The vaginal ring - sold under the brand name, NuvaRing - is a prescription contraceptive that is inserted into the vagina to effectively protect against pregnancy. The small, flexible ring works by releasing a combination of synthetic female hormones into the bloodstream, similar to the contraceptive pill but without the worry of daily dosing. When used correctly, NuvaRing is around 99% effective in preventing pregnancy.
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Reviewed by Dr Yasmin Aghajan, MD
Information last reviewed 07/07/19
NuvaRing is a brand version of the vaginal ring – a reversible method of birth control that works in a similar way to contraceptive pills. The small, flexible ring is around the same size of a dollar coin and is placed inside the vagina to release a synthetic combination of the female hormones ethinyl estradiol and etonogestrel. The ring may also be prescribed to ease premenstrual symptoms such as cramping as well as to regulate heavy periods.
NuvaRing releases a slow, steady dose of hormones that are absorbed into the bloodstream through the vaginal lining; it works in numerous ways to help protect against an unwanted pregnancy. The ring’s main function is to stop the release of an egg from the ovaries during the menstrual cycle (ovulation). In cases where an egg has been released, it thickens the vaginal mucus to prevent the sperm from reaching the egg (fertilization), as well as changing the lining of the uterus to prevent a fertilized egg from attaching to the womb (implantation).
When used correctly, NuvaRing is more than 99% effective in preventing pregnancy; however, its efficacy may decrease through improper use or if used in conjunction with certain medications. With perfect use, less than 1 out of 100 women will fall pregnant in one year, whereas with typical use, this figure will increase to approximately 9 out of 100 women.
The effectiveness of this method is dependent on the stage of your menstrual cycle. If inserted on the first day of your cycle, i.e. day one of your period, you will immediately be protected against pregnancy. If, however, you start using the ring at any other point of your cycle, you will need to use an additional form of non-hormonal contraception for the first 7 days, such as a condom.
NuvaRing is prescribed by a doctor and is not available for purchase over the counter in the U.S. You can purchase a 3-month supply on Medzino using a first or repeat prescription. Use the online consultation service and our doctors will carry out a medical assessment to determine if NuvaRing is a suitable contraceptive method for you.
The active ingredients in NuvaRing are 11.7mg of etonogestrol and 2.7mg of ethinyl estradiol (EE). These are synthetic versions of the female hormones progestogen and estrogen.
The inactive ingredients in NuvaRing are ethylene vinylacetate copolymers and magnesium stearate.
Be sure to carefully follow the instructions on the information label before using NuvaRing. You can also refer to the following steps on how to correctly insert and remove the ring:
Wash and dry your hands thoroughly before removing NuvaRing from the foil pouch.
Choose an insertion position that is most comfortable for you; this may be lying down, squatting or standing with one leg up.
Grip the NuvaRing between your thumb and index finger and press the sides of the ring together.
Start by gently inserting the tip into your vagina before pushing it up until it feels comfortable.
Do not worry about the exact placement of the ring as it does not need to cover the opening of the uterus, or the cervix to be effective. If the placement feels uncomfortable, try to push the ring as far into your vagina as you can – be assured that there is no risk of the NuvaRing being pushed too far up or getting lost.
Thoroughly wash and dry your hands.
Assume a position that is most comfortable for you.
Gently insert your index finger into your vagina and hook it through the NuvaRing.
Gently pull the ring downward to bring it out.
Place the used NuvaRing in the foil pouch and throw it in the trash – do not flush the ring down the toilet.
Removing the ring should be a pain-free procedure; however if you do experience any pain or bleeding, or cannot pull it out, seek medical advice immediately.
Your doctor will determine the most suitable time for you to start using NuvaRing, based on your menstrual cycle and previous birth control method. Unlike birth control pills, NuvaRing is a low-maintenance method as you do not have to worry about daily dosing to ensure effective monthly protection against pregnancy.
The NuvaRing operates on a 4-week cycle. A new ring must be inserted on the same day of the week, during each cycle to ensure optimum protection. After a period of 3 weeks you should remove the ring from the vagina, and on the fourth week you go ring-free before starting a new cycle. You should get your period during the ring-free week, also known as a withdrawal bleed, although this may not always occur.
For instance, if you insert your ring on a Sunday, you should remove it exactly 3 weeks later on a Sunday, and then insert a new ring the following Sunday – even if you are still bleeding.
Some women who use NuvaRing may experience some mild side-effects, these commonly include:
Increased vaginal discharge
Vaginal irritation and/or infection
Such side-effects will usually subside after 2-3 weeks, as your body adjusts to the contraception; however, if your symptoms persist or worsen discontinue use and seek medical attention.
Do not use NuvaRing if:
You are allergic to any of the active or inactive ingredients.
You are due to undergo major surgery that requires immobilization for a prolonged period.
You have a history of depression and your symptoms reappear or worsen.
It is important to note that NuvaRing does not offer protection from sexually transmitted infections (STIs). A condom is the only method of contraception that effectively protects against STIs and can easily be purchased over the counter from your local pharmacy.
Whilst using NuvaRing, other insertion methods of contraception should not be used as an additional safety measure, such as a diaphragm, cervical cap or sponge.
A small number of women using NuvaRing may develop blood clots in their veins or arteries; there is also an increased risk of being diagnosed with breast or cervical cancer with long-term use of hormonal contraception.
