Frequently Asked Questions

Hormonal birth control methods may not be a good choice for you if you have ever had jaundice (yellowing of the skin or eyes) caused by pregnancy or related to previous use of hormonal birth control.

Tell your health care provider if you have ever had any of the conditions listed above. Your health care provider can suggest another method of birth control.

Before you use NuvaRing tell your health care provider if you:

• Have any medical conditions
• Smoke
• Are pregnant or think you are pregnant
• Recently had a baby
• Recently had a miscarriage or abortion
• Have a family history of breast cancer
• Have or have had breast nodules, fibrocystic disease, an abnormal breast x-ray, or abnormal mammogram
• Use tampons and have a history of toxic shock syndrome
• Have been diagnosed with depression
• Have had liver problems including jaundice during pregnancy
• Have or have had elevated cholesterol or triglycerides
• Have or have had gallbladder, liver, heart, or kidney disease
• Have diabetes
• Have a history of jaundice (yellowing of the skin or eyes) caused by pregnancy (also called cholestasis of pregnancy)
• Have a history of scanty or irregular menstrual periods
• Have any condition that makes the vagina become irritated easily
• Have or have had high blood pressure
• Have or have had migraines or other headaches or seizures
• Are scheduled for surgery. NuvaRing may increase your risk of blood clots after surgery. You should stop using NuvaRing at least 4 weeks before you have surgery and not restart it until at least 2 weeks after your surgery.
• Are scheduled for any laboratory tests. Certain blood tests may be affected by hormonal birth control methods.
• Are breastfeeding or plan to breastfeed. Hormonal birth control methods that contain estrogen, like NuvaRing, may decrease the amount of milk you make. A small amount of hormones from NuvaRing may pass into your breast milk. Consider another non-hormonal method of birth control until you are ready to stop breastfeeding.
• Have (or have ever had) an allergic reaction while using NuvaRing, including hives, swelling of the face, lips, tongue, and/or throat causing difficulty in breathing or swallowing (anaphylaxis and/or angioedema)

Tell your health care provider about all medicines and herbal products you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Some medicines and herbal products may make hormonal birth control less effective, including, but not limited to:

• Certain anti-seizure medicines (such as barbiturates, carbamazepine, felbamate, oxcarbazepine, phenytoin, rufinamide and topiramate).
• Medicine to treat fungal infections (griseofulvin)
• Certain combinations of HIV medicines (such as nelfinavir, ritonavir, darunavir/ritonavir, (fos)amprenavir/ritonavir, lopinavir/ritonavir and tipranavir/ritonavir)
• Certain hepatitis C (HCV) medicines (such as boceprevir and telaprevir)
• Non-nucleoside reverse transcriptase inhibitors (such as efavirenz and nevirapine)
• Medicine to treat tuberculosis (such as rifampicin and rifabutin)
• Medicine to treat high blood pressure in the vessels of the lung (bosentan)
• Medicine to treat chemotherapy-induced nausea and vomiting (aprepitant)
• St John’s wort

Use an additional barrier contraceptive method (such as a male condom with spermicide) when you take medicines that may make NuvaRing less effective. Since the effect of another medicine on NuvaRing may last up to 28 days after stopping the medicine, it is necessary to use the additional barrier contraceptive method for that long to help prevent you from becoming pregnant. While using NuvaRing, you should not use certain female barrier contraceptive methods such as a vaginal diaphragm, cervical cap or female condom as your back-up method of birth control because NuvaRing may interfere with the correct placement and position of a diaphragm, cervical cap or female condom.

