What Should I Know Before Using the Vaginal Ring (Nuvaring)?

Written by Kristen Miranda, MD, MPH

Helpful things to know before starting your vaginal contraceptive ring.

Basic information about the vaginal ring

The birth control vaginal ring contains two hormones: estrogen and progestin. These hormones work in unison to prevent pregnancy in a variety of ways: they block ovulation (when the ovaries release an egg); they thicken the cervical mucus which makes it harder for sperm to get into the uterus; and they thin the lining of the uterus making it harder for a pregnancy to implant. These hormones are not only excellent at preventing pregnancy, but they also have many non-contraceptive benefits.

The Nuvaring is a rubber ring placed inside the vagina for three weeks. At the end of the three weeks, remove the ring and take a week off, known as the hormone-free interval. During this week, you may have a short period. On the start of the following week, place a new ring and then repeat the four-week cycle. You can find more information on the ring here.

When should I start my ring?

You can actually start your ring at any time, but be sure to use backup protection (i.e., using condoms or practicing abstinence) for the first seven days to avoid pregnancy. If you start your ring in the middle of the month, you may have some irregular bleeding or bleed twice during the first month. Don’t worry; this bleeding is normal and will go away with time as your body adjusts to the hormones. Just make sure you keep using the ring on the same schedule, even if you are spotting or bleeding.

Here is a good article about starting birth control pills or the ring.

What if I forget when I placed the ring or if it fell out and I cannot find it?

If you forget when you first placed the ring, or if your ring came out and you can’t find it, or if you took it out and forgot to put it back in, don’t panic! When you realize you’re off your ring schedule for whatever reason, insert a new ring and use condoms as backup for seven days. You may also want to consider emergency contraception. This quiz from Planned Parenthood can help you decide what to do, based on which week you are in (1st, 2nd, or 3rd week) with your ring and what happened.

It’s important to know that the ring lasts longer than 21 days, so if you have a hard time remembering which day you started yours, one option is to always place it on the first day of the month and then always take it out on the 25th. In short months like February, you may have only a three-day window without the ring, while there will be a six-day interval in a longer month like October. Many people find this method much easier to remember and could be a great option for you.

What will happen with my period when I use the ring?

Overall, your period will be lighter and likely shorter when you use the ring. Your body will eventually adjust to a pattern where you have no bleeding during the three weeks you have the ring in your vagina, and then in the “hormone free” week where you do not have the ring inside, you will have a “withdrawal bleed” similar to what you experience during your period. If you prefer not to have a period at all, you can skip it.

The first few months you use the ring, you may get some spotting or bleeding, known as “breakthrough bleeding,” which will go away over time. The more consistently you use the ring and place it on the same weekly schedule, the faster the bleeding should resolve. If the breakthrough bleeding becomes bothersome, reach out to your healthcare provider to discuss your options. Sometimes when you use the ring, your period will go away completely over time. That is normal and not dangerous, and your period will come back once you stop using the ring.

How effective is the ring?

The ring is highly effective at preventing pregnancy. With perfect use, it is 99.7% effective, and with typical use (how most women use it), the ring is still 93% effective.

How expensive is the ring?

Prices for the ring vary by pharmacy, but they are usually reasonable. You can check out various pricing options at our partner GoodRx.

The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of HeyDoctor, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.

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