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

  1. Bry Says:

    This is my third month on NuvaRing with no problems what so ever, following the 3 weeks in, 1 week out rule. I took my last ring out on the 23rd, and was supposed to put the new one in on the 30th. However, during moving, we managed to somehow throw this month’s ring away and I won’t be able to pick another ring up until tomorrow, making me two days late on my restart date. When I do start it, do I need to treat it like I’ve started all over again and use backup for the next 7 days, or should I be alright?

  2. JEN Says:

    Dr. Kate

  3. JEN Says:

    Dr. Kate
    So this is my first month on the nuvarring and i was wondering are you protected that forth week when the ring is out??? Or should ou just avoid sex at all costs??

  4. Nicholas Says:

    My girlfriend has been on the NuvaRing for about five months. She always takes out the ring 21 days after insertion. However, sometimes her bleeding is a bit delayed and she doesn’t want to put in the new ring until after the bleeding. Sometimes this is more than 7 days after taking out the ring (usually four or five days after bleeding starts). I get very nervous when she does this. Should we wait 7 days again before having unprotected sex?

    Also is putting the ring in before the end of bleeding somehow unsafe like my crazy gf thinks?

  5. Dr. Kate Says:

    Kara, yes, you’re protected. It’s fine to put the next ring in early – it may or may not shorten your period, but you’ll maintain protection from pregnancy.

    Anne, yes, it’s normal. Some women don’t start bleeding until almost the end of the ring-free week…and occasionally, women don’t bleed at all (scary but not unhealthy).

    Gal, the ring hasn’t been studied with EVERY intravaginal medication, but all the research done to date shows that the medication is absorbed quickly enough to not significantly delay the hormone release from the ring. Unfortunately, it’s impossible to tell how much longer the spotting will last (I wish I had a crystal ball about bleeding). But I’m glad you like the ring – and have a wonderful wedding!

    Lauren, I would definitely put the ring back in as scheduled, to maintain your protection against pregnancy. As I mention above, sometimes the bleeding just starts later than other times, and you may occasionally skip an entire period.

  6. Dr. Kate Says:

    Sophia, yes, this is likely the start of your period – your body is starting to bleed in response to the lack of hormones. It may be a different type of bleeding than what you’re used to (darker or lighter) – it may take several cycles for the bleeding to normalize.

    Rosie, the hormones are out of your system within days. So if you’re still feeling ill in the next few days, I would see your general doctor.

    Bry, start the ring as soon as you can get it, and use condoms for a week (since you’re starting late this month). After that, use it as usual – 3 weeks in, then one week out.

    Jen, if you always had to avoid sex, no one would use the ring! As long as it’s in your body for at least 3 weeks and no more than 5, before you take it out, you’re safe from pregnancy for the 7 days it’s out.

    Nicholas, your GF isn’t crazy – many women think what she does. But you’re right – when she puts the ring in late (more than 7 days after she removes it), she’s not protected until it’s been in for another 7 days. It’s totally fine to put the ring in when she’s bleeding…I tell patients that the blood acts as lubricant, and it’s even easier to place the ring. But if she’s really uncomfortable doing this, you’ll need to use condoms for the time it’s out, plus the first 7 days of the new ring.

  7. Terri Says:

    Dr. Kate,

    I forgot to put in my nuva ring one month, but put it in on the 6th day of my cycle. My bf and I had uprotected sex the next week on Thursday(a week and a day after insertion) I took the ring out on time, but my period seems very light, much lighter than usual. It started on time, just light, like no need for even a pantyliner light, but there a bit when going to the bathroom. I seem to have all the symptoms of a period, except it’s very very light. Is this normal, or should I take a pregnancy test. I’m thinking I’m just scaring myself for no reason(I hope).

    Thanks

  8. Blanca Says:

    Dear, Kate

    I am new to the NuvaRing. I started in August 4th 2009 and took it off Sept. 1 I have a week already without the ring. I got my period saturday and Tuesday is my day that I’m suppose to be inserting the ring again. But I’m still on my period can I put the ring while being on my period or wait untill my cycle is over? Thanks for your help

  9. kerry Says:

    how often can you take the ring out for up to three hours? every day? one and a half hours twice a day?

