Guide to the birth control ring

NuvaRing must be inserted within the first five days from the start of your period. If you insert it on the first day of your period, NuvaRing is immediately effective, but insertion on days two through five requires another seven days of additional contraception or back up method before NuvaRing becomes effective at preventing pregnancy. After 7 days of being on the ring, you are protected from pregnancy and no longer need to use a backup method. 

*The ring does not protect against STIs and you should always use a condom if you are not 100% sure of your partner’s STI status. 

For more information visit our How do I start my birth control FAQ.

1. 1. Wash and dry your hands. Find a private space where you feel comfortable inserting your ring. 
   2. Open the foil pouch where the ring is located. 
   3. For easy insertion you may want to sit or squat over a toilet or lay down on a bed with your knees bent. It’s like inserting a tampon.  
   4. Using your dominant hand, hold the vaginal ring between your thumb and index finger. Hold the sides together so they are touching and the ring is folded.
   5. While holding the folded ring, insert the ring into your vagina as far as it will go. If you need another strategy, you can use a tampon applicator with the tampon removed. Use the cardboard type applicator.  Remove the tampon and place the folded ring inside the empty container. Insert the container with the ring inside and push the applicator to insert the ring. Also, patients can request a tampon-like applicator from the manufacturer to assist in the process.

The ring is easy to remove. It cannot get lost in the vagina. First, wash your hands with soap and water. Next, insert your finger into the vagina until you feel the ring. Then, hook your finger around the ring. Finally, pull the ring out.

• Once you insert the ring, leave it in place for 3 weeks in a row. After 3 full weeks, remove the ring for 1 week before you start your next ring. Most people get their period during this “ring-free” week. At the end of the “ring-free” week, insert your new ring on the same day of the week you inserted your previous ring (so if you very first inserted your ring on a Sunday, you will insert your new ring on a Sunday too). Here is a link to a calendar that shows what that looks like. 
• It is safe to have sex with your ring inserted. You can remove it for up to two hours during intercourse if you find that more comfortable — just don’t forget to re-insert it.
• The ring can’t get lost inside of your vagina. Your cervix, which is located at the end of your vagina, prevents the ring from traveling up into your uterus.

Annovera is a new long-lasting contraceptive ring you use for an entire year. It is not disposable every month. Just like the Nuvaring, you insert it for 21 days and then remove it for 7 days to allow for a period. Annovera lasts an entire year, so every time you take it out to have a period you store it so that you will reinsert the same ring after 7 days.

Some patients experience increased vaginal discharge while using the ring. This is perfectly normal. The discharge should not have an odor and it should not cause itching, irritation, or burning. If any of those symptoms were to occur, you should get checked out for an infection.

You can use tampons or a menstrual cup while using the ring, but be careful when removing them so you don’t accidentally pull out the ring. If this happens, simply wash it off in lukewarm water and reinsert it.  Chances are you won’t need to use them at the same time because your ring is going to be out during your period week. 

If the ring falls out and it has been less than 3 hours you can simply put it back in.  There is no loss of effectiveness.  

If the ring is out for more than 3 hours during the first 1 or 2 weeks of its use, then you must replace it and use backup for 7 days.  Continue with your schedule and remove it on your usual day to have your ring-free week and a period.  

If it is out for more than 3 hours in the 3rd week of use you can EITHER: 1. Place a new ring and leave it in place for 3 weeks.  Use backup for 7 days.  Then remove it and have a period.  This will change the day you usually remove your ring.  OR 2.  Leave it out, have a period and start a new ring within 7 days.  Use backup for the first 7 days of use as if it were your first time ever using the ring.

The pill, patch, and ring are about 99% effective with perfect use. With typical use, they are about 91% effective. That means if there are 100 people using a method, about 9 will get pregnant yearly. It is important to pick a method that works best for you in terms of remembering to use it. For many people, it is easier to remember to change a ring once monthly rather than take a pill daily.

Although the patch and the ring aren’t FDA-approved for skipping periods, many people do use them this way. If you use the Nuvaring, just leave your ring in for four weeks instead of three, then when you remove it,  immediately replace it with a new ring.