How NuvaRing works with your body:
What should I do if NuvaRing slips out?
NuvaRing may slip out when removing a tampon, straining during a bowel movement, or having intercourse.
If NuvaRing does slip out, follow the directions below:
If NuvaRing is out for less than 3 hours:
Rinse NuvaRing with cool-to-lukewarm (not hot) water and reinsert it as soon as possible,
within 3 hours at the latest. You should still be protected from pregnancy.
If you’ve lost NuvaRing, insert a new NuvaRing and continue on the same schedule you had been following
If NuvaRing is out for more than 3 continuous hours during the first 2 weeks of starting a new NuvaRing:
Contraceptive effectiveness may have been reduced, so you might not be protected from pregnancy.
Reinsert the ring as soon as possible and use an extra method of birth control
(such as condoms or spermicide) until you have used NuvaRing for 7 days in a row
If NuvaRing has been out for more than 3 continuous hours during the third week of using a new NuvaRing: Throw the ring away and choose 1 of the 2 options below:
Insert a new ring immediately. This begins the next 3-week use period.
You may not have a period but you may experience breakthrough spotting or bleeding.
Have your period and insert a new ring no later than 7 days from the time the previous ring was removed or expelled. This option should be chosen only if the ring was used continuously for the preceding 7 days.
- In addition, in order to prevent pregnancy, you must use a barrier method (such as condoms or spermicide)
until you have used NuvaRing again for 7 days in a row.
Note: Women with conditions affecting the vagina, such as a prolapsed (dropped) uterus,
may be more likely to have NuvaRing slip out. If NuvaRing slips out repeatedly, please consult your doctor.
Can NuvaRing get lost inside of me?
No. NuvaRing cannot be pushed too far up or get lost in your body.
In fact, NuvaRing cannot go farther than the cervix.
Will NuvaRing dissolve?
No. NuvaRing does 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.
Is NuvaRing like a diaphragm?
No. NuvaRing is not a barrier method.
Just like the pill, it is a contraceptive that contains hormones for preventing pregnancy.
How should I use NuvaRing?
For the best protection from pregnancy, use NuvaRing exactly as directed.
Insert one NuvaRing in the vagina and keep it in place for three weeks in a row.
Remove it for a one-week break and then insert a new ring.
During the one-week break, you will usually have your menstrual period.
Your healthcare provider should examine you at least once a year to see if there are
any signs of side effects of NuvaRing use.
When can I start using NuvaRing?
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.
How do I insert and remove NuvaRing?
NuvaRing is easy to insert and remove:
After washing and drying your hands, remove NuvaRing from the foil pouch.
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, slide it farther in until it feels comfortable.
The exact position of NuvaRing is not important for it to be effective.
Once inserted, keep NuvaRing in place for 3 weeks in a row.
Remove the ring 3 weeks after insertion on the same day of the week it was inserted at about the same time.
Hook your index finger under the forward rim or hold the rim between your index and middle finger.
Gently pull out NuvaRing. Dispose of NuvaRing 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 after the last one
was removed even if your period has not stopped.
What should I do if I forget to put in a new NuvaRing?
After 3 weeks of use, NuvaRing should be removed for a 1-week break and then a new one should be
inserted 7 days later. If the ring-free interval has been extended beyond 1 week,
the possibility of pregnancy should be considered, and you must use an additional method of birth
control (such as condoms or spermicide) until you have used NuvaRing continuously for 7 days.
If you know or suspect you are pregnant, do not use NuvaRing. See your doctor as soon as possible.
What should I do if I keep NuvaRing in for too long?
If NuvaRing has been left in for more than 3 weeks (but less than 4 weeks),
remove it immediately and insert a new ring after a 1-week ring-free break.
If NuvaRing has been left in place for more than 4 weeks,
you may not be adequately protected from pregnancy and must check to be sure you are not pregnant.
If you are not pregnant, insert a new NuvaRing.
You must use an extra method of birth control (such as condoms or spermicide) until you have used
the new NuvaRing for 7 days in a row. If you know or suspect you may be pregnant, do not use NuvaRing.
See your doctor as soon as possible.
Safety considerations of NuvaRing
What are the possible risks and side effects of NuvaRing?
The hormones in NuvaRing may cause changes in your blood clotting system which may allow your
blood to clot more easily. If blood clots form in your legs, they can travel to the lungs and
cause a sudden blockage of a vessel carrying blood to the lungs. Rarely, clots occur in the
blood vessels of the eye and may cause blindness, double vision, or other vision problems.
