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

Thu, Feb 5, 2009

Advice, What's Up Doc?

nuvaring

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. Dr. Kate Says:

    Curious, you might skip your period – it’s tough to predict…

    Hana, it’s probably not “withdrawal” bleeding from the ring being out – are you near your period? If so, some blood may have been “shaken loose.” But otherwise, I’d consider visiting your gyno for a check-up if you’re due, just to make sure everything looks okay.

    Lee, the bleeding can be quite unpredictable when you stop any hormonal method in the middle of a pack/cycle. If you had your last ring in for at least 3 weeks, it’s unlikely that you’re pregnant. But if you don’t have a true period within 4 weeks of taking the ring out, take a pregnancy test just to be sure.

  2. Dr. Kate Says:

    April, yes, your guy can totally come inside you…use condoms to protect yourself from infection, but the ring will provide you excellent protection against pregnancy.

    Sarah, it could be that your uterus has decided that it needs a period…it’s not uncommon for women who use a pill/ring continuously to start bleeding after a few months. You can either take out the ring (after 3 weeks) and have a “real” bleed, or just keep using the ring as you’ve been using it. The spotting will eventually stop (though I can’t predict for sure when).

  3. Kati Says:

    If my boyfriend goes in deep during sex and pushes the ring hard against the cervix, vagina and uterus can it cause damage or bleeding to these areas?

  4. Dr. Kate Says:

    Kati, no – the ring is really flexible, and will just bend itself out of the way. So feel free to have sex as vigorously as you want to!

  5. Jacqueline Says:

    Dr. Kate,

    I am currently 21 and used the ring first when I was about 18. I stopped taking it the same year, and just recently started taking it again. It seemed like i was getting my period like normal, but I continued to bleed for about 5 weeks. it would be really light during the day and get heavy after having sex. once the bleeding started we would atop having sex till what it seemed like “I was finished with my period” and then once trying again, I would bleed. She suggested that since I was under a lot of stress at the time, that was the reason
    for the exceedingly long bleeding. She put me back on the nuvaring and told me to come back in a few months. I went to the doctor on the 22nd of July and my bleeding issue stopped the next day. We waited three days to have sex because I was told that was how long we needed to wait, and have been having sex since then till this past sunday. Since being on the nuvaring I have noticed breast tenserness and small periods where I will feel sick. no vommiting ever accures. I have been on medication for a urinary tract infection since this past Sunday morning… Could these side effects be from the usage of the ring in general? The mixing of medications? Or should I be worried about pregnancy?

    Please help.

  6. Colleen Says:

    Dr. Kate,
    I am getting married in 10 days. I went to the doctor and got a prescription for the Nuva Ring two weeks ago, but I haven’t had my period yet. I’ve been fairly stressed over planning the wedding and so I think I may have just skipped it this month. I am certan that I am not pregnant. I really need to start the birth control though. Is it possible for me to start the ring now? My last period started on the 17th of June. I haven’t had one since then. Can I start the ring without having a period? How long do I need to use the ring before I know it is working?

    Thanks for your help.

  7. Daisy Says:

    I was suppose to put the ring in Sunday the 2nd and forgot till Today Tuesday at 8pm. Do I need tobe careful all over again for a few weeks?? and since I started on the 4th can I just put in a new one each 4th of every month now?

    Daisy

  8. Leigh Says:

    Hi Dr. Kate,

    I took out my NuvaRing on a Saturday, started a period, and put a new one in on Tuesday in order to stop the period. Now it’s a week later and my period has only gotten heavier. What is going on? Is my body not responding to the hormone? How do I stop the bleeding?

    Thanks!
    Leigh

  9. Stephanie Says:

    Dr. Kate,

    I used to use the Nuva Ring for about three months. Then I went off of it for the month of June. I started the nuva ring the second or third day of my next period. I took it out three weeks later on a Sunday it is now the Saturday after and have not started my period. Should I be worried about being pregnant or is this normal.

    Thanks
    Stephanie

  10. Dr. Kate Says:

    Jacqueline, pregnancy is ALWAYS a possibility – take a test just to be sure. If it’s negative, it could be side effects from the ring, and they’ll likely resolve by your third month of using it.

    Colleen, you can definitely start the ring now (even not on your period). Use condoms for the first week, then you’re protected…and your period will hopefully be delayed till after the wedding. Congratulations!

