Vaginal Ring at a Glance
- A small ring you put in your vagina once a month for three weeks to prevent pregnancy
- Safe, effective, and convenient
- Easy to get with a prescription
- Costs about $15–$80 a month
Is the Vaginal Ring Right for Me?
Here are some of the most common questions we hear women ask about the vaginal ring. We hope you find the answers helpful.
What Is the Vaginal Ring?
The vaginal ring is a small, flexible ring a woman inserts into her vagina once a month to prevent pregnancy. It is left in place for three weeks and taken out for the remaining week each month. The vaginal ring is commonly called NuvaRing, its brand name.
How Does the Vaginal Ring Work?
Like other methods of birth control, NuvaRing releases hormones. Hormones are chemicals made in our bodies. They control how different parts of our bodies work.
- Keeping eggs from leaving the ovaries. Pregnancy cannot happen if there is no egg to join with the sperm.
- Making cervical mucus thicker. This keeps sperm from getting to the eggs.
How Effective Is the Vaginal Ring?
Effectiveness is an important and common concern when choosing a birth control method. The vaginal ring is very effective. It works best when a woman inserts it, keeps it in place for three weeks, takes it out for one week, and then inserts a new ring. That keeps the correct level of hormone in a woman’s body.
- Less than 1 out of 100 women will get pregnant each year if they always use NuvaRing as directed.
- About 9 out of 100 women will get pregnant each year if they don’t always use NuvaRing as directed.
Certain medicines and supplements may make NuvaRing less effective. These include
- the antibiotic rifampin — other antibiotics do not make the ring less effective
- the antifungal griseofulvin — other antifungals do not make the pill less effective
- certain HIV medicines
- certain anti-seizure medicines
- St. John's wort
How Safe Is the Vaginal Ring?
Most women can use NuvaRing safely. But all medications have some risks, so safety is a concern when choosing a birth control method. Serious side effects of the ring, though rare, may be more likely if you have certain conditions. Some of these conditions may even rule out using the ring. Talk with your health care provider to find out if the ring is likely to be safe for you.
You should not use the vaginal ring during prolonged bed rest or if you
• are pregnant
• get migraine headaches with aura
• have certain inherited blood-clotting disorders
• have or are being treated for blood clots or vein inflammation
• have had breast or liver cancer
• have had a heart attack, stroke, angina, or other serious heart problems
• have had serious heart valve problems
• have lupus with certain conditions
• have serious liver disease or have had liver cancer
• have uncontrolled high blood pressure
• have very bad diabetes or have had diabetes for longer than 20 years
• have weak pelvic floor muscles
• smoke and are 35 or older
• smoke and have high blood pressure
• have had complications after organ transplant
• need to stay in bed for a long time
If you have a condition that makes it unsafe to use the ring, don’t worry. There are many other methods of birth control that may be safe for you if you cannot use it. There are many other methods of birth control that may be safe for you if you cannot use the ring. Read about other methods to find one that may be right for you.
What Are the Benefits of the Vaginal Ring?
Using the vaginal ring is safe, simple, and convenient. There is nothing to do right before having sex. Some women say it improves their sex lives because it helps them feel more spontaneous.
Many women who use the vaginal ring have more regular, lighter, and shorter periods. And a woman’s ability to become pregnant returns quickly when use of the ring is stopped.
Because the ring works like the pill, it probably offers the same benefits. These health benefits may include some protection against
- bone thinning
- bad menstrual cramps
- breast growths that are not cancer
- cysts in the breasts and ovaries
- ectopic pregnancy
- endometrial and ovarian cancers
- heavy and/or irregular periods
- iron deficiency anemia
- pelvic inflammatory disease, which often leads to infertility when left untreated
- premenstrual symptoms, including headaches and depression
- serious infection in the ovaries, tubes, and uterus
The ring can be used to control when and how often you have your period. It can also be used continuously — without a monthly break — to eliminate monthly periods.
What Are the Disadvantages of the Vaginal Ring?
Because NuvaRing works like the pill, it probably carries the same possible disadvantages.
