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Dear Dr. Kate: Can You Tell Me All About the NuvaRing?

Thu, Feb 5, 2009

Advice, What's Up Doc?


Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City who’ll be answering your medical questions here regularly. After her recent post on the NuvaRing, a lot of you asked for more information on this birth control device, so here goes:

The NuvaRing is one of my favorite forms of hormonal contraception — all of the benefits of the Pill, without the daily hassle of remembering to use it. But since the Ring hasn’t been around as long as the Pill, many women have a lot of questions about using it. So I thought I’d address the most common Ring issues that come up in my office. When using the Ring….

What’s okay to put in your vagina:

  • A penis. Intercourse will not push the ring up into your pelvis, or to any place where you can’t retrieve it. And semen/sperm will not diminish the ring’s effectiveness.
  • A vibrator or other toys. Same as above.
  • Tampons. Ditto.
  • Medication. It’s fine to treat a yeast infection with over-the-counter creams like Monistat, or to treat vaginosis with prescription MetroGel. You don’t need to rinse the ring off afterward, either — the medication will all absorb eventually.

What’s okay to come out of your vagina:

  • The ring before sex. If sex is uncomfortable with the ring in place, just take it out. It sounds counter-intuitive, to take out your birth control before having sex. But the ring works its magic by turning off your ovaries — and the hormones will remain in your system after the ring comes out. You can remove the ring for up to three hours without losing effectiveness (and if anyone is having sex longer than three hours, please share your good fortune with the rest of us!). Just be sure to put it back in before you roll over and go to sleep.
  • Increased discharge. It doesn’t mean you have an infection — it’s just your vagina’s way of reducing friction with the ring in place. Think of it as more lubrication for sex.

Do any of you have questions about using the NuvaRing? [[Editors' note: Dr. Kate compiled all the most common questions she gets about the Nuva Ring and answered them in a post called "Everything You Need to Know About the Nuva Ring," so she will no longer be answering any Nuva Ring questions in this or other comments sections. The lady only has so much time.]]

– Dr. Kate

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City. She also lectures nationally on women’s health issues and conducts research on reproductive health. Check out more of her advice and ask her a question at Gynotalk.com.

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268 Responses to “Dear Dr. Kate: Can You Tell Me All About the NuvaRing?”

  1. lily Says:

    Dr. Kate,

    I started spotting almost 5 days before I took my NuvaRing out, and took it out at the 3 week mark. I waited a week and put it in just like the directions said, but since I was spotting much earlier than usual (usually 2 days after I remove the Ring I start my period) am I still protected?


  2. Sindy Says:

    Hi, I started using the nuvaring a week before my period (6/21/09)basically to skip it.. i had unprotected sex on July 2 and now im having pregnancy symptoms, is it possible that i am pregnant? eventhough i was on the nuvaring for 11 days??

  3. Emily Says:

    Dr. Kate,
    I had my period on a tuesday and wanted to do the “sunday start” so I stared it that sunday, (day 6)? My boyfriend came into town on friday and we had sex, which would be day five. I am a little worried. What are my chances of pregnancy if my cycle before birth control was usually 24-26 days?

  4. Dr. Kate Says:

    Dale, there are definitely risks of blood clots whenever you use hormonal birth control. But the risk of a blood clot is much higher if you become pregnant (more than double the risk of birth control), because the hormones in your body are at higher levels. I hope everything turned out okay.

  5. Dr. Kate Says:

    Mandy, once the ring’s been in your body for 3 full weeks, you’re safe from pregnancy for that cycle (as long as you put it in during your period)…so sex at that point IS protected, even if you’re not using condoms, and even if you haven’t yet started to bleed.

    Lily, we think so. We don’t think that spotting on the ring (or on the pill) means that the method isn’t working that month. Though we’re not sure why you’re bleeding, if you’ve been using the ring for the full time (and yay for not taking it out early!), you should still be protected.

