What to Know About the NuvaRing and Pregnancy Prevention

The NuvaRing prevents pregnancy by releasing hormones into your bloodstream. It is a flexible ring about 2 inches in diameter. The NuvaRing is 91% to 99.7% effective as a method of contraception if used correctly.

The NuvaRing is a hormonal prescription birth control. You insert it into your vagina for three weeks, then remove it to take a break for one week, and then insert a new ring to restart the four-week cycle.

NuvaRing is a brand name, and it's not the only vaginal ring birth control available. In 2019, the Food and Drug Administration (FDA) approved the first generic version of the NuvaRing, EluRyng.

You may experience side effects with the NuvaRing, and it's not recommended for people with certain health conditions, such as heart disease and diabetes. Additionally, the NuvaRing does not protect you from sexually transmitted infections (STIs). Your healthcare provider can help you decide whether the NuvaRing is right for you.

This article will discuss the NuvaRing, including how it works, its effectiveness, and how to use it. It will also discuss potential side effects and who the ring is not recommended for.

How the NuvaRing Prevents Pregnancy

The vaginal ring is hormonal birth control that prevents pregnancy by releasing two synthetic sex hormones into the bloodstream, preventing ovulation.

The NuvaRing contains two hormones: estrogen (in the form of ethinyl estradiol, 2.7 milligrams (mg)) and progestin (in the form of etonogestrel, 11.7 mg). It is considered a combination hormonal contraceptive.

After you insert it, the NuvaRing birth control releases a steady amount of hormone—approximately 0.12 mg of etonogestrel and 0.015 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.

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

Contraceptive Benefits of the NuvaRing

As a contraceptive, NuvaRing has these advantages:

• It's safe, simple, comfortable, and convenient.
• The exact position inside the vagina is not important for the 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 sexual partner. If you or your partner feel irritation or discomfort from the ring, check with your healthcare provider.
• You can use your NuvaRing to skip your period.
• It doesn't need to be fitted by a healthcare provider—you can insert it yourself.
• 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 being protected against pregnancy.

No STI Protection

The NuvaRing offers no protection against sexually transmitted infections (STIs). If you want to have STI protection while using NuvaRing, ask your partner to wear a condom or use a dental dam.

Effectiveness

The NuvaRing is 91% to 99.7% effective, depending on use. This means that with perfect use, fewer than one out of every 100 people who use the birth control ring will become pregnant in one year. With typical use, nine out of every 100 people who use NuvaRing will become pregnant in one year.

The effectiveness of the NuvaRing can be reduced if you use it incorrectly. You may be more at risk for pregnancy if:

• The ring does not stay in your vagina for three weeks in a row.
• 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.

The insert in your NuvaRing package has more detailed information about the use, risks, and effectiveness of the birth control ring. It also includes helpful steps in case your NuvaRing falls out or breaks.

When you first begin using the NuvaRing, how quickly it provides pregnancy protection depends on:

• The type of hormonal birth control you've been using, if any—for example, birth control pills, patch, or implant
• When exactly you insert the NuvaRing in your menstrual cycle or following an event like childbirth

Your healthcare provider will advise you on how long to use a backup birth control method. The NuvaRing package insert also has helpful information.

Other Benefits of the NuvaRing

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

Drawbacks of the NuvaRing

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.

Inserting and Removing the NuvaRing

The NuvaRing is simple to use. You only need to insert this birth control ring into the vagina one time each month: on day one of week one of your menstrual cycle.

After 21 days (three weeks), you'll need to remove your NuvaRing from your vagina. Leave it out throughout week four—at this time, you will most likely have your period. You will remain protected against pregnancy, even if you have sex during week four when your NuvaRing is not inserted.

At the end of week four, insert a new NuvaRing. Remember: Vaginal rings are not reusable.

Inserting the NuvaRing

The NuvaRing is simple to insert, similar to a tampon. To put one in:

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

From then on, the muscles in your vaginal wall will keep the NuvaRing in place and you're unlikely to feel it at all. If the ring is uncomfortable, try pushing it farther up into your vagina. There's no danger of it getting too high or lost inside you.

Make sure to insert your vaginal ring on the same day of the week that you inserted it during your last cycle. If you don't, your chance of becoming pregnant increases.

Removing the NuvaRing

Removing the NuvaRing is generally easy as well.

