Dear Alice,

What is the NuvaRing, and how does it work?

Dear Reader,

A true revolution in 1960, but these days the pill is old news. Today, there are a variety of birth control methods to choose from — including the NuvaRing, a vaginal contraceptive approved by the U.S. Food and Drug Administration (FDA) in 2001. The NuvaRing is a clear plastic ring (slightly larger than a rubber band) that is placed in the vagina for three weeks at a time. The ring provides a continuous low dose of progestin and estrogen hormones that are absorbed through the vaginal wall. Just like the pill or the patch, the ring prevents pregnancy by suppressing ovulation (meaning the ovaries don't release an egg) and thickening the cervical mucus, making it difficult for sperm to enter the uterus. The ring stays in the vagina for three weeks, then it's removed and a person experiences withdrawal bleeding (which mimics a menstrual period) during the fourth, "ring-free" week.

Inserting the ring may seem awkward at first, but practice makes perfect — similar to using a tampon or diaphragm.

  • First, make sure hands are clean and take the ring out of the foil pouch.
  • Next, find a comfortable position — lie down or put one foot up on a chair or bathtub.
  • Pinch the ring between the thumb and index finger so that the circle shape bends into an oval. Slowly insert the ring into the vagina and use the pointer finger to push the ring in.
  • To take out the ring, insert the index finger into the vagina and hook a finger under the edge of the ring. Slowly tug, and the ring can come out.

The ring is generally more comfortable and less likely to slip out if it's positioned at the back of the vaginal canal, past your pubic bone. The cervix keeps the ring from going in too deep or "getting lost" inside the vagina. If the ring has been out for more than three hours, it's suggested to use condoms as well to prevent pregnancy. The ring doesn't need to come out during sex, and it's designed to remain in place for the duration of the three weeks. If the ring does slip out, just rinse it off and re-insert it. After three weeks, take out the ring on the same day and at around the same time that it was inserted. When inserting and removing the ring, it's helpful to do so on the same day of the week around the same time of day. This helps to ensure continuous protection. For example, if it's inserted on a Sunday at noon, it's best to remove it for a ring-free week three weeks later on Sunday at noon. After the ring-free week, the new ring to start the next cycle will then be inserted around noon on the following Sunday (even if withdrawal bleeding is still occurring).

To get NuvaRing in the United States, a prescription is needed from a health care provider. A health care provider can provide information about when to insert the ring and how many days it will take for the ring to provide effective pregnancy prevention. If it's inserted during the first five days of menstruation, it begins working right away. If inserted at any other time, using a backup contraceptive method for the first seven days is advised. After the first week, the ring provides continuous pregnancy protection, even during the fourth "ring-free" week and the withdrawal bleeding that typically follows.

When used correctly and consistently, the ring is about 98 percent effective at preventing pregnancy, but is 91 percent effective with typical use. People using the ring may experience side effects such as vaginal discharge and irritation, headaches, weight gain, mood changes, change in libido, and nausea. The ring may also increase the risk of blood clots (particularly due to the type of progestin in the ring), heart attack, gallbladder and liver conditions, and stroke. Additionally, NuvaRing isn't recommended for those assigned female at birth who:

  • Smoke
  • Are over the age of 35
  • Are pregnant or may be pregnant
  • Have uncontrolled high blood pressure
  • Suffer from severe migraines
  • Have liver disease or liver tumors
  • Have breast or other cancers sensitive to reproductive hormones
  • Have a blood clotting disorder
  • Have a history of heart attack or stroke

List adapted from Mayo Clinic.

Whether or not you get hooked on the NuvaRing, it's nice to know there's another reliable form of birth control out there.


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