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Contraceptive Ring

A small flexible ring is placed in the vagina which prevents pregnancy by releasing hormones (estrogen and progesterone) into your body. There are 2 types of vaginal rings: Annovera (yearly) and Nuva Ring (monthly)

How does it prevent pregnancy?

The hormones prevent ovulation, thicken cervical mucous, and thin the uterine lining thereby collectively preventing pregnancy.

How effective is the contraceptive ring?

In theory and with perfect use the ring is 99% effective. In real-life practice, the ring is about 93% effective.

What makes the ring less effective?

  • Not putting the ring in on time every cycle
  • With Annovera, having the ring out more than 2 hours at a time or at different times that add up to 2 hours during the 21 days that it should be in place.

Medications/supplements that can decrease effectiveness:

  • Antibiotics Rifampin, Rifampicin, and Rifamate.
  • Antifungal Griseofulvin
  • Certain HIV medications
  • Certain antiseizure medications
  • St. John’s Wort (over the counter)

Potential Side Effects:

  • Headaches
  • Nausea
  • Sore breasts
  • Menstrual changes
  • Spotting
  • Vaginal discharge/wetness

* Minor side effects tend to resolve over 2-3 months. Report if they persist.

Potential Benefits:

  • Decreased acne
  • Decreased anemia
  • Decreased cysts of breasts/ovaries
  • Decreased risk of certain reproductive cancers
  • Decreased menstrual cramps, lighter menstrual flow, and less days of flow


Estrogen component of the contraceptive ring can put you at a slight increased risk for a heart attack, stroke, blood clot, liver tumors, and a rare risk of death.

Avoid the contraceptive ring if your history includes:

  • Smoker and 35 years of age and older
  • Migraine headache with aura
  • History of a blood clot, inherited blood clotting disorder or vein inflammation history
  • Breast cancer
  • Heart attack, stroke, angina or other heart problems
  • Uncontrolled high blood pressure
  • Uncontrolled diabetes or liver disease

Warning signs/ seek healthcare immediately:

  • Sudden back/jaw pain with nausea, sweating, or trouble breathing
  • Chest pain or discomfort
  • Aching/soreness in your leg
  • Trouble breathing
  • Severe pain in your stomach
  • Sudden, very bad headache
  • Headaches that are different, worse or happen more often than typical
  • Aura (seeing flashing, zig zag lines/lights)
  • Yellowing of skin /eyes

Ring Use:

  • Place the first ring (Nuva Ring or Annovera Ring) in the vagina any day/ as soon as you get your method. Use a backup method for the first 7 days (condoms).
  • At the end of 3 weeks (21 days), remove the ring and go ring free for 7 days (period week).
  • Discard the monthly ring (Nuva Ring)
  • Wash the yearly ring (Annovera) in mild soap and lukewarm water. Pat dry. Store in case.
  • Insert a NEW monthly Nuva Ring exactly 7 days after removing previous ring.
  • Insert YEARLY Annovera Ring exactly 7 days after removing/storing ring.
  • Then REPEAT same 28-day cycle as long as you want to use this birth control method.

Additional information:

  • Contraceptive rings do not protect against sexually transmitted infections (STIs). Condom use can help decrease the risk of STIs.
  • You may safely skip menstrual periods with the Nuva Ring. Ask your provider how.
  • Do NOT use oil/silicone-based vaginal products with rings. Water-based lubricants are OKAY.


In an emergency go to Mount Nittany Medical Center or call 911 for an ambulance.

This content is reviewed periodically and is subject to change as new health information becomes available. This information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.

Approved by the UHS Patient Education Committee Revised 01/2023

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Contraceptive Ring


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