Key takeaways

NuvaRing, a vaginal birth control ring, can cause common side effects such as nausea, irregular bleeding, and headaches. It has serious potential side effects, including depression, blood clots, and toxic shock syndrome (TSS).
The risk of serious side effects like blood clots and TSS is increased in certain populations, including women over 35 who smoke and those with specific health conditions.
Many side effects of NuvaRing, such as spotting and mood changes, tend to decrease after the first few months of use, but some women may experience persistent or severe symptoms.
Avoiding NuvaRing side effects can involve following usage instructions carefully, providing a full medical history to healthcare providers, and checking for drug interactions.

NuvaRing (progestin and estrogen) is a vaginal ring that’s a form of birth control for women. The ring is latex-free and flexible. NuvaRing is about two inches wide and transparent in color. As a combination hormonal contraceptive, NuvaRing releases two hormones continuously over a three-week period when inserted into the vagina. When used correctly, NuvaRing can be highly effective at preventing unwanted pregnancy. Like all forms of birth control, there are some NuvaRing side effects.

It is important for women to determine with their healthcare provider what form of birth control is right for them and their bodies. While NuvaRing may work great for some, it may not be a great fit for others. This article is going to dive into some of the possible side effects and interactions caused by NuvaRing.

Common side effects of NuvaRing

Here are some common side effects reported from women who have used the birth control method NuvaRing:

Nausea and vomiting
Irregular vaginal bleeding
Breast tenderness or pain
Headaches including migraines
Acne
Weight gain
Abdominal pain
Changes in sex drive
Vaginal discomfort or irritation
Vaginal discharge
Depression
Changes in moods or emotions
Painful menstrual periods
Vaginal injury due to broken ring
Ring falling out

Less common side effects include:

High blood sugar, especially in women who have diabetes
High fat (cholesterol, triglycerides) levels in blood
Blotchy darkening of the skin
Vaginal yeast infection
Eye discomfort (problems with wearing contact lens)
Fluid retention

Irregular periods

Different methods of birth control (including birth control pills, the birth control shot, intrauterine devices also called IUDs) can affect your menstrual period in different ways.

While using NuvaRing, some women may experience bleeding during times when they are not on their menstrual period. The amount of bleeding can vary from person to person. This bleeding may present as slight staining to breakthrough bleeding much like a regular period. Bleeding between periods is more common for new users. However, for some women, this bleeding continues throughout use. Such bleeding usually does not suggest any serious problems.

Most women will still have a period while using NuvaRing. They can experience changes in their periods, including length of period and changes in flow.

It is possible to miss a period while using NuvaRing even if a woman is not pregnant. However, if a woman does miss her period, she should consider a chance of pregnancy if she removed NuvaRing during the usage time for longer than three hours or if she did not insert a new ring within a week of taking out the old one. A woman may also be pregnant after missing a period if she left NuvaRing in for a duration exceeding four weeks or if she misses two periods consecutively while using NuvaRing correctly.

Yeast infections

Hormonal birth control can cause imbalances that lead to yeast infections. NuvaRing is a hormonal birth control method, so there is a chance that women who use it may experience yeast infections.

Hormone birth control methods can alter the balance of hormones in the body and cause an overgrowth of yeast in the vagina. Women’s bodies usually already have a healthy balance of yeast, but when there’s too much yeast, it can cause infections and discomfort.

If a woman thinks she may have a yeast infection, she can identify it with the following symptoms:

Thick, white discharge
Itching or burning
Red or swollen vagina
Discomfort during sexual intercourse

Usually, a yeast infection is treatable at home with over-the-counter (OTC) products. Women can go to their local pharmacy and find products to treat mild yeast infections.

Women should go to their OB-GYN if they experience a severe yeast infection. If OTC treatment is not helping a yeast infection, a stronger medication may be needed that can only be prescribed by a professional. If women experience extremely painful or amplified symptoms, they should consult with their provider right away.

The following indicate a need to contact a healthcare professional:

Yeast infection that lasts more than a week while being treated with OTC products
Frequent yeast infections (four or more in a year)
Additional symptoms such as fever, abdominal pain, or vaginal discharge with a foul or unpleasant odor
Those who are pregnant or nursing

Acne

Many women experience hormonal acne both during their period and in general. Hormone imbalances can cause acne, so it only makes sense that hormonal birth control could as well. NuvaRing does list acne as a potential side effect when using the product.

