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The Ring

The ring is a method of hormonal birth control in the form of a flexible plastic ring that is inserted into the vagina, where it stays in for 3 weeks and out for one week. There are 2 birth control rings: NuvaRing and the new Annovera. Like the pill, the ring can be used for other benefits. The ring does NOT protect against sexually transmitted diseases (STDs).

How does it work?

Hormones are slowly released from the ring and absorbed into the body through the lining of the vagina. Estrogen and progestin hormones work together to prevent pregnancy by preventing the release of an egg.

How well does it work?

The ring is 99% effective in preventing pregnancy with perfect use and 91% effective with typical use.

When does it start working?

When the ring starts to work depends on where you are in your cycle. If you insert the ring within the first 5 days of your period, it will get to work right away. Otherwise, you will need to use backup birth control, like condoms, for at least 7 days.

How do I use it?

Instructions for use are very similar for the NuvaRing and Annovera, but NuvaRing is thrown away after each use, while Annovera* is reusable for an entire year. For both rings, avoid using oil-based lubricants.

  1. Wash your hands.
  2. Pinch the sides of the ring and insert it into the vagina. (Applicators are available for easier insertion of NuvaRing.) The ring does not need to be in a specific position as long as you are comfortable and it doesn’t feel like it will slip out. It is normal to not feel it once it’s in place. Leave it in for 3 weeks.
  3. After the 3 weeks, wash your hands and remove the ring. Hook a finger under the rim of the ring and pull it out. Place it into the resealable foil pouch that it came in, and throw it away. Next, you will have 7 ring-free days. You can expect your period during this time.
  4. After those 7 days, repeat the cycle with a new ring. It is okay to insert the new ring if you are still on your period. Feel free to use tampons and have sex with the ring in.

*Because Annovera is reusable for a year (13 cycles), it is important to keep it clean. Before and after each use, wash it with mild soap and water and pat it dry. During the ring-free days, keep it in its storage case away from extreme temperatures.

What if the ring falls out?

If the ring falls out, gently rinse it with water and reinsert it. If NuvaRing is out for more than 3 hours, insert a new ring and use backup birth control, like condoms, for 7 days. If Annovera is out for more than 2 hours, use backup until the ring has been in place for 7 days in a row.

What if I want to get pregnant in the near future?

You can get pregnant as soon as you stop using the ring.

What if I forget to change it on time?

The NuvaRing has enough hormones to effectively prevent pregnancy for 4 weeks. If you have left it in for longer than 4 weeks, verify that you are not pregnant and insert a new ring, skipping the ring-free week. Use a backup method of birth control for the next 7 days. Consider using emergency contraception if you had sex during the time the ring was out of hormones. If the Annovera is left in for more than 21 days, remove it for a total of 7 days and then reinsert it to get back on schedule for 21 days.

What are some side effects I might experience?

Rare but serious side effects can occur with the ring, such as blood clots and strokes. If you experience sudden and/or severe pain in your stomach, chest, head, or legs with or without dizziness, nausea, vomiting, difficulty breathing, or changes in vision or mental status, call your health care provider right away and/or get to an emergency room. When starting the ring, you may experience nausea, headache, breast tenderness, or changes in weight, mood, sex drive, or bleeding. Typically, these resolve within 3 months. You may notice more vaginal discharge, which is harmless. If you have vaginal irritation or discharge that is clumpy, smelly, and colored, see your provider as these could be signs of an infection.

Is it right for me?

The ring is an effective, convenient, pill-free option that is safe for many people. Both rings are latex-free, making them safe for those with a latex allergy. Some health conditions (history of blood clots, high blood pressure, stroke, heart attack, migraine, smoking, and age over 35) make it unsafe to use the ring, so other methods (without estrogen) can be used instead (see other fact sheets here). Another important factor is comfort with using a vaginal product.

Updated August 2020