Thursday, October 15, 2009

The Ultimate User's Guide for the Nuva Ring

When it comes to hormonal birth control, I get more questions about the NuvaRing than any other method (see for yourself here). It just doesn't seem to be as intuitive as the once-a-day-every-day tyranny of the birth control pill. Most women's questions focus on the timing of the ring, and what happens if their schedule gets thrown off. So this is everything you need to know about using the NuvaRing.

1. When to start it. You can start the ring any time you want:

  • If you're starting it with your period, put in the ring during the first 5 days of bleeding.
  • If you're starting it later than that, or totally off your period, take a pregnancy test first. If negative, begin the ring that day.
  • If you're switching to the ring from the pill or patch, you can place the ring on the day you would have started your new pack of pills or box of patches.

2. How soon you're protected. It dependes on when you started the ring:

  • If you place the ring on the first day of your period, you're protected immediately.
  • If you directly switched from the pill or patch to the ring, you're protected immediately.
  • If you started the ring at any other time, you need to use condoms for 7 days for maximum contraception protection.

3. How long to leave it in. The ring needs to be in your body for 3 straight weeks. Don't take it out early if you start bleeding early than you expect - the ring needs its three weeks to work. If you remove the ring before the three weeks are up, you're at risk of pregnancy that cycle.

4. How long it can stay in. The ring has enough hormones so that it may be left inside for up to 5 weeks and still be effective. So you've got lots of flexibility in how long the ring is in. And you don't need to use the ring for the same amount of time each cycle - some months you may leave it in 3 weeks, some up to 5 weeks - your body will adjust. But if it's left in longer than five weeks, you're now at risk of pregnancy.

5. How long you can leave it out. The ring cannot be out of your body for more than 7 days - in other words, you need to put a new ring back in by the same day of the week that you removed the old one. This rule holds even if you're still bleeding - the new ring must be reinserted within a week.

6. When it's out, you're protected. If you've used the ring following these guidelines, you're still protected against pregnancy during the ring-free week. The ring has suppressed ovulation for that cycle, so you don't need a back-up method of birth control during the ring-free week (though condoms are always a good idea for infection prevention...).

7. Ring holiday. The exception to rule #3: you can remove the ring for up to 3 hours at a time for sex (or any other reason...) and still be protected against pregnancy. There are no studies that tell us how often you can take a ring holiday; I counsel my patients that they can remove the ring once a day for 3 hours and are likely still safe.

8. If the holiday runs long... If the ring is out of your body for more than 3 hours, it's possible that your ovaries will respond with a quickie ovulation. So put the ring back in and use condoms for a week.

9. If you're late putting a new ring in. If the old ring has been out for more than 7 days, put the new ring in anyway. Don't wait for your period to start (so many women become pregnant while they're waiting!). Then use condoms for 7 days.

10. Back-to-back. You can use a new ring directly after taking out the old one - you don't need to leave a ring out for any length of time, you don't need a back-up method, and you can do this indefinitely (no need to ever bleed).


11. Bleeding patterns. It's normal to have irregular spotting or bleeding during your first few months on a new birth control method. Don't pull the ring out if you begin to bleed early - it doesn't mean the ring is "finished," it's just breakthrough bleeding while your body is adjusting.

12. Other things in your vagina. All okay. Including semen.

13. You can't lose it in your body. As long as the ring is all the way in the vagina, and it feels comfortable, you’re good to go. It doesn’t need to be in a particular place to work, and it won't go in too far.

And one final thought - this should go without saying: If you have sex without using the ring correctly, you are at risk of pregnancy. Take a pregnancy test if your period doesn't come when you expect.

34 comments:

b said...

What if I remove the NuvaRing 2 days early? Am I still protected for the next 7 days?

Dr. Kate said...

No, B. The ring needs to be in your body at least 21 days in order to suppress ovulation that month. So if you only have the ring in for 19 days, you're at higher risk of pregnancy.

Sarah said...

Dr Kate, I just started on the ring Friday (11/27) which I thought was the first day of my period. I had spotting on the 26th, following by moderate flow on the 27th, which is normally how my cycle starts, and inserted the ring. I only had light spotting on Saturday and nothing at all yesterday or today. I took a home pregnancy test this morning and it was negative. My periods usually last 5 or 6 days.

Is this normal? I can't find any information to suggest whether it is or not. I am not particularly worried I am or might be pregnant, it just seems very odd.

julia said...

hi dr. kate,

i have been reading a lot of different information about how long nuvaring is effective and hardly any of it is backed up with sources or studies... how can i be sure that i can trust the 5 weeks? do your patients use it that way?

using the ring that long would be awesome, i'd just like to have a REALLY reliable source when extending what the packaging says by 2 weeks.

thanks!