If women experience a hormone imbalance while using NuvaRing, they may experience more acne. On the flip side, NuvaRing can also decrease acne if women have a hormone imbalance before starting hormonal contraceptives. So for women experiencing hormonal acne and interested in a hormonal contraceptive option, NuvaRing could help decrease their acne while providing pregnancy prevention.

Serious side effects of NuvaRing

NuvaRing has a black box warning, the FDA’s most strict warning for medications. Black box warnings are established to alert healthcare providers and patients about serious side effects that can result in injury or death. NuvaRing’s black box warning relates to cigarette smoking and how it increases the risk of serious cardiovascular side effects from combination contraceptive use. This risk increases with age and with heavy smoking (15 or more cigarettes per day) and has a higher risk in women over 35. Women who use combination hormonal contraceptives, including NuvaRing, should be strongly advised not to smoke.

While serious side effects are typically not common, there are instances reported where NuvaRing users have experienced more serious side effects. If women experience serious or persistent side effects, they should contact a healthcare professional promptly or seek medical help if necessary.

Toxic shock syndrome (TSS)
Cardiovascular side effects (stroke, cerebral hemorrhage, heart complications and heart attack, thrombosis and thromboembolism, or high blood pressure)
Pancreatitis
Depression
Anaphylaxis or anaphylactoid reaction
Hypersensitivity reaction
Hepatic adenoma
Cholestasis
Gallbladder disease
Erythema multiforme
Ocular lesions
Porphyria

Depression

Another potential side effect while using NuvaRing is depression or changes in mood. Since hormone levels can greatly affect a person’s moods, depression can develop when the body adjusts to hormones when starting NuvaRing and during regular use.

Women who have suffered from depression previously are at higher risk of experiencing depression while using NuvaRing.

Women should always contact their healthcare provider if they think they may be experiencing depression. This is especially important if women have any thoughts of self-harm, suicide, or thoughts of harming others. For free and confidential support, there is the National Suicide Prevention Lifeline: 1-800-273-8255.

Blood clots

A serious potential side effect while using NuvaRing is blood clots. This side effect relates to the black box warning associated with NuvaRing. There are certain women who are at a higher risk for clotting including those who are older than 35, obese, or smoke.

The risk for blood clots is highest when women first start using NuvaRing and when they re-start NuvaRing after not using it for at least one month. In some studies of women who used NuvaRing, the risk of getting a blood clot was similar to the risk in women who used oral combination birth control pills. Examples of serious blood clots are:

Legs (deep vein thrombosis)
Lungs (pulmonary embolism)
Eyes (loss of eyesight)
Heart (heart attack)
Brain (stroke)

Women should seek medical attention immediately if they experience any of the following symptoms associated with blood clots:

Persistent leg pain
Changes in vision, including blindness
Yellowing of the skin and eyes
Weakness or loss of feeling in limbs
Sudden headache that is extremely painful
Shortness of breath
Chest pain or pressure in the chest
Difficulty speaking

Toxic shock syndrome (TSS)

Another serious potential side effect of NuvaRing is toxic shock syndrome (TSS). This is a form of severe damage and illness that happens when bacteria release toxins into the bloodstream.

Since the ring is inserted into the vagina, there is the possibility that NuvaRing can provide a place for harmful bacteria to grow. It is very important to make sure NuvaRing is removed after using it for three weeks. If the user forgets to remove the ring, NuvaRing can safely be in place for up to four weeks.

Symptoms of TSS can be similar to the flu, but they can become serious very quickly. Since TSS is life-threatening, women should call their healthcare provider or get emergency treatment right away if they experience the following symptoms while using NuvaRing:

Sudden high fever
Vomiting and diarrhea
A sunburn-like rash
Muscle aches
Dizziness
Seizures
Confusion
Fainting

How long do NuvaRing side effects last?

Many women experience some of the mild side effects of NuvaRing within the first one to three months of using this contraceptive method. During this timeframe, the body is adjusting to having the product in place and to the new hormones introduced into the system.

Most women will notice that these side effects decrease after the first couple of months. However, some women may experience mild to severe side effects during the entire time of use.

Many women experience spotting or spontaneous bleeding between periods in the first couple of months of using NuvaRing. For most women, this is a temporary side effect and stops after one to three months. For women who continue to experience unexpected bleeding while using NuvaRing, they should notify their doctor.

Some of the other mild NuvaRing side effects that women may experience during the first couple months of using NuvaRing include acne, changes in mood or sex drive, discharge, and vaginal discomfort.

There are more mild side effects that some women may experience, especially during the first few months. If women experience persistent side effects after the first couple months of use or severe symptoms during any time of use, they should notify their healthcare provider.