    Daisy, if the ring was out longer than a week, you need to use condoms for the first week of the new ring to be sure. As long as you get a period when you expect (at the end of 3 weeks of use, when the ring comes out), I wouldn’t be worried about pregnancy. And yes, you can put a new ring in every 4th of the month (if you use the rings back to back).

  11. Dr. Kate Says:

    Leigh, unfortunately, you can’t stop bleeding by putting the new ring in early. You can often prevent it from starting by using rings “back to back”…but once you’ve started to bleed, more hormones won’t stop it. The easiest thing to do is to just leave the ring in (too much in and out makes the bleeding crazier), and next cycle, either put the new ring in right away or leave it out for a full week.

    Stephanie, it sounds like you did everything right, and you should have been protected against pregnancy. Some women do skip their periods on the ring…but since no method of birth control is foolproof, I would take a pregnancy test to be sure.

  12. kate Says:

    dr.kate

    i have been using the nuvaring for almost a year and a half and today was the first day i didnt get the new ring in time, meaning i’m a day late. i had unprotected sex but only for about 2 mins because i got nervous..do you think im protected? and how long should i have protected sex after i put it in tomorrow morning?

    thank you so much..you do a great job :)

    kate

  13. Dawn Says:

    I’ve been on the NuvaRing for about a year without any major issues. Usually my period would start a few days BEFORE I was due to take the ring out at the end of week 3, esp if I was very stressed. Before I was on the Ring I would get early periods if I was stressed as well. Months that I wasn’t stressed, I usually started the day I was supposed to take out the ring or a few hours after, and it was usually pretty light.

    However, in July I was more stressed and over scheduled than I ever have been. I put the ring in about 10 hours late. Then a week later realized I had never taken out the old ring. I left both in, as I wasn’t sure which was which. I did have sex w/o any other form of BC.

    I took the Ring out, as scheduled, and didn’t notice any real bleeding. There was some spotting, but nothing beyond that. It’s been about 24 hours and the spotting has stopped.

    I’m planning on taking a home pregnancy test in a few days if my period shows up — from what I understand it’s still a little early for a HPT to be accurate. But, of course, I’m panicking a little, as this isn’t so NOT a good time for me to get pregnant. How worried should I be?

    Thanks!

  14. Dawn Says:

    Oh, I forgot to add, in July I started bleeding about a week before I was supposed to, it stopped a little, then started up again. This is when I forgot to remove the old ring.

  15. Brittany Says:

    I have had the nuvaring for a month, I started it the first day of my cycle and took it out 3 weeks later. After a week I put the new ring in. I had unprotected sex about 3 days after putting the new ring in, am I safe from being pregnant?

  16. Laken Says:

    Dr. Kate,

    I have been on the Nuva Ring for about a year now and have had maybe 1 or 2 very, very short periods. is this normal?

  17. Sophia Says:

    hi, i had sex with my boyfriend and then took the ring out about 15 hours later. i have never had a problem with it, but i have also always waited longer than this to take the ring out. is 15 hours too soon? i’ve always been a little unclear about this

  18. unanswered Says:

    Dr.kate

    also just to confirm – he can come in me during the 3 weeks that the ring is on, right? how about during the week i have it off? can he come in me then?

    this question was unanswered and i was also wondering the same thing

  19. Dr. Kate Says:

    kate, if the ring goes in late, there’s a small chance that you ovulated this cycle. Put the ring in, use condoms for a week, and take a pregnancy test at the end of the month if you don’t get your period when you expect. (This is the biggest reason I think birth control should be available over the counter – so you could stock up and never run out.)

    Dawn, if the old ring was in for three weeks and 10 hours before the new one went in, you’re protected – since there’s enough hormone in the ring for 5 weeks, so it was still protecting you against pregnancy. But you had quite a bit of hormones in your system this month, between the new “full dose” ring and the old “still has a bit of juice left” one. I always recommend a PT to be sure, but I don’t think you have anything to worry about.

  20. Dr. Kate Says:

    Brittany, it sounds like you’re protected – if the ring was only out of your body for a week, then the new one went in, you should be safe from pregnancy this cycle.

    Laken, yes, some women are lucky enough to not have periods on the ring. It’s scary, without the reassurance that you’re not pregnant, but it’s not dangerous. Enjoy the bleeding-free time!

