recent post partum prolapse - nuvaring BC

How flexible is the Nuvaring? Does it kind of collapse into the shape of the vagina, or does it stay circular and stretch the vagina side to side?

Hard to say really. They haven't been around for that long. If it stays rigid I guess it could distend the vagina. If that distension is constant and the ring itself is made of small diameter material it would have a higher pressure per sq cm on the vaginal tissue than the relatively clunky ring pessary. I guess it could further damage fascia, but I think the weakness would have to be there first. They haven't been around for a long while. You would think they would have to test them for that sort of thing, but it is not well understood in the first place, so ...

Have you asked the manufacturer? It will be interesting to hear what they say.

Louise

Hi TMR

That makes sense to me. After my first pregnancy I could no longer retain tampons, but I didn't think of it as POP at the time. That was for old ladies. I was all of 30 at the time. But I now know that it was an early indication of POP. I did not know that I would end up with my uterus, rectum and bladder competing for the window seat twenty years down the track. Ironically, I am now back at the point where it doesn't worry me in everyday life. ;-)

Of course it was the first stages of POP that made your Nuvaring "come closer to the vaginal opening". That is called slipping (as opposed to slipping out)! The fact that they put a note about it shows that it is a common enough complaint, especially as there is only one(?) size, unlike pessaries, for which there are several sizes and a need to be fitted personally, like shoes or bras or diaphragms. Multiple sizes may be the next step, once they have better established their presence in the market place. All that has happened is that the Nuvaring has been the means of your discovering your POP. I am sure that I would have discovered it that way too, had Nuvaring been available, and my choice of contraception at the time.

The USA FDA website's document about it advises against use by women with prolapse, but of course you didn't know you had POP at the time of prescription. They also advise against it while breastfeeding because it is a combined contraceptive its hormones could interfere with breastmilk production. They do talk about avoiding it in the postpartum period but they do not define how long 'postpartum' is.

I am wondering if slipping Nuvarings may be responsible for earlier diagnosis of POP in the future? Now that is a scary thought, but it might also be good, if women are able to adopt WW posture and other practices when they are younger, maybe even slow or stop the progression.

It would be interesting for you to continue the dialog with them. Perhaps the Nuvaring shouldn't be used for the first two years postpartum if the Nuvaring slips with initial postpartum use? They say "Women with conditions affecting the vagina, such as a prolapsed (dropped) uterus, may be more likely to have NuvaRing® slip out. If NuvaRing® slips out repeatedly, please consult your doctor."

IMO, this makes it sound like there is something wrong with your body that only a doctor can sort out for you. In fact it is a sign that the Nuvaring is a bad fit for your vagina. It is like saying that if your clothes are too tight you should lose weight, when buying a size bigger is a more body-friendly response. The body is not the wrong size. The garment/device size is wrong!!! It is another case of 'blame the woman; there is something wrong with your body if our product does not fit.' This is a fashion industry-type statement, and we all know how much credibiity they have as an arbiter for what is good for women.

If doctors, specialist or not, don't fully understand POP, what knowledge would a contraceptive manufacturer have, especially as the product could be potentially implicated in causing or worsening POP by interfering with the postpartum reversion? I would rather see them advise against Nuvaring for postpartum use if they could slip out of position in a woman who has poor body awareness, and deliver the hormones too far away from the cervix to be effective in its contraceptive purpose. Perhaps the advice to 'see a doctor' is a means of bringing it to the notice of the doctor who prescribed it, and therefore shifts the responsibility for potentially unexpected pregnancy from manufacturer to medical practitioner. If the woman reports slippage to the doctor, the doctor can prescribe a different type of contraception and avoid a potentially unexpected pregnancy for his patient. The only person who seems to be out of the loop is the woman herself, who would not choose the Nuvaring as a postpartum contraceptive if she knew that it could potentially slip out of position because her pelvic organs are not yet stable postpartum.

Christine, and others, if your daughter wanted to use a Nuvaring, what would you advise her, based on what you know about postpartum reversion (apart from objections you might have to hormonal contraception)?

I too wonder if there are other WW members who have used Nuvaring postpartum. Maybe there are not. Maybe your doctor should have known better than to prescribe it postpartum? Maybe it is not appropriate prescribing, even though the manufacturer does not caution against use after the immediate postpartum period?

I am glad you have decided to change your contraceptive method, rather than finding out the hard way that it was not right for you. I think you will be fine POP-wise in the longer term, just by using WW posture and the other techniques.

Louise