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HomeHealth ConditionsBirth Control

Vaginal Birth Control Rings: Available Brands, Effectiveness, and Risks

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMPStacia Woodcock, PharmD
Updated on November 28, 2022

Key takeaways:

  • NuvaRing (etonogestrel/ethinyl estradiol) and Annovera (segesterone acetate/ethinyl estradiol) are the two types of vaginal birth control rings currently available.

  • Vaginal birth control rings are a great option if you don't want to take a pill every day. Both types of vaginal rings have similar side effects and warnings.

  • NuvaRing and Annovera are both available as brand-name medications. But you can also find NuvaRing as a lower-cost generic. GoodRx can help make your prescription more affordable.

Close-up of a woman's hand holding a birth control ring, vaginal ring contraceptive.
Cerro Photography/iStock via Getty Images

When you’re taking birth control pills, it’s essential not to miss any doses. But remembering to take a pill every day can be tricky. Contraception doesn’t have to be a daily burden, however. Vaginal birth control rings are an option that doesn’t require as much maintenance as daily birth control pills.

Vaginal rings are a safe and effective method of hormonal contraception. There are two main types: NuvaRing (etonogestrel/ethinyl estradiol) and Annovera (segesterone acetate/ethinyl estradiol).

But how do you choose which vaginal birth control ring is right for you? Let’s discuss.

What are vaginal birth control rings?

Vaginal birth control rings are small, flexible rings that are inserted into the vagina. They work by slowly releasing pregnancy-preventing hormones into the body. A ring is left in place in the vagina for 3 weeks, and then removed for 1 week. You should get your period during this week off. After that, the cycle is repeated.

Some healthcare providers may suggest using the vaginal ring continuously, without taking weeks off, which can allow the user to skip their period. But this use is considered off-label and isn’t recommended by the rings’ manufacturers. Discuss using vaginal rings this way with your provider before trying it on your own.

What are the options for vaginal birth control rings?

Both brand-name and generic birth control rings are available.

NuvaRing

NuvaRing was the first vaginal birth control ring, receiving FDA approval in 2001. Each ring contains enough hormones for 4 weeks and should be discarded after one use.

The FDA approved the first generic version of NuvaRing — EluRyng — in 2019. A second generic etonogestrel/ethinyl estradiol vaginal ring became available in 2021. A third, called Haloette, is the most recent generic version to come to market and received FDA approval in 2022.

For a while, there were rumors that NuvaRing would be discontinued in 2020. But this isn’t true. Brand-name NuvaRing is still available at this time.

Annovera

Annovera is another vaginal birth control ring. It was approved by the FDA in 2018. Each ring has enough hormones for about 1 year of birth control. It should be washed with soap and warm water between each 3-week use period. There is no generic version of Annovera available yet.

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What are the pros and cons of using a vaginal birth control ring?

It can be convenient to not have to remember your birth control every day, but there are also other things to consider when deciding whether a vaginal birth control ring is right for you. Here are a few pros and cons to think about.

Pros of vaginal birth control rings Cons of vaginal birth control rings
You don’t have to remember to take a pill every day. Insertion and removal take practice to get used to.
You can insert and remove the ring yourself. Some people might feel the ring during sex.
Birth control rings may make your periods lighter. In rare cases, the ring can fall out. If the ring falls out, its effectiveness goes down.
Fertility returns to normal right after stopping. Common side effects include breast tenderness, headache, and nausea.
Vaginal rings have other health benefits, such as lowering the risk of endometrial (uterine) and ovarian cancer. Serious side effects, such as blood clots and breast cancer, are rare but possible.

How effective are birth control rings?

If used perfectly, the birth control ring is 99% effective in the prevention of pregnancy. But people aren’t perfect, so it’s important to know that the vaginal ring’s typical effectiveness is slightly lower. Taking into account human error (like forgetting to put the ring in on time), real-life effectiveness is closer to 93%.

What are the side effects of birth control rings?

There are a few common side effects with birth control rings. Typical NuvaRing side effects and Annovera side effects include:

  • Irregular bleeding, including lighter or heavier periods and breakthrough bleeding

  • Headache, including migraines

  • Nausea or vomiting

  • Breast tenderness

  • Menstrual cramps or lower stomach pain

What are the potential risks of vaginal birth control rings?