  10. mar Says:

    Hi I had been using nuvaring and decided to stop because it had been causing severe depression for me which most bc do…anyway I took it out a week early had an extremely light period and had sex with the bf at the end of the period which was light and I barely bled anyway Its been almost 3 weeks since then and I have been having so many pregnancy symptoms sore nipples more frequent trips to the bathroom and bouts of extreme hunger and nausia during the day I have cramping and my body just doesn’t feel right could I really be pregnant here or could this be in my head please help me thanks

  11. Dr. Kate Says:

    Terri, since you started the ring within the first 7 days of your cycle, you should be protected. But if you’re really worried (and no method is 100% perfect, even if you use it just right), take a home pregnancy test to be sure.

    Blanca, you should have put the ring in on Tuesday, even if you’re still bleeding – your ovaries can “turn back on” if the ring is out of your body for a week, and bleeding doesn’t affect this chance. So put the ring in now, and use condoms for a week to be safest.

    Kerry, it’s a great question, and one that’s difficult to research. But knowing how the hormones are absorbed by the body, I think you’re safe to have the ring out every day for 3 hours total. It’s probably safe to have it out for 3 hours each time, but in the absence of data, that would make me nervous, to take it out multiple times for 3 hours. So I think a safe approach would be 3 hours total “out” time each day.

    Mar, since you took the ring out early, it’s very possible that you ovulated after the ring came out, so you ARE at risk of pregnancy. Please take a pregnancy test so you’ll know for sure – and if it’s negative, please start using condoms until you and your gyno can figure out a better birth control method for you. (How about an IUD?)

  12. Patti Says:

    I have been on the nuvaring for about a year.

    I took the ring out on Aug 11 (beginning of my week 4) and got my period Aug 13.

    I did not have my rx so I did not put a nuvaring back in.

    I had unprotected sex on Aug 27. I had what seemed to be a light period on Aug 30. It was not heavy enough to wear a panty liner but I would say heavier than simply spotting.

    Could this have been a period on Aug 30 and if so am I safe to say I am not pregnant? When shall I be expecting my next period? What are the chances I am pregnant?

  13. Kim Says:

    About a month ago, I put in a new ring on Thursday night, as usual. Normally, my period is still occurring when I put in my ring, but will stop 2-3 days afterwards. I normally use tampons during this time, but never had a problem with the ring falling out when taking out my tampon. However, 6 days later, I was still bleeding (although it was light, and I hadn’t used a tampon since the Saturday before). Thinking it was just a fluke, I didn’t think much of it until I was talking with my mom and she asked if I had the ring in. During this period, I did have unprotected sex with my husband on Sunday. I asked him if he felt it during sex, and he replied “no” (and he does feel it most of the time). So I decided to check, and the ring was not there. Talking with my doctor, I decided to wait until my next cycle to insert a new ring (besides, insurance wouldn’t cover it again so soon, so I would have to pay full price).

    Well, now my period is 4 days late. During these four days, I have the feeling that I have started my period (with discharge I can feel draining), but I go to the bathroom, and there is nothing. Not even a drop of blood. I also have some “typical” signs of pregnancy, but which can also be signs that I’m about to start my period. Since I have been either on the pill or nuvaring for 6 years, I have not had a “real” period in that time, so I’m confused whether or not I’m feeling PMS symptoms or pregnancy symptoms.

    So the ultimate question is, what are the chances that I am pregnant?

  14. Cher Says:

    Dr. Kate,

    I last started my ring on June 11 and 4 or 5 weeks and inserted another for four weeks, then put another one in for two weeks. So I have had the ring in for 12 and 1/2 weeks. Will I have a normal period? Can I take it out and have a regular period after two weeks?

  15. Dr. Kate Says:

    Patti, you probably ovulated the day you had unprotected sex! So unfortunately, there’s a decent chance that you could have become pregnant. If you had a true period Aug 13, it’s too soon for you to have had another period Aug 30. If you don’t get your period this weekend, I would take a pregnancy test. If you’re not pregnant, you should get a period soon.

    Kim, since we don’t know when the ring fell out, we don’t know if you had unprotected sex. You should have gotten a period by now – it’s been a month, right? So take a pregnancy test now – it’s the only way to know for sure. If it’s negative, start the next ring AS SOON AS POSSIBLE, and use condoms for a week…this way you’ll regain your protection as quickly as possible.

