The birth control pill vs. NuvaRing®: Comparing your options

Choosing birth control is a deeply personal decision—and there are seemingly countless options out there. If you’re considering the birth control pill or the ring (e.g., NuvaRing®), understanding how each method works can help you feel more confident in your choice.

The pill is a once-a-day oral contraceptive that uses hormones to prevent pregnancy. The ring is a small, flexible vaginal ring you insert once a month, where it steadily releases similar hormones to protect against pregnancy.

Each method has its own benefits and risk considerations:

• The pill offers daily control, which some people find easy to build into their routine
• The ring (e,g, NuvaRing®) is a low-maintenance option—just one insertion a month means less to think about day-to-day.

Both are highly effective when used correctly. The best choice really depends on what fits your body, your schedule, and your preferences. A healthcare provider can help guide you in making the best choice.

How do they work?

Birth control pills and rings are both highly effective hormonal methods for preventing pregnancy—but they work a little differently, especially when it comes to how you use them.

The pill

The pill is a daily oral contraceptive that uses synthetic versions of the hormones estrogen and progestin to prevent pregnancy. When you take the pill:

• The hormones enter your bloodstream through your digestive system.
• You take one pill around the same time each day to stay protected.
• Most packs have 21 hormone-containing pills and 7 placebo pills. During the placebo week, you’ll usually get your period.

This method can work well if you’re good with routines and like the feeling of daily control—but it’s important to be consistent. Missing pills or taking them late can lower effectiveness.

The ring (e.g., NuvaRing®)

NuvaRing® is a small, flexible ring that you insert into your vagina once a month. It stays in place for three weeks, releasing low doses of estrogen and progestin through the vaginal walls. Here’s how it works:

• The ring is inserted once and left in place for 21 days.
• After three weeks, you remove it for a seven-day break (when you’ll likely have your period).
• Then, you insert a new ring to begin the next cycle.

Because it doesn’t require daily action, NuvaRing® can be a great option for anyone with a busy schedule, irregular routines, or who just prefers a low-maintenance approach.

How effective are they at preventing pregnancy?

Both birth control pills and rings like the NuvaRing® are among the most effective reversible contraceptive options available today. When used perfectly—meaning no missed doses, delays, or incorrect use—both are about 99% effective at preventing pregnancy. That means fewer than 1 in 100 people using either method correctly for a year will get pregnant.

But let’s be real: perfect use isn’t always how things play out in everyday life.

Real-world use

With typical use, the numbers are very similar:

• Birth control pills: ~93% effective
• The ring: ~93% effective

The pill’s effectiveness can dip due to late or missed doses, stomach issues, or interactions with other medications. The birth control ring, on the other hand, is a little more forgiving—there’s less day-to-day management, and fewer factors can interfere with how it works.

What can affect effectiveness?

For the pill:

• Taking it at the same time every day matters
• Medications like antibiotics, anti-seizure drugs, and some herbal supplements can reduce effectiveness
• Vomiting or severe diarrhea within a few hours of taking a pill can interfere with absorption

For the ring:

• It bypasses your digestive system, so stomach issues don’t affect it
• You don’t need to remember it daily—but it must stay in place
• If it’s out for more than 3 hours, you’ll need to use backup birth control (like condoms) for 7 days after reinserting it/span>

Storage considerations

• Pills: Store in a cool, dry place—extreme heat can reduce their effectiveness
• The ring: If you’re not using it right away, it needs refrigeration (good for up to 4 months); once inserted, it’s fine at body temp for the 3 weeks it’s in place

STI protection

Neither the pill nor the ring protects against sexually transmitted infections (STIs). If STI prevention is part of your needs, consider pairing hormonal birth control with condoms for extra protection and peace of mind.

How to use them

Whether you’re new to birth control or just need a quick refresher, we’ve got you. Here’s how to use the pill and the NuvaRing® effectively—so you can feel confident in your routine and protected on your terms.

Birth control pills

Taking the pill at the same time every day keeps your hormone levels steady and your protection consistent.
Here’s how to get started:

• Start on the right day: Most providers recommend beginning your pack either on the first day of your period or the first Sunday after your period starts.
• Take one pill every day, at the same time: Pair it with something you already do daily—like brushing your teeth, drinking your morning coffee, or winding down before bed.
• Set a reminder: Many people find it helpful to use phone alarms or calendar notifications to stay on track.

If you miss one pill, take it as soon as you remember.
If you miss two or more, refer to the instructions in your pill pack or reach out to your provider—you may need backup protection (like condoms) for the next seven days.

Birth control ring<

Prefer fewer steps? The ring follows a simple, low-maintenance schedule.