The risk of getting blood clots may be greater with the type of progestin in NuvaRing than
with some other progestins in certain low-dose birth control pills. It is unknown if the risk
of blood clots is different with NuvaRing use than with the use of certain birth control pills.
If you take hormonal contraceptives and need surgery, need to stay in bed for a prolonged illness
or have recently delivered a baby, you may be at risk of developing blood clots. You should consult
your doctor or healthcare provider about stopping hormonal contraceptives three to four weeks before
surgery and not taking hormonal contraceptives for two weeks after surgery or during bed rest. You
should also not take hormonal contraceptives soon after delivery of a baby. It is advisable to wait
for at least four weeks after delivery if you are not breast-feeding. If you are breast-feeding,
you should wait until you have weaned your child before using the Pill.
See Prescribing Information for more information for nursing mothers.
Strokes and heart attacks:
Hormonal contraceptives may increase your risk of strokes (blockage of blood flow to the brain)
or heart attacks (blockage of blood flow to the heart). Any of these conditions can cause death
or serious disability. Smoking greatly increases the risk of having strokes and heart attacks.
Furthermore, smoking and the use of combination hormonal contraceptives, like NuvaRing,
greatly increases the chances of developing and dying of heart disease. If you use combination hormonal
contraceptives, including NuvaRing, you should not smoke.
High blood pressure and heart disease:
Combination hormonal contraceptives, including NuvaRing, can worsen conditions like high blood pressure,
diabetes, and problems with cholesterol and triglycerides.
Cancer of the reproductive organs and breast:
Breast cancer has been diagnosed slightly more often in women who use the Pill than in women of the
same age who do not use the Pill. This small increase in the number of breast cancer diagnoses gradually
disappears during the 10 years after stopping use of the Pill.
It is not known whether the difference is caused by the Pill.
It may be that women taking the Pill are examined more often, so that breast cancer is
more likely to be detected. You should have regular breast examinations by a healthcare provider
and examine your own breasts monthly. Tell your healthcare provider if you have a family history of breast
cancer or if you have had breast nodules or an abnormal mammogram.
Women who currently have or have had breast cancer should not use hormonal contraceptives,
including NuvaRing, because breast cancer is usually a hormone-sensitive tumor.
Some studies have found an increase in the incidence of cancer of the cervix in women who use oral contraceptives.
However, this finding may be related to factors other than the use of oral contraceptives.
There is insufficient evidence to rule out the possibility that pills may cause such cancers.
Combination hormonal contraceptive users may have a higher chance of having gallbladder disease.
In rare cases, combination hormonal contraceptives, like NuvaRing, can cause non-cancerous
(benign) but dangerous liver tumors. These benign liver tumors can break and cause fatal internal bleeding.
In addition, it is possible that women who use combination hormonal contraceptives, like NuvaRing, have
a higher chance of getting liver cancer. However, liver cancers are extremely rare.
Lipid metabolism and inflammation of the pancreas:
In women with inherited defects of lipid metabolism, there have been reports of significant elevations
of plasma triglycerides during estrogen therapy. This has led to pancreatitis in some cases.
The most common side effects reported by NuvaRing users are:
- vaginal infections and irritation
- vaginal secretion
- weight gain
In addition to the risks and side effects listed above,
users of combination hormonal contraceptives have also reported the following side effects:
- change in appetite
- abdominal cramps and bloating
- breast tenderness or enlargement
- irregular vaginal bleeding or spotting
- changes in menstrual cycle
- temporary infertility after treatment
- fluid retention (edema)
- spotty darkening of the skin, particularly on the face
- weight changes
- intolerance to contact lenses
- loss of scalp hair
Call your healthcare provider right away if you get any of the symptoms listed below.
They may be signs of a serious problem:
- sharp chest pain, coughing blood, or sudden shortness of breath (possible clot in the lung)
- pain in the calf (back of lower leg; possible clot in the leg)
- crushing chest pain or heaviness in the chest (possible heart attack)
- sudden severe headache or vomiting, dizziness or fainting, problems with vision or speech,
weakness, or numbness in an arm or leg (possible stroke)
- sudden partial or complete loss of vision (possible clot in the eye)
- yellowing of the skin or whites of the eyes (jaundice), especially with fever, tiredness, loss of appetite,
dark colored urine, or light colored bowel movements (possible liver problems)
- severe pain, swelling, or tenderness in the abdomen (gallbladder or liver problems)
- sudden fever (usually 102°F or more), vomiting, diarrhea, dizziness, fainting, or a sunburn-like
rash on the face or body (very rarely, toxic shock syndrome)
- breast lumps (possible breast cancer or benign breast disease)
- irregular vaginal bleeding or spotting that happens in more than one menstrual
cycle or lasts for more than a few days
- urgent, frequent, burning and/or painful urination, and cannot locate the ring in the vagina
(rarely, accidental placement of NuvaRing into the urinary bladder)
- swelling (edema) of your fingers or ankles
- difficulty in sleeping, weakness, lack of energy, fatigue, or a
change in mood (possible severe depression)
Who should not use NuvaRing?
