NuvaRing (Etonogestrel/Ethinyl Estradiol) - Vaginal

Warning:

NuvaRing has a black box warning. A black box warning is the strongest warning required by the Food and Drug Administration (FDA).

Smoking cigarettes increases the risk of serious cardiovascular (heart) events, such as heart attack and stroke in people who use combination hormonal birth control. NuvaRing is a combination of hormonal birth control. A combination of hormonal birth control contains estrogen (NuvaRing contains ethinyl estradiol) and progestin (NuvaRing contains etonogestrel).

The risk is higher with age, especially in people 35 years or older. The risk also increases with the number of cigarettes smoked. Because of this risk, combination birth control, including NuvaRing, should not be used in people who are over 35 years old and smoke.

What Is NuvaRing?

NuvaRing  (etonogestrel/ethinyl estradiol vaginal ring) is a form of hormonal birth control available in the form of a vaginal ring. The two primary ingredients, estrogen (ethinyl estradiol) and progestin (etonogestrel) are the two female sex hormones present.

The vaginal ring is inserted into the vagina (intravaginally) to prevent pregnancy in individuals of childbearing age. NuvaRing works in three ways:

  • By preventing ovulation. Ovulation is the release of eggs from the ovaries.
  • By changing the lining of the uterus, or womb, to prevent pregnancy from developing
  • By changing the mucus at the cervix (the opening of the uterus) to prevent sperm from entering

Drug Facts

Generic Name: Etonogestrel/ethinyl estradiol

Brand Name(s): NuvaRing, EluRyng

Drug Availability: Prescription

Therapeutic Classification: Contraceptive

Available Generically: Yes

Controlled Substance: N/A

Administration Route: Intravaginally

Active Ingredients: Etonogestrel/ethinyl estradiol

Dosage Form(s): Vaginal ring (inserted into the vagina)

What Is NuvaRing Used For?

The FDA has approved NuvaRing to prevent pregnancy in people of childbearing age.

While contraceptive vaginal rings are a very effective method of birth control, they do not prevent the spread of human immunodeficiency virus (HIV; the virus that causes acquired immunodeficiency syndrome, AIDS) and other sexually transmitted infections (STIs).

How to Use NuvaRing

If you are prescribed NuvaRing:

Read the prescription label, information leaflet, and medication guide that comes with your prescription. Consult your healthcare provider if you have any questions. Use NuvaRing exactly as directed by your healthcare provider. NuvaRing is inserted into the vagina. It is not worn outside the body.

To insert NuvaRing, you can start in one of three positions - standing with one leg up, squatting, or lying down. Compress the ring and insert it into the vagina. Or, you can use the applicator to insert NuvaRing. To remove, hook your index finger under the front rim, or grasp the rim between your index finger and middle finger and pull it out. Place the used ring in the foil pouch and discard it in the trash, out of reach of children and pets.

You must wear NuvaRing 24 hours a day for 21 days (three full weeks) to prevent pregnancy. It does not prevent pregnancy if you only wear it during intercourse. Do not wear more than one vaginal ring at a time.

For seven days after inserting NuvaRing for the first time, you may need to use a form of backup birth control, such as external condoms (not a diaphragm or internal condom). Ask your healthcare provider how long you need to use backup birth control. Remove the vaginal ring after 21 days. Do not leave it for longer than three weeks.

Then, wait seven full days before inserting a new ring. During this one-week break, you will usually get your period. Call your healthcare provider if you have difficulty removing the ring, or if you get off your schedule. Notify your healthcare provider if you have breakthrough bleeding.

If you are scheduled for surgery or will be on bed rest for a period of time, tell your healthcare provider. You may need to stop using NuvaRing for a short time.

Ask your healthcare provider if you have any questions or concerns about NuvaRing.

Storage and Disposal

NuvaRing can be stored for up to four months at room temperature. Keep NuvaRing out of direct light, heat, and moisture. Do not store it in the bathroom. Check the expiration date before using NuvaRing. Do not use an expired NuvaRing.

Each NuvaRing is packaged individually in a reclosable pouch. After removing a ring from the vagina, put it in the pouch and discard it in the garbage. Do not flush NuvaRing. Keep NuvaRing out of reach of children and pets.

Off-Label Uses

Occasionally, NuvaRing will be used off-label for indications that are not FDA-approved.

