Combined hormonal contraceptive (vaginal ring) Pregnancy: Not indicated during pregnancy — if pregnancy occurs with the ring in situ, the ring should be removed. Extensive epidemiological studies have revealed neither an increased risk of birth defects in children born to women who used COCs before pregnancy nor a teratogenic effect when COCs were used inadvertently in early pregnancy; clinical experience of pregnancy outcomes exposed to NuvaRing has not been reported. Consider the increased risk of VTE in the postpartum period when re-starting. Breastfeeding: lactation may be influenced by oestrogens (reduced quantity and altered composition of milk), so use is generally not recommended until the nursing mother has completely weaned her child; small amounts of contraceptive steroids and/or metabolites may be excreted in milk but there is no evidence of adverse effect on infant health.

Ethinylestradiol with etonogestrel

Brand names: NuvaRing

A combined hormonal contraceptive delivering ethinylestradiol with etonogestrel, most familiar as the combined contraceptive vaginal ring.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: One vaginal ring (NuvaRing) inserted into the vagina and left in place continuously for 3 weeks

Route: Vaginal — the woman inserts the ring herself; it is compressed and inserted until it feels comfortable (an optional applicator may be used where available). The exact position in the vagina is not critical for the contraceptive effect

Frequency: One ring worn continuously for 3 weeks, then removed on the same day of the week as it was inserted; after a ring-free interval of one week a new ring is inserted. The withdrawal bleed usually starts 2-3 days after removal and may not have finished before the next insertion is due

Max: Only one ring is to be used at a time

STARTING — no hormonal contraceptive use in the preceding cycle: insert on the first day of the natural cycle (first day of menstrual bleeding); starting on days 2-5 is allowed but an additional barrier method is recommended for the first 7 days of the first cycle. SWITCHING — from a combined hormonal contraceptive: insert at the latest on the day following the usual tablet-free, patch-free or placebo interval of the previous method; if the previous method was used consistently and correctly and pregnancy is reasonably excluded, she may switch on any day of the cycle, but the hormone-free interval of the previous method should never be extended beyond its recommended length. From a progestagen-only method (minipill, implant or injection) or a progestagen-releasing IUS: may switch on any day (implant/IUS on the day of removal; injectable when the next injection would be due) but use an additional barrier method for the first 7 days of use. AFTER PREGNANCY — following first-trimester abortion may start immediately with no additional measures (if immediate use is undesirable, follow the 'no hormonal contraceptive in the preceding cycle' advice and use an alternative method in the meantime); following delivery or second-trimester abortion start during the fourth week, and if starting later use a barrier method (the SPC extract is truncated at this point — clinician to confirm the full advice from the SPC). PRACTICAL POINTS — advise regular checking for the presence of the ring (e.g. before and after intercourse); if accidentally expelled follow the SPC advice on 'What to do if the ring is temporarily outside the vagina'. NuvaRing may interfere with the correct placement of a diaphragm, cervical cap or female condom, so these should not be used as back-up methods. Remove by hooking an index finger under the ring or grasping it between the index and middle finger; place the used ring in its sachet (out of reach of children and pets) and discard as described in the SPC. PAEDIATRIC — the safety and efficacy of NuvaRing in adolescents under the age of 18 have not been studied.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Presence or risk of venous thromboembolism — current VTE (on anticoagulants) or history of DVT/PE; known hereditary or acquired predisposition (APC-resistance including Factor V Leiden, antithrombin-III deficiency, protein C deficiency, protein S deficiency); major surgery with prolonged immobilisation; high risk of VTE due to multiple risk factors
Presence or risk of arterial thromboembolism — current or previous ATE (e.g. myocardial infarction) or prodromal condition (e.g. angina pectoris); cerebrovascular disease (current or previous stroke, or TIA); known hereditary or acquired predisposition (hyperhomocysteinaemia, antiphospholipid antibodies); history of migraine with focal neurological symptoms; high risk of ATE due to multiple risk factors or one serious risk factor such as diabetes mellitus with vascular symptoms, severe hypertension or severe dyslipoproteinaemia
Pancreatitis or a history thereof if associated with severe hypertriglyceridaemia
Presence or history of severe hepatic disease as long as liver function values have not returned to normal
Presence or history of liver tumours (benign or malignant)
Known or suspected malignant conditions of the genital organs or the breasts, if sex steroid-influenced
Undiagnosed vaginal bleeding
Hypersensitivity to the active substances or to any of the excipients
Concomitant use with medicinal products containing ombitasvir/paritaprevir/ritonavir and dasabuvir, glecaprevir/pibrentasvir, or sofosbuvir/velpatasvir/voxilaprevir

Side effects

Headache and migraine (common) — headache was among the most frequently reported effects in clinical trials, in 5-6% of women
Vaginal infection and vaginal discharge (common) — each reported by 5-6% of women; also genital pruritus, dysmenorrhoea, pelvic pain, breast tenderness (common)
Abdominal pain, nausea (common); abdominal distension, diarrhoea, vomiting, constipation (uncommon)
Vaginal ring discomfort and vaginal ring expelled (common); vaginal ring complication (uncommon); vaginal injury associated with ring breakage
Depression, libido decreased (common); fatigue, irritability, malaise, oedema, sensation of foreign body (common); acne (common); weight increased (common)
Venous thromboembolism and arterial thromboembolism (rare) — an increased risk of arterial and venous thrombotic and thromboembolic events including myocardial infarction, stroke, transient ischaemic attack, venous thrombosis and pulmonary embolism has been observed in women using CHCs

Interactions

Medicinal products containing ombitasvir/paritaprevir/ritonavir and dasabuvir, glecaprevir/pibrentasvir, or sofosbuvir/velpatasvir/voxilaprevir — concomitant use is contraindicated (stated in SPC §4.3 cross-referring to §4.5; the full §4.5 interaction section was not captured in this bundle — clinician to review it)
Female vaginal barrier methods (diaphragm, cervical cap, female condom) — NuvaRing may interfere with their correct placement and position; they should not be used as back-up methods (SPC §4.2)

Clinical monograph

How it works

The ring releases both hormones for transmucosal absorption, suppressing ovulation while thickening cervical mucus and altering the endometrium; the vaginal route avoids first-pass hepatic metabolism.

Prescribing in practice

Despite the non-oral route the systemic VTE and arterial risks are the same as for combined oral contraceptives, so apply the full UKMEC contraindication screen.
Counsel on what to do if the ring is expelled or left out beyond the permitted window, as efficacy may be compromised.
Efficacy can still be reduced by enzyme-inducing drugs.

Monitoring

Check blood pressure and reassess cardiovascular and VTE risk at initiation and periodic review.

Counselling the patient

Know how long the ring can be out before back-up contraception is needed.
The ring does not protect against sexually transmitted infections.
Seek urgent help for leg swelling, chest pain, breathlessness or sudden severe headache.

Evidence & guidelines

UKMEC applies the same combined-method eligibility criteria to the contraceptive vaginal ring as to oral preparations.

Reference: FSRH CHC guideline; UKMEC; MHRA Drug Safety Update; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways