The vaginal ring is kind of like a birth control underdog. Conversations about contraception often center around the pill or intrauterine devices. But the vaginal ring (sold under the name NuvaRing) can have a lot to offer, depending on what you’re looking for. Here are 14 things you should know about it.
NuvaRing uses estrogen and progestin to keep your uterus unoccupied. “People have mysterious thoughts about it, but it really is like taking a combined hormonal birth control pill in another form,” Mary Jane Minkin, M.D., a clinical professor of obstetrics and gynecology and reproductive sciences at Yale Medical School, tells SELF.
The estrogen suppresses ovulation, so your ovaries don’t release eggs for sperm to fertilize, and the progestin thickens your cervical mucus to make it harder for sperm to travel, the Mayo Clinic explains. The progestin also thins your uterine lining so that if an egg did happen to get fertilized, it wouldn’t be able to receive the nutrients it would need to grow.
What research has been done shows that with perfect use, NuvaRing has a failure rate of 0.3 percent. That means fewer than one woman out of 100 will get pregnant in the first year of using NuvaRing if they follow its instructions perfectly. With typical use (so, maybe you forget to insert and remove your ring exactly as you should), that number rises to nine women out of 100 getting pregnant in the first year of using NuvaRing. For what it’s worth, the birth control pill has the same failure rates, according to research estimates.
Another thing to keep in mind: NuvaRing doesn’t protect against sexually transmitted infections, so if you’re at risk for those, you should use barrier methods like condoms and dental dams during sex.
Thank NuvaRing’s progestin for this one. Since progestin reduces how much the lining of your uterus builds up, you can have a lighter flow during your period, Dr. Minkin says. Also, prostaglandins, which are hormone-like chemicals that create the hellish cramping tied to your period, come from your uterine lining, she explains. Less uterine lining can translate into fewer pain-inducing prostaglandins, so it’s really a win-win.
The ring itself is flexible, so it can bend and stretch to fit inside your vagina, Raquel Dardik, M.D., a gynecologist at NYU Langone Health, tells SELF. Sure, if you just had a vaginal delivery with a very big baby, this might not work for you in the immediate aftermath, Dr. Minkin says. But overall, NuvaRing should fit most people with vaginas. “I’ve never seen it not work for someone,” Dr. Minkin says.
During your off-week without the ring, you’ll get a “period,” which is really just a withdrawal bleed due to the lack of additional hormones. After the off-week is over, you should insert a fresh ring on the same day and time as you did before, even if your period hasn’t stopped.
The fact that NuvaRing offers many of the same benefits as the pill without the daily commitment makes it an attractive option for some people. “I have people who are great candidates for the pill but they have trouble remembering to take it. The ring is a fabulous alternative,” Dr. Minkin says.
“It’s very easy as long as women feel comfortable placing their fingers in their vagina,” Dr. Dardik says.
Here’s how the makers of NuvaRing recommend inserting the device:
- Wash and dry your hands.
- Choose a position that’s comfortable for you, like lying down, squatting, or standing with one leg up.
- Take your NuvaRing out of the foil pouch, hold it between your thumb and forefinger, and squeeze the sides together.
- Insert the ring into your vagina and push it up using your index finger. If you feel too aware of it or uncomfortable with where it is, you may need to push it up more.
“It usually only takes people a couple of minutes to get the hang of it,” Dr. Minkin says. You can also ask your doctor about a tampon-like applicator that may make it easier for you to insert NuvaRing.
The removal process is also pretty simple.
- Wash and dry your hands.
- Get into your comfortable position.
- Stick your index finger into your vagina and hook it through the ring.
- Pull gently downward and forward to pull it out.
- Toss it in the trash.
“That’s also typically easy,” Dr. Minkin says. “But I always reassure people that I can get it out of them if they can’t.”
You do not need to keep your NuvaRing in the fridge, but your pharmacist should. The prescribing information for NuvaRing says that its users should keep the device at room temperature (between 68 and 77 degrees Fahrenheit) for up to four months or until the expiration date, whichever comes first.
That prescribing information also advises pharmacists to keep NuvaRing in a fridge at 36 to 46 degrees Fahrenheit before dispensing the device to patients. It’s all about helping the product last longer, Jamie Alan, Ph.D., an assistant professor of pharmacology and toxicology at Michigan State University, tells SELF. Pharmacists might hang onto NuvaRing for longer than four months, and keeping them in the fridge helps preserve them.
Don’t think that you can keep your vaginal ring past its expiration date or after four months as long as you chuck it in the fridge. You really don’t want to roll the dice with this—it’s birth control, after all.
This might feel like a legit concern when you’re putting anything in your vagina, but there’s no need to stress about this. Your cervix (the narrow, lower end of your uterus) will block the ring from going anywhere inside your body other than your vagina, Dr. Minkin explains.
One thing to keep in mind, though: The makers of NuvaRing point out that some people have accidentally inserted the ring into their bladder (through their urethra) instead of their vagina. So, if you have pain after you insert the ring and you can’t find it in your vagina, call your doctor ASAP.
Manipulating your period via your birth control is off-label use. Because of that, it’s important to talk to your doctor before you do it. Cool? Cool.