  6. Dr. Kate Says:

    Sindy, if you start the ring mid-cycle (not on your period), there’s a small chance that you got pregnant BEFORE the ring went in. But if not, eleven days should have been enough to prevent a pregnancy this cycle. (And if you got pregnant July 2, you shouldn’t be feeling symptoms yet – so try not to worry). Take a pregnancy test at the end of this ring cycle if you don’t bleed, to be sure.

    Emily, you’re right on the line with everything! It sounds like you had sex on about day 11 of your cycle (counting from the first day of your period). With your natural cycles around 24-26 days, that means you had sex right around the time you would ovulate. If you put the ring in within 5-7 days of bleeding, you’re usually protected. I usually recommend condoms for the first 7 days of use, just to be sure, though we think the ring is “up and running” in as little as 5 days. So bottom line? I think your chance of pregnancy is small. But (as I boringly say all the time) take a pregnancy test if you skip your period this month.

  7. Angela Says:

    Dr. Kate
    I’ve been on NR for a year now and this is the first time this has happened. My period started 4 days before I’m supposed to take the ring out (this upcoming Mon). If I stay on schedule and put in the new ring the following Mon, it will be 11 days after the start of my period. Should I stick with the schedule or revise it to accommodate the start of my period? Thanks in advance for your help!

  8. Heather K Says:

    I started my period yesterday morning and inserted the nuvaring last night. When I woke up this morning, I felt miserable. I had a migraine, I was sick to my stomach, and a little dizzy. A few hours after waking, I vomited. Now, hours later, I’m feeling a little bit better but still have that sour stomach feeling and a mild headache. Could this have been from the nuvaring? Is it normal or could it be an allergic reaction?


  9. ashley Says:

    Dr.kate i put the nuvaring in the day before my period ended and ive had it in for a week and i noticed i have my period again? or just some blood im not too sure about? why is that?

  10. Dr. Kate Says:

    Angela, stay on schedule. Think of it this way – the NuvaRing works by turning off your ovaries. To keep them turned off, the ring needs to be in your body for at least 3 weeks (and no more than 5). And your ovaries don’t know if you’re bleeding or not. So even when the bleeding is irregular, stick to your schedule – it should regulate by next month.

    Heather K, it doesn’t sound like an allergic reaction – those are usually rashes, hives and (worst case) trouble breathing. It is possible (though unlikely) that your symptoms are from the ring. I’d give it time to see if you feel better before removing the ring.

    Ashley, whenever you start a hormonal birth control method, it’s not unusual to see crazy bleeding for the first few months. Spotting, double periods – you name it. Just try to wait it out, and it should resolved by the end of the third ring.

  11. Stepheni Says:

    i started using nuvaring last month. i put it in the day i got my period i kept it in for 3 weeks and took it out that sunday i got my period for about 3 days i put the ring back in the following sunday and i just took it out again this sunday(yesterday) i still didnt get my period yet… should i be worried that i could be pregnant or what. i just had a baby and i really cant afford another one right now…is this normal

  12. Dr. Kate Says:

    Stepheni, some women start bleeding the day they take out the ring, and others start bleeding days into that ring-free week. You’ll likely start bleeding at some point this week, even if it’s light. If you used the ring for 3 straight weeks, and didn’t ever have it out for more than 3 hours, you’re very protected (the ring is about 97% effective when used this way).

  13. Jessica Says:

    I have been on Nuva Ring for about 4 years and have experienced no side effects, and my periods are like clockwork.I have no complaints but I have heard that staying on one particular birth control for too long can make it become ineffective or increases the possibility of side effects/ infertility in the future. Is this true?

  14. Olivia Says:

    Dr. Kate,

    I’ve been using the Nuvaring for 10 months. I chose to remove and insert a new ring on the 1st of the month (so I either skip or have a very short very light period). I know that isn’t a 28 day cycle, but it’s much easier to remember. I figure there are still hormones being released, and I do have it in for the first 3 critical weeks of each cycle. so I’m covered. Is this ok?

    Also, I wanted to know if you’ve heard of any women getting more frequent UTI’s on Nuvaring. I’ve never had a UTI in my life until this past year, during which I’ve had 6 or more. Some of those were also possibly kidney infections, so it’s not something I take lightly as only a mild discomfort. It’s a pretty big deal when I get them because I can get very sick.