    Cher, don’t take the ring out after only two weeks, or you won’t be protected this cycle. Leave it in for an additional week (so three total), then take it out to have a withdrawal bleed.

  16. shirley Says:

    Hi Dr. Kate,

    I took my nuvaring out last month after 3 weeks, I had a period, but did not put my new ring in during the first seven days, I put it back in on day #9. This cycle I did not take it out until almost 4 weeks, but just put a new one in right away. All the other months I have used the ring, I always started spotting a few days before the ring was suppose to come out. But, that didn’t happen this month, now I am wondering if i could be pregnant or if my body has just gotten used to the nuva ring that’s why I didn’t have any spotting just before taking it out. What should I do continue with this ring for three week and take it out to see if I have a period, or take a pregnancy test??

  17. Cher Says:

    I don’t know if I made myself very clear. I have been on the ring for 12 weeks strait. The the last ring I put in was two weeks ago. Is it okay to take out the one ring after two weeks?

  18. Claudia Says:

    Hello Dr. Kate

    I started using the nuva ring 7/26 the first day of my period and removed it 8/9 and started my period on the 8/11 and ended sunday 8/16. I had unprotected sex with my partner 8/18. The following day I took the plan b pill and inserted the nuva ring day #10. (I have had unprotected sex while on the ring) I removed the ring 9/9 and still no period. I took a pregnancy test on thursday 9/10 (just because) and the results were negative. I have read several comments on other sites with women saying that it took 4-5 days for their period to come. Is this common?

  19. Rose Says:

    Hi Dr. Kate,

    I started using the ring three weeks ago and took it out today. When I took it out there was some brown discharge on it, and I had a little more about an hour later-it looked like the dry blood I sometimes get on the last day of my period. A few hours later I had a little red blood spotting too, is this my period? It is not continuous and I just took the ring out, and if it is not my period, is it normal?

    Thanks~

  20. Rebecca Says:

    Hi Dr. Kate!

    I started using the nuvaring on August 29, I was sick when I started using it (cough, mucus, runny nose). I am still sick, it has been three weeks now.. but my symptoms have changed and I have muscle aches in my hips mostly, I am tired all the time, my appetite has diminished and I feel pressure on the back of my eyes. I also feel cramping in my abdomen and vagina sometimes. It has crossed my mind that some of these symptoms could be caused from the nuvaring? I have considered taking it out with the hopes of feeling better, but I am not convinced that my most recent symptoms are indeed caused from the ring. Has the nuvaring been known to cause any symptoms that I am experiencing?
    thanks for your time :)

  21. Rebecca Says:

    oh, I also forgot to ask… I do not want my period and was hoping to keep the nuvaring in for four weeks and change it with a new one immediately… is this safe? how long can I continue this pattern?

  22. Liv Says:

    Thanks for your advice in July regarding conception during first cycle after stopping Nuvaring. After years of trying to conceive my first child, I am happily pregnant, only 5 weeks after stopping Nuvring!

  23. Liv Says:

    (happily pregnant with my second, that is!)

  24. Lynn Says:

    Hey I started the nuvaring 3weeks ago and started antibiotics for bv during the second week and during this second week me and my partner had unprotected sex without knowing I could get pregnant.. On the third week I took the nuva ring out but it’s the second day and still no period. What are my chances of being pregnant?

  25. Dr. Kate Says:

    Shirley, there IS a chance that you ovulated in the two days before the ring went in. Take a pregnancy test, and if it’s negative, keep the ring in for 3 or 4 weeks (whichever you prefer).

    Cher, I still think you shouldn’t take the new ring out yet, not until at least 3 weeks has passed. How well this ring protects you is not affected by whether or not you’ve been skipping the ring-free weeks before.

    Claudia, while it’s possible that your period is late, you really haven’t been protected from pregnancy much – the ring does you no good in a cycle if you remove it early and don’t put another one in right away. So take a PT to be sure, and consider another method of birth control if you don’t like how the ring is used.

    Rose, some women start bleeding right away, and some don’t start for days. If you see bleeding of any sort, I wouldn’t worry – so many patterns are considered normal.

  26. Dr. Kate Says:

    Rebecca, those don’t sound like symptoms that are usually associated with the ring – I’d visit your primary doc for a check-up. You can use the rings back-to-back indefinitely. Some women will eventually have break-through bleeding with this pattern, but the rings are still effective.