    Sophia, the ring is supposed to stay in your body on a consistent schedule, regardless of when/if you have sex – you don’t take it out in relation to sex. It needs to stay in your body for at least three weeks, and be out of your body no longer than one week. (Of course, if you want to take it out FOR sex, that’s fine, as long as it’s out no more than 3 hours.)

    unanswered, as long as you use the ring on a consistent schedule – at least 3 weeks in (and no more than 5 weeks), and out for no more than one week – you’re protected from pregnancy, even if he ejaculates inside you. The ring still keeps your ovaries asleep, even on the ring-free week, if you use it in this way. So ring in or out, he can come inside you.

  21. maria Says:

    I left a big long question for you Dr. Kate, but the problem is that I can not find it. I don’t remember the question because it was more than one and like 2 paragraphs. I know I sent it. please let me know whether you do or don’t find a different message/comment from me
    (maria). THANKS!!

  22. maria Says:

    oh never mind Dr. Kate (lol).sorry. I guess I should have checked my email first! THANKS!! :)

  23. Ruth Says:

    DR. KATE MY NAME IS RUTH AND I BEEN USING THE NUVA RING SINCE JUNE AND I ONLY CHANGD IT TWICE….AND I HAVENT HAD A PERIOD SINCE MAYBE THE END OF JUNE AND NOW ITS AUGUST I DIDINT HAVE ONE IN JULY NOR THIS MONTH….WHAT SHOULD I DO…..I TOOK A PREGNANCY TESDT AND IT SAY UINVALID…IDK WHAT TO DO CAN YOU PLEASE HELP ME OUT….

  24. Brittamy Says:

    Dr. Kate I put my Nuvaring in on 7/14 my last cycle was 7/9. I could not afford a new ring so I used the same one from 7/14 is this safe and still affective? I have not gotten a cycle which makes me about 1 week late. How long are the hormones effective in the ring?

  25. Brittamy Says:

    oh just to add I removed the ring 8/4 (3week date) and I put the same one back in yesterday (after 1 week break but no cycle) and was hoping it would be effective for the next 3 weeks is this possible??

  26. brie Says:

    i have just started nuvaring and am new to it all im on my second month in using it…my question is when i start the second ring do i have to wait another week for it to be safe and effective??

  27. Rachel Says:

    Dr. Kate,

    Here is my timeline:
    -Started period July 9th
    -Put Nuvaring in July 24th
    -Started period Aug 4th
    -Visited boyfriend and had sex Aug 4-11th, did not wear condom but he never ejaculated inside me
    -Removed Nuvaring Aug 14th
    -Experienced brown spotting and breast soreness Aug 15th

    The spotting and soreness are getting better but I am scared the spotting is from implantation and am scared I could be pregnant. My breasts have never gotten sore before and I have never had spotting like this. Am I overreacting? I am not going to go back on the Nuvaring or any other birth control. When should I expect my next period?

  28. Clare Says:

    Hi Dr Kate

    I have been using Nuvaring for about a year now and I’m usually really good at remembering when to take it out and when to put it in. But I took the ring out about 3 weeks ago (it had been in just over 3 weeks forgot to take it out) and I forgot to put it back in. my partner and I have been having unprotected sex since I took the ring out, though when i finished my period he did start pulling out, that was until last night, he completely forgot that i was unprotected and started to come inside me before he remembered and pulled out, he’s pretty sure he didn’t get out in time. Hoe likely is it that i could now fall pregnant PS I usually ovulate on the 14th day of my cycle, I know this because I get cysts if i’m not using hormone based cotraception, the pains associated with the cyst started on Sunday it’s now thursday.

  29. Brooke Says:

    Dr.Kate,
    I have been using nuvaring for 6 months (3 weeks in, 1 week out) and I have loved it. I decided to skip my period in July so I left the ring in for 4 weeks and inserted a new ring right away, after I started the new ring I started spotting everyday for 14 days so I took the new ring out a week early, I started withdrawal bleeding. I spotted/bled for almost 20 days. My boyfriend and I had unprotected sex (August 10) the day before I started my current ring. We always have unprotected sex even before or after my withdrawal bleeding during my ring free week and have never had a pregnancy scare. It is possible I was not protected this passed ring free week because I took it out a week early and skipped my period the month before? Thanks!