    I’ve been sick in general this year, so I’m wondering if the Nuvaring may have contributed to the UTI’s, or something else in my body that’s been making me get lots of kinds of infections.

  15. Dr. Kate Says:

    Jessica, not at all! The NuvaRing will always stay as effective for you…new side effects won’t appear…and your fertility is definitely not threatened by long-term use.

    Olivia, I think you’re using the ring very wisely. There’s enough hormones in the ring for 5 full weeks of use, so you’re more than covered. And you’re right, changing the ring on the same day every month is easier to remember.

    I haven’t heard of the ring increasing the incidence of UTIs. Have your docs sent your urine for sensitivity testing? Often, a “rebound” UTI (one just a few weeks or a month after the last one) is due to resistance to the antibiotic your doctor chose. Another reason for frequent UTIs is a kidney stone – and as long as the stone is there, the infections may keep coming. Best of luck with everything.

  16. unknown. Says:

    Dr.Kate. I inserted the nuvaring right after my period but having sex with my boyfriend it fell out and didnt tell me. I had started bleeding but I figured it was because I had just started it back after being off of it for three months and didnt have sex while was off of it. He just told me tonight when I called him to tell him I couldnt find it. We have had sex since it has fallen out and he came in me everytime and it has been two week since it has been out. Could I be pregnant?

  17. unknown Says:

    Dr.Kate, The sides of my breats by my armpits are very sore (like the would be when i’m on my period) and have been sore since i started the ring.. it seems (for about 2 weeks ive had it in) i’m wondering if this has anything to do with the nuvaring?

  18. Kristen Says:

    I just want to tell you that when I was 23 years old, I had been using NuvaRing for about 1 1/2 years. One day I developed extreme shortness of breath and was rushed to the hospital. It turns out that I had a blood clot lodged in my lung, which was potentially fatal. My doctors ruled out every other cause (I was young, healthy, and a non-smoker with no family history) apart from an act of God, it had to be NuvaRing.
    Now I work in the medical profession and see all of these young girld being rushed in with clots and strokes because of hormonal contraception. I do not believe we know all of the dangers associated with it yet, and it should be closely monitored. I think it is now my purpose to inform every woman I meet about my experience (especially ones who are thinking about the ring). I hope this helps someone down the road.

  19. Gina Says:

    Dr. Kate, I just wanted to verify that it is okay to leave the ring in the full five weeks and then remove it and immediately replace with a new ring? When I originally started the ring I inserted it on the first day of my period as indicated, but now based on the insertion and removal schedule I end up removing it about fours days before my period starts. My periods have shortened and I end up replacing the ring at the end of my cycle. Is this normal and still effective?

  20. Nicole Says:

    Dr. Kate,

    The beginning of my cycle was July 6th, and I inserted the Nuva Ring on Monday July 13th. Today, Friday July 17th, my fiance and I did not notice the condom had torn until after he ejaculated, and by then it was too late. I panicked and flushed as much as I could out of myself, knowing all of the while it would be impossible to get all of it out. (Still, it did ease my nerves.) I am, of course, a bit concerned considering it has not been the full seven days. How concerned should I be?

  21. MRA Says:

    Hello Dr. Kate,

    I was on my third week on the nuvaring when I began spotting. I was very anxious to take it out in order to have my period, because in the past this stopped the spotting. Still, I had to wait for Saturday (the end of my third week) to take it out. With all the anticipation and such, I seemed to mistake Friday for Saturday and took out my Nuvaring a day earlier. I didn’t realize this until more than 4 hours later. I’m wondering if the Nuvaring will still be effective once I put it back in next Saturday (the end of the fourth week when I was supposed to replace the ring)? Also, perchance, if my period ends before Saturday, do you think it would be safe for me to be intimate with my husband without risk of becoming pregnant.

  22. Pepper Says:

    I have been on the nuva ring for 2 years. I took it out on the correct day and exactly a week later put it in on the correct day, and then had unprotected sex right after inserting the ring. Am I protected?