Healthcare providers may prescribe NuvaRing to individuals:

  • To treat severe acne (when external acne medications do not work)
  • To treat amenorrhea (the absence of a monthly period)
  • For abnormal bleeding or heavy periods
  • For excess hair growth on the face, chest, and back
  • To treat polycystic ovary syndrome (a hormone imbalance caused by the ovaries)
  • To treat endometriosis

How Long Does NuvaRing Take to Work?

NuvaRing starts working in about a week. However, depending on what type of birth control, if any, you used before, as well as at what point in your cycle you inserted the ring, you may need to use backup birth control such as an external condom (not a diaphragm or internal condom), for at least seven days. Consult your healthcare provider for a recommendation.

What Are the Side Effects of NuvaRing?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Like other medications, NuvaRing can cause side effects. Tell your healthcare provider about any side effects you experience while taking this medication.

Common Side Effects

Common side effects include:

Severe Side Effects

NuvaRing has a black box warning. A black box warning is the strongest warning required by the FDA.

Smoking cigarettes increases the risk of serious cardiovascular (heart) events, such as heart attack and stroke in individuals who use combination hormonal birth control. NuvaRing is a combination of hormonal birth control. A combination of hormonal birth control contains estrogen (NuvaRing contains ethinyl estradiol) and progestin (NuvaRing contains etonogestrel).

The risk is higher with age, especially in those 35 years or older. The risk also increases with the number of cigarettes smoked. Because of this risk, combination birth control, including NuvaRing, should not be used in people who are over 35 years old and smoke.

Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Hypersensitivity reaction or anaphylaxis: Symptoms can include rash, hives, swelling around the lips, tongue, and face, difficulty breathing, and require emergency medical attention. 
  • Blood clots: Be aware of sudden vision loss, chest pain, shortness of breath, coughing up blood, pain, or warmth in the leg(s).
  • Heart attack: Be aware of chest pain or pressure, pain spreading to the jaw or shoulder, nausea, and sweating.
  • Stroke: Be alert to sudden numbness or weakness (especially on one side of the body), sudden severe headache, slurred speech, or vision or balance problems.
  • High blood pressure: Blood pressure should be monitored and communicated to the healthcare provider. Your healthcare provider will tell you how often to check your blood pressure.
  • Liver problems: Symptoms may include appetite loss, upper stomach pain, tiredness, dark urine, and yellowing of the skin or whites of the eyes (a potential sign of jaundice)f
  • Depression: Symptoms may include mood changes and/or thoughts of hurting yourself
  • Eye lesions: Report any vision changes or eye pain to your healthcare provider.
  • Toxic shock syndrome: Be alert to fever, body aches, skin rash, vomiting, diarrhea, and dizziness.
  • Possible increased risk of cervical or breast cancer: Ask your healthcare provider about your risk and steps you can take for monitoring, such as regular gynecologic exams and mammograms.

Long-Term Side Effects

Individuals who use NuvaRing should discuss possible long-term health risks with their healthcare provider.

With combination birth control, the risk of breast cancer is slightly increased. One study noted that there were limited breast cancer cases in people who used birth control methods such as the vaginal ring, but that there was not enough evidence to make an association specifically between the vaginal ring and breast cancer.

Combination birth control may cause an increased risk of clotting. In studies, some cases of clotting occurred in people who used NuvaRing, but the association is not clear.

Other long-term side effects can occur, such as eye, liver, or gallbladder problems.

You should discuss the risks versus benefits of using NuvaRing with your healthcare provider, especially since every person has a unique medical history that may affect their risk of long-term complications.

Report Side Effects

NuvaRing may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication. If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much NuvaRing Should I Use?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For vaginal dosage form (ring):
    • For contraception (to prevent pregnancy):
      • Adults—One ring inserted into the vagina for 3 weeks, followed by a 1 week ring-free interval. Then, a new ring is inserted 1 week after the last ring was removed.
      • Children—Use and dose must be determined by your doctor.

Modifications

Users should be aware of the following before beginning NuvaRing:

Individuals with liver problems: People with any type of liver tumor should not use NuvaRing. People with any type of liver problem should consult their healthcare provider for medical advice.

Individuals with kidney problems: People with any type of kidney problem should consult their healthcare provider for medical advice.

Postmenopausal people: NuvaRing has not been studied in postmenopausal people and should not be used.

Pregnant people: NuvaRing is intended to prevent pregnancy and should not be used on pregnant people.