• Insert the ring once every 4 weeks: Squeeze it between your thumb and finger, then gently place it in your vagina (similar to a tampon). There’s no “wrong” way to do it—as long as it feels comfortable, it should be working.
• Leave it in for 3 weeks: Then remove it by hooking a finger under the rim and pulling gently.
• Take a 1-week break: This is when you’ll typically get your period.
• Insert a new ring after 7 days: Even if you’re still bleeding, don’t delay reinsertion.

Helpful tip: Use a calendar or set recurring reminders so you don’t forget when it’s time to remove or replace your ring.

Want to skip periods?

Both methods can be used to safely skip your period:

• With the pill: Skip the placebo pills and start a new pack immediately.
• With the ring: Insert a new ring right after removing the old one—without taking a week off.
  

Just make sure to check in with your provider before trying this, especially if it’s your first time.

Do you need backup birth control?<

You might—depending on when you start:

• With the pill: If you start mid-cycle (not during your period), use backup protection for the first 7 days.
• With the ring: Same rule—if you’re not on your period when you insert it, use condoms or avoid sex for 7 days.

Hormone levels in each method

If you’re weighing up a birth control ring like the NuvaRing® against the pill, one key difference lies in how each method delivers hormones—and how your body responds.

Hormone delivery

Birth control pills deliver a daily dose of hormones that your body absorbs all at once. After taking the pill, hormone levels spike, then taper off until your next dose. That means your hormone levels naturally fluctuate every day, which some people are more sensitive to.

The NuvaRing®, for example, works differently. It’s a small, flexible ring that you insert vaginally once a month. Over the course of three weeks, it steadily releases 0.120 mg of etonogestrel (a progestin) and 0.015 mg of ethinyl estradiol (an estrogen) per day—resulting in more stable hormone levels throughout the month.

Hormone content

Combined oral contraceptives (COCs) aren’t one-size-fits-all. There’s a wide range of pill types with varying doses and hormone formulations. For example:

• Low-dose pills typically contain 20–35 micrograms of estrogen.
• Standard-dose pills may contain up to 50 micrograms
• Progestin types vary, too. Brands like Sprintec® and Junel® Fe use different formulations, which can affect side effects like mood changes or acne differently from person to person.

This variability means that if you’re using the pill, your experience can depend on which one you’re on.

Hormone exposure

Because the ring releases hormones directly through the vaginal wall into nearby blood vessels, it bypasses the liver (a process known as “first-pass metabolism”). This often means:

• Lower total hormone exposure
• Potentially fewer systemic side effects,like nausea or headaches

This local delivery method can feel gentler on your system—and for some people, it’s a big reason why they prefer it over oral contraceptives.

Daily fluctuations vs. steady support

Oral birth control pills create a daily cycle: hormone levels peak shortly after taking your pill, then decline throughout the day. By the next dose, your hormone levels are at their lowest—something that can lead to:

• Mood swings
• Nausea
• Headaches

With the birth control ring, the steady hormone release helps maintain a more stable hormonal environment. This consistency may result in fewer side effects for people who are sensitive to hormonal ups and downs.

What works for one body may not work for another

Some people feel best on a steady, low-dose method like the NuvaRing®. Others prefer the flexibility and wide variety of options the pill offers. There’s no “right” answer—just what works best for you. It may take some trial and error to find your fit, and that’s okay.

What are the side effects?

Starting a new birth control method is a personal decision—and it’s completely normal to have questions about how your body might react. Both birth control pills and the ring contain similar hormones, so many of the side effects overlap. The good news? Most side effects are temporary and tend to ease as your body adjusts.

What to expect with either method

Hormonal birth control can come with a few changes early on. Here are some of the most common side effects people experience:

• Nausea, especially when pills are taken on an empty stomach
• Breast tenderness, which often improves within a few months
• Headaches or mood changes, especially in the beginning
• Lower sex drive, though not everyone experiences this
• Spotting or light bleeding between periods, often called breakthrough bleeding
• Skin changes —some people see clearer skin, while others may notice more acne at first

All of these side effects are part of your body adjusting to new hormone levels. Most people feel significantly better by the third month of consistent use.

At Nurx, we offer a range of pills like Sprintec® and Junel® Fe, along with ring options like the NuvaRing®or Annovera®. Many patients report minimal side effects after the initial adjustment period. If symptoms become disruptive or don’t improve, your provider can help you find a better fit.

Weight changes and hormonal birth control

Concerns about weight gain are totally understandable. Fortunately, research shows that most people don’t experience significant weight gain from either pills or the NuvaRing®. Here’s what we know:

• Any early weight gain is usually due to water retention, not fat
• Average weight change is small for both methods
• Some people may feel hungrier and eat more—being aware of that shift can help

Everyone’s body reacts differently. Genetics, stress, and lifestyle can all influence how your weight changes over time. If you’re concerned, tracking your weight and eating patterns when starting a new method can give you helpful insights.