OK, here’s the deal: Sometimes the ring-free period week may be scheduled for a time that’s completely inconvenient for you, like that beach weekend you have planned. So, you might want to change when your period comes or skip it entirely.
Remember, the ring uses a combination of progestin and estrogen to prevent an unintended pregnancy when it’s actually in your body. But when it comes out, there are no hormones from the ring circulating in your body, so you’ll bleed in response to the absence of those extra hormones. (Don’t worry, as long as you put in a new ring in seven days, you’ll still be protected from pregnancy.) So, if you want your period to arrive earlier than usual (like the week before your vacation instead of during it), you can remove your ring for that week, then put in a fresh one after (on the same day of the week and at the same time as you’ve been inserting and removing it in the past).
If you want to skip your period altogether, you can just keep your ring in for four weeks instead of three (you’ll still have pregnancy protection in this time), then put in a new ring instead of having seven ring-free days, Dr. Minkin says. Dr. Minkin stresses that, again, this an off-label use, so you really should talk to your doctor before you attempt this. Also, FYI, you might experience some breakthrough bleeding when trying to manipulate your period this way.
This benefit has less to do with the ring itself and more to do with its proper usage, Dr. Minkin says. Technically, the ring uses the same hormones as the pill, so you have the same risk of breakthrough bleeding, she explains. But with typical use, some people will forget to take the pill on occasion (because life)—and that increases your odds of bleeding randomly, Dr. Minkin says. Since you don’t have to switch out your NuvaRing as often as you need to take the pill, that lowers your chance of messing up how you use it.
The most common side effects of the ring include irritation inside your vagina or on your cervix, along with vaginal discharge, according to NuvaRing.com.
This is just because there’s something foreign sitting in your vagina, Dr. Minkin says, though she hasn’t seen patients have these issues. “My patients who use the ring seem to be just fine,” she says. It’s the same for Maura Quinlan, M.D., M.P.H., an assistant professor in the department of obstetrics and gynecology at the Northwestern University Feinberg School of Medicine, who tells SELF that she makes it a point to warn patients that this could happen, but has only seen it rarely.
There’s a chance that the ring can slip out when you remove a tampon, have sex, or strain when you’re pooping, according to NuvaRing.com. (This is why you’re supposed to check your ring regularly, including after those moments we just mentioned, in order to make sure it’s still in place.) If it’s been out of your vagina for less than three hours, rinse it off in cool to lukewarm water, and reinsert it, the company says.
If it’s been out for longer than three hours and you’re in weeks one or two, clean it off and reinsert it, but you should also use a backup method of birth control until your ring has been in place for seven days in a row, the company says. If you’re in week three, throw it out and either insert a new ring (knowing that you might not have a period for 21 days, or may have breakthrough bleeding), or insert a new ring no later than seven days after you’ve noticed the ring has fallen out (knowing that you’ll probably have a period during that time).
If you’re confused about any of this, make sure to ask your doctor exactly what you should do in the event that your NuvaRing falls out.
This is totally a personal preference. You definitely don’t need to remove the ring during sex, but a small number of partners can sometimes feel it during intercoure. If you want to, you can take your NuvaRing out for up to three hours and then reinsert it, the Mayo Clinic says.
You’re OK during this window of time because the hormones are still circulating in your bloodstream, Dr. Minkin explains.
Some of the biggest contraindications include:
- Having had blood clots in your arms, legs, eyes, or lungs: Like other combined hormonal contraceptives, the ring puts you at an increased risk for blood clots because its hormones increase the clotting factors in your blood. While the overall risk of blood clots is very low, even on combined hormonal birth control, things like a personal history of clots raise the chances that it might happen to you.
- Having had a stroke: There is a higher risk of stroke when you take birth control that contains ethinyl estradiol, which the ring does. Again, this is not something most people using the ring need to worry about, but factors like a history of stroke elevate your risk.
- Having high blood pressure that medicine can't control: The ring can raise your blood pressure even more, the American College of Obstetricians and Gynecologists (ACOG) says, so it’s not advised for people who already deal with hypertension that doesn’t respond well to medication.
- Smoking and being over the age of 35: Smoking increases your risk of serious heart and blood vessel problems in general, so it’s one of the main ways to make it more likely that you’ll have severe contraceptive-related side effects like blood clots, heart attack, and stroke. This risk is especially high in smokers over the age of 35, according to the Mayo Clinic.
When discussing your contraceptive options with your doctor, be sure to talk about these or any other factors in your health history that may affect which birth control is right for you.
The ring works by giving you a steady stream of hormones while it’s in, but once you take it out, your body simply goes back to normal, Dr. Dardik says. Usually, your ovaries “wake up” pretty quickly, but there are some people who may take a few months to have a normal cycle, Dr. Minkin says.
If you’re having any issues with your cycle a few months after you stop using the ring, talk to your doctor. It could be that the ring was masking symptoms of an underlying condition that affects your period or fertility, Dr. Minkin says, or that your fertility changed naturally as a result of age. Either way, your doctor should be able to run some tests to figure out what the deal is.
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