- I Got Pregnant While Using Nuvaring. It’s Rare, But It Happens
- So, just how did I manage to get pregnant while using Nuvaring birth control?
- That is where things must have gone wrong.
- Finding out I was pregnant was like Ross on “Friends” finding out Rachel was pregnant.
- Could I be pregnant? (Nuvaring)?
- Is the NuvaRing safe?
- Who can’t use NuvaRing?
- What are the risks of NuvaRing?
- What warning signs should I know about?
- Is it safe to use NuvaRing while breastfeeding?
- Starting NuvaRing
- The Ring
I Got Pregnant While Using Nuvaring. It’s Rare, But It Happens
I went on birth control for the first time when I was 20. I had just started having sex and I was petrified of getting pregnant. Little did I know, about six years later, I would get pregnant while on birth control. So much for that then huh? After all those years of making sure that I didn’t get pregnant, my birth control had failed me. I felt betrayed honestly, and then confused. How could this have happened? I mean, I knew that birth control isn’t 100 percent foolproof, but after being on it for so many years you think you’re safe. That, is apparently not the case because I got pregnant while using Nuvaring.
So, just how did I manage to get pregnant while using Nuvaring birth control?
Well, there’s no way to know really, but let’s at least get the backstory. After going on birth control at 20, I went off at 22 when I was no longer insured. I had been using the Nuvaring because I loved not having to remember to take it every day. I could set my calendar months in advance because I knew exactly when I had to take it out, when I should begin my period and when it was time to insert the next ring. But the Nuvaring isn’t cheap when you’re uninsured. Luckily my mom was friendly with the nurses at her gynecologist’s office so she got me samples of the Nuvaring. But that only lasted for a few months. Since I was living at home and was single I just went off it. I wasn’t having sex anyway so it didn’t matter.
Fast forward almost two years. I was in a serious relationship. We were spending several nights a week together so birth control just seemed like the smart thing to do. This time I went to Planned Parenthood and was able to get insurance. They gave me pills while we waited for my approval and while I wasn’t thrilled at the switch but it was only temporary. I went back to the Nuvaring and everything was fine. Then we moved cross country a year and a half later. My doctor wrote my prescriptions for multiple rings at a time so I was actually covered for a while. When I went back home for a friend’s wedding I was able to fill my next prescription so again I was covered and I could pay for a few out of pocket while I figured out my insurance.
That is where things must have gone wrong.
There was never a time when I didn’t have birth control, so it’s hard to figure out exactly how I got pregnant. Maybe it was a ring that wasn’t properly stored and therefore less effective. Or maybe my hormones were thrown out of whack by the stress I was experiencing at work. When you’re on birth control an irregular cycle is kind of hard unless you mess up somehow. The Nuvaring is actually one of the most effective birth control options you can have; there’s only a two percent failure rate. According to the Dept. of Health and Human Services, only 9 out of 100 women get pregnant yearly while on the ring.
Finding out I was pregnant was like Ross on “Friends” finding out Rachel was pregnant.
I wanted to call up the birth control people and give them a firm talking to (I didn’t.) In spite of being on birth control when I got pregnant (and for a couple months after), my son developed completely normally. I had been nervous, but my doctor assured me that everything was fine. He was almost seven pounds at birth, even though he was 15 days early. Now he is a energetic 4 year old who is as tall as a kindergartener. The biggest lesson I learned from is that nothing is 100 percent foolproof!
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Could I be pregnant? (Nuvaring)?
It takes at the LEAST seven days to work, unless you put it in the very day you start your period, then you are protected right away. From what you say, you didnt put it in on the first day of your period (or cycle) If you truly were ovulating you have a pretty good chance of pregnancy. On any given month, a woman has about a 20-30% chance to get pregnant so chances are better (70-80%) that you are not pregnant (this is why not every unprotected sexual episode leads to pregnancy) Sooner or later though, you will time it right and get pregnant going on like you are. I would advise that you keep the ring in, follow your schedule, and see what happens and if on the fourth week when you have the ring out, see if you get your period. Use a condom until you have used the ring for seven consecutive days. (this is what KM means by had you read the directions thoroughly, you would have known that you need back up the first seven days and pulling out doesnt count as back up by the way-too many women think that it does and this just doesnt work because men secrete sperm all through the sex act not just at ejaculation) You could try Plan b (and I hate to recommend that stuff) but you are kind of right on the edge for that. It is best if used within 3 days of sex and it has been 4 since your first unprotected act. Plan b will mess your cycle up, most likely delay your period and give you nasty side effects from the hormones but it is your body and your choice. You can just hope for the best and see what happens (like we did in the days before Plan b) Plan b will only slightly improve your chances of not getting pregnant by maybe 5-10% more. If your period is late, wait until it is at least a week late and you can test then. It is too early to test now. Good Luck!
