Using the NuvaRing as a Birth Control Method

The NuvaRing is a type of hormonal prescription birth control. It's a flexible ring that's about 2 inches in diameter. When used correctly, it's very effective at preventing pregnancy.

NuvaRing is a brand name. In 2019, the Food and Drug Administration (FDA) approved the first generic version of the NuvaRing, which is called EluRyng and is produced by Amneal Pharmaceuticals.

This article will discuss the NuvaRing, including its effectiveness and how to use it.

Uses

The NuvaRing contains two synthetic estrogens:

• Etonogestrel: 11.7 milligrams (mg)
• Ethinyl estradiol: 2.7 mg

After you insert it, the NuvaRing birth control releases a steady amount of hormone—approximately 0.12 mg of etonogestrel and .015 mg of ethinyl estradiol per day—into your bloodstream over the course of three weeks. The release of hormones is activated by contact with the vagina, which absorbs them and feeds them into your bloodstream.

Studies show the NuvaRing is effective at preventing pregnancy for a month and is superior to some other contraceptive rings on the market when it comes to preventing ovulation.

Advantages

As a contraceptive, NuvaRing has these advantages:

• It's safe, simple, comfortable, and convenient.
• The exact position is not important for NuvaRing to be effective.
• Unlike the birth control pill, you don't need to think about it every day.
• Due to the low and steady hormone delivery, the NuvaRing has fewer hormonal ups and downs than daily or weekly birth control methods.
• NuvaRing is discreet—nobody will know that you are using it and it usually can't be felt by you or your partner.
• You can use your NuvaRing to skip your period.
• It doesn't need to be fitted by a healthcare provider.
• It can lead to regular, lighter, and shorter periods.
• It's completely reversible—you regain the ability to become pregnant quickly after you stop using it.
• NuvaRing doesn't interfere with having sex and can allow for more spontaneity than a diaphragm or sponge—you can have sex whenever you want while protecting against pregnancy.

Noncontraceptive Benefits

The NuvaRing may offer some of the same non-contraceptive advantages as the birth control pill. Some of these additional benefits may include protection against:

• Ectopic pregnancy (pregnancy outside the uterus)
• Irregular menstrual cycles
• Anemia (iron deficiency) that results from heavy periods
• Painful menstrual cramps
• Endometrial and ovarian cancers
• Pelvic inflammatory disease
• Ovarian and breast cysts
• Acne

Disadvantages

Some disadvantages are linked to NuvaRing birth control use:

• If you are using the NuvaRing, you cannot also use a diaphragm, cervical cap, or sponge as a backup method of contraception as the ring may interfere with placement.
• If you have a history of depression, you may need to stop using NuvaRing if your depression worsens.
• You need to stick to a once-a-month insertion schedule.
• NuvaRing may cause vaginal irritation or an increase in vaginal discharge.

Before Using

The NuvaRing is a safe birth control option for most healthy people. It is important that you honestly discuss your complete medical history with your healthcare provider before using the NuvaRing.

In order to get the NuvaRing, you will need a prescription from your healthcare provider. Your healthcare provider will most likely conduct a medical evaluation, blood pressure check, and pelvic exam. You can then have your NuvaRing prescription filled at a local pharmacy.

Precautions and Contraindications

The NuvaRing is not recommended if you're breastfeeding, are over 35 and smoke cigarettes, or if you have:

• Uncontrolled high blood pressure
• A history of serious heart valve problems or heart attack
• Breast cancer or cancers sensitive to estrogen or progestin
• Controlled blood pressure and smoke more than 15 cigarettes a day
• A history of blood clots, vein inflammation, or certain inherited blood clotting disorders
• Certain types of migraine headaches
• Undiagnosed abnormal uterine bleeding
• Liver disease or liver growths
• Weak pelvic floor muscles
• Diabetes (your body's inability to use blood sugar properly)
• Certain vascular conditions or have had a stroke (blood supply to the brain is interrupted or reduced)

Associated NuvaRing Costs

If you use NuvaRing, costs will include the price of each month's NuvaRing pack, plus the expense of having a medical exam (in order to get the prescription).

In many areas, Medicaid covers the cost of this birth control method. If you have private health insurance, you can check with your provider since NuvaRing should be covered with no out-of-pocket costs for most insurance plans.

How to Use It

The NuvaRing is simple to use. You only need to insert this birth control ring into the vagina one time each month:

1. You insert NuvaRing on day one of week one of your cycle.
2. During this time, the muscles in your vaginal wall will keep the NuvaRing in place.
3. After 21 days (or three weeks), you need to remove your NuvaRing from your vagina.
4. You leave the NuvaRing out during week four—at this time, you will most likely have your period.
5. Once week four is over, you begin all over again with week one of your next cycle by inserting a new NuvaRing.

Using the NuvaRing this way will allow for you have continuous pregnancy prevention (you are still protected against pregnancy if you have sex during week four when your NuvaRing is not inserted).