Cigarette smoking increases the risk of serious cardiovascular side effects
when you use combination oral contraceptives. This risk increases even more if you are over
age 35 and if you smoke 15 or more cigarettes a day. Women who use combination hormonal
contraceptives, including NuvaRing, are strongly advised not to smoke.
Do not use NuvaRing if you have any of the following conditions:
- A history of heart attack or stroke
- A history of blood clots in your legs (thrombophlebitis), lungs (pulmonary embolism), or eyes
- A history of blood clots in the deep veins of your legs
- Chest pain (angina pectoris)
- Severe high blood pressure
- Diabetes with complications of the kidneys, eyes, nerves, or blood vessels
- Headaches with neurological symptoms
- Known or suspected breast cancer or cancer of the lining of the
uterus, cervix, or vagina (now or in the past)
- Unexplained vaginal bleeding (until a diagnosis is reached by your doctor)
- Yellowing of the whites of the eyes or of the skin (jaundice) during pregnancy or during previous
use of hormonal birth control of any kind (the Pill, patch, vaginal ring, injection, or implant)
- Liver tumor (benign or cancerous)
- Heart valve or heart rhythm disorders that may be associated with formation of blood clots
- Need for a long period of bed rest following major surgery
- Known or suspected pregnancy
- Active liver disease with abnormal liver function tests
- An allergy or hypersensitivity to any of the components of NuvaRing
Tell your health care provider if you have ever had any of the conditions just listed.
Your health care provider can suggest another method of birth control.
Talk with your health care provider about using NuvaRing if you:
- Recently had a baby
- Recently had a miscarriage or abortion
- Are breastfeeding
- Are taking other medications
In addition, talk to your health care provider about using NuvaRing if you have any of the following conditions.
Women with any of these conditions should be checked often by their doctor or health care provider
if they choose to use NuvaRing.
- A family history of breast cancer
- Breast nodules, fibrocystic disease, an abnormal breast X-ray, or abnormal mammogram
- Elevated cholesterol or triglycerides
- High blood pressure
- Migraine or other headaches or epilepsy
- Gallbladder, liver, heart, or kidney disease
- Scanty or irregular menstrual periods
- Plan to have major surgery
(You may need to stop using NuvaRing for a while to reduce your chance of getting blood clots.)
- Any condition that makes the vagina get irritated easily
- Prolapsed (dropped) uterus, dropped bladder (cystocele), or rectal prolapse (rectocele)
- Severe constipation
- History of toxic shock syndrome
Is there anything I should avoid while using NuvaRing?
Cigarette smoking increases the risk of serious cardiovascular side effects when you use
combination oral contraceptives including NuvaRing. This risk increases even more if you are over age 35 and if you smoke
15 or more cigarettes a day. Women who use combination hormonal contraceptives, like NuvaRing,
are strongly advised not to smoke.
Do not breastfeed while using NuvaRing. Some of the medicine may pass through the milk to the baby
and could cause yellowing of the skin (jaundice) and breast enlargement in your baby. NuvaRing could
also decrease the amount and quality of your breast milk.
The hormones in NuvaRing can interact with many other medicines and herbal supplements.
Tell your doctor about any medicines you are taking, or begin to take, including prescription medicines,
over-the-counter medicines, herbal remedies, and vitamins.
The blood levels of the hormones released by NuvaRing were increased when women used a vaginal medication
(miconazole nitrate) for a yeast infection while NuvaRing was in place. The pregnancy protection of
NuvaRing is not likely to be changed by use of these products. The blood levels of these hormones were not
changed when women used vaginal, water-based spermicides (nonoxynol or N-9 products) along with NuvaRing.
