Nuvaring dosage, forms, and strengths

Nuvaring is a brand-name female contraceptive used to prevent pregnancy. The NuvaRing is a small, flexible ring inserted into the vagina at the beginning of each menstrual period. It remains in the vagina for three weeks while it delivers steady low doses of two female hormones, ethinyl estradiol and etonogestrel, that work together to prevent ovulation. These hormones, an estrogen and a progestin, are the same as those found in combination birth control pills. In the final week of the menstrual cycle, the ring is removed to promote menstruation. A new ring is then inserted at the beginning of the next cycle. NuvaRing follows the same schedule as most birth control pills, but missed doses are less of a risk because daily dosing is not required.

RELATED: What is NuvaRing? | Get NuvaRing discounts 

NuvaRing forms and strengths

Nuvaring is a vaginal contraceptive device that releases a constant low dose of etonogestrel and ethinyl estradiol.

• Vaginal ring: 11.7 milligrams (mg) etonogestrel and 2.7 mg ethinyl estradiol

The vaginal ring releases an average daily dose of 0.12 mg per day of etonogestrel and 0.015 mg per day of ethinyl estradiol.

Source: Epocrates, NuvaRing prescribing information

NuvaRing dosage for adults

The NuvaRing vaginal insert is designed to release a constant low dose of progestin and estrogen. The ring itself contains 11.7 mg etonogestrel and 2.7 mg ethinyl estradiol, but it releases a daily dose that averages 0.12 mg etonogestrel and 0.015 mg ethinyl estradiol to ensure steady concentrations of these hormones in the blood for 21 days. To prevent ovulation and pregnancy, the ring should remain in the vagina for exactly three weeks. 

Source: Epocrates 

NuvaRing dosage for birth control

NuvaRing is a hormonal birth control device that delivers the same active ingredients as combination birth control pills—progestin and estrogen—to prevent pregnancy. Daily doses of these two female hormones in the first three weeks of a woman’s menstrual cycle prevent the release of eggs from the ovaries (ovulation), change the lining of the uterus to prevent a fertilized egg from attaching to the uterine lining, and alter the mucus at the cervix to prevent sperm from passing into the uterus. 

NuvaRing is a small flexible ring inserted like a tampon into the vagina for 21 days to prevent pregnancy and then removed for seven days. As with birth control pills, many women will have their period during the ring-free interval of the cycle.

• Standard NuvaRing usage: Insert vaginal ring on the first day of each menstrual cycle, leave the ring in place for 21 days, and then remove the ring for seven days to promote menstruation.

Nuvaring dosage for children

NuvaRing is FDA approved for use in any woman of reproductive age, that is, any woman or adolescent past puberty. As with birth control pills, dosages are the same for adolescents as they are for adult women.

• Standard NuvaRing usage for postpubertal adolescents: Same as adult usage above.

Nuvaring dosage restrictions

Women who cannot take hormonal contraceptives will be unable to use NuvaRing. In particular, women who have an increased risk for forming blood clots in their blood vessels (venous thromboembolism) will not be prescribed either birth control pills or hormonal contraceptive devices such as NuvaRing. Blood clots could cause serious problems such as deep vein thrombosis, heart attack, or stroke. Because surgery increases the risk for blood clots, women who have surgery will be taken off hormonal contraceptives for a few weeks before and after surgery. 

Other contraindications for hormonal contraceptives include liver disease, liver tumors, uncontrolled high blood pressure (hypertension), high blood pressure with blood vessel disease, undiagnosed bleeding in the uterus, pregnancy, a history of hormone-sensitive breast cancer, or any severe allergic reaction to NuvaRing or its ingredients.

Some women can be prescribed NuvaRing, but the hormones may make existing physical conditions worse, like depression, gallbladder disease, high cholesterol, high triglycerides, hereditary angioedema, or a skin darkening disorder called chloasma (“the mask of pregnancy”). These women may require closer monitoring by a healthcare professional to spot problems before they become too serious. Women who have vaginal problems may also not be suitable for vaginal inserts like NuvaRing because of the increased risk of vaginal irritation, sores, and tissue erosion.

Source: NuvaRing prescribing information

How to take Nuvaring

The hormones in NuvaRing are contained in a small, flexible ring that is inserted into the vagina at the beginning of each menstrual cycle. Once inserted, the ring is left in place for exactly 21 days. The ring is then removed and the next ring is to be inserted exactly seven days later. In the week without a ring, most women will have their period.

• A healthcare provider will demonstrate how to put in the ring. Make sure any questions or confusion are cleared up during this demonstration.

• NuvaRing comes with a patient information package insert. Please read over the illustrated Instructions for Use in this patient information sheet each time you are ready to insert a ring.

• NuvaRing comes in a box with three sachets, each containing one ring. These rings can be stored at room temperature (59-86°F) for up to four months.

• As with birth control pills, women should use a backup barrier method of birth control during the first seven days after insertion to avoid pregnancy. 

• When using a backup barrier method of birth control, do not use female barrier methods such as a diaphragm, female condom, or cervical cap. They may not be positioned correctly with the NuvaRing inside the vagina.

• NuvaRing is inserted on the first day of each menstrual cycle. However, the first time it is used, NuvaRing can be inserted without loss of effectiveness on any of the first five days of the menstrual cycle. 

• A healthcare professional will tell you the appropriate time to start NuvaRing if you have had a recent abortion or miscarriage, or for post-partum use of the device.

