Does a patient using a NuvaRing (etonogestrel/releasing intrauterine system) need to remove it for one week when changing to a new one?

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Last updated: November 10, 2025View editorial policy

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NuvaRing Requires a One-Week Ring-Free Interval Between Rings

Yes, a patient using NuvaRing must remove it for one week when changing to a new ring. The standard regimen consists of 3 weeks of continuous ring use followed by a mandatory 1-week ring-free period before inserting the next ring 1, 2, 3.

Standard NuvaRing Regimen

  • Insert the ring and leave it in place for 3 consecutive weeks 3, 4
  • Remove the ring after 3 weeks and remain ring-free for exactly 7 days to allow withdrawal bleeding 1, 2
  • Insert a new ring after the 7-day ring-free interval, even if bleeding has not stopped 1, 2
  • Each ring is designed for single-cycle use only and should not be reused 3, 5

Why the Ring-Free Week Matters

The 7-day hormone-free interval is built into the contraceptive design to induce withdrawal bleeding, similar to the placebo week in combined oral contraceptives 3, 4. However, this interval represents the most vulnerable time for contraceptive failure if extended beyond 7 days 1.

  • If ring insertion is delayed by less than 48 hours after the scheduled 7-day interval, no backup contraception is needed 2
  • If ring insertion is delayed by 48 hours or more, backup contraception (condoms) must be used until the ring has been worn continuously for 7 days 2
  • Studies show that even 3 consecutive days of ring use can interfere with follicle growth, but extending the ring-free interval allows follicular development that could lead to ovulation 6

Extended or Continuous Use Option

While the standard regimen includes the weekly break, extended cycles are possible for women who prefer less frequent bleeding 2:

  • The ring can be used continuously for up to 35 days (5 weeks) before replacement 2
  • This approach may benefit women with conditions exacerbated by hormonal cycling 2
  • Extended use eliminates the ring-free week entirely, with immediate replacement of one ring with another 2

Common Pitfall to Avoid

Do not confuse the ring-free interval with ring removal during intercourse. The ring can be temporarily removed for up to 3 hours during sexual activity if desired, but this does not replace the scheduled 7-day ring-free week 1, 2. Most partners do not notice or are not bothered by the ring during intercourse 1.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

Vaginal Hormonal Ring for Women with ADHD

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Research

Contraceptive efficacy and tolerability with a novel combined contraceptive vaginal ring, NuvaRing.

The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception, 2002

Research

The contraceptive vaginal ring.

Seminars in reproductive medicine, 2010

Research

Ovarian function with a novel combined contraceptive vaginal ring.

Human reproduction (Oxford, England), 2002

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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