Certain drugs and herbal supplements may interact with combined hormonal birth control to make them less
effective in preventing pregnancy or cause an increase in breakthrough bleeding. Such drugs include rifampin,
drugs used for epilepsy such as barbiturates (for example, phenobarbital), carbamazepine, and phenytoin,
primidone, topiramate, phenylbutazone, modafinil, and some drugs used for HIV such as ritonavir. Pregnancies
and breakthrough bleeding have been reported by users of combined hormonal birth control who also used the
herbal supplement St. John’s Wort. You may need to use a nonhormonal method of contraception during any cycle
in which you take drugs that can make oral birth control less effective. Be sure to tell your doctor if you
are taking or start taking any other medications, including nonprescription products or herbal products, while
While using NuvaRing, you should not rely upon a diaphragm when you need a backup method of birth control
because NuvaRing may interfere with the correct placement and position of a diaphragm.
If you are scheduled for any laboratory tests, tell your doctor you are using NuvaRing.
Birth control hormones may change certain blood test results.
Can I overdose when using NuvaRing?
NuvaRing is unlikely to cause an overdose because the ring holding the medicine releases a steady
amount of contraceptive hormones. Do not use more than one ring at a time.
Overdose of combination hormonal contraceptives may cause nausea, vomiting, or vaginal bleeding.
Is it all right to use NuvaRing after the expiration date?
No. Before inserting NuvaRing, always check the expiration date on the label.
Do not insert if the expiration date has passed.
Does NuvaRing protect against sexually transmitted diseases (STDs)?
No. As with other hormonal birth control methods,
NuvaRing does not protect against HIV infection (AIDS) or other sexually transmitted diseases (STDs),
such as chlamydia, genital herpes, genital warts, gonorrhea, hepatitis B, and syphilis.
Storing and disposing of NuvaRing
How do I dispose of NuvaRing?
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.
How should I store NuvaRing?
After being dispensed by the pharmacy, NuvaRing can be stored for up to 4 months at room temperature
(25°C or 77°F). Temperatures can be from 59° to 86°F (15° to 30°C).
Avoid direct sunlight or storing above 86°F (30°C).
How NuvaRing feels
What does NuvaRing feel like when it is in?
Although some women may be aware of NuvaRing in the vagina, most women can’t feel NuvaRing once it’s in place.
Once inserted, NuvaRing will mold to your body and your muscles should keep it in place.
If you do feel discomfort, NuvaRing is probably not fully inserted. In that case, just use your finger
to gently push the NuvaRing farther in. Rest assured, there is no danger of NuvaRing being pushed too
far up or getting lost in your body. 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.
Will my partner or I feel NuvaRing during intercourse?
During intercourse, some sexual partners may feel NuvaRing in the vagina. However, in clinical studies
9 out of 10 (90%) of couples did not find this to be a problem.
Other questions about NuvaRing
What happens if I miss a menstrual period when I’m using NuvaRing?
If you miss a menstrual period you must consider the possibility that you are pregnant, especially if:
- You miss a period and NuvaRing was out for more than 3 hours during the 3 weeks of ring use
- You miss a period and waited longer than 1 week to insert a new ring
- You have followed the instructions and you miss 2 periods in a row
- You have left NuvaRing in place for longer than 4 weeks
If you know or suspect you are pregnant, do not use NuvaRing. See your doctor as soon as possible.
Can I use a tampon when using NuvaRing?
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.
What should I do if the ring disconnects?
There have been reported cases of NuvaRing disconnecting at the weld joint causing the ring to change shape
and straighten out. This is not expected to affect the contraceptive effectiveness of NuvaRing. If NuvaRing
disconnects, expulsion (slipping out) is more likely to occur (see “if NuvaRing slips out”). If you discover
the ring has disconnected, you should discard the ring and replace it with a new ring.
Can I use vaginal medications when using NuvaRing?
Use of spermicides or vaginal yeast products will not reduce the contraceptive efficacy of NuvaRing.
How effective is NuvaRing?
If NuvaRing is used according to the directions, your chance of getting pregnant is about 1 to 2% a year.
This means that, for every 100 women who use NuvaRing for a year, one or two will become pregnant.
Your chance of getting pregnant increases if NuvaRing is not used exactly according to the directions.
By comparison, the chances of getting pregnant in the first year of typical use (not always following
directions exactly) of other methods of birth control are as follows:
- No birth control method: 85%
- Spermicides alone: 26%
- Periodic abstinence methods (calendar, ovulation, thermometer): 25%
- Withdrawal: 19%
- Cervical cap with spermicides: 20 to 40%
- Vaginal sponge: 20 to 40%
- Diaphragm with spermicides: 20%
- Condom alone (male): 14%
- Condom alone (female): 21%
- Oral contraceptives: 5%
- IUD: less than 1 to 2%
- Implants: less than 1%
- Injection: less than 1%
- Sterilization: less than 1%