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

What to Do if the Ring Falls Out

If your ring slips out of your vagina but appears usable, rinse it in cool water and reinsert it. If the ring is lost or unusable, insert a new ring. If it's out for less than three hours, you should still be protected from pregnancy.

If the ring is out for more than three hours during the first two weeks of use, use a backup birth control method until the ring has been back in for seven days. In other situations, the NuvaRing packaging information can be a helpful guide—or you can contact your healthcare provider.

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.

Make sure to see a healthcare provider at least once a year for a blood pressure check and other relevant tests.

Common Side Effects

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

• Vaginitis—vaginal inflammation or infection, which can show up as pain, itching, discharge, and odor
• Headaches and migraines
• Changes in mood, including depression (especially if you've experienced depression in the past), mood swings, and constantly shifting moods
• Ring-associated problems such as slipping out or vaginal irritation
• Nausea and vomiting
• Weight gain
• Breast tenderness or pain
• Pain during menstruation
• Stomach pain
• Acne
• Reduced sexual desire
• Bleeding or spotting between periods

Less Common Side Effects

Less common side effects and risks include:

• Allergic reactions, 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 Side Effects

Rare but serious risks include:

• Blood clots—let your healthcare provider know if you're about to undergo major surgery
• Liver problems, including tumors—NuvaRing may not be suitable if you have liver disease
• Toxic Shock Syndrome (TSS)
• High blood pressure—NuvaRing may not be suitable if you have uncontrolled high blood pressure
• Gallbladder problems

Additionally, if you have a family history of angioedema (swelling in deep layers of skin), the estrogen in NuvaRing may make your angioedema symptoms worse.

Prior to getting your NuvaRing, let your healthcare provider know your full medical and family histories.

Precautions and Contraindications

The NuvaRing is generally safe and well-tolerated. However, it is important that you honestly discuss your complete medical history with your healthcare provider before using the NuvaRing.

The NuvaRing is not recommended if you're pregnant or breastfeeding, are over 35 and smoke cigarettes, or if you had or will have a major surgery within 30 days.

The NuvaRing is not recommended if you have a history of the following medical conditions:

• Heart disease, such as serious heart valve problems, or heart attack
• Blood clots, vein inflammation, or certain inherited blood clotting disorders
• Uncontrolled hypertension (high blood pressure)—as well as controlled blood pressure if you smoke more than 15 cigarettes a day
• Diabetes (your body's inability to use blood sugar properly)
• Liver disease or liver growths
• Certain types of migraine headaches
• Undiagnosed abnormal uterine bleeding
• Breast cancer or other cancers sensitive to estrogen or progestin, such as endometrial, vaginal, or cervical cancers
• Certain vascular conditions or have had a stroke (blood supply to the brain is interrupted or reduced)

Let your healthcare provider know if anyone in your family has had these conditions—the NuvaRing may not be suitable for you if you have a family history of:

• Breast lumps or cancers
• Liver disease
• Heart disease
• Hypertension
• Migraines

Typically, serious problems do not occur very often with hormonal birth control use. You may even be able to still use NuvaRing even if you have certain risk factors—as long as you remain under close medical supervision.

Costs Associated With the NuvaRing

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). Most insurances, including Medicaid, cover the NuvaRing itself so you can get it for free or at a low cost.

Government programs are also available to help you pay for the NuvaRing, if you qualify. If none of these options are available to you, the NuvaRing may cost up to $200.

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.

Summary

NuvaRing is a hormonal birth control ring that you insert into your vagina on a four-week cycle. It is safe and well-tolerated by most people, and highly effective if you follow the insertion and removal schedule and the ring doesn't slide out.

Some potential side effects of the NuvaRing include vaginal pain, itching, discharge, and odor; discomfort from the ring; headaches; and mood changes. These usually go away after two to three months of using the ring. In rare cases, serious side effects such as blood clots may occur. Some people may not be able to use NuvaRing, including those with a personal or family history of heart or liver diseases.

NuvaRing is covered by most health insurance plans and costs $0. However, you may need to pay for an appointment with a healthcare provider to get a prescription. While using the ring, it's essential to check in yearly with your healthcare provider to monitor your blood pressure and other vitals.

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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By Dawn Stacey, PhD, LMHC
Dawn Stacey, PhD, LMHC, is a published author, college professor, and mental health consultant with over 15 years of counseling experience.