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The vaginal ring doesn't offer protection from sexually transmitted infections.

About one out of 100 women will get pregnant in a typical year of using NuvaRing.

NuvaRing is generally very well-tolerated, but possible side effects include:

• Breakthrough bleeding or spotting
• Vaginal infection or irritation
• Increased vaginal secretion
• Headache
• Nausea
• Depression
• Decreased sex drive
• Breast tenderness
• An increased risk of blood-clotting problems, heart attack, stroke, liver cancer, gallbladder disease and toxic shock syndrome

Call your health care provider as soon as possible if you have:

• Foul vaginal odor or vaginal itching
• Irregular vaginal bleeding during more than one menstrual cycle
• New or worsening headaches
• Signs or symptoms of a blood clot in your leg, such as persistent pain in your calf
• Two missed periods or other possible signs of pregnancy

You'll need to request a prescription for NuvaRing from your health care provider. Your health care provider will review your medical history and check your blood pressure. Talk to your health care provider about any medications you're taking, including nonprescription and herbal products.

Your health care provider will determine the appropriate timing for you to start using NuvaRing based on your menstrual cycle and your previous birth control method. You may need to take a pregnancy test and use a nonhormonal backup method of contraception for one week when you start using NuvaRing.

A backup method of contraception may not be necessary if you previously used combination birth control pills or the skin patch (Ortho Evra) and insert NuvaRing on any day up to the day you would have started your new pack of pills or applied a new skin patch.

To use NuvaRing:

• Insert NuvaRing. Remove NuvaRing from its foil pouch. Find a position that's comfortable, such as standing with one leg up, squatting or lying down. Separate your labia with one hand. With your other hand, squeeze together the opposite sides of NuvaRing between your thumb and index finger.

Gently push NuvaRing deep inside your vagina. The exact placement of the ring doesn't change its effectiveness. What's important is that the ring is in a place that's comfortable for you.

If you feel discomfort, try pushing NuvaRing deeper inside your vagina. Keep the ring in place for three weeks.

You don't need to remove NuvaRing during sex. However, if you prefer, the ring can be removed for up to 3 hours and then reinserted.

• Gently remove NuvaRing. After three weeks of continuous use, gently remove NuvaRing. Hook your index finger under the rim of the ring or grasp the ring between your index finger and middle finger and gently pull it out.

Discard the used NuvaRing. Don't flush it down the toilet.

Wait one week to insert a new ring. Withdrawal bleeding usually begins two to three days after removing the ring.

You may still be bleeding when you insert the new ring. If you locate NuvaRing in your vagina but can't remove it, consult your health care provider.

• If NuvaRing falls out, reinsert it. NuvaRing can be expelled during tampon removal, sex or a bowel movement. If NuvaRing accidentally falls out, rinse the ring with cool or warm — not hot — water and reinsert it within three hours.
• If NuvaRing remains outside of your vagina for longer than three hours, use backup contraception. If this happens during the first or second week of NuvaRing use, reinsert NuvaRing as soon as possible and use a backup method of contraception for a week. If this happens during the third week of NuvaRing use, discard the ring.

Alternatively, if the NuvaRing is outside the vagina for more than three hours during the third week, you can start using a new ring right away. This may cause breakthrough spotting or bleeding. Use a backup method of contraception until you have used the new ring continuously for seven days.

Or, if you used NuvaRing continuously for at least the previous seven days prior to explusion, you can discard the ring and wait up to seven days from the time the ring was removed or expelled to insert a new ring. You'll have withdrawal bleeding. Use a backup method of contraception until you use the new ring continuously for seven days.

You can use a tampon while using the NuvaRing. NuvaRing, however, can interfere with the placement of a diaphragm. Don't use a diaphragm as a backup method of birth control while using NuvaRing.

If a ring breaks, discard it and use a new ring.