  23. Dr. Kate Says:

    Unknown #1 – yes, you could be pregnant. If you don’t get a period this month, take a pregnancy test.

    Unknown #2 – yes, breast tenderness could be a side effect of the ring (though not a usual one). It will likely improve by the end of the third cycle…if you decide to stick with the ring, try ibuprofen or naproxen for comfort.

  24. Dr. Kate Says:

    Kristen, thank you for sharing your story – I’m glad you’re doing well. Yes, hormonal contraception (pill, patch, ring) carry a risk of blood clots…but the risk of clots is higher in pregnancy than with any of these methods. So if a woman is at risk of pregnancy, it’s safer for her to be using birth control than to be pregnant (in most cases).

    Gina, as long as the ring isn’t in longer than 5 weeks, you’re safe. The timing of the ring going out and in shouldn’t be linked to bleeding – change it whenever the time is most convenient for you, within those 5 weeks – and back-to-back rings are fine.

  25. Dr. Kate Says:

    Nicole, you’re still at risk of pregnancy this month – it’s hard to tell how great the risk is. You would normally ovulate around the 20th, if your cycles are 28 days, and 4 days of ring use may not have been enough to suppress ovulation. Consider taking plan B – it still is effective up to 5 days after sex – and if you don’t get a period in 3-4 weeks, take a pregnancy test.

    MRA, by taking out the ring early, you’re at risk of ovulating this week. So you won’t be protected against pregnancy again until the new ring has been in your body for a full week. Consider putting the ring in as soon as you can, to get that 7 days complete as soon as possible. (So no, I don’t think sex on Saturday will be safe without a condom!)

    Pepper, as long as the ring was in for 3 full weeks (and not more than 5), and out for no more than 7 days, you’re protected – even right away.

  26. Alana Says:

    Hey! I was on nuvaring for about 4 months & was having bad side effects so I took it out after having it in for 1 week this past month. I had my period June 29, put the new ring in July 2 (on schedule) & removed it 1 week later on July 9. I got my period on the 13th (it was a normal cycle, about 4-5 days) & now I feel like I’m getting it again, just a week later. Am I going to continue getting it now that I took it out that early? And also I’ve always had an irregular schedule, which was my reason for nv. Thanks!

  27. Dr. Kate Says:

    Alana, yes, your bleeding may be irregular due to taking out the ring early (after only one week). You may see bleeding on and off for the rest of the month, until your next period comes (which may be hard to identify, if you’re generally irregular).

  28. Jennifer Says:

    Dear Dr. Kate,
    I had a d&c on July 2nd, and i bleed for two weeks until the 15TH when I stopped completely then I started bleeding again on the 17th and I thought that I was having a period but im not sure I was, I inserted my nuvaring thinking I was having a period on saturday Morning (July 18th). My boyfriend and I had sex on both friday and Monday (Unprotected) but he did not ejaculate inside me. What are the chances that im pregnant and should I take out the nuvaring since I really didnt have a period? And how much will the nuvaring throw my period off? T.Y.

  29. Dr. Kate Says:

    Jennifer, you can ovulate as soon as 10 days after a D&C – and you can’t tell by your bleeding when your fertility returns. Since the ring wasn’t in for a full week before you had sex, you are at risk of pregnancy this cycle. The effectiveness of withdrawal for birth control is not great, so consider taking plan B TODAY to help reduce the risk of pregnancy. I would leave the ring in now, to try to regulate your cycles as soon as possible. Your bleeding is likely to be irregular for a month or two from the D&C, despite the ring. So get your pregnancy protection from the ring, and try to wait out the irregular bleeding – it should regulate by the end of the second cycle.

  30. Jennifer Says:

    I took the plan b today, its been five days though how effective will it be?

  31. Dr. Kate Says:

    We know it’s still effective 5 days after sex – though not as effective as it would be when taken within 12 hours. Fingers crossed…

  32. Melissa Says:

    Hi, Dr. Kate

    I have been using nuvaring for a few months now, i put it on every 4th day of my period. I just took off my nuvaring on tuesday i wanted to know if its ok if i insert my nuvaring the first day of my period without it affecting me.