Like most medications, vaginal birth control rings have potential risks.

  • Blood clots: Because vaginal birth control rings contain forms of estrogen, they carry a risk of blood clots. If you experience sudden pain, redness, or swelling in your legs, seek emergency care. Birth control rings should be avoided if your blood clot risk is higher, such as if you smoke and are over the age of 35.

  • Breast cancer: Breast cancer is a rare but serious potential side effect of birth control methods that contains estrogen. If you have had breast cancer or have a strong history of breast cancer in your family, vaginal rings might not be right for you.

  • Ulcers on the vagina or cervix: This is a rare side effect that occurs with vaginal rings. If you already have these issues, birth control rings aren’t recommended. In severe cases, a ring can become embedded in vaginal tissue and will have to be removed by a healthcare provider.

  • Vaginal injury: There are reports of NuvaRing breaking inside the vagina, which could cause injury.

  • Toxic shock syndrome (TSS): Although rare, TSS (a bacterial infection) can occur. Symptoms to look out for include sudden skin redness, vomiting, or flu-like symptoms. TSS requires medical attention in a hospital to help avoid serious complications.

  • Vaginal infections: About 10% of women using Annovera reported urinary tract infections or vaginal yeast infections. Careful cleaning of the ring with warm soap and water before each monthly reinsertion helps lower this risk. Vaginal douching isn’t recommended.

Can my partner feel a birth control ring?

Not usually. Vaginal birth control rings are made of soft, flexible plastics. So when they are placed correctly you shouldn't feel them at all. Most partners also say they can't feel vaginal rings during sex. But there are rare reports of male partners experiencing irritation on their penis after having vaginal sex with someone who has a ring in.

How to save on vaginal birth control rings

There are many ways to save on NuvaRing and Annovera. Both are available as brand-name medications. But you can also find NuvaRing as a lower-cost generic. GoodRx can help you navigate many ways to save on your prescription.

  • Save with GoodRx. GoodRx can help you save over 70% off the average retail price of the generic version of NuvaRing. Generic Nuvaring’s price at certain pharmacies is less than $50 with a free GoodRx discount.

  • Save with a copay savings card. If you have commercial insurance and meet eligibility requirements, Annovera’s price is as little as $0 using a savings card from the manufacturer.

Which birth control ring is right for me?

Choosing the right vaginal birth control ring for you can be tricky. Both types are effective and are placed in a similar way, but there are a few small differences you should know about. We’ve laid out basic information about each type of ring in the table below. But it is best to consult your healthcare provider to decide what type of birth control is best for you.

Questions NuvaRing Annovera
How effective is it? 99% with perfect use
93% with typical use
99% with perfect use
93% with typical use
Is there a generic version? Yes No
How long does the ring stay in the vagina? 21 days 21 days
How long does each ring last? One menstrual cycle 13 menstrual cycles (about 1 year)
Does it protect against sexually transmitted infections (STIs)? No No
What do I do if the ring falls out? If NuvaRing falls out and has been out for less than 3 hours, rinse it with lukewarm water and reinsert it. If it’s been out for more than 3 hours, contact your healthcare provider or pharmacist for detailed instructions on how to proceed. With Annovera, clean off the ring as you would before inserting it for the 21-day ring-in time. If it’s out for more than 2 hours total during the 21 days you have the ring inserted, you should reinsert it and use a back-up birth control method (such as condoms) until Annovera has been in place again for 7 days in a row.

The bottom line

Nuvaring and Annovera are the brand names of the two types of vaginal birth control rings currently available. Both are inserted for 3 weeks at a time and removed for 1 week, during which you can get a period. When used correctly, vaginal birth control rings can be up to 99% effective.

One advantage of using this method of birth control is that you don’t have to remember daily pills. But vaginal birth control rings still carry a few common side effects and some serious risks. Speak to your healthcare provider or pharmacist if you’re interested in starting a vaginal birth control ring.

References

Amneal. (2019). Amneal receives abbreviated new drug application approval for EluRyng, the first generic NuvaRing.

Houn, F. (2019). Approval letter. U.S. Department of Health & Human Services.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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