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Key Points for Providers and Clients

Requires keeping a flexible ring in the vagina.

It is kept in place all the time, every day and night for 3 weeks, followed by a week with no ring in place.

Start each new ring on time for greatest effectiveness.

Bleeding changes are common but not harmful.

Typically, irregular bleeding for the first few months and then lighter and more regular bleeding.

Combined vaginal ring


What Is the Combined Vaginal Ring?

  • A flexible ring placed in the vagina.
  • Continuously releases 2 hormones—a progestin and an estrogen, like the natural hormones progesterone and estrogen in a woman’s body—from inside the ring. Hormones are absorbed through the wall of the vagina directly into the bloodstream.
  • The ring is kept in place for 3 weeks, then removed for the fourth week.
  • During this fourth week the woman will have monthly bleeding.
  • Also called NuvaRing.
  • Works primarily by preventing the release of eggs from the ovaries (ovulation).

How effective?

Effectiveness depends on the user: risk of pregnancy is greatest when a woman is late to start a new ring.

The combined vaginal ring is new, and research on effectiveness is limited. Effectiveness rates in clinical trials of the vaginal ring suggest that it may be more effective than combined oral contraceptives, both as commonly used and with consistent and correct use (see Combined Oral Contraceptives, How Effective?).

Return of fertility after ring use is stopped: no delay

Protection against sexually transmitted infections: none

Side Effects, Health Benefits, and Health Risks

Side Effects

Some users report the following:

Changes in monthly bleeding, including:

– Lighter bleeding and fewer days of bleeding

– Irregular bleeding

– Infrequent bleeding

– Prolonged bleeding

– No monthly bleeding

  • Headaches
  • Irritation, redness, or inflammation of the vagina (vaginitis)
  • White vaginal discharge

Known Health Benefits and Health Risks

Long-term studies of the vaginal ring are limited, but researchers expect that its health benefits and risks are like those of combined oral contraceptives(see Combined Oral Contraceptives, Health Benefits and Health Risks).

Medical eligibility criteria, guidelines for when to start, and helping continuing users are the same for the combined ring as for combined oral contraceptives.

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