Possible Side Effects of the Vaginal Ring
Some women may have undesirable side effects while using NuvaRing. But many women adjust to it with few or no problems.
Some of the most common side effects usually clear up after two or three months. They include
- bleeding between periods
- breast tenderness
- nausea and vomiting
NuvaRing may also cause more long-lasting side effects. It may cause increased vaginal discharge, vaginal irritation, or infection. The hormones in NuvaRing may change a woman’s sexual desire.
It’s important that you find a method that won’t make you feel sick or uncomfortable. If you continue to experience side effects after using the vaginal ring for three months, talk with your health care provider.
After ring use is stopped, it usually takes one or two months for a woman’s periods to return to the cycle she had before using it. Once in a while, a woman may have irregular or absent periods. This may go on for as long as six months after stopping. This is more likely if her periods were irregular before using the ring.
Regularly using oil-based medicines in the vagina for yeast infections while the ring is in place may increase the level of hormones released into the blood. This will not reduce the effectiveness of the ring. The effect of using these types of yeast infection medications with the vaginal ring long-term is unknown. Talk with your health care provider if you need long-term treatment for yeast infections while you are using the ring.
Serious Side Effects of the Vaginal Ring
Many women have concerns about the possible risks of taking hormones in birth control. Serious problems do not occur often.
Women who use birth control with estrogen — like NuvaRing —have a slightly greater chance of certain serious problems than nonusers. The most serious — in very rare cases — may be fatal. These include heart attack, stroke, or having a blood clot in the legs, lungs, heart, or brain.
Other rare risks include developing high blood pressure, liver tumors, gallstones, or yellowing of the skin or eyes (jaundice). The risk for these problems increases if you
- are age 35 or older
- are very overweight
- have certain inherited blood-clotting disorders
- have diabetes
- have high blood pressure
- have high cholesterol
- need prolonged bed rest
Serious problems usually have warning signs. Report any of these signs to your health care provider as soon as possible:
- a new lump in your breast
- a sudden very bad headache
- achy soreness in the leg
- aura — seeing bright, flashing zigzag lines, usually before a very bad headache
- bad pain in your abdomen or chest
- headaches that are different, worse, or happen more often than usual
- no period after having a period every month
- trouble breathing
- yellowing of the skin or eyes
The Vaginal Ring and Breast Cancer
You may have heard claims linking the hormones in the vaginal ring to breast cancer. The most recent literature suggests that the use of these hormones in birth control has little, if any, effect on the risk of developing breast cancer.
See the insert from NuvaRing for more information about possible side effects.
How Do I Start the Vaginal Ring?
To find out what day is best for you to start using the ring, talk with your health care provider. Most often, women start using the ring within the first five days after the start of their periods. That way, they are protected against pregnancy right away. That means that if your period starts on a Wednesday morning, you can insert the vaginal ring as late as the following Monday morning to be protected right away.
If you insert the vaginal ring later than five days after the start of your period, protection will begin after seven days. Use another method of birth control — like a condom or spermicide — if you have vaginal intercourse during the first week of ring use.
The ring can interfere with the placement of the cervical cap, diaphragm, and sponge. They cannot be used as backup methods with the vaginal ring.
Starting the Vaginal Ring After Pregnancy
It’s possible to get pregnant again shortly after being pregnant. Starting birth control after pregnancy is an important concern for many women.
You can start using the ring after waiting at least three weeks after giving birth vaginally.
You can start using the ring after waiting at least six weeks if you are nursing — it may reduce the amount and quality of milk in the first six weeks of breastfeeding. Also, the milk will contain traces of the ring's hormones. It is unlikely that these hormones will have any effect on your child. But talk with a health care provider about what birth control methods might be right for you after giving birth.
You should wait at least six weeks after birth if you have an increased risk of blood clots. Women have a higher risk of blood clots if they
- are obese
- are over age 35
- had a cesarean section (C-section)
- had heavy bleeding after delivery
- had preeclampsia
- have certain inherited blood clotting disorders
- have had blood clots in the past
- have a close family member who has had blood clots
- need prolonged bed rest
- received a blood transfusion at delivery
You can start using the ring right after an abortion or miscarriage.
