Do not use NuvaRing if you smoke cigarettes and are over age 35. Smoking increases your risk of serious heart and blood vessel problems from combination hormonal contraceptives (CHCs) including heart attack, blood clots, or stroke which can be fatal. This risk increases with age and the number of cigarettes smoked.
NuvaRing can slip or accidentally come out of (be expelled from) your vagina during sexual intercourse, bowel movements, use of tampons, or if it breaks.
Option 1. Insert a new ring right away to start your 21-Day NuvaRing use cycle. You may not have your regular period but you may have spotting or vaginal bleeding.
Option 2. Insert a new ring no later than 7 days, from the time the previous ring was removed or expelled. During this time, you may have your period.
Note: You should only choose to do option 2 if you used NuvaRing for 7 days in a row, prior to the day that your previous NuvaRing was accidentally removed or expelled.
With either option 1 or 2, you should use another birth control method such as male condoms with spermicides until the new NuvaRing has been used for 7 days in a row.
No. Rest assured that once inserted in the vagina, there is no risk of NuvaRing being pushed too far up or getting lost. There have been some reports of women accidentally inserting NuvaRing into their bladder. If you are experiencing pain during or after insertion and you cannot find your NuvaRing in your vagina, call your health care provider right away.
No. NuvaRing is non-biodegradable so it will not dissolve. It releases a low dose of hormones into your body over the course of 3 weeks. After that time, you need to remove it, take a week off from NuvaRing, and insert a new one 7 days after removal.
No. NuvaRing is not a barrier method. Just like the pill, it is a contraceptive that contains hormones for preventing pregnancy.
Use NuvaRing exactly as your health care provider tells you to use it.
It is important to consult with your doctor to make sure you are not pregnant before starting NuvaRing.
When you start using NuvaRing depends on your current birth control situation. Talk to your doctor and read the Prescribing Information for more details. For basic directions on how to start NuvaRing, read this.
NuvaRing is easy to insert and remove:
Inserting NuvaRing: After washing and drying your hands, remove NuvaRing from the foil pouch. Keep the foil pouch for proper disposal of the ring after use. Holding NuvaRing between your thumb and index finger, press the sides together while lying down, squatting, or standing with one leg up—whatever is most comfortable for you. Gently push the folded ring into your vagina. If you feel discomfort after inserting NuvaRing (etonogestrel/ethinyl estradiol vaginal ring), slide it farther in until it feels comfortable. Once inserted in the vagina, there is no risk of NuvaRing being pushed too far up or getting lost. Some women have accidently inserted NuvaRing into their bladder. If you have pain during or after insertion and you cannot find NuvaRing in your vagina, call your health care provider right away. For more information, read this or refer to the Patient Information.
Removing NuvaRing: Remove the ring 3 weeks (21 days) after insertion on the same day of the week it was inserted at about the same time. After washing and drying your hands, hook your index finger under the forward rim or hold the rim between your index and middle finger. Gently pull out NuvaRing . Place the used NuvaRing in the re-sealable foil pouch and dispose of it in a waste receptacle out of the reach of children and pets. Do not throw it in the toilet. Your menstrual period will usually start 2 or 3 days after the ring is removed and may not have finished before the next ring is inserted. To continue to have pregnancy protection, you must insert a new ring 1 week (7 days) after the last one was removed even if your period has not stopped. For more information, read this or refer to the Patient Information.
You must use another birth control method, such as male condoms with spermicide, until the new NuvaRing has been used for 7 days in a row.
Do not use NuvaRing if you:
Hormonal birth control methods may not be a good choice for you if you have ever had jaundice (yellowing of the skin or eyes) caused by pregnancy or related to previous use of hormonal birth control.
Tell your health care provider if you have ever had any of the conditions listed above. Your health care provider can suggest another method of birth control.
Before you use NuvaRing talk with your health care provider if you:
Tell your health care provider about all medicines and herbal products you take, including prescription and over-the-counter medicines, vitamins and herbal supplements.
Some medicines and herbal products may make hormonal birth control less effective, including, but not limited to:
Use an additional birth control method (such as a male condom with spermicide) when you take medicines that may make NuvaRing (etonogestrel/ethinyl estradiol vaginal ring) less effective. Continue back-up birth control for 28 days after stopping the medicine to help prevent you from becoming pregnant.
Some medicines and grapefruit juice may increase the level of ethinyl estradiol in your blood if used together, including:
Hormonal birth control methods may interact with lamotrigine, a medicine used for seizures. This may increase the risk of seizures, so your health care provider may need to adjust your dose of lamotrigine.
Women on thyroid replacement therapy may need increased doses of thyroid hormone.
Ask your health care provider if you are not sure if you take any of the medicines listed above. Know the medicines you take. Keep a list of them to show your health care provider and pharmacist when you get a new medicine.
Blood Clots: Like pregnancy, combination hormonal birth control methods increase the risk of serious blood clots (see graph below), especially in women who have other risk factors, such as smoking, obesity, or age greater than 35. This increased risk is highest when you first start using a combination hormonal birth control method or when you restart the same or different combination hormonal birth control method after not using it for a month or more. Talk with your health care provider about your risk of getting a blood clot before using NuvaRing (etonogestrel/ethinyl estradiol vaginal ring) or before deciding which type of birth control is right for you.
In some studies of women who used NuvaRing, the risk of getting a blood clot was similar to the risk in women who used combination birth control pills.
Other studies have reported that the risk of blood clots was higher for women who use combination birth control pills containing desogestrel (a progestin similar to the progestin in NuvaRing) than for women who use combination birth control pills that do not contain desogestrel.