NuvaRing is a ring that’s inserted in the vagina to prevent pregnancy. It contains the drugs ethinyl estradiol and etonogestrel, which are female hormones.
The device is only available with a doctor’s prescription.
It works by preventing the release of an egg from the ovaries and by changing the cervical mucus in the uterine lining, which makes it harder for a fertilized egg to attach to it.
The drug is manufactured by Merck & Co., Inc. It was approved by the Food and Drug Administration (FDA) in 2001.
NuvaRing may increase your risk of breast cancer, liver cancer, heart attack, stroke, toxic shock syndrome (TSS), or serious blood clot. Talk to your doctor about these risks.
Smoking while taking hormonal contraceptives can increase the chances of serious or life-threatening side effects, especially among women over 35 years of age who smoke 15 or more cigarettes a day. Don’t use NuvaRing if you smoke.
The medicine may also increase your risk of developing liver tumors that are not cancerous. However, these tumors can break and cause serious bleeding in the body.
Before using NuvaRing, tell your doctor if you have or have ever had:
- Yellowing of the skin or eyes during pregnancy or while using another type of hormonal birth control medicine
- Breast lumps
- An abnormal mammogram
- Fibrocystic breast disease
- A family history of breast cancer
- Any type of cancer
- A stroke or mini-stroke
- Severe migraine headaches
- Heart disease
- A heart attack or chest pain
- Any condition that affects heart valves
- High cholesterol or triglyceride levels
- High blood pressure
- Unexplained vaginal bleeding
- Bladder, uterus, or rectum that’s dropped or bulged into the vagina
- Liver, kidney, thyroid, or gallbladder disease
- Tuberculosis (TB)
Also, tell your physician if you’re on bed rest or are unable to walk for any reason before taking this medicine.
NuvaRing may cause skin discoloration. Avoid unnecessary sun exposure, sunlamps, and tanning beds while using this medicine.
This medicine is effective at preventing pregnancy, but it doesn’t stop the spread of sexually-transmitted diseases such as human immunodeficiency virus (HIV).
If you’re having surgery, including a dental procedure, tell your doctor or dentist that you’re using NuvaRing.
Don’t use a diaphragm while your NuvaRing is inserted.
If you wear contact lenses and notice vision changes while on NuvaRing, see an eye doctor.
According to drugwatch.com, more than 1,500 people have filed federal lawsuits against NuvaRing’s manufacturer because they claim the company failed to alert consumers about possible risks.
In 2014, Merck agreed to pay $100 million to settle the suits.
Pregnancy and NuvaRing
NuvaRing can cause birth defects. Don’t use this medicine during pregnancy.
Call your doctor immediately if you become pregnant or miss two menstrual periods in a row while using NuvaRing.
If you’ve recently had a baby, wait at least four weeks before starting on NuvaRing.
The hormones in NuvaRing can pass into breast milk and may cause harm to a breastfeeding baby. Don’t use this medicine while breastfeeding.
I cannot describe how much my husband and I were looking forward to our daughter Erika’s trip home to Arizona from Washington DC for Thanksgiving. When I saw her name come up on my phone the Monday before, I answered with joy: “We can’t wait to see you, Schmoo Bear” (what we had called her since she was a baby). But it was not Erika on the other end of the phone; instead it was her boyfriend, Sean. This is how our nightmare began.
We never had a chance to talk to Erika again. Our beautiful, caring, full of life, daughter, only just 24, had collapsed in her apartment, and had two heart attacks in the ambulance on the way to hospital. A doctor called to say we needed to get there as soon as possible. We took a flight at midnight and arrived by her side on Tuesday morning, but she was still in a coma.
One of the first things the doctors asked was whether Erika had been using hormonal contraceptives. When they found out she was using NuvaRing – a vaginal ring that releases so-called third-generation synthetic hormones – they removed it immediately. On the Wednesday before Thanksgiving we were shown scans of her lungs, which were full of massive blood clots. We were told NuvaRing was the cause of the pulmonary embolisms, heart attacks and subsequent irreversible brain swelling. On Thursday – Thanksgiving – they told us Erika wasn’t coming back. She died that day. It absolutely broke our hearts.
We considered ourselves well-informed people, Erika even more so, and yet we did not know NuvaRing had this risk. We soon learned that most people, including many doctors, are not aware of the potential dangers or even the symptoms to look out for. Erika had been prescribed NuvaRing four years earlier as a treatment for ovarian cysts – an off-label use.