How to Insert the NuvaRing

The NuvaRing is simple to insert, kind of like a tampon. To put one in:

1. Wash and dry your hands.
2. Choose a comfortable position, such as squatting, standing with one leg up, or lying down.
3. Remove the NuvaRing from its foil pouch. Keep the pouch to dispose of the ring when you're done with it.
4. Holding NuvaRing between your thumb and index finger, pinch the sides together.
5. Insert the folded ring into your vagina, then use your index finger to gently push it up higher. The exact position isn't important, and a small amount of movement after insertion is normal.

Most people don't feel the ring once it's in place. If it's uncomfortable, try pushing it farther up into your vagina. There's no danger of it getting too high or being lost inside of you.

How to Remove the NuvaRing

Removing the NuvaRing is generally easy, as well.

1. Wash and dry your hands.
2. Choose a comfortable position (the same one you used for insertion).
3. Put your index finger in your vagina until you feel the ring. Hook your finger through it and pull gently.
4. Put the ring in the foil pouch and throw it away someplace out of reach of children and pets. Don't flush the ring down the toilet.

Side Effects 

Combined estrogen-progestin hormonal birth control options like NuvaRing have more potential side effects than progestin-only products. However, the added estrogen can lower the risk of breakthrough bleeding that you have when you're only taking progestin.

Most users don't experience many NuvaRing side effects. Among those who do, the side effects usually go away after two to three months of use. The most common reported side effects include:

• Breast tenderness
• Headaches and migraines
• Weight gain
• Nausea and vomiting
• Changes in mood, especially if you have a history of depression
• Spotting or light breakthrough bleeding
• Increased vaginal discharge
• Vaginal irritation or infection
• Acne
• Reduced sexual desire
• Ring-associated problems such as slipping out or causing discomfort

Less-common side effects and risks include:

• Allergic reaction, including hives
• Discharge from the nipples
• In sexual partners, penis rash or irritation
• Blotchy darkening of skin, especially on the face
• High blood sugar, especially if you have diabetes
• High blood levels of cholesterol and triglycerides (type of fat in the blood)

Rare but serious risks include:

• Liver problems, including tumors
• High blood pressure
• Gallbladder problems
• Angioedema (swelling in deep layers of skin) in people with a family history of it

When to See a Healthcare Provider

Some possible side effects of NuvaRing are serious enough to warrant immediate medical attention. You should see a healthcare provider right away if you experience:

• Symptoms of a blood clot in the legs, lungs, eyes, heart, or brain: Persistent leg pain, sudden shortness of breath, sudden partial or complete blindness, severe chest pain or pressure, sudden severe headaches, weakness or numbness in a limb, trouble speaking, or yellowing of the skin or eyeballs
• Symptoms of toxic shock syndrome: Sudden flu-like symptoms such as high fever, vomiting, diarrhea, muscle aches, dizziness, faintness upon standing, or a sunburn-like rash

Other things that warrant a call to the healthcare provider include:

• A change in odor or appearance of vaginal discharge
• Unexplained fever or chills
• Pelvic or belly pain
• Heavy, long-lasting vaginal bleeding when you're not due for a period
• Severe headaches
• Suspected pregnancy

Also, see your healthcare provider if any side effects last longer than expected or become severe or especially bothersome.

Effectiveness

The NuvaRing is 91%–99% effective. This means that with perfect use, less than 1 out of every 100 people who use the birth control ring will become pregnant in one year. With typical use, 9 out of every 100 people who use NuvaRing will become pregnant in one year.

Unlike a diaphragm, which you need to leave in for several hours after sex, you don't need to time the removal of NuvaRing based on when you've had intercourse. Following the recommended schedule will keep you protected from pregnancy.

The effectiveness of the NuvaRing can also be reduced if you do not use it the correct way. You may be more at risk for pregnancy if:

• The ring does not stay in your vagina for three weeks in a row.
• If the ring is left in the vagina for more than four weeks.
• The ring slides out of the vagina and is not replaced within three hours.
• The unopened NuvaRing package is exposed to direct sunlight or very high temperatures.

You should read the insert inside the NuvaRing package for more detailed information about the use, risks, and effectiveness of the birth control ring. It may also be helpful for you to know ahead of time what to do if your NuvaRing falls out or breaks.

How Soon Does NuvaRing Become Effective?

When you first begin using the NuvaRing, how quickly it provides pregnancy protection depends on whether you've been using another type of hormonal birth control, which type it is, and when exactly you insert your first NuvaRing.

If you haven't been using hormonal birth control and start NuvaRing for contraception:

• If you insert it on day one of your menstrual period, which is the preferred time, it becomes effective immediately and you don't need a backup birth control method.
• If you insert NuvaRing on days two through five of your period, you should use an additional birth control method for the first seven days.

If you're switching to NuvaRing from birth control pills or a patch:

• Start NuvaRing when you'd take your next birth control pill or put on your next patch
• You shouldn't need a backup birth control method

If you're switching from progestin-only birth control, including a minipill (progestin-only birth control pill), implant, injection, or intrauterine system (IUS):

• Start NuvaRing when you're due for your next pill, implant, injection, or IUS
• Use a backup method of birth control for the first seven days

A Word From Verywell

There are many birth control options. The NuvaRing is one of them. It is an effective method of birth control (91%–99%), but it does come with some side effects. Talk to your healthcare provider about birth control options and whether the NuvaRing is right for you.