Contraindications for NuvaRing Use

Absolute Contraindications

• The American Academy of Dermatology recommends that NuvaRing is contraindicated in patients with active or history of deep vein thrombosis (DVT) or pulmonary embolism (PE) 1, 2
• The American Academy of Dermatology recommends that NuvaRing is contraindicated in patients with active or history of arterial thromboembolic disease (stroke or myocardial infarction) 1, 2, 3
• The American Academy of Dermatology recommends that NuvaRing is contraindicated in patients with cerebrovascular disease or coronary artery disease 1, 2, 3
• The American Academy of Dermatology recommends that NuvaRing is contraindicated in patients with thrombogenic valvular or thrombogenic rhythm diseases 1
• The American Academy of Dermatology recommends that NuvaRing is contraindicated in patients with known hypercoagulopathies 1
• The American Academy of Dermatology recommends that NuvaRing is contraindicated in patients with uncontrolled hypertension (systolic ≥160 mmHg or diastolic ≥100 mmHg) 1, 4
• The American Academy of Dermatology recommends that NuvaRing is contraindicated in patients who smoke and are ≥35 years of age 1
• The American Academy of Dermatology recommends that NuvaRing is contraindicated in patients with headaches with focal neurologic symptoms 1, 3, 4
• The American Academy of Dermatology recommends that NuvaRing is contraindicated in patients with migraine headaches with or without aura if ≥35 years of age 1
• The American Academy of Dermatology recommends that NuvaRing is contraindicated in patients with hepatic dysfunction or hepatic disease 1, 2, 3
• The American Academy of Dermatology recommends that NuvaRing is contraindicated in patients with hepatic adenomas or carcinomas (benign or malignant hepatic tumors) 1, 2, 3
• The American Academy of Dermatology recommends that NuvaRing is contraindicated in patients with cholestatic jaundice of pregnancy or jaundice with previous pill use 1, 2, 3
• The American Academy of Dermatology recommends that NuvaRing is contraindicated in patients with breast cancer or other estrogen- or progestin-sensitive cancers 1, 2
• The American Academy of Dermatology recommends that NuvaRing is contraindicated in patients with carcinoma of the endometrium 1, 2, 3
• The American Academy of Dermatology recommends that NuvaRing is contraindicated in pregnant patients 1, 2, 3
• The American Academy of Dermatology recommends that NuvaRing is contraindicated in patients with undiagnosed abnormal genital/uterine bleeding 1, 2, 3
• The American Academy of Dermatology recommends that NuvaRing is contraindicated in patients with renal dysfunction 1
• The American Academy of Dermatology recommends that NuvaRing is contraindicated in patients with adrenal insufficiency 1
• The American Academy of Dermatology recommends that NuvaRing is contraindicated in patients with anaphylactic reaction or angioedema to components 1, 2
• The American Academy of Dermatology recommends that NuvaRing is contraindicated in patients undergoing surgery with prolonged immobilization 3, 4

Critical Clinical Considerations

• The American Academy of Pediatrics notes that NuvaRing carries at least equivalent thromboembolic risk to combined oral contraceptives 5, 6
• The Journal of Allergy and Clinical Immunology states that combined parenteral estrogen-progestin formulations, including vaginal rings, contain as much ethinyl estradiol as oral contraceptives and have similar hepatic side effects, with limited evidence of tolerance in HAE patients 7
• The European Heart Journal recommends that the vaginal ring is inappropriate for patients with complex valvular disease, despite containing lower doses of ethinyl estradiol (15 μg) 8
• The Journal of Hepatology states that concomitant use of sofosbuvir/velpatasvir/voxilaprevir with ethinyl estradiol-containing contraception (including NuvaRing) is contraindicated due to risk of ALT elevations 9