Stopping NuvaRing

When the body has gotten used to hormonal contraception, women can experience symptoms when they stop using it. These symptoms are similar to the symptoms many women experience when they first start using NuvaRing.

When stopping hormonal birth control of any kind, like NuvaRing, women may experience the following symptoms:

Changes in menstrual period
Mood changes
Changes in sex drive
Sore breasts
Headaches

NuvaRing contraindications and warnings

Restrictions

While NuvaRing can be a convenient contraceptive option for some women, it is not the best fit for everyone. Certain women should not use NuvaRing. If women have any of the following contraindications, they should consider alternative birth control methods:

Women over the age of 35 who smoke
A history of blood clots or are more prone to getting blood clots
Any medical history of high blood pressure that does not respond to prescription drugs
Abnormal vaginal bleeding
Any female-related cancer (breast cancer, uterine cancer, etc.)
Allergies to any of the hormones or ingredients used in NuvaRing
Heart problems or a previous heart attack or stroke
Diabetes that has affected your blood vessels
Severe migraines, or if you are over 35 and have trouble with migraines
Take certain medications for hepatitis
Women who are pregnant
Active liver disease or liver tumors
Known or suspected pregnancy
Major surgery requiring prolonged bed rest

According to the FDA, NuvaRing has an extremely rare chance of causing liver tumors and even liver cancer. Women should tell their provider if they have a history of liver disease.

Overdose

NuvaRing should stay in place for three weeks and be removed for one week, and then a new NuvaRing should be inserted. If a woman forgets to remove her NuvaRing after three weeks, the NuvaRing can safely remain in place for a total of four weeks. After this amount of time, women are at risk for pregnancy.

Overdose of NuvaRing is not likely if the user follows the proper directions. If the NuvaRing breaks or loses its’ shape while in the vagina, it will not release a higher amount of the hormones. Women can become pregnant if NuvaRing is left in longer than advised.

For hygienic reasons, NuvaRing should not remain in place longer than four weeks. If women have forgotten to change their NuvaRing for longer than four weeks, they should consult their provider for medical advice.

Women should never use more than one NuvaRing at a time. This can cause an excess of hormones, leading to symptoms including bleeding, nausea, or vomiting.

NuvaRing interactions

Unsafe reactions can happen if NuvaRing is used with certain medications. It is important to not take the following medications while using NuvaRing:

Cisapride (GERD medication)
Certain medications used to treat hepatitis (dasabuvir, ombitasvir, paritaprevir, ritonavir)
Certain medications used to treat HIV, such as fosamprenavir
Thioridazine (antipsychotic medication)
Tranexamic acid (heavy menstrual bleeding medication)

How to avoid NuvaRing side effects

While for some women NuvaRing side effects may be unavoidable, there are a few steps that can be taken to prevent side effects with NuvaRing.

1. Follow instructions for using NuvaRing

One of the best ways to avoid side effects and complications while using NuvaRing is to follow the package directions. It is important to know that NuvaRing does not protect against HIV infection (AIDS) and other sexually transmitted diseases.

During a four-week cycle, NuvaRing is placed in the vagina for three weeks and then removed for one week. Women will typically have their period during the week without using the NuvaRing.

Some women have accidentally inserted NuvaRing into their bladder. If women have pain during or after insertion and can’t find NuvaRing in their vagina, they should call a health care provider right away. Only use NuvaRing with the supervision of a professional. Make sure to discuss any questions or concerns about birth control methods with your healthcare provider.

2. Provide a full medical history

Before deciding to start using NuvaRing or any other form of hormonal birth control, always discuss it with a professional. Providers can look back at a woman’s medical history and note anything that may prevent NuvaRing from being the best and safest option. Make sure that NuvaRing is the best choice before starting it.

3. Check interactions

Certain drugs can interact with NuvaRing. It is important for women to talk with a doctor if they are using medications for HIV, hepatitis, or heavy menstrual bleeding before taking NuvaRing.

Picking the best birth control can feel challenging at times. The most helpful way to figure out the best option is to have a conversation with a provider. Do not start any form of hormonal birth control without first talking to a doctor or OB-GYN.

Resources:

Adverse reactions, Epocrates
Frequently asked questions, NuvaRing
What are the disadvantages of the birth control ring, Planned Parenthood
Possible risks and side effects for NuvaRing, NuvaRing
Patient information, Merck
Toxic shock syndrome, John Hopkins Medicine
NuvaRing, FDA
Drug interactions, Epocrates
Prescribing information, Merck