All you need to know about vaginal rings (NuvaRing)

Vaginal rings are a convenient contraceptive option


What is a vaginal ring?

The vaginal ring is one of many birth control options and, just like the pill and contraceptive patches, it’s based on two hormones; estrogen and a progestin (ethinylestradiol and etonogestrel, to be precise).  As implied by the name, it’s a rubber ring that’s inserted into the vagina.  The most commmon brand-name version is Nuvaring, but it’s also available in generic form. Like almost all contraceptive medications, it’s only available with a doctor’s prescription.

The hormonal combination in the vaginal ring stops ovulation and thickens cerevical mucus, which makes it more difficult for sperm to advance inside the uterus.  A third effect is the thinning of the uterine lining, which makes it harder for eggs to implant in the uterus. Like other contraceptive medication, the vaginal ring can also lead to lighter and less irregular periods and reduce the symptoms of  PMS.

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As with any drug, there are also negative side effects.  In five studies with a total of 2,500 women, the most common side effects associated with the ring were vaginitis (14%) and headache (10%).  6% of vaginal ring users may experience breakthrough bleeding, and an increased risk of blood clots is noted with any estrogen-containing birth control.

This risk profile is similar to other birth control options (pills and patches), as they all deliver the same hormonal treatment. When you ask a doctor for a vaginal ring prescription, make sure to talk about the potential side effects and contraindications.

In terms of protection against unwanted pregnancies, efficacy ranges between 93-99%.    

One of the biggest benefits of the ring, is that you don’t have to think about it every day. It’s changed only once every four weeks, including a one-week break period. 


How is a vaginal ring used?

The ring is inserted into the vagina for a three-week period, where it will be held in place by the vaginal muscles.  Even during sexual intercourse and physical exercise it very rarely falls out.  In the unlikely event of such an accident, simply rinse the ring and reinsert it properly. But don’t wait too long.  If the ring is outside your vagina for more than three hours, protection is no longer guaranteed. If you do leave it outside the vagina for more than three hours, you’ll need to use back up protection, such as condoms, for seven days, or refrain from sexual activity altogether. 

There’s really no need to remove the ring.  You cant feel it and your partner most likely won’t either.  Studies show that 85% of men will not notice the ring at all during sex. 

Similar to birth control pills and patches, after a three-week period, you’ll have one hormone-free week.  Remove the ring after 3 weeks and then after seven days insert a new ring. Then repeat this 4 week cycle indefinitely.  During the fourth week (the week without a ring), you’ll get your period.  This may not happen in the first month however, as your body still is adapting to the treatment.  In the following months, you’ll experience a regular and comparatively light period in the fourth week of the cycle. 

You can start using a vaginal ring at any time during your monthly cycle. Doctors recommend that during the first 7 days of using a ring, you also use backup protection, such as condoms, or stop having sexual intercourse.  This is because it takes a few days for the treatment to build up in your system and reach maximum effect.


What should I do if I lose the ring or forgot when I inserted it?

Losing the ring is difficult, but it can happen. It’s also possible to mix up your ring schedule and forget when you should insert a new ring — although it should always be the exact same weekday.  If this does happen, just insert a new ring as soon as you can, and apply the aforementioned seven-day backup protection rule. 


  1. Roumen, Frans JME. “Review of the Combined Contraceptive Vaginal Ring, NuvaRing®.” Therapeutics and Clinical Risk Management, vol. 4, no. 2, 1 Apr. 2008, pp. 441–451, Accessed 13 Mar. 2020.
  2. Guida, Maurizio, et al. “Effects of Two Types of Hormonal Contraception--Oral versus Intravaginal--on the Sexual Life of Women and Their Partners.” Human Reproduction (Oxford, England), vol. 20, no. 4, 1 Apr. 2005, pp. 1100–1106,, 10.1093/humrep/deh686. Accessed 13 Mar. 2020.
  3. Oddsson, Kristjan, et al. “Efficacy and Safety of a Contraceptive Vaginal Ring (NuvaRing) Compared with a Combined Oral Contraceptive: A 1-Year Randomized Trial.” Contraception, vol. 71, no. 3, Mar. 2005, pp. 176–182, 10.1016/j.contraception.2004.09.001. Accessed 13 Mar. 2020.

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