Is The Ring Just Bad As The Birth Control Pill? Here Are The Pros And Cons

“Tired of your old birth control routine? Maybe it’s time to break free from the pack with NuvaRing,” suggests a friendly voice narrating an old NuvaRing commercial. On screen, happy-go-lucky synchronized swimmers don their yellow, retro flower petal swim caps and matching swimsuits as they dive into a pool during a choreographed routine. Who wouldn’t watch a commercial like this and feel like their old-fashioned, daily pill popping is so passé when you could instead place a silicone ring in your vagina and be pregnancy-free for weeks on end? 

This form of birth control, known commercially as NuvaRing or Annovera, however, is anything but as lighthearted as its marketing once made it seem. Though there are numerous women who have gone on and off their birth control rings with no issue, the contraceptive ring has a bit of a questionable reputation, including a class action lawsuit which the manufacturer lost. Ahead of trying out any new hormonal birth control, it’s critical that you understand all of the pros and cons associated, so let’s take a look at this contraceptive.

What’s This Removable, Long-Acting Contraceptive Anyway?

According to NuvaRing’s and Annovera’s official websites, these flexible birth control vaginal rings are as effective as the hormonal birth control pill when used as directed. They assert that rings are easy to both insert and remove, and that they are convenient because you don’t have to remember to take it every day as you would with the pill.

Here’s how it works: On the same day at the same time once a month, you have to insert a new ring and then remove it after 21 days. During this three week period, the little ring delivers you a low dose (15 micrograms) of ethinyl estradiol, the synthetic estrogen, and etonogestrel (120 micrograms), which is the synthetic progesterone known as progestin. 

Together, these work to prevent your ovaries from releasing a monthly egg and thicken your cervical mucus to prevent sperm from entering. Then, after you go through one week without a ring in, you must insert a new ring seven days later.

Annovera is also a combination hormonal contraceptive, but uses segesterone acetate as its synthetic progesterone and ethinyl estradiol as its synthetic estrogen, both at nearly identical dosage levels. This ring is FDA-approved to be effective for up to 13 cycles.

Pro: You’re Getting a Lower Dose of Synthetic Hormones

By using the ring, you’re supposed to have a reduced risk for side effects due to the lower levels of the synthetic hormone ethinyl estradiol. For comparison, the standard combined hormonal contraceptive pill (not the progestin-only pill) can contain anywhere between 30 to 50 micrograms of estrogen. There are low dose pills that have grown in popularity, such as Loestrin, but your standard birth control pill will typically have about 30 to 35 micrograms of estrogen. 

Additionally, the ring’s external makeup is ethylene vinyl acetate copolymer, which means that any damage to the ring itself wouldn’t cause the contraceptive to accidentally release higher levels of hormones into your body. While this also means it’s safe for people with latex allergies, the verdict is out on whether or not you should be concerned about putting silicone into sensitive organs for long durations of time.

Pro: You Can Sort of “Fix It and Forget It”

Instead of having to remember to take your pill daily, vaginal rings are much easier to use because you have one day a month you remove it and one day a month you insert a new one. 

Are things getting hot and heavy with your man? Well, since you’ve already got a little silicone device in your vagina, you wouldn’t have to interrupt sex if your goal is not to get pregnant. 

Pro: It’s Actually Quite Effective When Used Properly

The effectiveness of birth control rings is about 91%, but when used correctly, it can be up to 99% effective in preventing pregnancy. This is contingent on you making sure you know the right day on the calendar each month you’re supposed to remove the ring and then follow up seven days later with a new ring. If you’re using NuvaRing, you also need to make sure that before you insert your ring, it has been stored at a temperature range between 68 and 77 degrees, otherwise its effectiveness could be a bit faulty.

Your risk of certain cancers is lowered, and you’re less likely to develop functional ovarian cysts.

Pro: You Do Benefit from Lessened Risks for Certain Conditions

Birth control rings are considered to be safer contraceptive options for women who have a history of iron deficiencies or struggle with anemia. In fact, some evidence shows that the rings can actually improve anemic conditions. Some women who experience intermenstrual or irregular bleeding (from anemia or other conditions like dysmenorrhea or menorrhagia) may also see improvement in their regularity of bleeding. Let’s be clear, however, the bleeding you’d be experiencing isn’t a typical menstrual bleed.

Furthermore, your risk of certain cancers (ovarian, endometrial, and benign breast disease) is lowered when using the birth control ring, and you’re less likely to develop functional ovarian cysts.

Con: You May Experience Irregular or Abnormal Bleeding

As with all forms of hormonal birth control, you’re sort of taking a gamble on how your body will react to the different levels of synthetic estrogens or progesterones (in the form of progestin) flowing through your system. Consequently, while some women will end up with very regular bleeding cycles while using the ring, others have reported light to heavy intermenstrual spotting, light to heavy spotting during the 21 days, or even amenorrhea (no bleeding at all).

Con: Synthetic Hormones May Make You Feel a Bit Ick

While the ring does contain a lower dosage of synthetic hormones, your body may still have a few adverse reactions to this new medication. At varying levels of severity, some women experience mood swings, fatigue, breast tenderness, headaches, loss of appetite, an urge to throw up, anxiety, and depression.

If, while on the ring, your acne ends up getting worse, you develop hirsutism (excess hair growth particularly on the face), or you experience breast enlargement and discharge, you’d understandably feel a bit worse about your body image as well. Furthermore, some women have experienced a significant increase in their body weight while using the ring.