    Liv, yay! I’m so glad the ring worked for you, until you didn’t need it anymore. Congratulations!

    Lynn, the antibiotics didn’t affect the ring’s efficacy. So if the ring was in for the full 3 weeks, I doubt you’re pregnant. Some women don’t start bleeding for a few days when the ring comes out – it may even take all week to start, and that’s okay.

  27. jewels Says:

    I have been on nuvaring for the last 4 yrs. I didn’t realize my prescription was done so I wasn’t able to get one this month. It will be 2 wks on sunday sine I shouldve inserted the new ring. I originally thought itd be best to wait and start it again next month but after reading your responses to other questions, I’m questioning if I’d be better off waiting or starting now. If I should insert monday(since I can’t get another prescription on a Sunday), will I need to remove it 4 wks later or will I need to do it in a week? Last, but not least, will it affect me having a reg cycle?

  28. jewels Says:

    Well… I guess itd be a week or two wks since I’m two wks into when I should have inserted and you remove after 3. Leave it to me to somehow manage to mess up the easiest birth control method other than the shot… Can you see why I opted not to take the pill? Me remembering to take them at the same time everyday was about as frequent as I’ve been struck by lightening… Which hasn’t happened. (Yet) lol. Thanks!

  29. Kara Says:

    I’ve had some trouble finding a clear answer to this on the web. Do antibiotics affect the ring’s effectiveness? What about other types of medications?

  30. Hannah Says:

    Dr. Kate,
    I used the Nuva Ring for the first time approximately 3 weeks ago before I saw blood. So I took it out and started bleeding very heavily. My period is usually really light and doesn’t last for more than 3 days. But I am bleeding so much I left stains everywhere I went. I soaked through a maxi pad in half an hour to an hour. Everyone said this is normal for Nuva ring, but I am still worried. Is there anyway to stop this bleeding? Should I still continue using the ring after 1 week of taking it out?

  31. Dominique Says:

    i used to take nuvaring but i missed a month and i never came on so i thought maybe its because im not still using nuva ring so i put in my nuva ring on august 26 and i kept it in for 3 weeks and just recently took it out on september 16. I was told that you come on 3 days after you take the ring out, but my third day was yesterday and i still havent came on. Is it possible that im pregnant?

  32. Sophia Says:

    This is my first month using Nuva Ring; before Nuva ring I had been off BC for 3 months. Last Sunday I started my period and inserted Nuva ring that day; by Monday night I was not bleeding at all. Although I continued to have period like symptoms almost all week. I normally bleed for 4-6days so such a short light period is unusual for me. Is it caused by the start of Nuva Ring?

  33. Lynsey Says:

    I have been on the nuvaring for about three years. I took it out because me and my husband want to start trying to have a baby. How long before I should be able to get pregnant?

  34. Denise Says:

    My question is in regard to the actual taking out of the ring.
    I’m a bit confused..maybe I’m just overthinking it..but, do you leave the ring in for 21 FULL days(taking it out on the 22nd day) or do you take it out on the 21st day(meaning you actually leave it in for 20 days???)…OR do you take it out on the 21st day about the same time of day you first inserted it? *confuzzled*

  35. Denise Says:

    …forgot to add….today (Sunday night for me) marks my 21st day….What’s weird is that it usually takes my period a few days to come after my removal of the ring, but this time I’ve already started bleeding and i haven’t removed it yet.

  36. Emily Says:

    I have been on Nuvaring for 3 months. First, I took the ring out Sep. 4th which is when I’m supposed to. But, I didn’t put it back in until 6 days after i was supposed to-Sep 17th. I don’t have a good reason for this. Then yesterday I took the ring out to have sex and totally forgot to put it back in. I realized it before the 3 hours was up but when I went to look where I put it I couldn’t find it! I was in a hurry to go somewhere and when I got back it had been 8 hours since I took it out. I finally found it and put it back in but the sex was unprotected and then we had unprotected sex again that night…I’m afraid I may have really messed up. Could I have gotten pregnant from doing that?

  37. Ashley Says:

    Hi,

    I’ve been on the Nuvaring for the past few years. However, this past week was crazy and I put the ring in approximately 29 hours later than I normally do (period started on the 9th). My boyfriend and I were fooling around and he was inside me for a few minutes (unprotected) last night but he didn’t even come close to finishing inside of me. To complicate things more, my doctor put me on Lupron this past Wednesday. Should I be worried about being pregnant?

