6 Things to Know About the Birth Control Ring

Although the pill is still the most widely used hormonal contraceptive in the United States, many people prefer a method that doesn’t require them to remember to take a pill every day. Those who dislike a daily pill might prefer a birth control patch that gets changed weekly, a birth control shot that you receive every three months or a longer-acting contraceptive like an IUD or birth control implant. For people looking for a method that’s more easily reversible than an IUD but doesn’t require much headspace, the birth control ring might be perfect. Here are six things to know if you are considering this method.

The birth control ring works similarly to the pill.

The birth control ring contains both estrogen and progestin, just like combination birth control pills. But unlike the pill, you don’t need to think about it every day. The ring slowly releases the hormones into your body over the course of three weeks, preventing ovulation and thinning the uterine lining to protect you from pregnancy. 

There are two types of birth control ring.

The original birth control ring, called Nuvaring, and now available in generic form, needs to be replaced once a month. But as of last year there is also a ring that you can use all year. Called Annovera, it’s a flexible silicone ring similar to Nuvaring but slightly bigger, and you use the same ring for an entire year.

Annovera also contains the hormones estrogen and progestin but compared to Nuvaring, Annovera contains a slightly lower dose of estrogen and a different type of progestin (called segesterone acetate), and it releases these hormones steadily over 13 cycles. After leaving Annovera in for 21 days, you remove it for 7 days when you have a period (or, technically, a “withdrawal bleed”). When you remove the Annovera ring, clean it with a mild soap and water, pat it dry with a cloth or paper towel, then store it in its case for a week. Like other forms of hormonal contraception, Annovera will likely make periods lighter and less painful, with reduced premenstrual symptoms.

You can use the ring to skip periods.

It’s perfectly safe to use Nuvaring and its generic version to skip your period. If you want a period, then remove your ring after three weeks, wait a week (when you’ll have a period), then insert a new ring at the end of the fourth week. To skip your period simply leave the ring in for all four weeks and immediately replace it with a new ring. If you do this consistently for a few months you may begin to have spotting or breakthrough bleeding throughout the month. If this happens and annoys you, then take a ring-free week to allow yourself to bleed and reduce spotting when you insert your next ring. Annovera is not FDA-approved for continuous use to skip periods, but some doctors may prescribe it this way for “off label” use. If you do use it to skip periods for a year you might need to replace it after 12 cycles instead of 13.

It’s best for people with insurance.

The out-of-pocket price for the ring is on the high side, about $150 for the generic version of Nuvaring and $2000 for Annovera. However, both rings may have a $0 copay with insurance, so if you are insured and interested in the birth control ring you should check with your plan on pricing.

You can take it out during sex.

It may sound weird to have a ring inside you all the time, but the rings are small (even Annovera is no bigger than a tampon), and they’re placed far enough into your vagina that you won’t feel it. There’s no risk that it can go up too far or “get lost.”

The ring is designed to be kept in during sex and it’s unlikely that your partner will be aware of it. However, you can remove the birth control ring during sex if you prefer, as long as you remember to put it back in as soon as you’re done. With Nuvaring, you can remove it for up to three hours every 24 hours and still be protected. For Annovera, you can safely take the ring out for up to two hours during a three-week cycle (either for one two-hour stretch or multiple shorter stretches that add up to two hours), but if it is outside of your body for longer than two hours you should use back-up contraception like a condom during sex for seven days.

The ring isn’t right for everybody.

People with certain risk factors shouldn’t use birth control containing estrogen, including the birth control ring. People over 35 who smoke, those who experience migraine with aura and those with a history of blood clots or stroke are some examples of people who should choose a progestin-only or non-hormonal birth control method instead. Nurx offers progestin-only pills and the birth control shot, and the birth control implant and IUD are two estrogen-free methods you can receive from an in-person provider. 

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