It is possible to die or be permanently disabled from a problem caused by a blood clot, such as heart attack or stroke. Some examples of serious blood clots are blood clots in the:
To put the risk of developing a blood clot into perspective: If 10,000 women who are not pregnant and do not use hormonal birth control are followed for one year, between 1 and 5 of these women will develop a blood clot. The figure below shows the likelihood of developing a serious blood clot for women who are not pregnant and do not use hormonal birth control, for women who use hormonal birth control, for pregnant women, and for women in the first 12 weeks after delivering a baby.
Likelihood of Developing a Serious Blood Clot (Venous Thromboembolism [VTE])
*CHC=combination hormonal contraception
**Pregnancy data based on actual duration of pregnancy in the reference studies. Based on a model assumption that pregnancy duration is 9 months, the rate is 7 to 27 per 10,000 woman-years.
Call your health care provider right away if you have:
Other serious risks include:
The most common side effects of NuvaRing (etonogestrel/ethinyl estradiol vaginal ring) are:
Some women have spotting or light bleeding during NuvaRing (etonogestrel/ethinyl estradiol vaginal ring) use. If these symptoms occur, do not stop using NuvaRing. The problem will usually go away. If it doesn’t go away, check with your health care provider.
Other side effects seen with NuvaRing include allergic reaction, hives, and penis discomfort of the partner (such as irritation, rash, itching).
Less common side effects seen with combination hormonal birth control include:
Tell your health care provider about any side effect that bothers you or that does not go away. These are not all the possible side effects of NuvaRing. For more information, ask your health care provider or pharmacist. Call your health care provider for medical advice about side effects. You may report side effects to FDA at
Do not use more than one NuvaRing at a time. Too much hormonal birth control medicine in your body may cause nausea, vomiting, or vaginal bleeding.
No. Before inserting NuvaRing, always check the expiration date on the label. Do not insert if the expiration date has passed. Store NuvaRing at room temperature for up to 4 months after you receive it and throw it away if the expiration date on the label has passed.
No. As with other hormonal birth control methods, NuvaRing does not protect against HIV infection (AIDS) or other sexually transmitted infections.
Hormonal birth control methods do not seem to cause breast cancer. However, if you have breast cancer now or have had it in the past, do not use hormonal birth control, including NuvaRing, because some breast cancers are sensitive to hormones.
Women who use hormonal birth control methods may have a slightly higher chance of getting cervical cancer. However, this may be due to other reasons such as having more sexual partners.
Dispose of NuvaRing by placing the used ring in the reclosable foil pouch and properly dispose of it in a waste receptacle out of the reach of children and pets. Do not throw it in the toilet.
Although some women may be aware of NuvaRing in the vagina, most women can’t feel NuvaRing once it’s in place. NuvaRing may move around slightly within your vagina. This is normal. If you do feel discomfort, NuvaRing is probably not fully inserted. In that case, just use your finger to gently push the NuvaRing as far as you can into your vagina.
Rest assured, there is no danger of NuvaRing being pushed too far up in the vagina or getting lost. The cervix (the narrow, lower end of the uterus) will block NuvaRing from going any farther. NuvaRing can accidentally slip out of the vagina while removing a tampon, during intercourse, or straining during a bowel movement.
Some women have accidentally inserted NuvaRing into their bladder. If you have pain during or after insertion and you cannot find NuvaRing in your vagina, call your health care provider right away.
During intercourse, some sexual partners may feel NuvaRing in the vagina. However, in clinical studies 9 out of 10 (90%) partners did not find this to be a problem.
Some women miss periods on hormonal birth control, even when they are not pregnant. Consider the possibility that you may be pregnant if:
If you know or suspect you are pregnant, do not use NuvaRing. See your health care provider as soon as possible.
Use of tampons will not reduce the contraceptive efficacy of NuvaRing. Insert NuvaRing before inserting a tampon. You should pay particular attention when removing a tampon to be sure that the ring is not accidentally pulled out. If this should occur, simply rinse the ring in cool to lukewarm (not hot) water and immediately reinsert it.
NuvaRing may break, causing the ring to lose its shape. If the ring stays in your vagina, this should not lower NuvaRing’s effectiveness at preventing pregnancy. If NuvaRing breaks and slips out of your vagina, throw the broken ring in your household trash out of the reach of children and pets and immediately insert a new ring.
Use of spermicides or vaginal yeast products will not reduce the contraceptive efficacy of NuvaRing.
When used as directed, NuvaRing has been shown to be 98% effective, just like the pill. Your chance of getting pregnant depends on how well you follow the directions for using NuvaRing. The better you follow the directions, the less chance you have of getting pregnant.
When you use NuvaRing you may have bleeding and spotting between periods, called unplanned bleeding. Unplanned bleeding may vary from slight staining between menstrual periods to breakthrough bleeding, which is a flow much like a regular period. Unplanned bleeding occurs most often during the first few months of NuvaRing use, but may also occur after you have been using NuvaRing for some time. Such bleeding may be temporary and usually does not indicate any serious problems. It is important to continue using the ring on schedule. If the unplanned bleeding or spotting is heavy or lasts for more than a few days, you should discuss this with your health care provider.
Do not use NuvaRing (etonogestrel/ethinyl estradiol vaginal ring) if you smoke cigarettes and are over age 35. Smoking increases your risk of serious heart and blood vessel problems from combination hormonal contraceptives (CHCs) including heart attack, blood clots, or stroke which can be fatal. This risk increases with age and the number of cigarettes smoked.
You are encouraged to report negative side effects of prescription drugs to the FDA.
Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Please read the Patient Information for NuvaRing (etonogestrel/ethinyl estradiol vaginal ring), including the information about the increased risk of serious cardiovascular side effects, especially in women who smoke, and discuss it with your health care provider. The physician Prescribing Information is also available.