Con: Your Risk for Certain Conditions and Diseases Will Increase

Though many of the more severe side effects from the birth control ring are rare, it’s worth mentioning them to dot all your i’s and cross all your t’s! Studies have shown associations between the hormones used in contraceptives like the ring or the pill and developing hepatitis or hepatic adenomas, which are liver lesions that may begin as benign but then become malignant tumors. Similarly, your risk of other cancers like liver cancer and breast cancer is increased when taking hormonal contraceptives through the birth control ring.

You should also be aware of the fact that your risk for developing a sexually transmitted infection or disease is heightened when just relying on the birth control ring. So, your risk of contracting human papillomavirus (HPV), herpes, syphilis, hepatitis, trichomoniasis, gonorrhea, chlamydia, human immunodeficiency virus (HIV), and more could theoretically increase. 

If you’re choosing to have condomless sex with your man and you don’t happen to know if he’s STI-free, you won’t be protected from contracting anything from him just by virtue of using the ring.

Con: Your Ring Might Accidentally Fall Out During Use

There are a few circumstances where your birth control ring could actually fall out. The most awkward situation is definitely that penetrative sex can cause the ring to fall out, and your man might even feel the ring while you’re deep in the heat of the moment! Additionally, using tampons and dildos as well as just going “number two” might also move it out of place. If this happens, you’re supposed to have a two to three-hour window where you can re-insert the ring and maintain effectiveness.

Cycle issues before birth control will still be cycle issues after birth control. 

Con: You’re Masking and Potentially Exacerbating Hormonal Issues

Of all the hormonal birth control options, many say that the ring is one of the easiest to quit and then be able to return to your normal fertility. The typical window of time for detoxing your body and getting back to normal cycles is anywhere from a couple weeks to three months, but this could drag on even longer. Hormonal birth control is a band-aid solution for a wide number of feminine health conditions because it masks symptoms rather than actually resolving issues.

For example, you might feel inclined to start using the ring because you’d like to regulate cycle intensity or irregularity that comes with a condition like polycystic ovarian syndrome (PCOS), but make no mistake – cycle issues before birth control will still be cycle issues after birth control. Hormonal contraceptives both cause and then mask immune system imbalances which may perpetuate autoimmune conditions or thyroid issues. This could make it more difficult for you to return to natural cycles and get pregnant when you’re finally ready.

Con: There Are Very, Very Serious Cardiovascular Complications Associated with the Ring

The biggest elephant in the room when it comes to risks associated with the contraceptive ring is its ties to a wide variety of cardiovascular health conditions. Annovera and NuvaRing both provide plenty of stipulations as to why if you have preexisting cardiovascular issues or risk factors, you should steer clear of their product. This includes, but is not limited to, being a smoker, being obese, being older than 35, and having had the Covid-19 vaccine.

As I mentioned before, the ring uses ethinyl estradiol as its form of synthetic estrogen, and it uses a newer type of synthetic progesterone called etonogestrel, which is a form of desogestrel. Earlier types of progestins had been found to slightly raise a woman’s risk of developing blood clots, but research has found that the newer progestins – like etonogestrel – actually raise your risk of blood clots even higher.

Using the birth control ring can genuinely increase your risk of experiencing thromboembolic events like pulmonary embolism (stroke), myocardial infarction (heart attack), calf vein thrombosis, retinal vessel thrombosis, and cerebrovascular accidents. One study from Denmark found that, on average, the risk of venous thromboembolism increased 6.5 times for women who used vaginal rings compared to same-age women who didn’t use hormonal contraceptives. 

Is it any surprise, then, that NuvaRing was the subject of a major class action lawsuit? In 2014, NuvaRing maker Merck had to pony up $100 million in a settlement for a lawsuit alleging the ring not only had faulty design and testing, but also that the potential hazards related to NuvaRing weren’t adequately disclosed. Collectively, 2,000 lawsuits from plaintiffs alleged that NuvaRing was behind serious injuries or outright death from blood clots, strokes, and heart attacks.

According to HuffPost, one woman named Lyndsey Agresta, a 27 year old who had only been using NuvaRing for a month, began developing migraines which were discovered to have developed into brain hemorrhaging upon admittance to the ER. She suffered a massive stroke as a result of the blood clot from NuvaRing, but even after surgeons removed a portion of her brain, her health did not turn around. Within half a year, Agresta was dead. 

CNN reported on another woman, Megan Henry, who had been training for the 2014 Winter Olympics in skeleton, a type of high-speed downhill sledding, as part of the U.S. Army’s Soldier-Athlete Program, suffered multiple blood clots which blocked her lungs. Though she survived – which was attributed to her peak physical health – her athletic career was cut short, and she’ll have to deal with a much higher risk of recurring blood clots forevermore.

Again, these cases are rare, but that doesn’t mean they’re any less real.

Closing Thoughts

Whether it’s the pill, patch, implant, IUD, or in this case, the ring, birth control reduces your personal autonomy over your body’s natural fertility and frankly leaves you dependent on a daily drug that could carry along with it very pesky to very risky side effects. While the birth control pill is soon to be available over the counter, the contraceptive ring – like most other methods – still requires a prescription. Big names in Big Pharma like Pfizer, Bayer, Johnson & Johnson, Allergan, Novartis, and Merck rake in plenty of cash as the market demand increases, so much so that the global contraceptive market is expected to reach upwards of $16.5 billion by 2028. 

As mentioned, many women have no issues at all when going on and getting off the ring as their preferred form of birth control, but that doesn’t mean you should disregard any of the potential risks. 

Choosing to go on hormonal birth control can change your life – whether that’s preventing an unwanted pregnancy or leaving you with short-term or life-long health complications. If you’re a bit wigged out by it all – and I totally don’t blame you if you are at this point – you should know that there are Fertility Awareness methods that are pharmaceutical-free, side-effect free, and effective. But ultimately, the choice is up to you!

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