Karen Langhart with Erika. Photograph: Karen Langhart
From Sean we learned that Erika had felt her leg was sore, but thought it was from helping her friends move the previous weekend. She had had some congestion in her chest and thought she was coming down with a cold. Erika was always too busy to worry about such things. Unfortunately she did not know these are the symptoms of blood clots (leg pain) and pulmonary embolisms (congestion).
As we tried to make sense of Erika’s death, we learned that Food and Drug Administration hearings to discuss rising concerns about NuvaRing – as well as newer hormonal contraceptives, Yaz and Yasmin birth control pills, and the Ortho Evra patch – were scheduled two weeks from that fateful Thanksgiving. We told our lawyer that if we were to agree to pursue a legal case on behalf of Erika, first and foremost we would never “settle” her case. We were only interested in seeing the NuvaRing manufacturer, Merck, examined in a jury trial. He explained they were planning to fast-track Erika’s case in order to get to jury trial within the year, so the truth would come out and save lives. Terrified, but determined to help other young women, we agreed.
Unfortunately the attorneys involved in the class action lawsuit against Merck did end up settling out of court. These cases included 3,800 women, 83 of whom had died. We never got that jury trial we were promised. My husband and I refused to opt in to the $100m settlement agreement. Merck would not now be held accountable in a trial – to us this felt like watching Erika die all over again. The only thing that has ever mattered to us is the pursuit of truth in honour and memory of our beloved Erika.
In our opinion, Merck got away with murder, and continues to do so to this day. In 2011 NuvaRing made the company $623m; in 2013 it was $686m; and in 2014, after the settlement, Merck made a staggering $723m from it. Settlements are just the cost of doing business to Merck, all at the expense of women’s health and lives.
Merck, makers of NuvaRing Photograph: Justin Lane/EPA
During the FDA hearings, we heard the “argument” that NuvaRing, Yaz, Yasmin and the Ortho Evra patch all have “acceptable risk factors” because “it is more dangerous to be pregnant”. Our daughter was not an “acceptable risk factor percentage”, and neither are you or your daughter, wife, mother or friend. Erika was our 100%. It makes no sense when there are safer, effective alternative contraceptives available. Women do have other choices, if only they knew all the facts. To say these drugs have “acceptable risk factors” is an insult to women who have been injured and or who have died as a result of that acceptability.
We talk about what happened to Erika to everyone we meet; we know it’s too important not to be shared. Erika’s classmate at university nearly lost her life after being told by four doctors her symptoms were not related to NuvaRing, though she later learned they were. As a result of an article written about Erika in Vanity Fair magazine and a CNN report, many women who have been injured and the families of women who have lost their lives have been in touch with us. There are too many incidents such as this that we have come across. We have stopped calling them coincidences.
It fills us with horror to think of all the women out there using NuvaRing and other risky hormonal contraceptives because they think there is no alternative for them but an unplanned pregnancy. If you are using it, please take the time to consider the ParaGard copper IUD, barrier methods, and the support of fertility-awareness methods.
We believe it is doing a huge disservice to women when media reports written about the risks of hormonal contraceptives end with the minimising message that it is more dangerous to be pregnant. This scares women into not exploring their options, and stops them from worrying enough to at least research the symptoms they need to look out for – information that could save lives. We believe the argument that NuvaRing and other hormonal contraceptives are harmless is dangerous and harmful in itself.
In memory of our daughter, we have established a foundation, InformedChoiceForAmErika.com. Our greatest hope is that more lives can be saved by the sharing of honest information.
The birth control ring is safe for most people, but all medicines have some risks and side effects. Your doctor will help you figure out if the ring is safe for you.
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Is the NuvaRing safe?
There’s a good chance NuvaRing will be totally safe for you — most people can use it with no problems. The hormones in the ring are the same ones in most birth control pills, and millions of people have used these hormones to safely prevent pregnancy for more than 50 years.
Who can’t use NuvaRing?
Like all medicines, NuvaRing isn’t for everyone.
Smoking and the birth control ring don’t always mix. If you’re over 35 and a smoker, don’t use NuvaRing or any other kind of birth control that contains the hormone estrogen.
Also avoid using the ring if you’ve had any of these health problems:
blood clots, an inherited blood-clotting disorder, or vein inflammation
heart attack, stroke, angina, or other serious heart problems
migraine headaches with aura (seeing flashing, zigzag lines)
uncontrolled high blood pressure
very bad diabetes or liver disease
Talk with your doctor or nurse about your health history. They can help you decide if the ring is right for you.
NuvaRing is totally latex-free, so it’s safe for people with latex allergies.
What are the risks of NuvaRing?