• The NuvaRing must be removed on the same day of the week at the same time it was inserted exactly 21 days after insertion. The next ring must be inserted on the same day of the week at the same time exactly seven days after removal.

Insertion

• Before inserting the ring, wash and dry your hands. You can then choose a position that is the most comfortable. Sitting, standing, or lying down are all okay.

• Remove the ring from the foil pouch and squeeze the sides of the ring together.

• Insert the ring into the vagina. Push it with the index finger deeper into the vagina. There is no “correct” position for the ring. It will work anywhere within the vagina.

• An applicator is also available to help insert the ring. If an applicator is preferred, ask a pharmacist for one.

• Once the ring is in place, most women don’t feel it. If the ring is uncomfortable, it may not be inserted far enough. Gently push the ring farther into your vagina. 

• If the insertion is painful, it is possible that the ring was inserted into the bladder by mistake. Check to see if the ring is in the vagina. If it isn’t, call a healthcare provider immediately.

• Regularly check to make sure the ring is still in the vagina. 

If the ring slips out

• If a ring slips out of the vagina and is broken, dispose of the ring and insert a new ring.

• If a ring slips out of the vagina and is not broken, it can be reinserted if it has been out of the vagina for less than three hours. Rinse the ring with cool to lukewarm water and reinsert the ring immediately. 

• If the ring has been out of the vagina for longer than three hours in the first two weeks of the cycle, it can be reinserted, but barrier method birth control such as male condoms with spermicide must be used for the seven days following reinsertion. Do not use female barrier methods of birth control.

• If the ring has been out of the vagina for longer than three hours in the third week of the cycle, it cannot be reinserted. A new ring can be inserted immediately or within seven days to start the next 21-day cycle. An additional barrier method of contraception such as male condoms with spermicide must be used for the first seven days after inserting the new ring. Do not use female barrier methods of birth control.

Removal

• Wash and dry your hands.

• Insert a finger into the vagina, hook it through the NuvaRing, and gently pull it from the vagina.

• Put the used ring back in its resealable pouch and dispose of it in a trash can out of the reach of children.

NuvaRing dosage FAQs

How long does it take Nuvaring to work?

NuvaRing will prevent pregnancy in its first month of use. However, as with birth control pills, NuvaRing will not prevent pregnancy in the first seven days after insertion. Women should use a male barrier method of contraception for the first seven days after insertion.

What happens if I miss a dose of Nuvaring?

To prevent pregnancy, a new NuvaRing must be inserted on the same weekday at the same time exactly seven days after the used NuvaRing has been removed. If a new ring has not been inserted on the proper day, get medical advice from a healthcare provider about what to do next.

How long can you take Nuvaring?

A NuvaRing can prevent pregnancy for 28 days, but not longer. If the ring is inserted for up to 28 days, remove the ring. Insert a new ring exactly seven days later. If the ring is inserted for longer than 28 days, talk to a healthcare professional. A pregnancy test may be required before restarting birth control.

How do I stop taking Nuvaring?

Combination hormonal contraceptives (CHCs) such as NuvaRing can be stopped safely at any time.

Many women discontinue NuvaRing or other CHCs for various reasons. Some may wish to get pregnant. Others may experience serious adverse reactions such as a blood clot, heart attack, stroke, high blood pressure, toxic shock syndrome, or a severe hypersensitivity reaction. Even common side effects can be troublesome for some people, including breakthrough bleeding, breast pain, mood changes, abdominal pain, vaginal discharge, or weight gain. In addition to these common side effects, NuvaRing can also cause vaginal discomfort, enough for a woman to consider other forms of birth control.

Women have many other hormonal methods of birth control to choose from, including a wide range of single hormone or combination oral contraceptives. Other contraceptive methods deliver a continual dose of hormones as well. These include skin patches, beneath-the-skin implants, and hormonal intrauterine systems (IUS), a type of intrauterine device (IUD) that releases progestin. An implant and IUS can both provide birth control for years after being implanted.

Can you overdose on Nuvaring?

An overdose of birth control hormones is not considered dangerous, but it can cause symptoms such as vaginal bleeding, nausea, and vomiting. NuvaRing is designed to deliver a constant daily dose of female hormones. Ring breakage will not change the dose delivered. Therefore, the only way to overdose on NuvaRing is to insert more than one ring per month. If an overdose is suspected, remove the ring and talk to a healthcare provider.

What interacts with Nuvaring?

Like all prescription drugs, the hormones in NuvaRing have significant drug interactions. Treatments may need to be modified.

Most importantly, some medicines reduce the effectiveness of the hormones in NuvaRing, making pregnancy more likely. These include some anticonvulsants, antifungal medications (such as griseofulvin), hepatitis C medications, HIV drugs (such as ritonavir or dasabuvir), tuberculosis antibiotics, migraine medications (topiramate), and St. John’s wort, a popular supplement. If these drugs are being taken along with NuvaRing, women should also use barrier method birth control. Some drugs, like ritonavir and dasabuvir, will never be prescribed with NuvaRing.

Women taking thyroid replacement medications will need higher doses of their thyroid drugs when using NuvaRing.

Is it safe to take Nuvaring during pregnancy?

NuvaRing is never prescribed to women who are pregnant.

Combined hormonal contraceptives like NuvaRing can both reduce lactation and cause side effects in a nursing baby. Women who are breastfeeding will be advised to use non-estrogen birth control methods or stop breastfeeding. 

Related resources for Nuvaring dosages:

• NuvaRing, Epocrates

• NuvaRing prescribing information, U.S. National Library of Medicine

• Oral contraceptive pills, StatPearls