Using the Ring (Annovera, EluRyng, NuvaRing)

How does the ring work?

When you 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 the ovaries are “napping,” they don’t release hormones, and don’t cause the release of an egg, which is how the ring works for birth control.

The ring’s hormones also thicken the mucus on your cervix. This thicker cervical mucus blocks sperm so it can’t swim to an egg.

The ring can be used to treat other conditions affected by estrogen and progesterone. These include irregular or absent menstrual periods, heavy periods, menstrual cramps, endometriosis or polycystic ovary syndrome (PCOS).  The ring can help regulate hormone levels, which may ease symptoms like headaches or acne.

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 bleeding or result in pregnancy.

How do I use the ring?

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 21-28 days. On day 29, take the ring out for 4-7 days.

Most people start bleeding on the second or third day that the ring is out. You may still be bleeding when it is time to place the ring back in the vagina and that is okay.

If you are taking the ring with an extended cycle, your doctor will tell you when to expect to bleed.

If the ring is removed or falls out, it can stay out for up to 2 hours.

Annovera is one ring which lasts for an entire year. It comes with a storage case for safe keeping during the week of the month you take it out. It does not need to be refrigerated.

The NuvaRing and EluRyng are replaced each month.

NuvaRings and EluRyngs that will not be used within 3 months should be stored in a refrigerator.

What if I forget the ring?

If you forget to put the ring in after 7 days, you may not be protected from pregnancy. You must use an extra method of birth control, such as male condoms, until the new ring has been in place for 7 days in a row. If you know or suspect you may be pregnant, call the clinic. You may be asked to see your doctor or for a pregnancy test.

The ring can stay in place during sex, however some people prefer to take the ring out during sex. The ring should not stay out for more than 2 hours. Rinse the ring in warm water, put it back in your vagina.

If you forget to take out the ring and it has been in place for 4 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 clinic.

If you have questions about what to do with missed or late restart of the ring, call the clinic.

Are there side effects with the ring?

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 may happen more 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. Keep track of the dates of any bleeding that you have on a calendar or menstrual tracking app. Bring the calendar to each visit with your doctor.

While other side effects are not common, you may have:

• breast tenderness
• headaches
• nausea
• mood changes

If this happens, it is usually mild and doesn't last long.

If you are having side effects that make you feel miserable, call the clinic. Do not stop using the ring.

The ring does not cause weight gain.

Danger signs of the ring

Call the office immediately if you have:

• Dizziness
• Vision changes

Consider immediate evaluation if you have:

• A severe headache (the worst headache you've ever had)
• Chest pain
• Shortness of breath

What else do I need to know?

• The ring does not protect against sexually transmitted infections. Use condoms every time you have sex.

• Never run out of rings. Call the clinic and ask for a refill.
• If you are having a problem, don't just stop using the ring. Call the clinic.
• There are many forms of birth control and many ways to treat heavy or painful periods. If you feel miserable while using it, discuss this with your doctor.

Questions?

This information is for general purposes. If you have any questions, contact your health care professional.

Reviewed GYN 7/2022

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