Even though NuvaRing is very safe, using a form of birth control that has estrogen can slightly increase your risk of certain health problems. These NuvaRing risks aren’t common and complications are rare, but they can be serious. These include heart attack, stroke, blood clots, and liver tumors. In very rare cases, they can lead to death.
When you talk with your doctor about birth control, tell them about any medicines you’re taking and any health problems you’ve had.
There’s a very small chance that you can get pregnant even if you always use the ring correctly. But if you do get pregnant and accidentally use the ring during the early part of your pregnancy, it won’t increase the chances of birth defects.
It’s important to remember that the chance of having any of these problems while using the birth control ring is really, really low for most people. In fact, pregnancy is more likely to cause serious health problems than NuvaRing. Your doctor or nurse can help you figure out which birth control method will be safest for you.
What warning signs should I know about?
Most people using NuvaRing won’t have any problems at all. But just in case, it’s good to know what the signs of a serious issue are.
See a doctor or nurse right away if you have:
sudden back/jaw pain along with nausea, sweating, or trouble breathing
chest pain or discomfort
achy soreness in your leg
severe pain in your belly or stomach
sudden, very bad headache
headaches that are different, worse, or happen more often than usual
aura — (seeing flashing, zigzag lines)
yellowing of your skin or eyes
You can always call a nurse or doctor, like the ones at your local Planned Parenthood health center if you have questions or you’re worried about any health issues.
Is it safe to use NuvaRing while breastfeeding?
The estrogen in the ring may lower the amount and quality of your breast milk in the first 3 weeks of breastfeeding. If you’re nursing, wait at least 3 weeks after giving birth to start using the ring.
Your breast milk will contain traces of the ring’s hormones, but it’s not likely that these hormones will have any effect on your baby. Talk with your nurse or doctor if you have any concerns about breastfeeding and birth control.
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Important Safety Information Do not use NuvaRing if you smoke cigarettes and are over age 35. Smoking increases your risk of serious heart and blood vessel problems from combination hormonal contraceptives (CHCs) including heart attack, blood clots, or stroke which can be fatal. This risk increases with age and the number of cigarettes smoked.
- The use of a CHC, like NuvaRing, is associated with increased risks of several serious side effects, including blood clots, stroke, or heart attack. NuvaRing is not for women with a history of these conditions or any condition that makes your blood more likely to clot. The risk of getting blood clots may be greater with the type of progestin in NuvaRing than with some other progestins in certain low-dose birth control pills. The risk of blood clots is highest when you first start using CHCs and when you restart the same or different CHC after not using it for a month or more.
- NuvaRing is also not for women with high blood pressure that medicine can’t control; diabetes with kidney, eye, nerve, or blood vessel damage; certain kinds of severe migraine headaches; liver disease or liver tumors; take any Hepatitis C drug combination containing ombitasvir/paritaprevir/ritonavir, with or without dasabuvir, as this may increase levels of the liver enzyme “alanine aminotransferase” (ALT) in the blood; unexplained vaginal bleeding; breast cancer or any cancer that is sensitive to female hormones; or if you are or may be pregnant.
- NuvaRing does not protect against HIV infection (AIDS) and other sexually transmitted infections.
- The most common side effects reported by users of NuvaRing are irritation inside your vagina or on your cervix; headache (including migraine); mood changes (including depression); the ring slipping out or causing discomfort; nausea and vomiting; vaginal discharge; weight gain; vaginal discomfort; breast pain, discomfort, or tenderness; painful menstrual periods; abdominal pain; acne; and less sexual desire.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Please read the Patient Information for NuvaRing (etonogestrel/ethinyl estradiol vaginal ring), including the information about the increased risk of serious cardiovascular side effects, especially in women who smoke, and discuss it with your health care provider. The physician Prescribing Information also is available.
What is the birth control ring?
- The birth control ring (sometimes called Nuvaring) is a thin plastic ring containing 2 hormones (estrogen and progestin) that you put inside your vagina*.
How does the ring prevent pregnancy?
- In order to get pregnant, sperm must enter your vagina, swim up into your uterus and fertilize an egg that has been released from your ovaries during ovulation. The ring prevents you from ovulating.
- The ring thickens the mucus on your cervix (the opening to your uterus). This makes it harder for sperm to travel into your uterus and fertilize an egg.
- The ring thins the lining of your uterus (the endometrium). This makes it harder for a fertilized egg to implant in your uterus and become a pregnancy.
How effective is the ring?
- The ring is 99% effective. This means that if 100 people used the ring correctly for one year, only one person would get pregnant.
- Because the ring may be used incorrectly, it is closer to 92% – 97% effective with typical use.