Michelle said...

I have been using nuvaring four over a year now. In October my husband was working out of town so I didn't use it (trying to save 40 dollars). I started my period on 11-17-09 and put the nuva ring in on Saturday the 21st (saturday has always been my removal and put back day) since my husband would be back in town on the 22nd. I recently got sick and started anti-biotics on 12-5-09 and have been taking them twice a day since. I was under the impression that antibiotics didn't interfere with the Nuvaring. Is pregnancy a possibility if we have been using no back up methods since 11-22-09? Removal of the Nuvaring is due 12-12-09.

Samantha said...

This is an involved question. I was on a three day course of antibiotics the last week of my ring being in. I know it can interfere with the pill. If I insert the ring a few days early will I be protected seven days after insertion, or will the antibiotics still affect it?

RZB said...

If I am in my first week after my period (4th day after insertion of new ring) after 3 years of using the ring correctly... (!!)
The ring was slipping out, wanted to wash it before putting it back in but forgot. Duh.
9 hours later, had intercourse (almost 12 hours ago now) and didn't remember until after. Duh.
Put it in as soon as I remembered, but clearly outside of the 3 hour window, or "holiday" as you put it.
Would using Plan B (on my own suggestion as an alternative to pregnancy) be a wise choice? Thanks.

Dr. Kate said...

Sarah, I'm sorry for answering your comment late. It's unusual for the ring to "stop" your bleeding - so you may have been destined to only bleed for a day or two this cycle anyway. Has your bleeding regulated on the ring?

Dr. Kate said...

Julia, I don't blame you for wanting to be absolutely sure before you extend your birth control. I DO have some patients who use the ring this way (and they love it). More importantly, my research team in NY worked with the manufacturers of the ring, and that's the primary source of the 5-week-efficacy knowledge. (And you can bet that the company wouldn't talk to us about that if they weren't sure!)

Dr. Kate said...

Michelle, I'm sorry for my delayed response. The antibiotics should NOT have interfered with the effectiveness of the ring. So you were as protected that month as you were any month using the ring. (Did everything turn out okay?)

Dr. Kate said...

Samantha, just like I wrote to Michelle, the antibiotics WON'T affect the function of the ring. So placing the ring a few days early isn't necessary - but you'll still be protected after 7 days of use.

Dr. Kate said...

RZB, yes, Plan B would be a wise choice. The chance of pregnancy is not great, given where you are in your cycle, but you're right, there's still a chance. You can continue to use the ring while taking Plan B, as well.

Tracy said...

Hi Dr. Kate,

My ring fell out during my last cycle, on day 19. According to my gyno & the website, I could choose to put a new ring back in or leave it out for 7 days (if I knew when it fell out). I chose to put a new ring in. This was two weeks ago today. This means that I am scheduled to take out my ring on Wed. the 10th of Feb. I leave for vacation with my boyfriend on the 12th & it will be Valentine's Day. I DO NOT WANT TO HAVE MY PERIOD. I was thinking of taking out my ring tomorrow (a day into the 3rd week) because the website says if the ring is out into the 3rd week, you can take out, have a period & reinsert in 7 days. This would give me a period early & I would finish before vacation. Or should I keep my ring in for a week? Side note, I am having LOTS of breakthrough bleeding bc I didn't have a full period the last cycle. PLEASE ADVICE!

Dr. Kate said...

Tracy, don't take the ring out. If the ring isn't in your body for 21 days, you can still ovulate this month. Your best chance at avoiding bleeding during your vacation is to leave the ring in during your trip. It can be in your body for up to 5 weeks and you'll still be protected against pregnancy. Remove the ring after 5 weeks--or when you get home from your trip--to have a full bleed then. Unfortunately, there's nothing to do about the breakthrough bleeding this cycle. It should stop with the next ring.

Rita said...

Dr. Kate, I was supposed to put my Nuvaring in this past Wednesday (2/10) but due to a blizzard was only able to get to the pharmacy the next day and insert it then (2/11). Last night (2/12) I started having brownish bleeding. The site said that you should put the Nuvaring in even if its a day late and then wait seven days before you are protected and can have sex without a condom. It didn't say anything about bleeding. What should I do?

Corinne said...

Dr. Kate,
I have sucessfully been on nuvaring for 4 months. This month, I put the ring back in on the 7th day of my period. As soon as I put it back in.. I got a puddle of blood! Its almost as if the pressure from the ring is pushing out the blood or something. Should I be worried?

Nikki said...

My first day using the ring was Monday, Feb 1st. I had sex 13 days later. Could I be pregnant? Is the ring not giving protection? Sigh...

keeks said...