  30. Annie Says:

    Can you use NuvaRing with silicone-based lubricants??…such as Pink lubricant with additives such as aloe-vera & vitamin E

  31. Dr. Kate Says:

    Ruth, some women do skip their periods on the ring – but to be sure, I’d take another pregnancy test. If it’s negative, I think you’re one of the lucky ones who doesn’t bleed when using the ring.

    Brittamy, I’m sorry, but the ring only has enough hormones in it for 5 weeks. So while you’re protected for an additional 2 weeks this cycle, it’s then going to run out. So USE CONDOMS until you get your period, then talk with your gyno about possibly getting some samples.

    Brie, if you start the next ring on time (meaning you’re ring free for no longer than 7 days), you’re good to go right away.

  32. Dr. Kate Says:

    Rachel, because you started the ring late (not within 7 days of the first day of your period), you may have ovulated and become pregnant this month. Take a pregnancy test to be sure. It’s unclear when you’ll get your next period – some women get their period exactly when they expect after they stop hormonal birth control, but it’s not uncommon for your period to come early.

    Clare, you haven’t been protected against pregnancy for several weeks now. And the withdrawal method of birth control is only about 60% effective overall. So yes, there’s a chance that you got pregnant this month…if your period is late or very light, take a pregnancy test.

  33. Dr. Kate Says:

    Brooke, since you took the ring out a week early, you ARE at risk of pregnancy this cycle. Any time the ring isn’t in your body for at least 3 weeks (no matter what your bleeding is doing), you’re at risk. So if you don’t get a genuine period in the next 4 weeks, take a pregnancy test.

    Annie, as far as we know, all lubricants are okay with the ring. They haven’t done large-scale studies of different kind of lube among ring users (though that would be a fun study to be in), but lab testing has shown that lube – used in the usual fashion – doesn’t decrease the effectiveness of the ring.

  34. Jessica Says:

    Wow what a great article and great responses! My boyfriend is moving in with me and I really appreciate all this info. I will be starting the ring as soon as I get it (mail order). Hopefully it will be in time for the start of my cycle, otherwise we’ll double up for the first seven days on the ring. Thanks Dr. Kate!

  35. Rachel Says:

    Dr. Kate,
    I thought that I would be protected as long as I had the ring in for at least 7 days before I had sex, even if I started mid cycle. Is this not right? I had the ring in for 11 days before having sex. Could I still have gotten pregnant?

  36. Renee Says:

    Dr. Kate,
    I have used the ring for one month and am debating whether is should use it continuously or use it from time to time, meaning once every couple of months? (my husband is absent for several months at a time.)
    Perhaps, I am asking if it is “OK” to use the ring from time to time as a punctural birth control? or is it better to not start and stop the body’s natural cycle? What are your thoughts? many thanks
    Renee

  37. Britany Says:

    Dr. Kate,
    I stopped using the ring 3 weeks ago and am now 2 weeks late for what should have been my period week. I have not had sex since I took the ring out but I am experiencing moodiness and sore breasts/nipples and other signs of early pregnancy. Is this common for someone who has just stopped using the ring. I took a HPT and it came out neg. Is this reliable? Thank you for all your great work!

  38. Annie Says:

    Dr. Kate, you are awesome!
    i will be starting nuvaring for the first time this sunday and would really like to skip a few periods. Is it okay if i leave the ring in for 4 weeks, remove it, and immediately insert a new ring for another 4 weeks without having a ring-free week in between? Will i still be protected against pregnancy even if i take the ring out for less than 3 hours everytime i have sex?

  39. Dr. Kate Says:

    Rachel, because you didn’t put the ring in during your period, it’s possible that you ovulated even before you started the ring. Yes, it takes 7 days to be up and working…but if there’s an egg there already, the ring doesn’t destroy it. The chance that you became pregnant is small but possible.

    Renee, that’s a great question. It’s perfectly safe to start and stop the ring, with several caveats: One, start it with your period during the month he’s coming back, so it will be active (and you’ll be protected) when he’s there. Two, you may experience spotting when using the ring – it’s a common side effect during the first month of birth control, and since you’ll stop the ring for months at a time, you’ll experience lots of “first months.” It’s not unhealthy, and the ring will still work.