- If you use the ring incorrectly, your risk of getting pregnant increases.
How do you use the ring?
- The ring works on a 28-day (4 week) cycle. You will insert one ring, leave it in for 3 weeks and then remove it for one week.
- After that “ring-free” week is over, you insert a new ring and the cycle starts all over again.
- Week 1: put one ring into your vagina. Leave it in for 21 days (3 weeks).
- Week 4: on day 22, remove your ring. Put the used ring into the foil pouch it came in and throw it away. The next 7 days (week 4) will be “ring-free”. You can expect your period sometime during this week.
- At the end of that 7 day ring-free week, insert a new ring.
- Remember, you are protected from pregnancy during the ring-free week as long as you have been using your ring correctly and you insert your next ring on time.
- Some people use the ring continuously (no ring-free week) to avoid having their period, sometimes called “stacking”. If you are interested in doing this, speak to your clinician first.
- If you are late removing your ring or late inserting a new ring, consult the instructions in your ring package and/or call your clinician to see if you need to come in for an appointment and/or use a back-up method of birth control for 7 days.
How to start the ring
- If you decide, along with your clinician, that the ring is right for you, they will write you a prescription. You can purchase your rings at a pharmacy (approximately $30/month) or at PPT’s Health Services (approximately $10/month).
- If you start the ring within the first 5 days of getting your period, you are protected from pregnancy right away.
- If you start the ring 6 or more days after getting your period, you are not protected from pregnancy until you have been using the ring for a full week. To avoid pregnancy during this time, use a back-up method of birth control like condoms or spermicides.
- A clinician may recommend that you use a back-up method of birth control for a longer period of time when you start the ring.
- Some people like to start the ring on the first Sunday following the start of their period, whether they are still bleeding or not. This will likely keep you from getting future periods on the weekend.
How do you insert the ring?
- Get into a comfortable position. It may help to put one foot up on a chair, lie down or have your partner insert the ring.
- If you have a physical disability, you may need a partner or support person to help you insert and remove the ring.
- Using clean, dry hands, pinch the sides of the ring together to make an oval. Gently push the ring into your vagina as high as you can. You should not feel the ring once it has been inserted.
- There is no specific position the ring needs to be in – as long as it is inserted high enough so that you don’t feel it, it will work. You cannot lose the ring in your vagina and it cannot get stuck.
What are the side effects of the ring?
- You may experience minor side effects such as nausea, sore breasts*, irritation in your vagina and/or spotting (a little bit of bleeding that is lighter than your period). These usually go away within the first 3 months of using the ring.
- If after 3 months you are still experiencing side effects or your side effects are severe, you may want to try a different method.
- There is a rare risk of getting blood clots or having a heart attack or stroke while using the ring. Smoking, obesity, and other health conditions increase this risk. Speak to your clinician for more information.
- Signs of a blood clot include: blurred or loss of vision, chest pain or difficulty breathing, migraine headaches, severe abdominal cramps, or severe pain in the leg. If you experience any of these symptoms, get medical attention right away.
Advantages of the ring
- If you use the ring correctly, your chances of getting pregnant are very low.
- You don’t have to do anything before or after you have sex.
- You don’t have to do something every day.
- You are less likely to have side effects than you are with the pill.
- Your period will likely become shorter, lighter, less painful, and more regular.
- The ring can improve acne and increase bone strength.
- It doesn’t affect your ability to get pregnant in the future.
- Your partner(s) don’t have to be involved. A partner may feel the ring during sex but it doesn’t hurt or interfere with pleasure.
- The ring lowers your risk of ovarian and endometrial cancer.
Disadvantages of the ring
- You have to remember to remove and insert a new ring.
- If the ring is out for more than 3 hours, if you forget to take it out after 3 weeks, or if you forget to insert a new one after your ring-free week, your risk of getting pregnant increases and you may need to use a back-up method of birth control for seven days (one week).
- You have to be comfortable touching the inside of your vagina.
- You may experience side effects.
- You may not be able to use the ring if you have certain health problems.
- If you have a personal and/or family history of breast cancer or you are HIV positive, talk to your clinician for more information.
- If you smoke and you use the ring, there is an increased risk of getting a blood clot.
- You need a prescription.
- It can be expensive. However, PPT’s Health Services sells the ring at a reduced cost.
- The ring doesn’t protect you from sexually transmitted infections.
For a downloadable resource on this topic, please visit Planned Parenthood Toronto Factsheet Database.
If you have questions about this topic, feel free to contact one of our peer educators.
*We know that these aren’t the words everyone uses for their bodies (eg. trans folks), and support you using the language that feels best for you.