10/23/09
Everything You Need to Know About the Nuva Ring

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City and she answers your medical questions here once every two weeks. To ask her your own question (not about the Nuva Ring, please), click here.

When it comes to hormonal birth control, I get more questions about the NuvaRing than any other method — for proof, just check out the comments sections of my posts “Tell Me About the Nuva Ring” and “Does the Nuva Ring Deserve Its Bad Press.” The ring just doesn’t seem to be as intuitive as the once-a-day-every-day tyranny of the birth control pill. Most women’s questions focus on the timing of the ring, and what happens if their schedule gets thrown off. So, since Em & Lo have put a moratorium on Nuva Ring questions for the time being, here are the 14 points about the Nuva Ring that should hopefully answer any and all questions.

1. When to start it: You can start the ring any time you want…

  • If you’re starting it with your period, put in the ring during the first 5 days of bleeding.
  • If you’re starting it later than that, or totally off your period, take a pregnancy test first. If negative, begin the ring that day.
  • If you’re switching to the ring from the pill or patch (and you completed your pack of pills/box of patches), you can place the ring on the day you would have started your new pack of pills or box of patches.

2. How soon you’re protected: It depends on when you started the ring…

  • If you place the ring on the first day of your period, you’re protected immediately.
  • If you started the ring at any other time, you need to use condoms for 7 days for maximum contraception protection.
  • If you directly switched from the pill or patch to the ring (and you completed your pack of pills/box of patches), you’re protected immediately.

3. The minimum you must leave it in: The ring needs to be in your body for 3 straight weeks. Don’t take it out early if you start bleeding earlier than you expect — the ring needs its three weeks to work. If you remove the ring before the three weeks are up, you’re at risk of pregnancy that cycle.

4. The maximum it can stay in: The ring has enough hormones so that it may be left inside for up to 5 weeks and still be effective. So you’ve got lots of flexibility in how long the ring is in. And you don’t need to use the ring for the same amount of time each cycle — some months you may leave it in 3 weeks, some up to 5 weeks — your body will adjust. But if it’s left in longer than five weeks, you’re now at risk of pregnancy.

5. How long you can leave the old ring out before you put a new one in: When switching between old and new rings, the device cannot be out of your body for more than 7 days — in other words, you need to put a new ring back in by the same day of the week that you removed the old one. This rule holds even if you’re still bleeding — the new ring must be reinserted within a week. (If you want to shorten your ring-free week and, say, put a new one in after 3 or 4 days, that’s fine — you’ll still be protected.)

6. When it’s out for that one week, you’re protected: If you’ve used the ring following these guidelines, you’re still protected against pregnancy during the ring-free week. The ring has suppressed ovulation for that cycle, so you don’t need a back-up method of birth control during the ring-free week (though condoms are always a good idea for infection prevention, whether the ring is in or out).

7. Temporarily taking the ring out for three hours or less:
The exception to rule #3: you can remove the ring for up to 3 hours at a time and still be protected against pregnancy. For instance, you can take it out for a gyno visit, sex, or masturbation (some people don’t like the idea of playing ring toss in their vagina), but in each of those cases it isn’t necessary to do so.  There are no studies that tell us how often you can take a ring holiday; I counsel my patients that they can remove the ring once a day for 3 hours and are likely still safe.

8. Taking the ring out for more than three hours:
If it’s out for more than 3 hours, it’s possible that your ovaries will respond with a quickie ovulation. So put the ring back in and use condoms for a week.

9. If you’re late putting a new ring in:
If the old ring has been out for more than 7 days, put the new ring in anyway. Don’t wait for your period to start (so many women become pregnant while they’re waiting!). Then use condoms for 7 days.

10. Using rings back-to-back. You can use a new ring directly after taking out the old one — you don’t need to leave a ring out for any length of time, you don’t need a back-up method, and you can do this indefinitely (no need to ever bleed).

