Pediatric and Adolescent Gynecology

Using the Nuva Ring

How the Nuva Ring works

When your are not using birth control, estrogen and progesterone are released from your ovaries. When you are using “the ring“, your body knows that estrogen and progesterone are coming from somewhere else (from the ring). Because your ovaries don’t need to release hormones, they “take a little nap.” While they’re “napping,” they don’t release hormones, and don’t cause the release of an egg, which is how the ring works for birth control.

Forgetting to use the ring can cause the ovaries to “wake up.” When that happens, the ovaries release hormones and may release an egg, which can cause women to get pregnant.

How to use the Nuva Ring works

  • Start using the ring as directed - You may be told to start on the first day of your next period, or - on the Sunday after your next period begins, or- on the day you are in the clinic or office.
  • The ring stays inside the vagina for 21 days. On day 22, take the ring out for 7 days.
  • Most people start bleeding on the 2nd or 3rd day that the ring is out.
  • If you are taking the ring with an extended cycle, your doctor or nurse practitioner will tell you when to expect bleeding.

What to do if you forget the ring

  • If you forget to put the ring in after 7 days, you may not be adequately protected from pregnancy.. You must use an extra method of birth control, such as male condoms or spermicide, until the new ring has been in place for seven days in a row. If you know or suspect you may be pregnant, do not use the ring. Call the triage nurse. She may ask you to come to the office to see your clinician to see if you are pregnant.
  • Some people prefer to take the ring out during sex. If you do this, don’t leave it out for more than 3 hours. You should rinse the ring in warm water before putting it back in. If you leave the ring out for more than 3 hours, your ovaries may “wake up” and you could get pregnant. Rinse the ring, put it back in your vagina, and use a backup method like condoms or spermicide for the next seven days.
  • If you forget to take out the ring and it has been in place for four weeks or less, take out the ring for 7 days and then put in a new ring. If it’s been longer than 4 weeks, call the triage nurse.
  • If you have questions about what to do with missed or late restart of the ring, call the triage nurse.

Most people don’t have any side effects with the ring

  • However, during the first three months you may experience:
  • Bleeding or spotting during the time when the ring is in. This is called breakthrough bleeding and is usually worst during month 1, less during month 2, and by month 3 most people have regular periods during the week the ring is out. If breakthrough bleeding continues after month 3, you may need a different method.
  • Write down the dates of any bleeding that you have on a calendar. Bring the calendar to each visit with your clinician.
  • Other problems are not common, but you may have nausea, breast tenderness, headaches, or mood changes. If they occur, they are usually mild and don’t last long.
  • If you are having problems that are making you feel miserable, do not stop using the ring, but call the triage nurse.
  • The ring does • not cause weight gain.

Danger signs using the ring

Call the office immediately if you have:

  • Dizziness
  • Vision changes

Consider immediate evaluation if you experience the following

  • Severe headaches (the worst headache you’ve ever had)
  • Chest pain
  • Pain in the calf of one leg


  • The ring does not protect against sexually transmitted diseases. Use condoms every time you have sex.
  • Never run out of rings. You can always call the triage nurse and ask for a refill.
  • If we gave you a sample of the ring and you will run out before your next visit, call the triage nurse and we will call a prescription to your pharmacy.
  • If you are having a problem, don’t just stop using the ring. Call the triage nurse.
  • The NuvaRing is currently the only vaginal ring available for birth control. If you are miserable on it, you will need to discuss another method with your doctor or nurse practitioner.