  38. Ashley Says:

    Also, if there is a risk of being pregnant. Is it OK to take the morning after pill while I’m on these medications?

  39. bacterial vaginosis symptom Says:

    Yeast infections are not considered to be sexually transmitted infections (STI) because a celibate woman can develop them, but having unprotected sex can pass them along. A man who has unprotected sex with a woman who has an active yeast infection can get a penile yeast infection. Transmission of genital yeast infections from woman to man is uncommon, but it does happen.

  40. Jewls03 Says:

    Hi
    i been on the nuvaring for 8 months now since 2-3 months ago i been feeling pregnant all the time…nausea..tired all the time my breast are sore anyways i got the whole package and i know the feeling of being pregnant because i got 3 little kids at home but i had normal periods and took pregnancy test that came back negetif and also took a blood test i was just wondering if its the ring that could be causing me to feel like this

  41. krystal Says:

    I used yaz for almost a year, and just recently switched to the nuvaring. I have had the nuva ring in for more than a month, but I still have not had my period. Why am I not getting my period?? I know Im not pregnant, the pregnancy scare is out of the picture.

  42. Barbbie Says:

    I inserted the nuvaring 5 days ago, I had no previous b/c before starting the nuvaring. I had intercourse last night and did not use a back up method AND it’s been 14 days since my last period. What are the chances that I could get pregnant because of ovulation etc? I am so scared.

  43. Frida Says:

    I have been on the nuvaring for about six months now. My husband and I had sex last night and I did not feel my ring fall out. The next day I found my ring under my bed when I was vaacuming. I washes the ring and put it back in. I put if back in aproximarely 12 hours after I had sex. Does that mean I’m pregnant?

  44. Kate Says:

    Dr. Kate:

    I went on NuvaRing the first day of my period and two days later my boyfriend and I had sex. My moodswings were pretty bad so I took it out the following evening, but put a new ring in 36 hours later. We had sex again (he used a condom since that would have been day 6 of my period for a first day to insert and the website said to use other protection), but I took it out again the next day because I was sick of the moodswings. I’ve been spotting now for 5 days…is this normal if you go off of hormonal birth control? It’s been day 6 of spotting (and now 13 days after starting my period) and usually my period only lasts for 4 days.

  45. Whitney Says:

    So my doctor wrote me a perscription for the NuvaRing because i have trouble regulating my period, and i have a hard time remembering the pill. She also perscibed me a progesterone to get my period to start. After 10 days of taking it i have finaly gotten my period, and now realize that she never really explained anything about using the NuvaRing and will not return my calls….
    HELP!

  46. miyana Says:

    i put in nuvaring for one day and took it out the next day and then 3 or 4 days later i stared spotting snot like discharge but it was bloodly!

    what does this mean someone plz help me!!

  47. Melissa Says:

    Hello Dr. Kate,

    I have been using the nuvaring now for 6 days. I inserted it on day 5 of my period. So far I’m very unsure about it….I am really moody and have NO libido. I called my doctor and he said give it 3 months!!! Does it reallly take this long for your body to adjust to the hormones or is it just no agreeing with me? Will it really take 3 months?????????????

  48. Crystal Says:

    I just got on nuvaring I haven’t been on any bc in two years. I started spotting on Sept 15, I put the ring in on Sept 17. I have been on my period for two weeks now. It has been heavy to med flow the whole time. I was put on bc cause of a 4cm cyst on my left ovary. Why am I still bleeding and what should I do?

  49. Ashley Says:

    Dr. Kate,
    Ive been on the ring since May 09. I had my period 9/8/09 and put my ring in on 9/13/09. the ring fell out one night (about a week later after inserting it)and wasnt put back in until the next morning. THEN the next night it fell out after sex again and this time was out longer than 24 hours. Needless to say this obviously happened at a bad time (right around when i was ovulating). Is there is a good chance i might be pregnant? i have heard that the ring is pretty effective and that some women actually take a few months to get pregnant after using the ring. Thanks!

  50. Sarah Says:

    i just started the ring.. on day 6 i had sex, condom broke and “it” all went inside me of course. could i be pregnant and could the ring harm my baby if i am?


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