11. Bleeding patterns: It’s normal to have irregular spotting or bleeding during your first few months on a new birth control method. Don’t pull the ring out if you begin to bleed early — it doesn’t mean the ring is “finished,” it’s just breakthrough bleeding while your body is adjusting.

12. Other things in your vagina: Fingers, penises, tampons, sex toys, semen — all okay.

13. You can’t lose it in your body.
As long as the ring is all the way in the vagina, and it feels comfortable, you’re good to go. It doesn’t need to be in a particular place to work, and it won’t go in too far.

14. Risk of pregnancy: If you have sex without using the ring correctly, you are at risk of pregnancy. Take a pregnancy test if your period doesn’t come when you expect.

Dr. Kate of Gynotalk 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. 

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102 Comments on "Everything You Need to Know About the Nuva Ring"

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Gary
Gary
1 hour 57 minutes ago

My wife took the ring out a day early from her three weeks, is she still protected or should i use protection?

Chelsea
Chelsea
5 days 20 hours ago

I started NuvaRing for the first time on day 2 of my period. I have now been bleeding for over 2 weeks and it is very heavy (using a pad and super plus tampon). Why am I bleeding for so long, and will I stop bleeding if I remove it? I had 2 miscarriages back to back before starting the NR, so I feel as if I have been bleeding for months and months! I am totally over it! Help!

Ash
Ash
10 days 22 hours ago

I took the ring out on a Wednesday night but forgot to put it back in. There was no additional protection, but no ejaculation either. I was meant to take it out as per my schedule the following day on Thursday evening anyway… is it possible that taking it out one day early put me at risk of pregnancy for this cycle? I am trying to decide if I need to take Plan B.

Loretta
Loretta
14 days 22 hours ago

Do you have to wait a week before having sex every time to put a new Nuva ring each month to make sure you don’t get pregnant? Or once you go through the first month and do the 3 weeks in and 1 week out monthly your ok?

jazmin
20 days 23 hours ago

I have doubts on how the nuvaring works exactly. I started it this month. I put it in the first day of this month and I know I have to take it out in 3 weeks. Leave it out 1 week and put a new one the same day that I started but do I need to use a back up method for 7 days again? Do I use another contraception method for 7 days every month I put a new ring?

Dr. Kate
Dr. Kate
18 days 7 hours ago
Hi Jazmin, The ring works by tricking your brain into thinking that you’re pregnant, so the brain doesn’t release the hormones that stimulate egg development in your ovary. As long as you use the ring in the correct way – as you said, in for 3 weeks, out for one, new one back in – you DON’T need to use a back-up method again. Your ovaries will stay “turned off” during that ring-free week. That said, if the ring-free week becomes 8 days, 9 days, 10 days….when you put in a new ring, you’ll need to back it up again… Read more »
Jay
Jay
21 days 21 hours ago

I inserted my nuvaring for the 1st time on Friday 5-6-16 at 1130 am. I took it out around 6 that night and here we are 5-8-16. I put it back in the foil and in fridge. Can I just start it tomorrow using the same one?

Dr. Kate
Dr. Kate
18 days 7 hours ago

Hi Jay,
Yes, you can restart using the same ring when you’re ready. The ring has enough hormones for 5 weeks of use, so you can ignore that first “try it out”day May 6th – and when you put it back in, use it for at least 3 weeks (but no more than 4 weeks 6 days).
Good luck!

veronica
veronica
28 days 8 hours ago

This is my first month of using the nuvaring. It’s due to come out this coming su day but I already got my period this past Friday. Do I keep the ring I and take it back out on Sunday. And will I get my period again. As well as when do I put it back in if I already had my period this month.

Dr. Kate
Dr. Kate
26 days 9 hours ago

hi Veronica – even if your bleeding started early, leave the ring in until your scheduled removal day. And put in a new one no more than 7 days later. Your ovaries need to be suppressed for the full 3 weeks, and they’ll “wake up” if you delay putting the ring back in. Don’t worry about the bleeding – it’s normal for your body to be a little irregular in the first three months of a new birth control method. It will normalize soon!

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