How Do I Use the Vaginal Ring?
Most women find that NuvaRing is very easy to use. Insert one new ring into your vagina and keep it in place for three weeks in a row. Then remove it for one week — three weeks in, one week out. Insert a new ring after one week.
Here are some more specific details about using the ring:
- Store your unused rings at room temperature and out of direct sunlight.
- Check the expiration date of each ring package before insertion.
- Wash your hands with soap and water.
- Use your fingers to press the sides of the ring together.
- Gently push the ring into your vagina.
- The exact position of the ring doesn’t matter.
- There’s no need to remove the ring during vaginal intercourse.
- Remove it in three weeks on the same day of the week that it was inserted.
- Hook your finger under the forward rim and gently pull it out of the vagina.
- Wrap it up in the original foil wrapper, and throw it out in the trash — do not flush. Used rings still contain some hormones. Using the foil wrapper protects children and pets who might play with a used ring. It also reduces the chance that hormones will get into the soil and water supply.
- After one week without the ring, insert a new one — on the same day of the week that the previous one was inserted in your last cycle.
During the one-week break, you will usually have your period. You may still be bleeding when it is time to insert a new ring. This is normal, too. But the vaginal ring must be inserted on the same day of the week as it was inserted in the last cycle, or you could get pregnant.
Some women use the ring every day without a one-week break to keep from getting their periods. They simply replace the ring every three weeks with a new ring. If you use the ring continuously, it is normal to have spotting or bleeding the first six months. It may get less over time. Some women stop having any bleeding at all. This is normal and will not harm your body.
Helpful Tips About Using the Vaginal Ring
What Do I Do if the Ring Slips Out or I Make a Mistake Using It?
It’s pretty common for women to make a mistake at some time when using the vaginal ring.
If you use the ring, the key to protecting yourself from an unplanned pregnancy is knowing what to do if you make a mistake or if the ring slips out of your vagina.
Pregnancy can happen if
- the ring slips out of your vagina and is not replaced within three hours
- the ring does not stay in your vagina for three weeks in a row
- the ring is left in your vagina for more than three weeks
- you forget to insert a new ring more than a week after taking out the previous ring
Here are some general instructions if any of these things happen to you. Talk with your health care provider for more information.
If the Ring Slips Out of Your Vagina
- Wash the ring with lukewarm or cool water and put it back in as soon as possible.
- Use a backup method of birth control for seven days if the ring is out of your vagina for more than three hours.
If You Leave the Ring in Your Vagina for Longer than You Should
Up to four weeks after insertion
- Remove the ring.
- Take a ring-free week.
- Insert a new ring after the ring-free week.
More than four weeks after insertion
- Remove the ring.
- You may have become pregnant if you had vaginal intercourse more than four weeks after you inserted the ring. You may want to take a pregnancy test.
- When you restart with a new ring, use backup birth control for seven days.
When Backup Birth Control Is Needed
Use a backup method of birth control for seven days in a row
Do not use a diaphragm, cap, or sponge as a backup method. The ring could keep them from being placed properly in your vagina. Latex condoms or spermicide, used separately or together, are good choices for backup protection.
How Do I Get the Vaginal Ring? How Much Do Vaginal Rings Cost?
First, you’ll need to get a prescription. Visit a Planned Parenthood health center, a clinic, or a private health care provider for a prescription. Your health care provider will discuss your medical history with you, check your blood pressure, and give you any other medical exam that you may need. If you need an exam, it may cost about $35–$250. You won’t need a fitting from a health care provider — NuvaRing only comes in one size that fits all women.
NuvaRing may be purchased with a prescription at a drugstore or clinic. It costs about $15–$80 a month.
Planned Parenthood works to make health care accessible and affordable. Some health centers are able to charge according to income. Most accept health insurance. If you qualify, Medicaid or other state programs may lower your health care costs.
Call your local Planned Parenthood health center to get specific information on costs.
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