Some medicines and grapefruit juice may increase the level of ethinyl estradiol in your blood if used together, including:

• The pain reliever acetaminophen
• Ascorbic acid (vitamin C)
• Medicines that affect how your liver breaks down other medicines (such as itraconazole, ketoconazole, voriconazole, fluconazole, clarithromycin, erythromycin and diltiazem)
• Certain HIV medicines (atazanavir/ritonavir and indinavir)
• Non-nucleoside reverse transcriptase inhibitors (such as etravirine)
• Medicines to lower cholesterol such as atorvastatin and rosuvastatin

Hormonal birth control methods may interact with lamotrigine, a medicine used for seizures. This may increase the risk of seizures, so your health care provider may need to adjust your dose of lamotrigine.

Women on thyroid replacement therapy may need increased doses of thyroid hormone.

Ask your health care provider if you are not sure if you take any of the medicines listed above. Know the medicines you take. Keep a list of them to show your health care provider and pharmacist when you get a new medicine.

Use NuvaRing as prescribed by your healthcare provider.

• NuvaRing is used in a 4-week cycle.

• Insert 1 NuvaRing in the vagina and keep it in place for 3 weeks (21 days). Regularly check that NuvaRing is in your vagina (for example, before and after intercourse).
• Remove the NuvaRing for a 1-week break (7 days). During the 1-week break (7 days), you will usually have your period.

Note: Insert and remove NuvaRing on the same day of the week and at the same time:

• For example, if you insert your NuvaRing on a Monday at 8:00 AM, you should remove it on the Monday 3 weeks later at 8:00 AM.
• After your 1-week break (7 days), you should insert a new NuvaRing on the next Monday at 8:00 AM.

• NuvaRing should not be used in conjunction with certain female barrier contraceptive methods such as vaginal diaphragm, cervical cap, or female condom because NuvaRing may interfere with the correct placement and position of these methods.
• Use of spermicides or vaginal yeast products will not make NuvaRing less effective at preventing pregnancy.
• Use of tampons will not make NuvaRing less effective or stop NuvaRing from working.
• If NuvaRing has been left inside your vagina for more than 4 weeks (28 days), you may not be protected from pregnancy and you should see your health care provider to be sure you are not pregnant. Until you know the results of your pregnancy test, you should use an extra method of birth control, such as male condoms with spermicide, until the new NuvaRing has been in place for 7 days in a row.
• Do not use more than 1 NuvaRing at a time. Too much hormonal birth control medicine in your body may cause nausea, vomiting, or vaginal bleeding.

Although some women may be aware of NuvaRing in the vagina, most women can’t feel NuvaRing once it’s in place. NuvaRing may move around slightly within your vagina. This is normal. If you do feel discomfort, NuvaRing is probably not fully inserted. In that case, just use your finger to gently push the NuvaRing as far as you can into your vagina.

Rest assured, there is no danger of NuvaRing being pushed too far up in the vagina or getting lost. The cervix (the narrow, lower end of the uterus) will block NuvaRing from going any farther. NuvaRing can accidentally slip out of the vagina while removing a tampon, during intercourse, or straining during a bowel movement.

Some women have accidentally inserted NuvaRing into their bladder. If you have pain during or after insertion and you cannot find NuvaRing in your vagina, call your health care provider right away.

During intercourse, some sexual partners may feel NuvaRing in the vagina.

When used as directed, NuvaRing has been shown to be 98% effective. Your chance of getting pregnant depends on how well you follow the directions for using NuvaRing. The better you follow the directions, the less chance you have of getting pregnant.

No. NuvaRing does not protect against HIV infection (AIDS) or other sexually transmitted infections.

Hormonal birth control methods do not seem to cause breast cancer. However, if you have breast cancer now or have had it in the past, do not use hormonal birth control, including NuvaRing, because some breast cancers are sensitive to hormones.

Women who use hormonal birth control methods may have a slightly higher chance of getting cervical cancer. However, this may be due to other reasons such as having more sexual partners.

How to Use NuvaRing

It is important to consult with your health care provider to make sure you are not pregnant before starting NuvaRing.

When you start using NuvaRing depends on your current birth control situation. Talk to your health care provider and read the Prescribing Information for more details. Also read some basic directions on How to Start NuvaRing.

