Puttin' a ring on it... The vaginal contraceptive ring that is!

Dear Reader, 

A true revolution in 1960, 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. When used correctly and consistently, the NuvaRing and ANNOVERA ring are about 98 percent effective at preventing pregnancy, but they’re usually about 91 percent effective with typical use. 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. In addition to the NuvaRing, the FDA also approved the ANNOVERA ring in 2018. This contraceptive is very similar to the NuvaRing in appearance and use, with the exception that the ANNOVERA ring can be reused for up to one year. 

Inserting either ring may seem awkward at first, but practice makes perfect, similar to using a tampon or diaphragm. To put a contraceptive ring in place:  

• 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. 
• If you're using the ANNOVERA ring, make sure to wash the ring with mild soap and lukewarm water, then pat it dry with a clean cloth or paper towel and put it back in its case away from pets, children, and extreme temperatures. 

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. Furthermore, neither ring need to come out during sex and are designed to remain in place for the duration of three weeks. If the ring does slip out, it can just be rinsed off and re-inserted. After three weeks, the ring can be taken out on the same day and at around the same time that it was inserted. 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 NuvaRing, or the current ANNOVERA ring you have, is then to be inserted around noon on the following Sunday to start the next cycle (even if withdrawal bleeding is still occurring). 

If the ring falls out or was removed for more than a few hours (three for NuvaRing, two for ANNOVERA), it’s wise to get the contraceptive back in as soon as possible. In any circumstance, it’s recommended to use backup contraception for seven days. 

• If the NuvaRing falls out in the first two weeks, that same ring can simply be reinserted. If it comes out in the third week, the ring that fell out can be thrown away and a new ring can be started.  
• If the ANNOVERA comes out at any point, it can be washed with mild soap and water, pat dry with a paper towel or cloth, and reinserted.  

To get NuvaRing or the ANNOVERA ring 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. 

People using either ring may experience side effects such as vaginal discharge, irritation, headaches, weight gain, mood changes, change in libido, and nausea. These contraceptives 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 and the ANNOVERA ring aren'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 
• Live with severe migraines 
• Have liver disease or liver tumors 
• Have history of 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 or the ANNOVERA ring, it's nice to know there's another reliable form of birth control out there. If you want to learn more about these or other forms of contraception, you may want to check out the Contraception category of the Go Ask Alice! Sexual & Reproductive Health archives.