NuvaRing may make your period lighter or skip altogether, particularly if you use the ring continually each week; however, this should not be a cause for concern.
Prior to using NuvaRing, ensure that you inform your doctor of your full medical history as there are certain risk factors that render the ring unsuitable for some women. Your doctor will prescribe you alternative contraception if you suffer, or have previously suffered, from any of the following:
Blood clots, heart attack or stroke
High blood pressure
Hormone-sensitive cancers such as breast or cervical cancer
Hepatitis or other liver issues
Are older than 35 and smoke
Certain medications may render NuvaRing less effective. Inform your doctor of any other medications you are taking, both prescribed and over-the-counter, as well as any herbal or vitamin supplements, especially:
The antibiotics Rifampin, Rifampicin or Rifamate
The antifungal Griseofulvin
St John’s Wort
While NuvaRing is a good choice of contraception for a large number of women, it may not be suitable for everyone. However, there are a wide variety of alternative birth control options available. If you are not entirely sure about your options or would like more advice, speak to a healthcare professional or a doctor.
Implant (Implanon or Nexplanon)
The hormonal implant is a small rod that is inserted beneath the skin into the upper arm. It has been shown to be 99 percent effective in preventing pregnancy. The matchstick-sized implant typically lasts for 4 years. It is a good choice for patients looking for birth control methods that are low-maintenance. Furthermore, it is suitable for women with estrogen sensitivity as it does not contain any estrogen. The implant is also safe to use for diabetics and smokers. Known side effects include an irregular menstrual cycle, headaches, dizziness, acne and occasionally hair loss.
This is a contraceptive patch, similar to a Band-Aid, which is applied to the skin to effectively prevent pregnancy. It contains a synthetic combination of the female hormones progestin (norelgestromin) and estrogen (ethinyl estradiol) that are absorbed into the bloodstream through the skin to prevent ovulation. Xulane contains hormone medication similar to birth control pills but with a dose that is around 60 percent higher.
This method is not suitable for women who smoke and are aged over 35 years.
The so-called shot is an injectable that contains progestin as its main hormone ingredient. It is 94 percent effective in preventing pregnancy and lasts for 3 months. It does not contain estrogen which makes the shot a good alternative for patients who are breastfeeding or are sensitive to estrogen. Side effects may include some changes to the menstrual cycle including heavier flow or spot bleeding between cycles. Weight gain has also been reported as a consequence of the shot.
Intrauterine Device (Mirena, ParaGard, Skyla, Liletta and Kyleena)
The intrauterine device (IUD) is a tiny device in the shape of a ‘T’ that, when implanted into the uterus, prevents pregnancy with an effectiveness of 99 percent. It lasts between 3 to 12 years making it an excellent option for women who prefer not to have to remember to take a pill. In some women, the IUD has led to a reduction of menstrual cramps and overall lighter periods. It is suitable for those with hypertension or diabetes and smokers. In rare cases, the device could slip out or push through the wall of the uterus which may cause an infection.
Cervical Cap (FemCap)
The FemCap is a silicone cup that covers the uterus and blocks sperm from reaching the womb. Before it is inserted into the vagina, the cup is usually coated with a spermicide, which increases the effectiveness of the contraceptive method. The cervical cap can be purchased without a prescription. It is also suitable for women who are breastfeeding. It has been tested to be 70 to 86 percent effective in preventing pregnancy. Side effects include some vaginal irritation. It is not suitable for patients with known allergies against silicone or spermicides. Women have reported that it can be difficult to insert the cervical cap. During intercourse, it can be pushed out of place.
The male condom is latex sheath that is placed over the erect penis and prevents sperm from meeting the egg. It is a very safe and effective form of contraception. During typical use, it is 85 percent effective. Condoms can split and occasionally slip off during intercourse.
The female condom is shaped like a little pouch that, once inserted into the vagina, blocks the sperm from reaching the uterus. It is 79 percent effective. Side effects include irritation and users have reported lower sensitivity during intercourse.
Both, male and female condoms, are available prescription-free. The male condom is effective in protecting against STIs.
If you forget to change your NuvaRing, insert a new ring as soon as you remember. You will need to use additional contraception, such as condoms, for a period of 7 days.
If the NuvaRing has been in for up to 7 days after week 3, remove it as soon as you remember but do not insert a new ring; you should begin your 7-day interval as normal and only insert the new ring after the full 7 days have passed.
If the NuvaRing is out for less than 3 hours at any point in your cycle:
If the NuvaRing is out for more than 3 hours during the first or second week:
If the NuvaRing is out for more than 3 hours in the third week, dispose of it and select one of the following two options:
NuvaRing does not need to be removed during intercourse. Some partners may feel the ring inside the vagina; however, around 90 percent of partners do not find it a cause for concern.
While breast milk may contain traces of the hormones present in NuvaRing, it is not likely to harm the baby. Speak with your doctor about any concerns you may have about breastfeeding and birth control.
The ring may also affect the amount and quality of breast milk, particularly during the first 3 weeks of breastfeeding. It is advised to wait a minimum of 3 weeks after giving birth before using NuvaRing.
Disclaimer: This is not medical advice. You and your physician will determine if and how you should take any medication prescribed to you following a medical consultation.
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