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NuvaRing (etonogestrel-ethinyl estradiol) alternatives: What can I take instead of NuvaRing?

Used to prevent pregnancy, this brand-name contraceptive doesn't work for everyone, but there are other options available
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By | May 31, 2024
A NuvaRing: NuvaRing alternatives

Key takeaways

  • There are many birth control options available, which differ in their composition, side effects, and specific patients who may benefit most or be at increased risk of adverse effects. 

  • Nuvaring provides a set-it-and-forget-it approach to contraception, as it is inserted once every cycle. Individual responses to hormonal contraception vary. If a patient experiences a significant side effect, alternative methods should be explored.

  • Certain individuals may not be candidates for estrogen-based birth control methods. Healthcare providers can offer a comprehensive range of alternative hormonal and non-hormonal options.

  • Transitioning from one form of contraceptive to another should only happen with medical advice. There is nuance to a change, and it is best to get accurate information to protect yourself from unwanted side effects or an unplanned pregnancy. 

In this article:

NuvaRing (etonogestrel-ethinyl estradiol) is branded formulation of a type of combined hormonal contraceptive, a vaginal birth control ring that is inserted similarly to a tampon and left in place for 3 weeks, followed by one ring-free week. A new ring is inserted with the subsequent cycle. Choosing a contraceptive can be an overwhelming process. There are many birth control options and countless considerations, including patient-specific needs, side effects, and drug interactions to consider. Continue reading to learn which hormonal contraceptive might be best for you.

RELATED: NuvaRing dosage, forms, and strengths

What can I take in place of NuvaRing?

If a contraindication or aversion to a combined hormonal contraceptive exists, there are other options besides NuvaRing. These alternative medications include other types of contraceptives, such as combined oral contraceptives (birth control pills) and depot medroxyprogesterone acetate injection (the birth control shot), as well as emergency contraception, intrauterine devices, progestin-only pills, progestin-only options, and nonhormonal options. It is important to note that contraceptives are not always taken as a birth control method but may also be used to manage conditions such as endometriosis, dysmenorrhea, and menorrhagia. 

Compare NuvaRing (etonogestrel-ethinyl estradiol) alternatives
Drug name Uses Dosage Savings options
NuvaRing
(ethinyl estradiol / etonogestrel) 		 Contraception Vaginal ring inserted and left in for 3 weeks, followed by one ring-free week. Repeat with each cycle. NuvaRing coupons 
Eluryng
(ethinyl estradiol / etonogestrel) 		 Contraception Vaginal ring inserted and left in for 3 weeks, followed by one ring-free week. Repeat with each cycle. Eluryng coupons 
Mirena (levonorgestrel intrauterine device)  Abnormal uterine bleeding, contraception, dysmenorrhea, endometrial hyperplasia Insert into the uterine cavity and replace by the end of 8 years. Mirena coupons 
Depo-Provera (medroxyprogesterone acetate)  Abnormal uterine bleeding contraception, endometrial carcinoma, endometriosis, endometrial hyperplasia, secondary amenorrhea 150 mg injection intramuscularly every 3 months (every 13 weeks) Depo-Provera coupons 
Depo-SubQ Provera 104 (medroxyprogesterone acetate)  Abnormal uterine bleeding contraception, endometrial carcinoma, endometriosis, endometrial hyperplasia, secondary amenorrhea 104 mg injection intramuscularly every 3 months (every 13 weeks) Depo-SubQ Provera 104 coupons 
Annovera
(ethinyl estradiol / segesterone acetate) 		 Contraception Vaginal ring inserted and left in for 3 weeks and removed for 1 week. The ring should be washed and can be reused for up to 13 cycles. Annovera coupons 
Nexplanon
(etonogestrel implant) 		 Contraception Insert 1 implant in the inner side of the upper, nondominant arm; remove no later than 3 years after the date of insertion. Nexplanon coupons 
Paragard
(intrauterine copper) 		 Contraception Insert into the uterine cavity and replace by the end of 10 years. Paragard coupons 

Other alternatives to NuvaRing

Top 5 NuvaRing alternatives

The following are some of the most common alternatives to NuvaRing.

1. Eluryng

Eluryng is a generic version of NuvaRing and shares the same dosing and side effects. Its biggest advantage over NuvaRing might be cost. Besides cost and preference, alternatives to both Nuvaring and Eluryng should be considered in women who smoke and are greater than 35 years old, have blood clots, have a history of certain types of cancers, have cardiovascular disease or uncontrolled diabetes, suffer from migraines, or take medications that interfere with the efficacy of the vaginal ring. 