Nursing people: People who are breastfeeding should consult their healthcare provider regarding how long after childbirth they can start using NuvaRing.

People over 65: NuvaRing has not been reviewed in postmenopausal people and is not used in this population.

Children: The safety and efficacy of NuvaRing have been established in people of reproductive age. Efficacy is expected to be the same for postpubertal adolescents under 18 and users 18 years and older.

Missed Dose

If your NuvaRing falls out, rinse the ring with warm water. Then, reinsert the ring into the vagina. If your ring is lost or broken, insert a new ring and stay on the same schedule.

If a ring has been out of the vagina for more than three hours:

During week 1 or 2: Reinsert the ring as soon as you remember. Use a barrier method of birth control (external condom with spermicide) until the ring has been used for seven continuous days.

During week 3: Discard the ring. Then, you can either:

  • Insert a new ring immediately, which starts a new three-week use period. You may have breakthrough bleeding.
  • Insert a new ring no less than seven days from the time the previous ring was removed or expelled. You may have bleeding during that time. You should only choose this option if the ring was used continuously for at least seven days before it was inadvertently removed or expelled. You will need to use a barrier method of birth control until the new ring has been in place for at least seven days.

If you're not sure how long NuvaRing was out of the vagina, take a pregnancy test before inserting a new ring.

If you are not sure what to do, consult your healthcare provider or pharmacist for instructions.

Overdose: What Happens If I Take Too Much NuvaRing?

The prescribing information shows that there have been no reports of serious problems from combination birth control overdose. Overdose may cause withdrawal bleeding and nausea. If the vaginal ring breaks, it will not cause an overdose.

What Happens If I Overdose on NuvaRing?

If you think you or someone else may have overdosed on NuvaRing, call a healthcare provider or the Poison Control Center (800-222-1222). If someone collapses or isn't breathing after taking NuvaRing, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your progress at regular annual visits to make sure this medicine is working properly and does not cause unwanted effects. Your doctor may also want to check your blood pressure while using this medicine.

Although you are using this medicine to prevent pregnancy, you should know that using this medicine while you are pregnant could harm your unborn baby. If you think you have become pregnant while using this medicine, tell your doctor right away. You may start using this medicine 4 weeks after giving birth and if you are not breastfeeding.

Vaginal bleeding of various amounts may occur between your regular menstrual periods during the first 3 months of use. This is sometimes called spotting when lighter, or breakthrough bleeding when heavier.

  • If this should occur, continue using NuvaRing®.
  • The bleeding usually stops within 1 week. Check with your doctor if the bleeding continues for more than 1 week.
  • If the bleeding continues after you have been taking hormonal contraceptives on schedule and for more than 3 months, check with your doctor.

You may be pregnant if:

  • You missed a period and NuvaRing® was out of the vagina for more than 3 hours during the 3 weeks of ring use.
  • You missed a period and waited longer than 1 week to insert a new ring.
  • You missed two periods in a row.
  • You have left NuvaRing® in place for longer than 4 weeks.

If you suspect that you may be pregnant, stop using this medicine and check with your doctor right away.

Do not use this medicine together with medicine to treat hepatitis C virus infection, including ombitasvir/paritaprevir/ritonavir, with or without dasabuvir (Technivie®, Viekira Pak®).

Do not use this medicine if you smoke cigarettes or if you are over 35 years of age. If you smoke while using NuvaRing®, you increase your risk of having a blood clot, heart attack, or stroke. Your risk is even higher if you are over age 35, if you have diabetes, high blood pressure, high cholesterol, or if you are overweight. Talk with your doctor about ways to stop smoking. Keep your diabetes under control. Ask your doctor about diet and exercise to control your weight and blood cholesterol level.

Using this medicine may increase your risk of having blood clotting problems. Check with your doctor right away if you have pain in the chest, groin, or legs, especially the calves, difficulty with breathing, a sudden, severe headache, slurred speech, a sudden, unexplained shortness of breath, a sudden loss of coordination, or vision changes while using this medicine.

Check with your doctor immediately if blurred vision, difficulty in reading, or any other change in vision occurs during or after treatment. Your doctor may want an eye doctor (ophthalmologist) to check your eyes.

Toxic shock syndrome (TSS) may occur while using this medicine. Call your doctor right away if you have any of the following symptoms: sudden high fever, diarrhea, dizziness, fainting, vomiting, muscle aches, or a sunburn-like rash.