  40. Dr. Kate Says:

    Britany, home pregnancy tests are very reliable, and if you took the ring out on time, it’s unlikely that you’re pregnant. The moodiness and tenderness may be from your hormones resuming their normal levels. But if you haven’t gotten your period in another 2 weeks, take another PT just to be sure.

    Annie, you’ve got it down perfectly! You’ll be as protected as you can be, using the ring as you’ve described. You may experience spotting when you skip the ring-free weeks, but it’s not unhealthy, and the ring is still working.

  41. Confused!! Says:

    Dr. Kate,
    This is the end of my first month on the ring and i was wondering if it was safe to have sex in the last week aka the week where the ring isnt in. Im only 17 so would it be better if i just didnt have periods and continuously changed the ring or could that cause damage.

  42. Dr. Kate Says:

    Confused, if the ring has been in your body for at least 3 weeks (and no more than 5), then yes, you’re protected against pregnancy in the ring-free week at the end. If you don’t want periods, it’s totally fine to use rings back-to-back – it won’t damage anything.

  43. Ashley Says:

    Dr. Kate,
    I’ve been on the ring now for about a year and a half and have always remembered when to take my ring out and put a new one in. Unfortunately, I was supposed to take it out Sunday night but I didn’t remember until Wednesday. I’ve always gotten my period from Thursday – Saturday but because I took it out Wednesday instead of Sunday, I have yet to get it. Will I still get my period, even though it was taken out three days late? Also, should I still put my ring in on Sunday as I normally do?

  44. Dr. Kate Says:

    Ashley, you’ll probably still get your period, just a bit later. If you like changing your ring on Sundays, I would put the new ring in on Sunday as usual, to get back to that schedule.

  45. Kara Says:

    This is my first time using the NuvaRing. I can’t remember exactly where I was in my cycle when I started–I think around day 10. After having it in for three weeks, I took it out. It has now been out for four days. I had (otherwise) unprotected sex tonight. Am I protected against pregnancy? What will happen if I insert the next ring tomorrow instead of waiting for two more days, as I had initially planned?

  46. Anne Says:

    This is my first time using the nuvaring and I’ve been on my free week for 3 days now and still haven’t started my period. Is that normal?

  47. Gal Says:

    Dr. Kate,

    You mentioned using MetroGel together with the NuvaRing. I had bacterial vaginosis and treated it with Zidoval (a gel which also contains metronidazole). Isn’t there a chance this sort of medication interacts with the ring, so that it covers it and prevents, at least partially, the release of hormones?

    Another issue: Because I’m getting married in October, I wanted to make sure I didn’t have my period on the week of the wedding. So I decided to change the day on which the ring is inserted. I did this by shortening the ring-free period twice (two months in a row). Specifically, I changed the day a new ring is inserted from Thursday to Saturday, and on the following month – from Saturday to Monday. Although it’s been almost two months since the last change I made, I’m still having some breakthrough bleeding/spotting. Is this normal? How long is this annoying situation expected to continue?

    On a more optimistic note, I really love the ring (:

  48. Lauren Says:

    I have been on nuvaring for about a year now..never had any issues with the ring until about 2 months ago the nuvaring fell out and I had 2 periods that month. July was normal and this month I started brown spotting 2 days before I was due to take the nuvaring out. I continued to spot all this week. I took it out as normal and my period is 3 days late now and I am due to put the nuvaring back in tomorrow. I took 2 pregnancy tests which both came back negative. Am I ok to put the nuvaring back in and if so why did I not have a regular period this month?

  49. Sophia Says:

    I have been on nuva ring for 6 weeks today. My doctor said once my period is over insert it. after the first three weeks I realized I was going on a trip and did not want to have my period for that week nuva ring was out so they told me just to insert another one right away. Today is the first time in 6 weeks i have not had nuva ring in and for the past 3 days i have been getting brown discharge and it is more and more. This worries me is this my period?

  50. Rosie Says:

    Hi Dr. Kate,

    I had been on the Nuva Ring for 2 and a half weeks, and for most of that time I had been very, very sick (horrible nausea, vomiting, anxiety, depression and I somehow developed agoraphobia), so I took it out yesterday. I was told the nausea and vomiting would pass in a few days and they simply weren’t going to. Even now I still feel very ill. How long will the hormones be in my system? I just want to feel back to normal because I have a life I need to live and that I can’t. Also, I have never been on birth control before.

    Thank you!


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