Breakthrough bleeding and irregular cycles

Irregular bleeding—especially in the first few months—is one of the most common reasons people switch methods. Here’s what to know:

• Breakthrough bleeding means spotting outside of your regular period
• It’s often linked to lower estrogen doses or inconsistent use
• The ring may cause less frequent spotting, thanks to its steady hormone release

To minimize breakthrough bleeding:

• Take your pill at the same time every day
• Leave rings like the NuvaRing® in for exactly three weeks before removing them
• Avoid skipping or delaying your dose

If bleeding continues beyond the three-month mark, reach out. Your provider might recommend a different method or a pill with a slightly higher estrogen dose to help stabilize things.

Breast tenderness and other changes

It’s common to feel some breast tenderness when starting hormonal birth control—this typically peaks during the first month.

Other symptoms may include:

• Bloating or mild digestive discomfort
• Changes in vaginal discharge, especially with the NuvaRing®
• Occasional irritation or awareness of the ring during sex—though most partners don’t notice it

And while many people feel emotionally stable on hormonal birth control, some may notice mood shifts. If you’re experiencing increased anxiety, depression, or mood swings:

• Keep a mood journal to track changes
• Don’t hesitate to bring it up with your provider—we take mental health seriously and can help adjust your method if needed

What are the risks and safety considerations?

All medications come with potential risks, and hormonal birth control is no exception. The pill and the ring are both safe and effective for most healthy people—but knowing what to expect helps you and your healthcare provider make a choice that truly fits your needs, lifestyle, and health history.

Blood clots and serious health risks

Estrogen-containing birth control methods—like combination pills and the NuvaRing®—slightly increase the risk of developing blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolism). While this risk is small overall, it’s still important to understand:

• For people who don’t use hormonal birth control, the yearly risk of a blood clot is about 1 in 1000.
• With estrogen-containing methods, that risk increases.

You may face a higher risk of blood clots if you:

• Smoke—especially if you’re over age 35
• Have obesity
• Are immobile for long periods
• Have a personal or family history of blood clots
• Experience migraines with aura

Watch for warning signs: If you’re using an estrogen-containing method, contact an in-person healthcare provider or seek emergency care right away if you experience:

• Sudden, severe leg pain or swelling
• Sharp chest pain or shortness of breath
• A sudden, intense headache

Other rare but serious risks—like stroke, heart attack, or liver problems—are more likely if you have certain underlying conditions, including high blood pressure, diabetes, or migraines with aura. That’s why regular check-ins with a provider are essential for staying safe and supported.

Who should avoid birth control pills or NuvaRing®

Hormonal birth control that contains estrogen isn’t the right choice for everyone. You may need a different method if you:

• Have a history of blood clots, stroke, or heart disease
• Currently have or have had breast cancer
• Have uncontrolled high blood pressure or diabetes with complications
• Smoke and are over 35 years old
• Have liver disease
• Experience migraine with aura

If you’re pregnant or breastfeeding:

• Neither the pill nor NuvaRing® should be used during pregnancy.
• Estrogen can reduce milk supply in the early postpartum months. If you’re breastfeeding, a progestin-only pill may be a better fit until at least six weeks after delivery.

Listening to your body matters, too

Some side effects—like persistent nausea, mood changes, or irregular bleeding—aren’t dangerous, but they can still affect your quality of life. If a method isn’t working for you, that’s reason enough to consider a change.

At Nurx, we’re here to help you find birth control that works with your body, not against it. Our licensed providers review your health history and preferences to recommend safe, effective options that suit you—without unnecessary hassle or judgment.

Interactions with other medicines

Certain medications and supplements can interfere with hormonal birth control—either by lowering its effectiveness or increasing side effect risks. Knowing what to look out for can help you protect against unintended pregnancy and feel confident in your birth control choices.

Whenever you start a new medication or supplement, let your healthcare providers know—especially if you’re using hormonal contraception.

Antibiotics

You may have heard that antibiotics make birth control less effective—but that’s mostly a myth.

• Most antibiotics, like amoxicillin, do not impact birth control.
• The only one that’s proven to interfere is rifampin, a medication used to treat tuberculosis.

If you’re prescribed rifampin, your provider will likely recommend a backup method—like condoms—while you’re on it.

Other medications and supplements to watch

Some drugs and herbal supplements can change how your body processes birth control hormones. These include:

• Anti-seizure medications, like phenytoin, carbamazepine, and topiramate
• HIV treatments
• Certain antifungal medications
• St. John’s Wort, a common herbal remedy for depression
• Modafinil, often used for sleep disorders
• Some barbiturates

If you’re using any of these, it’s a good idea to use a backup method while taking the medication—and for 7 days after stopping.