Check with your doctor right away if you have pain or tenderness in the upper stomach, dark urine, pale stools, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.

Your blood pressure might get too high while you are using this medicine. This may cause headaches, dizziness, or blurred vision. You might need to measure your blood pressure at home. If you think your blood pressure is too high, call your doctor right away.

This medicine may increase your risk of having gallbladder disease. Check with your doctor if you start to have stomach pains, nausea, and vomiting.

Using this medicine may increase your risk of breast cancer or cervical cancer. Talk with your doctor about this risk. Check with your doctor immediately if you experience abnormal vaginal bleeding.

This medicine may cause skin discoloration. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds.

Check with your doctor before refilling an old prescription, especially after a pregnancy. You will need another physical examination and your doctor may change your prescription.

Make sure any doctor or dentist who treats you knows that you are using this medicine. The results of some medical tests may be affected by this medicine. You may also need to stop using this medicine at least 4 weeks before and 2 weeks after having major surgery.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.

What Are Reasons I Shouldn't Use NuvaRing?

NuvaRing is not appropriate for everyone. You should not take this medication if you are allergic to ethinyl estradiol, etonogestrel, or any of the inactive ingredients in NuvaRing.

Other people who should not use NuvaRing include:

  • Pregnant people
  • Individuals who are less than four weeks postpartum (and not breastfeeding)
  • Individuals who are less than weeks postpartum (and breastfeeding)
  • Individuals with cancer or a history of cancer that is estrogen-dependent or progestin-dependent
  • People with breast cancer or a history of breast cancer
  • People with a liver tumor or active liver disease
  • People with a history of cholestatic jaundice (a liver disease associated with blocked bile flow), that is associated with oral birth control or pregnancy
  • People with blood clots, a history of blood clots, or blood that forms clots too easily
  • People who are having major surgery where will be immobilized (not able to move about) for a period of time
  • People over 35 years old who smoke, or individuals of any age who smoke heavily
  • Individuals with heart or blood vessel disease
  • Individuals whose systolic blood pressure (the top number) is over 160 millimeters of mercury or diastolic blood pressure (the bottom number) is over 100 millimeters of mercury
  • People with blood vessel conditions, or diabetes with blood vessel conditions
  • Individuals with migraine headaches
  • People with undiagnosed vaginal bleeding
  • Individuals with positive or unknown lupus antibody

NuvaRing may be prescribed with caution in some people, only if the healthcare provider determines it is safe. This includes:

What Other Medications May Interact With NuvaRing?

Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter (OTC) medicines, and vitamins or supplements. While taking NuvaRing, do not start any new medications without approval from your healthcare provider.

Examples of drugs and supplements that can decrease the effectiveness of NuvaRing (making breakthrough bleeding or an unintended pregnancy more likely):

Talk to your healthcare provider about possible drug interactions. If you take a medication that may interact with NuvaRing, you may need a backup method of birth control, such as an external condom and spermicide. Certain barrier methods, like the internal condom or diaphragm, may not be able to be positioned correctly due to the NuvaRing.

Some drugs may increase levels of NuvaRing's hormones in the body. Examples of these drugs include antifungals such as Diflucan (fluconazole), Nizoral (ketoconazole), and Sporanox (itraconazole). This can happen with grapefruit, too. Avoid grapefruit and grapefruit juice while using NuvaRing.

Certain antiviral drugs can also interact with NuvaRing. If you have HIV or the hepatitis C virus (HCV), consult your healthcare provider about drug interactions.

NuvaRing can interact with Lamictal (lamotrigine), with the effect of reducing seizure control. A dosage adjustment may be needed.

Individuals who take thyroid replacement, such as Synthroid (levothyroxine), may need higher doses of levothyroxine.

This is not a full list of drug interactions. Other drug interactions may occur with NuvaRing. Consult your healthcare provider for a complete list of drug interactions.

What Medications Are Similar?

There are various methods of birth control. Some just prevent pregnancy, while others can also help prevent sexually transmitted infections. Discuss the best method of birth control with your healthcare provider, who can help determine which method would be best for you, considering your medical conditions, other drugs you take, and your lifestyle.

For example, some prefer to take a pill by mouth every day, while others have a hard time remembering to take it and prefer a longer-acting form of birth control, such as an injection.

NuvaRing is a type of hormonal birth control. It is a vaginal ring that is inserted into the vagina to prevent pregnancy. Another vaginal ring is called Annovera.