NuvaRing is easy to insert and remove:

• Manual insertion: After washing and drying your hands, remove NuvaRing from the foil pouch. Keep the foil pouch for proper disposal of the ring after use. Holding NuvaRing between your thumb and index finger, press the sides together while lying down, squatting, or standing with one leg up—whatever is most comfortable for you. Gently push the folded ring into your vagina. If you feel discomfort after inserting NuvaRing (etonogestrel/ethinyl estradiol vaginal ring), slide it farther in until it feels comfortable. Once inserted in the vagina, there is no risk of NuvaRing being pushed too far up or getting lost. Some women have accidentally inserted NuvaRing into their bladder. If you have pain during or after insertion and you cannot find NuvaRing in your vagina, call your health care provider right away. Regularly check that NuvaRing is in your vagina (for example, before and after intercourse) to ensure you are protected from pregnancy.

For more information, refer to the Patient Information.

• Removing NuvaRing: Remove the ring 3 weeks (21 days) after insertion on the same day of the week it was inserted at about the same time. After washing and drying your hands, hook your index finger under the forward rim or hold the rim between your index and middle fingers. Gently pull out NuvaRing. Place the used NuvaRing in the resealable foil pouch and dispose of it in a waste receptacle out of the reach of children and pets. Do not throw it in the toilet. Your menstrual period will usually start 2 or 3 days after the ring is removed and may not have finished before the next ring is inserted. To continue to have pregnancy protection, you must insert a new ring 1 week (7 days) after the last one was removed even if your period has not stopped.

For more information, refer to the Patient Information.

• Store NuvaRing at room temperature between 68°F to 77°F (20°C to 25°C).
• Store NuvaRing at room temperature for up to 4 months after you receive it. Throw NuvaRing away if the expiration date on the label has passed.
• Do not store NuvaRing above 86°F (30°C).
• Avoid direct sunlight.

Dispose of NuvaRing by placing the used ring in the resealable foil pouch and properly dispose of it in a waste receptacle out of the reach of children and pets. Do not throw it in the toilet.

While Using NuvaRing

NuvaRing can slip or accidentally come out of (be expelled from) your vagina during sexual intercourse, bowel movements, use of tampons, or if it breaks.

• NuvaRing may break, causing the ring to lose its shape. If the ring stays in your vagina, this should not lower the effectiveness of NuvaRing at preventing pregnancy.
  • If NuvaRing breaks and slips out of your vagina, dispose of it as noted above.
  • Insert a new NuvaRing. (See Inserting NuvaRing.)
  • You should pay attention when removing a tampon to be sure that your NuvaRing is not accidentally pulled out.
    • Be sure to insert NuvaRing before inserting a tampon.
    • If you accidentally pull out your NuvaRing while using tampons, rinse your NuvaRing in cool to lukewarm (not hot) water and insert it again right away.

    During Weeks 1 and 2, you may not be protected from pregnancy. Reinsert the ring as soon as you remember. Use another birth control method, such as male condoms with spermicide, until the ring has been in place for 7 days in a row.

    During Week 3, do not reinsert the NuvaRing that has been out of your vagina, but dispose of it as noted above. Use another birth control method, such as male condoms with spermicide, until the new NuvaRing has been used for 7 days in a row, following 1 of the 2 options below:

    Option 1. Insert a new ring right away to start your next 21 day NuvaRing use cycle. You may not have your regular period but you may have spotting or vaginal bleeding.

    Option 2. Insert a new ring no later than 7 days from the time the previous ring was removed or expelled. During this time, you may have your period.

    Note: You should only choose to do option 2 if you used NuvaRing for 7 days in a row, prior to the day that your previous NuvaRing was accidentally removed or expelled.

    • If NuvaRing was out of the vagina for an unknown amount of time, you may not be protected from pregnancy. Perform a pregnancy test prior to inserting a new ring and consult your health care provider.