  33. Katie Says:

    Dr. Kate:

    My doctor put me on the NuvaRing last week (1 week exactly), about 1 day after my period ended. I was in her office because I have severe anxiety and depression and thought that it may be due to an imbalance in my hormones. Anyway, since I have had the NuvaRing in, my moods are so much better (at least I think). However, my breasts are huge, I am pigging out, I have headaches..and terrible jaw pain (my left side..top and bottom hurts…maybe like a cavity)…oh..and so tired a lot. I was thinking of taking the NuvaRing out..however, I am not sure what will happen. I am 37 and am afraid of blood clots and heart attack (jaw pain). What will happen if I take out the ring? Will it lessen my chance of the clots, etc? Will my jaw stop hurting? I don’t know if it’s because of the ring or not..which is why I want to take it out…just to see.

  34. Jackie Says:

    Dr. Kate,
    I recently switched to NuvaRing from Yaz because Yaz always made me very nauseous. I finished my last pack of Yaz and immediately started NR the Sunday of my period. This was exactly 2 weeks ago. Last night my boyfriend and I were having sex and when we were done I realized I was bleeding. It feels like I have my period but it has only been 2 weeks since my last one and I still have the ring in. Should I be worried? When should I insert my next ring? Ps. I checked to see if the ring was there and it was.

  35. Unknown Says:

    Dr. Kate,
    I took my ring out after a full three weeks around morning time and later that night I had unprotected sex. Its been three days since I took the ring out and I have not gotten my period. Is it possible to get pregnant if you have sex after you take the ring out but before you get your period?

  36. unknown Says:

    thank you dr.kate for all the help, is there a little chat blog on the birth control pill? or the patch?

  37. melissa Says:

    Dr. Kate, My doctor just put me on the ring, and she told me to put it in the sunday after my next period ended. So my period ended on a thursday and i put the ring in the following sunday(which was 7/19). Now i am reading about how i should have put it in the first day of my period. I had un-protected sex last night(7/25) with my boyfriend for the first time since i put the ring in…am i protected from pregnancy?

  38. Dr. Kate Says:

    Melissa, when it comes to taking the ring in and out, it’s not the bleeding, but the calendar that matters. The ring needs to be in your body at least 3 weeks (but not more than 5), and out for no more than 7 days. As long as you follow these “rules,” you can put the ring in and out whenever you want.

    Katie, I really doubt that the ring is causing your jaw pain. As long as you’re not a smoker, the ring doesn’t increase your risk of a heart attack. As for blood clots, yes, the ring increases your chance of a clot, but it’s a small chance…and pregnancy would give you a bigger chance. But you need to use a method that makes you feel comfortable – you may want to consider the Mirena IUD (no estrogen, so no increased risk of clots).

  39. Dr. Kate Says:

    Jackie, it’s not uncommon to see breakthrough bleeding on the first month of a new hormonal method. The sex may have “shaken” the blood loose, as opposed to causing bleeding from your cervix. If the bleeding continues after the first cycle, and only with sex, have your gyno check you for STDs to be safe. Leave the ring in at least 3 weeks (but not more than 5), then remove it for up to 7 days.

    Unknown, if the ring was in for 3 full weeks, then you ARE protected this cycle. Some women don’t bleed for a few days after the ring comes out. But if you never get a period this month, it’s possible that you got pregnant BEFORE the ring went in…so take a pregnancy test.

  40. Dr. Kate Says:

    unknown, there’s no chat like this that I know of for the pill or the patch. But the interest in this post is making me write similar columns for both the patch and the pill in the next few weeks – so stay tuned!

    melissa, when did your period start? If you put the ring in within 5 days of the period beginning, you’re safe this cycle. If not, yes, unfortunately you’re at risk of pregnancy. Take plan B to decrease the chance, and keep the ring in for the rest of the cycle. If you don’t bleed like a period within the next 4 weeks, take a pregnancy test.

