The vaginal ring is a plastic ring that you insert into your vagina as a method of birth control. It releases the hormones estrogen and progestin.
This article is part of our Contraception Series!
What we're covering
Note: the information below was sourced from references (1-5), unless stated otherwise.
What is it?
The contraceptive ring (you may know this as the NuvaRing) is a plastic ring that you insert into your vagina. There, it releases the hormones estrogen and progestin (explained below).
Typically, you take the ring out after three weeks to allow one week of hormone-free time. Menstruation usually occurs during this time. After this hormone-free week, you insert a new ring into your vagina.
You can also leave the ring in for a whole month and immediately replace it with a new one, without a week off. This is called “extended-cycle contraception”, which prevents menstruation but can lead to irregular spotting or so-called breakthrough bleeding. Which schedule is more suitable for you, should be discussed with your doctor.
Vaginal rings can sometimes be felt during sex. If this is the case for you, you can take it out before sex, as long as you put it back in within three hours (counting from the moment you took it out). Putting the ring in correctly has a bit of a learning curve, but once you’ve got the hang of it, it’s usually easy and quick to do. You can ask your doctor to show you how to do it.
Before your doctor prescribes the ring to you, they will usually measure your blood pressure.
How does it work?
The ring contains both estrogen and progestin. Estrogen is a hormone found naturally in the body, and progestin is a synthetic version of the natural hormone progesterone. These hormones suppress ovulation, preventing the release of an egg. If there’s no egg, fertilization can’t take place. The hormones also thicken the mucus in the cervix, which prevents sperm cells from going through the cervix into the uterus. This prevents fertilization of an egg if one did get released. Lastly, the ring makes the endometrium thinner, which prevents implantation of any egg that did get fertilized.
How effective is it?
The ring is very effective. With perfect use, it is 99.7% effective in protecting against pregnancy (meaning out of 1000 people* using this method, about 3 people* become pregnant in a year).
With typical use, effectivity decreases to 91% (leading to 90 pregnancies per 1000 people* per year). This is because it’s important to change out your ring in time. If you don’t, your risk of pregnancy increases. If you think it will be difficult for you to remember to change your ring, a different method of contraception might be more suitable. For example, you could opt for an injection, an implant, or you could use a condom.
Certain medications can reduce the effectivity of the ring, including medication for seizures and certain antibiotics. Ask your doctor about any interactions with drugs and supplements you’re taking, because this might increase your risk of pregnancy.
What are possible side-effects?
There may be a change in your bleeding pattern, with menstruation becoming lighter. Sometimes, irregular spotting occurs. Some people experience headaches, nausea, tenderness in the breasts, irritation or inflammation of the vagina, or an increase in discharge.
Note that only a portion of people experience (some of) these side-effects, and some people will experience side-effects not listed here. Whether you will, depends on many different factors.
When can't I use it?
During the first three to six weeks after you gave birth to a child. You also sometimes can’t use this contraception if you’re a smoker, if you have high blood pressure (hypertension), certain rheumatic diseases, migraines with aura, multiple sclerosis, diabetes (of more than 20 years), inflammatory bowel disease (such as Crohn’s disease or ulcerative colitis), liver disease, gallbladder disease, cardiovascular (heart and vessel) disease, stroke, thrombosis or risk factors for thrombosis, or breast cancer.
Sometimes, you can use the ring even if you have one of these things. Talk to your doctor to find out if your health issue would definitely mean you can’t use the ring.
Some evidence suggests the ring may not be suitable for you if you have obesity, because it might not release enough hormone to reliably prevent pregnancy in that case. Ask your doctor whether this applies to you if you’re concerned.
Does it work immediately?
This depends on when you start using the vaginal ring. If you start within five days of starting your menstruation, you’re protected immediately. If you start after more than five days since starting your menstruation, you need to use another method of contraception (for example, a condom) if you’re having sex in the seven days following insertion of your first ring. You also need to do this if you’re more than three weeks postpartum and aren’t breastfeeding. Check with your doctor which situation applies to you if you’re not sure.
If you insert any of your rings late (meaning you’re more than 48 hours late), contact your health care provider if you’re unsure what to do. The same applies to when you’ve been vomiting or when you’ve had severe diarrhea. The insert in your ring packet will usually describe in which cases you’re still protected and in which cases you aren’t, but some situations are quite complicated. If it’s not entirely clear to you, it’s better to check with your doctor to minimize your risk of pregnancy.
What happens to my fertility if I stop using it?
Fertility typically returns in a couple of weeks to three months after you stop using the rings (6).
Does it protect against sexually transmitted diseases (STDs)?
No. Hormones alone do not protect against STDs. If you’re having sex with someone new or untested, use a condom as well
*People, here, means anyone who is able to become pregnant, including girls, women, and non-binary people and transgender men who still have their uterus, vagina, and ovaries.
Are you curious about other methods to protect yourself from an unwanted pregnancy? Read about other birth control options here!
This article is pending medical review.
Contributors
Written by Juliëtte Gossens
Reviewed by Sophie Oppelt and Selina Voßen
Edited by Juliëtte Gossens
References
McFarlane I (ed.). Seeing the unseen: The case for action in the neglected crisis of unintended pregnancy. United Nations Population Fund. 2022. Available from: https://www.unfpa.org/sites/default/files/pub-pdf/EN_SWP22%20report_0.pdf
Hacker NF, Gambone JC, Hobel CJ (eds.). Hacker & Moore’s Essentials of Obstetrics & Gynecology. 6th ed. Philadelphia: Elsevier; 2016.
Hoffman BL, Schorge JO, Halvorson LM, Hamid CA, Corton MM, Schaffer JI (eds.). William’s Gynecology. 4th ed. New York: McGraw-Hill Education; 2020.
Centers for Disease Control and Prevention. The United States Medical Eligibility Criteria for Contraceptive Use, 2016 (US MEC). Available from: https://www.cdc.gov/reproductivehealth/contraception/mmwr/mec/summary.html
Centers for Disease Control and Prevention. 2016 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR). Available from: https://www.cdc.gov/reproductivehealth/contraception/mmwr/spr/summary.html
Girum T, Wasie A. Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. Contraception and Reproductive Medicine. 2018;3:9. DOI: 10.1186/s40834-018-0064-y
Please note: the information we provide to you here is for educational purposes only. If you’re experiencing any discomfort or have any complaints or questions about your health, please contact your doctor or other relevant health professional. We don’t provide medical advice.