What about the ring?
Because rings deliver hormones locally (rather than through your digestive system), they may have fewer interactions with other medications. That said, it’s still important to talk with your provider if you’re currently on or start taking anything new—just to be safe.

Hormonal birth control can also change how your body processes other medications. For example, it might slightly raise levels of some antidepressants or lower the effectiveness of certain diabetes medications. A provider can help you find the right balance.

What to do if you miss a dose or ring

Life happens—and sometimes that means missing a dose of birth control. Whether you’re using the pill or the NuvaRing®, knowing what to do can help you stay protected and feel confident in your next steps.

If you miss a pill

The key thing to remember is that timing matters.

• Less than 24 hours late? Take the missed pill as soon as you remember, then keep taking your pills as usual. You’re still protected—no need for backup.
• Missed two or more pills? Take the most recent missed pill right away, even if it means taking two pills in one day. Then, continue your pack as normal.
  

  • Use a backup method, like condoms, for the next 7 days.
  • If you’ve had unprotected sex in the past 5 days, emergency contraception may be a good option—especially if you missed hormonal pills at the start of your cycle.

If you miss a NuvaRing® dose

NuvaRing® is a bit more flexible, but timing still matters.

• If the ring slips out and it’s been less than 3 hours: Rinse it with cool water and put it back in right away. You’re still protected.
• If it’s been more than 3 hours, or if you forgot to insert a new ring on time:
  • Insert a new ring as soon as you can.
  • Use an additional birth control method for 7 days.
  • If you had unprotected sexual intercourse during that time, consider emergency contraception.

Making the best choice for your body

If you’re deciding between the birth control pill vs. the birth control ring, think about your daily habits and routines.

Are you comfortable taking a pill every day at the same time, or would you prefer a method that only needs attention once a month? Consider your comfort with vaginal insertion, since the ring requires placing and removing the ring yourself. It’s also important to factor in any other medications or health conditions that might affect your choice.

Your lifestyle matters too—if you travel often or have an unpredictable schedule, the monthly routine of the ring might be easier to manage. Side effects tend to be similar for both methods and usually improve after a couple of months.

Not sure which method fits your needs best? Nurx makes it easy to connect with a healthcare provider who will help you find the right birth control option for your life—and get it delivered right to your door.

Frequently Asked Questions (FAQ):

Is NuvaRing® or the pill better?

Both the ring and birth control pills are highly effective—over 99% when used correctly. The best choice depends on your personal preferences, lifestyle, and how easily you can follow the daily or monthly schedule.

What is a disadvantage of NuvaRing®?

Some people experience vaginal irritation or increased discharge with the ring. It also requires remembering to replace the ring every month, which might feel inconvenient for some.

What birth control is equivalent to NuvaRing®?

The ring works similarly to other hormonal methods like birth control pills and the contraceptive patch. While pills are taken daily and the patch is changed weekly, the ring is inserted monthly, offering another flexible option.

Which birth control has the fewest side effects?

Side effects vary from person to person. It’s best to talk with your healthcare provider to find the method that fits you.

 

The information provided is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon this content for medical advice. If you have any questions or concerns, please talk to a medical professional.

Services not offered in every state. Medications prescribed only if clinically appropriate, based on completion of required consultation. Individual results may vary.

If you’re experiencing a mental health crisis, please call 911 or go to your nearest emergency department. If you are contemplating suicide, call 911 or call/text the National Suicide and Crisis Lifeline at 988. These services are available 24/7.

NuvaRing® (etonogestrel 0.12mg/ethinyl estradiol 0.015mg vaginal ring), Rx only, is used as contraception to prevent pregnancy. This drug may cause side effects, including irregular uterine bleeding, nausea, breast tenderness, headache, and increased or unusual vaginal discharge. If you would like to learn more, see full prescribing information, here. You are encouraged to report negative side effects to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Sprintec® (norgestimate and ethinyl estradiol), Rx only, is an oral contraceptive used to prevent pregnancy. This drug may cause side effects, including headaches, irregular and/or heavy uterine bleeding, dysmenorrhea, nausea and/or vomiting and back pain. If you would like to learn more, please see the full prescription information here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch: HTTPS://WWW.FDA.GOV/SAFETY/MEDWATCH /default.htm or call 1-800-FDA-1088.

Junel Fe 1.5/30® (norethindrone acetate and ethinyl estradiol, and ferrous fumarate), Rx only, is an oral contraceptive used to prevent pregnancy. This drug may cause side effects, including headaches, irregular and/or heavy uterine bleeding, dysmenorrhea, nausea and/or vomiting and back pain. If you would like to learn more, please see the full prescription information here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch: HTTPS://WWW.FDA.GOV/SAFETY/MEDWATCH /default.htm or call 1-800-FDA-1088.