  41. Liv Says:

    Been on the nuvaring a little over 6 months, and now we are ready to try to conceive a second baby. I have been told that the risk of miscarriage is increased if pregnancy occurs during the first hormone free cycle after removing the NuvaRing or after stopping the pill. Is this acccurate and if so, how many ring-free cyles do I need to have before trying to conceive?

  42. Dr. Kate Says:

    Liv, it’s not true. No research study has ever indicated a problem with a rapid pregnancy after birth control discontinuation. And I know many patients (and fellow physicians) who have gotten pregnant the first month off the pill/ring without a problem. So go for it!

  43. Angel Says:

    Dear Dr. Kate,
    Due to extreme pain during my periods, my doctor has had me continuously cycling on the nuvaring since the beginning of 2005. He had me inserting a new ring every three weeks, which stopped my menstrual bleeding altogether. All of my reproductive organs are normal and there is no sign of endometriosis.
    I have had problems with extreme vaginal dryness, as well as decreased sex drive while on the ring. I moved to a foreign country to study abroad in April of this year and decided to stop birth control altogether and allow my body to return to its normal hormone cycle. I stopped taking birth control in January. By march I was experiencing dull brown spotting for several days but not an actual period. in June I began bleeding, first dark brown spotting, and then bright red blood lasting for 3 weeks. The bleeding finally stopped and I went two weeks without bleeding, and began bleeding again in July. Right now I am at the end of the third week of bleeding, and I am getting small amounts the dark brown blood that used to signal the end of my period, but orgasm with masturbation will bring on bright red blood. I am not experiencing any irregular discomfort, only a little cramping and breast tenderness. I am not bleeding abnormally heavy for me (I have always bled heavily on my periods). Due to the lifestyle change of moving to a different country, I have also lost a large amount of weight since April, 13kg.
    Recently I have become a little concerned about the prolonged bleeding. I am taking iron supplements and a b-vitamin complex. Is this sort of bleeding normal after stopping the nuvaring? If so, how long might I expect it to take until my periods come normally again?

  44. Curious Says:


    I started Nuvaring on July 12th. I would like to take it out because I don’t like the side effects. If I take it out early, will I get my period early? I am getting married on August 8th and really don’t want my period.

  45. Dr. Kate Says:

    Angel, being on birth control (the ring, the pill, the IUD) doesn’t change the nature of your periods – it just disguises any irregularity (or heaviness, or awful cramps) while you’re on it. Your gyno can evaluate you for thyroid or pituitary abnormalities, as well as polycystic ovaries. If the testing is all normal, this may just be what your periods are like without birth control.

    Curious, you may begin to bleed irregularly if you take it out before the 3 weeks are up. So you’ll have to weigh the discomfort of the side effects with the possibility of bleeding on your wedding day if you discontinue.

  46. Curious Says:

    Dr Kate, thank you for your response. I took the ring out yesterday after 17 days in. If I put a new one ring in today will I skip my period?

  47. Hana Says:

    I have been on the ring for a couple of years now and not had any problems with it. Last night, however, I removed the ring during intercourse (for no more than an hour), and this morning I experienced a small amount of vaginal bleeding. Is this cause for concern? Could it be due to the removal of the hormones during that one hour period?

  48. Lee Says:


    I have been off the ring for about 2 weeks now.. i discontinued use due to severe side effects. Anyway, i was spotting for about a week before i decided to stop using the ring.. When i took the ring out i almost immediatly stopped spotting.. I have yet to get my period or any kind of spotting since.. Is this normal??.. should i be worried??.. can i be pregnant??– Thanks in advance

  49. April Says:

    If I decide to get the ring, can i be came in? This is big!! Like need-to know basis, thanks!

  50. sarah Says:

    I have been on Nuvaring for about four months now. I will usually leave it in for 3/4 weeks and then immediately replace it with a new ring. I have had no problems so far, but starting about five days ago I began bleeding (or spotting I guess you could say), and it still hasn’t stopped. Could I be pregnant or is this normal?


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