Other types of hormonal birth control (that are used for pregnancy prevention and do not protect against sexually transmitted infections) include:

  • Birth control pills are about 91% effective with typical use, and around 99% effective with perfect use (taking the pill at the same time every day and never skipping a dose). Some contain estrogen and progestin and are known as combined oral contraceptives, such as Lo Loestrin Fe. Others only contain progestin and are known as the "mini-pill," such as Micronor or Heather.
  • Birth control patches are worn on the skin. They are also about 91% effective.
  • The birth control shot, called Depo-Provera, is about 94% effective. It is given every three months by a healthcare provider. The Depo-subQ Provera 104 is another form of birth control shot that people can administer themselves, once trained.
  • An intrauterine device (IUD) such as Mirena or Kyleena, is 99% effective and is a small device that is inserted into the uterus by your healthcare provider to provide contraception for several years (the length of time depends on which IUD is used). There is also a hormone-free IUD called Paragard.
  • A birth control implant, Nexplanon, is a very small rod inserted under the skin of the upper arm. It is about 99% effective and provides contraception for up to three years.

There are other types of birth control methods too, such as external or internal condoms, and diaphragms, among others. Talk to your healthcare provider about the best method of birth control and/or sexually transmitted infection prevention.

This list is a list of drugs also prescribed for birth control. It is NOT a list of drugs recommended to take with NuvaRing. Ask your pharmacist or a healthcare provider if you have questions.

Frequently Asked Questions

  • What is NuvaRing used for?

    NuvaRing is a vaginal ring. It is inserted into the vagina in individuals of childbearing age who want to prevent pregnancy. It does not prevent sexually transmitted infections.

  • How does NuvaRing work?

    NuvaRing works by preventing ovulation, changing the uterine lining, and changing the cervical mucus. This helps prevent pregnancy.

  • What drugs interact with NuvaRing?

    NuvaRing can interact with various medications. Before using NuvaRing, review your medication list with your healthcare provider. Be sure to include prescription and OTC drugs, vitamins, and supplements. Some examples of drugs that interact with NuvaRing include certain antifungals and drugs that treat seizures.

  • How long does it take for NuvaRing to work?

    NuvaRing starts working in about a week, but you may need to use a certain type of backup birth control for a period of time, depending on what type of birth control, if any, you used previously.Ask your healthcare provider for medical advice.

  • What are the side effects of NuvaRing?

    Common side effects may include irregular bleeding, nausea, vomiting, tender breasts, headache, stomach pain, bloating, weight changes, mood swings, acne, changes in sex drive, vaginal itching or yeast infection, and increased blood pressure, cholesterol, and blood sugar.

    Other side effects may occur. Before taking NuvaRing, talk to your healthcare provider about what side effects to expect.

How Can I Stay Healthy While Taking NuvaRing?

Smoking, while using hormonal birth control, can greatly increase the risk of blood clots, stroke, or heart attack. Do not smoke while using NuvaRing. If you need help stopping smoking, talk to your healthcare provider about various options.

While we often think of drug interactions, NuvaRing has a food interaction to be aware of. Grapefruit can interact with NuvaRing. While using NuvaRing, avoid grapefruit, grapefruit juices, or any mixed fruit drinks that contain grapefruit juice. Let your healthcare provider know of any medications, OTC, and herbal supplements that you take.

NuvaRing does not protect you against sexually transmitted diseases such as HIV and AIDS. A condom is the best protection against these diseases. You can always consult your healthcare provider for more information about preventing pregnancy and sexually transmitted infections.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. MedlinePlus. Estrogen and progestin (vaginal ring contraceptives).

  3. Epocrates. NuvaRing

  4. Prescribers’ Digital Reference. Ethinyl estradiol/etonogestrel - drug summary.

  5. Quaas A, Weedin E, Hansen K. On-label and off-label drug use in the treatment of endometriosis. Fertil. Steril. 2015;103(3): 612-625. doi:10.1016/j.fertnstert.2015.01.006

  6. Wieder DR, Pattimakiel L. Examining the efficacy, safety, and patient acceptability of the combined contraceptive vaginal ring (NuvaRing)Int J Womens Health. 2010;2:401-409. doi:10.2147/IJWH.S6162

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By Karen Berger, PharmD
Karen Berger, PharmD, is a community pharmacist and medical writer/reviewer.