2. Mirena

Mirena is an intrauterine device (IUD) exuding between 7 to 21 mcg per day of levonorgestrel, depending upon the duration of insertion. Mirena is a good option for individuals unable or unwilling to adhere to the exchange of NuvaRing needed every 28 days. This is because it is inserted and can remain in place and effective at preventing pregnancy for up to 8 years. In addition to contraception, Mirena may be a preferred alternative to NuvaRing in individuals who suffer from dysmenorrhea, treatment of endometrial hyperplasia, or prevention of estrogen therapy-associated endometrial hyperplasia. Mirena, as a progestin-only form of hormonal contraception, may also be preferred over NuvaRing in those who smoke cigarettes which is known to increase the risk of serious cardiovascular events in those on combination hormonal contraceptives. 

3. Depo-Provera

Depo-Provera is a depot medroxyprogesterone acetate injection. It can be administered either intramuscularly (IM) or subcutaneously (SQ). Depo-Provera is a good alternative to NuvaRing in individuals also receiving medications known as CYP3A4 inducers, which classically include phenytoin, carbamazepine, topiramate, among many others. Those medications may decrease the efficacy of estrogen-containing contraceptives. For those seeking long-acting contraception, the injectable option offers convenient dosing every 13 weeks. For individuals suffering from endometriosis, dysmenorrhea, or menorrhagia, Depo-Provera is also a desirable alternative based on clinical evidence to reduce symptoms associated with these conditions. A downside to this alternative is frequent irregular breakthrough bleeding, especially early on. Depo-Provera could also delay return to fertility for up to 12 months after the last dose. 

4. Annovera

 Annovera, like NuvaRing, is a vaginal birth control ring. But Annovera uses segesterone acetate, a different progestin than NuvaRing’s etonogestrel. Annovera shares common side effects with NuvaRing, like breast tenderness and irregular bleeding. However, the different progestin types might cause fewer side effects for some users. Like a tampon, Annovera is a vaginal ring inserted for 21 days, then removed for a week, typically causing a period. Neither protects against sexually transmitted infections. The difference between Annovera over NuvaRing is that the same vaginal ring is reused for 13 menstrual cycles (approximately one year). At the completion of the one-week ring-free period, the same ring is cleaned and reinserted. 

5. Nexplanon

Nexplanon offers an additional unique administration route for a hormonal contraceptive. The implant is a thin rod, like a matchstick, inserted under the skin in the upper arm by a healthcare professional. It may be left in place for up to 3 years. Nexplanon releases a low dose of a progestin-only, etonogestrel. For women who cannot tolerate estrogens, such as those with multiple cardiovascular risk factors or poorly controlled cardiovascular risk factors, Nexplanon is a preferred option. The implant provides continuous and long-lasting birth control and very little maintenance. Insertion is generally painless with the use of a local anesthetic, and, once removed, does not impact long-term fertility. 

Natural alternatives to NuvaRing

Non-hormonal birth control options also include barrier methods, which include;

  • Female condoms- internal condoms, which can help protect against pregnancy and sexually transmitted infections (STIs).
  • Diaphragms- smaller, shallow, cup-shaped disks made of silicone that cover the bottom of a female’s cervix to stop sperm from reaching a released egg.
  • Cervical caps
  • Sponges
  • Spermicides  

Some of these options require a prescription, while others are available over-the-counter. Additional non-hormonal methods of birth control options exist and include natural family planning methods, which may incorporate tracking factors like menstruation, cervical mucus, and basal temperature to predict ovulation. Lastly, copper intrauterine devices (IUDs) provide long-acting and reversible contraception. It is important to note that tracking methods and the copper IUD are not effective at preventing the transmission of STIs. 

How to switch to a NuvaRing alternative

Switching to a NuvaRing alternative may require planning, depending on the type of birth control and its use for pregnancy prevention. Implants, like Mirena, may be inserted at any time, including the hormone-free interval of the cycle. If Mirena is inserted during active use of a NuvaRing, remove the NuvaRing 7 days after Mirena insertion or at the end of the current treatment cycle. Transitioning from NuvaRing to Depo Provera, the injection should be administered within 7 days of removing the vaginal ring. When switching from Nuvaring to Nexplanon, Nexplanon should be inserted on the same day the vaginal ring was removed, or the day following the ring-free interval (at the latest). Given the nuance of switching forms of birth control, it should occur in discussion with the prescribing healthcare professional. 

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