University of California, Berkeley
2222 Bancroft Way
Berkeley, CA 94720
/Users/!uhs-sgodley/Desktop/Nuva Ring (1).docx 01/20
NUVA RING
Background Information
The Nuva Ring is a slender, flexible, transparent ring, which is inserted into the vagina once per month. Low-
doses of estrogen and progestin (similar to the hormones found naturally in the body and used in combined
birth control pills) are released. These hormones, when provided in adequate amounts, prevent ovulation—if
there is no egg to meet the sperm, pregnancy cannot occur. In addition they have a reversible effect on
cervical mucous and uterine lining, which also discourages pregnancy. Average effectiveness 92%.
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Instructions for Use
§ Quickstart: Insert the ring the day you get your prescription. Unless this is within 5 days of the start of
your menstrual period, use a back-up method like condoms for 7 days OR
§ First Day Start: Insert the Nuva Ring between Day 1 and Day 5 of your menstrual cycle, even if you
have not stopped bleeding. No additional contraception is needed
§ IF YOU TAKE ELLA (ULLIPRISTAL) FOR EMERGENCY CONTRACEPTION WAIT 5 DAYS BEFORE
INSERTING THE RING. THE RING WILL NOT BE EFFECTIVE FOR 7 DAYS AFTER INSERTION.
There is no interaction with Plan B (levonorgestrel) so you can start the ring immediately after using it.
§ The Nuva Ring is inserted by pressing opposite sides of the Ring together and gently pushing the
folded Ring into the vagina. The position of the Ring in the vagina is not important, however, it should
not be uncomfortable.
§ The Ring should be left in place for 3 consecutive weeks. After 3 weeks, the Ring should be removed
for 1 week, during which you should experience withdrawal bleeding (a menstrual bleeding).
§ After 1 week, you should insert a new Ring, even if you are still bleeding.
§ Repeat the cycle (3 week use, 1 week off) each month. If continuous cycling is desired to avoid a
menstrual period, stop the ring free week and insert a new ring.
Avoid storing Nuva Ring in direct sunlight or at temperatures above 86 degrees Fahrenheit.
Recommended Actions After Delayed Insertion or Reinsertion With Combined Vaginal Ring
Delayed insertion of a new ring or delayed reinsertion of a current ring for <48 hours since a ring should
have been inserted
• Insert ring as soon as possible.
• Keep the ring in until the scheduled ring removal day.
• No additional contraceptive protection is needed.
• Emergency contraception is not usually needed but can be considered if delayed insertion or
reinsertion occurred earlier in the cycle or in the last week of the previous cycle.
Delayed insertion of a new ring or delayed reinsertion for ≥48 hours since a ring should have been inserted
• Insert ring as soon as possible.
• Keep the ring in until the scheduled ring removal day.
• Use back-up contraception (e.g. condoms) or avoid sexual intercourse until a ring has been worn for
7 consecutive days.
• If the ring removal occurred in the third week of ring use:
-Omit the hormone-free week by finishing the third week of ring use and starting a new ring
immediately.
-If unable to start a new ring immediately, use back-up contraception (e.g. condoms) or avoid sexual
intercourse until a new ring has been worn for 7 consecutive days.
• Emergency contraception should be considered if the delayed insertion or reinsertion occurred
within the first week of ring use and unprotected sexual intercourse occurred in the previous 5 days.
• Emergency contraception may also be considered at other times as appropriate.
*If removal takes place but the person is unsure of how long the ring has been removed, consider the ring to
have been removed for ≥48 hours since a ring should have been inserted or reinserted.
Dispose of the Nuva Ring in the same packet in which it is dispensed.
University of California, Berkeley
2222 Bancroft Way
Berkeley, CA 94720
/Users/!uhs-sgodley/Desktop/Nuva Ring (1).docx 01/20
People with conditions affecting the vagina, such as prolapsed (dropped) uterus, may be more likely to have
Nuva Ring slip out of the vagina. If the Ring slips out repeatedly, you should consult your healthcare provider.
Answers to the most common questions about the Nuva Ring
What should I do if I am spotting
or having my period (withdrawal
bleeding) when I don’t expect it?
• Keep using the Nuva Ring. Consult a clinic Advice Nurse 643-7197.
• Practice abstinence or use a back-up method during intercourse
until the problem is resolved.
If I miss a period (withdrawal
bleeding) but I have used the
Nuva Ring correctly, do I need to
worry that I may be pregnant?
• Some people who use the Nuva Ring miss withdrawal bleeding
(period) every now and then. If you are using the ring for
contraception, consider getting a pregnancy test. If you have
additional concerns, consult a clinic Advice Nurse 643-7197.
Temporary Minor Discomforts
Some people experience a variety of minor discomforts when starting combined contraceptives, including the
Nuva Ring. Some of these symptoms may be nausea, breakthrough bleeding, breast enlargement or
tenderness, slight weight gain, mood changes, and changes in libido. Most symptoms will disappear within the
first three months of using the Nuva Ring. Acne, although often improved in the long run, may worsen for a
couple of months when you first start the Nuva Ring. .Potential side effect unique to the Nuva Ring is increased
vaginal discharge. If any of your symptoms are severe or persist, call a clinic Advice Nurse at 643-7197
The Nuva Ring Danger Signs
Abdominal pain (severe)
Chest pain (severe)/shortness of breath/coughing up blood
Headaches (severe)/dizziness/weakness/numbness
Eye problems (vision loss or blurring)/speech problems
Severe leg pain of calf or thigh
If you develop any of these symptoms:
§ Call or immediately come to Urgent
Care 642-3188, or other emergency
medical facility
§ Call 911 in an extreme emergency
Major Nuva Ring Complications
The most serious risk of combined contraceptives is the potential for cardiovascular complications: blood clots,
stroke, hypertension, or heart attack. These side-effects are extremely rare and occur most often in people
who smoke, who are over age 35, who have other health problems like hypertension, diabetes, heart disease,
vascular disease, or blood clots, and those who have a family history of diabetes or heart attack under the age
of 50. If you smoke, you may have an increased risk for developing major complications. Young, healthy, non-
smoking people can use the Nuva Ring with very little risk of developing serious complications. Learn the Nuva
Ring Danger Signs listed above.
The Nuva Ring, Emergency Contraception (EC) and Other Drugs
If you need to use emergency contraception while using the vaginal ring (had intercourse and didn’t use a
backup method for the first 7 days or you forgot to insert the ring when you were supposed to), use Plan B or
the generic equivalent (levonorgestrel) rather than ELLA (ullipristal) because ELLA can decrease the efficacy of
your ring and the ring reduces the efficacy of ELLA.
The Ring may have adverse interactions with some other medications. In some cases contraceptive
effectiveness is lowered. In a few cases another drug may reach a toxic level in combination with the Ring. Be
sure to inform your clinician and pharmacist at each visit of any medications, including non-prescription drugs,
you are taking. Always advise any clinician that you see for any medical problem, especially if admitted
to a hospital or before surgery, that you are using Nuva Ring.
Sexually Transmitted Diseases and Preventative Care
The Nuva Ring doesn’t protect against sexually transmitted diseases.
Even though you are using the Nuva Ring, seriously consider using condoms as well in order to protect each
other from sexually transmitted diseases (STD’s) e.g., herpes, chlamydia, syphilis, HIV, etc. Pap testing is
recommended starting at age 21. See the UHS website for screening recommendations, self-directed testing
and scheduling an appointment. https://uhs.berkeley.edu/medical/primary-care/sexual-health-care-tang
