NuvaRing & OrthoEvra
14 October, 2003
I have some questions about OrthoEvra (hormonal contraceptive patch) and NuvaRing (hormonal contraceptive vaginal ring).
1 – The ring must be in place for 7 days before it is effective; therefore, it must be inserted no later than nightfall after a hefsek, meaning it will be in place during shiva neki’em. I believe (though I’m not certain) that it is medically preferable to leave it in place, but it can be rinsed and put back in after being out of the body for a short time without losing effectiveness. I have no idea whether doing so repeatedly (once or twice a day for a week) has a worse effect. Should the ring be removed to perform each bedikah of that week, or should it be left in place?
2 – Is the ring a chatzitzah for the purposes of mikvah immersion? If the answer is generally “no,” under what circumstances would it have to be considered a chatzitzah?
3 – Can either of these methods be used to establish a veset kavua as with oral contraceptives?
The ring is technically easier to remove and replace than the patch. The patch, and all the glue, need to be removed prior to mikveh immersion. To the best of our knowledge, according to the ORTHO EVRA package insert, a woman can put the original patch back on after immersion only if it is clean and still sticky. Otherwise, she should use a new patch. Please check your package insert to confirm. The patch does not interfere with bedikot.
In order to be effective contraception, the ring is inserted seven days after the removal of the previous ring, regardless of where in the cycle you are.
The ring should be removed prior to mikveh immersion as a potential chatzitzah. (If it is inadvertently left in for immersion, a halachic question should be asked.) The ring should be removed for the hefsek taharah. Some authorities, including our halachic supervisor Rav Yehuda Henkin, also recommend removing the ring in order to perform one bedikah each on days one and seven of the shivah neki’im. The ring is rather mobile, so for other bedikot it can be removed or pushed to the side as you go around it. According to the manufacturer, the ring can be out for up to three hours without affecting efficacy. Therefore, removing it for the above purposes should not impair its efficacy.
Establishing a veset after taking off the patch or taking out the ring is halachically similar to establishing one after stopping the active pills in a package of oral contraceptive pills. There is a difference of opinion as to how to proceed in this case (see Hormonally controlled vestot). If to date you have counted your veset based on the interval from cessation of the pill, you can do the same after taking out the ring or taking off the patch. Thus, if you start your period every month at a consistent interval after cessation, then you can establish a veset kavua similar to that established by the cessation of the active pills of oral contraception.
This internet service does not preclude, override or replace the psak of any rabbinical authority. It is the responsibility of the questioner to inform us of any previous consultation or ruling. As even slight variation in circumstances may have Halachic consequences, views expressed concerning one case may not be applied to other, seemingly similar cases. All health and health-related information contained within Nishmat's Women's Health & Halacha Web site is intended to be general in nature and should not be used as a substitute for consulting with your health care professional. The advice is intended to offer a basis for individuals to discuss their medical condition with their health care provider but not individual advice. Although every effort is made to ensure that the material within Nishmat's Women's Health & Halacha Web site is accurate and timely, it is provided for the convenience of the Web site user but should not be considered official. Advice for actual medical practice should be obtained from a licensed health care professional.
For further questions or comments:
The Nishmat Women's Health and Halacha Site is a public service of Nishmat, The Jeanie Schottenstein Center for Advanced Torah Study for Women. This project and others like it are made possible by contributions from people like you. If you have benefited from the service, and wish to enable us to help others, click here to donate.
Users of Internet filtering services: This site discusses sensitive subjects that some services filter without visual indication. A page that appears 100% complete might actually be missing critical Jewish-law or medical information. To ensure that you view the pages accurately, ask the filtering service to whitelist all pages under yoatzot.org.