Dr. Kate,
I've been a nuvaring user for over a year now, and for the first time, I have started my period a full week early. I haven't taken the ring out, just stuck a tampon in, but should I be worried in any way? And should I just keep the ring in until the usual time? And if I stop bleeding before it's time to put the new one in, am at risk to get pregnant or is my uterus just out of bloody layers to shed?

Basically, should I do anything or should I just pretend nothing is out of the ordinary?

Allie P. said...

I am hoping to re-arrange my period cycle, but unsure of whether this is possible. I have a performance going on the planned week of my period (which includes a tech. rehearsal week from hell) and additionally, am lined up to have my period when my boyfriend gets home from overseas in a few months.

I have no concerns about getting pregnant (boyfriend abroad=no sex for the time being) only about messing up everything in my system for the show. If I remove the ring this week, as opposed to next week, and then replace it next week, will this restart my cycle? or will I simply have breakthrough bleeding? I've been hearing that people who leave the ring in sometimes have breakthrough bleeding when they would have had their period, anyway. What's best in this situation?

A said...

Dr. Kate,
My periods have always been irregular. I just started the NuvaRing late December and my period came right on time. I had taken out the NuvaRing Feb. 20, 2010 and I had intercourse the same day and have not yet gotten my period. The day after, Feb. 21, 2010, I began throwing up. Is it possible that I could be pregnant?

Farida said...

I have a question and my gyno and the Nuva Ring helpline have not given me a straight answer. My last period started on Feb 9th (first day of bleeding) and my doctor told me to start nuvaring Sunday, Feb 14th. This is 6 days into my cycle. The Nuva Ring guide specifically says to either start on Day 1, or Days 2 - 5. No one can tell me if it is OK to have started on Day 6. I just want to know if I will be protected this cycle if I continue to keep it in. This is my first time going on hormonal birth control. Do I need to take out the ring, and start again on Day 2 - 5 of my next period cycle?

Chris said...

i just started the ring three days ago. I don't want it anymore, im going to use a new method. If i take this out now, will i start my period?

founa said...

hi dr Kate,
i inserted the ring the first day of my period. i had unprotected sex while on my period 5 days later and continued to do so until the 7th day of my period. i was still bleeding. on the 8th day i took plan B just because i was scared.
what are the chances of me getting pregnant

mld1383 said...

I'm in a long distance relationship where I only see him on the weekends. What's the best day to start the Nuvaring to prevent having a period during the weekend days?

Dr. Kate said...

Rita, you just have to wait out the irregular bleeding this cycle. It's normal to have strange bleeding whenever you deviate from the normal ring schedule. It should get back on track by the next month.

Dr. Kate said...

MLD1383, it depends on when you start bleeding after ring removal. Some women begin bleeding the first day, but for some, bleeding starts many days later. The only way you'll know how your body is going to react is to try the ring, and see when your bleeding begins. Then you can adjust the timing of the start of the next ring accordingly.

Dr. Kate said...

Corinne, it's likely just a little bleeding weirdness and nothing to worry about.

Dr. Kate said...

Founa, since you started your ring on the first day of your period, your chances of pregnancy are really low - I wouldn't worry.

Dr. Kate said...

Chris, you might. Whenever you stop a hormonal birth control method in the middle of a cycle, you may have some irregular bleeding. Make sure you use condoms, then, until you're well-established on another method.

Dr. Kate said...

Farida, I would leave in the ring, and use condoms for one week. Whenever you begin birth control outside of the first 5 days of a cycle, you should use condoms as back-up for a week. You'll then be protected for the rest of the cycle.

Dr. Kate said...

A, if you were using the ring correctly (in for 3-5 weeks, not out for more than a week), you have a VERY small chance of being pregnant. Just put the new ring in after the 7-day break, and you'll likely have a bleeding episode when you expect it, at the end of the month.

Dr. Kate said...

Allie P, if you remove the ring a week early (when it's only in for 2 weeks), you may breakthrough bleeding that may last longer than the 7-day ring-free week. But you may also have a typical "period"--it's hard to predict. Based on your life stressors, it may be worth a shot. You can then restart your cycles by replacing the ring after a week like you plan to do.

Dr. Kate said...

Keeks, the safest thing to do is to pretend the bleeding never happened. Leave the ring in the usual time, and take it out for no more than 7 days. Chalk it up to one weird cycle, and don't let it throw off your schedule. You're at no greater risk of pregnancy, as long as you follow the usual ring rules.

Dr. Kate said...

Nikki, the ring protects you for the whole cycle, as long as you started it on your period (or used condoms for the first week). So it's unlikely that sex 2 weeks after starting the ring will get you pregnant.