week seem longer than a week, and you could end up ovulating by the end of the break week.

To be 100% sure, you could simply skip the break week and either reinsert the next new ring immediately or keep the current one in through the 4th week.

(This is based on what my doctor told me when I had a similar thing happen. In my case, the ring had been out for an indeterminate period of time; I only knew it had fallen out when I found it in the dog's mouth. Gross.)
posted by wyzewoman at 3:33 AM on June 27, 2007

Oh, and I don't have the resources at hand right now, but I did go looking for papers on this and other issues regarding hormone levels over time with the NuvaRing and other hormonal contraception. What I found did jibe with the story I told above about missing some setting a clock ticking and "1 week with full hormone resets the clock".
posted by wyzewoman at 3:38 AM on June 27, 2007

just seconding that Plan B was not nearly as bad as I thought it would be. I took both pills at once as instructed by PP and though I felt a little fluttery and a little tired and icky, no yorking. Definitely worth the peace of mind.
posted by Soulbee at 7:38 AM on June 27, 2007

my experience with emergency contraception was just fine, and was similar to others above. I felt sick to my stomach on and off for a day, and then felt absolutely fine. And felt very relieved that there was no chance I could be pregnant.

Yes, there was.
Plan B is better than nothing, but it's not 100%-reliable you'll not get pregnant. You can get pregnant despite Plan B. I've seen it happen. It's not fun.
posted by FlyingMonkey at 8:05 AM on June 27, 2007

If you do take the Plan B, and you can stand to be a little groggy, take half a Unisom or one Benadryl at the same time. It may help you with the nausea.
posted by peep at 9:44 AM on June 27, 2007

"my experience with emergency contraception was just fine, and was similar to others above. I felt sick to my stomach on and off for a day, and then felt absolutely fine. And felt very relieved that there was no chance I could be pregnant."

Yes, there was.
Plan B is better than nothing, but it's not 100%-reliable you'll not get pregnant. You can get pregnant despite Plan B. I've seen it happen. It's not fun.

Well, the reason I was pretty sure I wasn't pregnant was because my period arrived right away. I can imagine how unfun it would be to get pregnant despite the emergency measures, though.
posted by hurdy gurdy girl at 1:13 PM on June 27, 2007

What are these horror stories about Plan B all about? I have dispensed Plan B countless times (as a family planning counselor, and now as a nurse), and the worst I have ever heard as a side effect from a patient was nausea and vomiting. Only 5% of people who use plan B experience vomiting; nausea rates are about 20%, but premedicating with an OTC antinausea medication (e.g. dramamine) can help prevent this, as can taking it with food. Most women tolerate Plan B extremely well, and it's extremely safe, so much so that it's now available over the counter.

I find in cases where people are extremely anxious about pregnancy risk, it is often most reassuring for them to use Plan B. In your case, it seems like taking Plan B provokes just as much anxiety as the possibility that the ring was out too long. I don't think anything magical happened in the 30 minutes over the 3 hour mark that the ring was out - if you think about the way the NuvaRing works, it doesn't make sense that there would be a sharp drop off of hormone levels at one given moment, especially since this was day 16 of ring use. As a NuvaRing user, I wouldn't be concerned about pregnancy. However, I'm not you, and you are obviously really concerned about this. Using Plan B can go a long way towards comforting people who are really anxious about getting pregnant.

Anxious people tend to want to have statistics, research, reassurance that there is one RIGHT way to do things and that they can be guaranteed 100% that they are making the right choice. Unfortunately, no one is going to be able to tell you what to do - only you can decide what will be most comfortable for you. Your risk of pregnancy is very small; taking Plan B will reduce it further, but unfortunately the risk will not be zero. It would be a good idea perhaps to think about whether or not, in the future, you would feel less anxious if you changed methods, or used condoms as a backup, or kept Plan B at hand in your medicine cabinet.
posted by tuff at 4:41 PM on June 27, 2007