Can I use NuvaRing (etonogestrel/released levonorgestrel) for one year?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: November 10, 2025View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

NuvaRing Use for One Year

Yes, NuvaRing is specifically designed and FDA-approved for continuous use over one year, with each ring used for 3 weeks followed by a 1-week ring-free period, cycling through 13 cycles annually. 1

Standard Usage Protocol

NuvaRing follows a monthly cycling regimen that can be safely continued for one year or longer:

  • Each ring is inserted vaginally and remains in place for 3 consecutive weeks 1, 2
  • After 3 weeks, the ring is removed for a 7-day ring-free period to allow withdrawal bleeding 1, 2
  • A new ring is inserted after the 7-day break, even if bleeding has not ceased 1
  • This 4-week cycle (3 weeks in, 1 week out) is repeated for 13 cycles per year 3

Efficacy Over One Year

The contraceptive effectiveness of NuvaRing has been well-established in one-year clinical trials:

  • Pearl Index of 0.65 (95% CI 0.24-1.41) in European studies with 12,109 cycles of exposure 2
  • Typical use failure rate of 9%, comparable to combined oral contraceptives 1
  • High compliance rates of 90.8% of cycles meeting protocol criteria 2
  • In Chinese women, Pearl Index of 1.92 over 13 cycles with 82.4% study completion 3

Safety Profile for Extended Use

One-year safety data demonstrates NuvaRing is well-tolerated for continuous annual use:

  • 41% of women experienced no adverse events during the entire year 2
  • Most common treatment-related adverse events were headache (6.6%), leukorrhea (5.3%), and vaginitis (5.0%) 2
  • Low incidence of estrogen-related effects: nausea (2.8%) and breast tenderness (1.9%) 2
  • No clinically relevant changes in blood biochemistry, hematology, blood pressure, or cervical cytology over one year 2
  • Discontinuation due to adverse events occurred in 15.1% of users, with device-related issues (expulsion, foreign body sensation) being most common at 2.6% 2

Cycle Control Throughout the Year

Bleeding patterns improve with continued use over the year:

  • Breakthrough bleeding/spotting decreases from 18.6% in Cycle 1 to 4.2% by Cycle 11 3
  • Withdrawal bleeding is regular in 97-99% of cycles, lasting 4.7-5.3 days 4
  • Absence of withdrawal bleeding ranges from 8.6% in Cycle 1 to 3.0% by Cycle 11 3

User Satisfaction Over Time

Long-term acceptability data supports one-year continuous use:

  • Over 90% of women were satisfied or very satisfied at each assessment throughout the year 5
  • 97% of women who completed one-year studies said they would recommend NuvaRing to others 5
  • More than 80% of women at each assessment said they would use NuvaRing as their first-choice method 5
  • High satisfaction at Cycle 3 was a good predictor of low subsequent discontinuation risk 5

Important Caveats

  • NuvaRing shares the same contraindications as combined oral contraceptives 6
  • It does not protect against HIV or other sexually transmitted diseases; condom use should be counseled 1
  • The ring can be removed for up to 3 hours if desired, though this is not typically recommended 1
  • If ring insertion is delayed by 48 hours or more, backup contraception should be used until the ring has been worn for 7 consecutive days 7

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 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

Efficacy and safety of the contraceptive vaginal ring (NuvaRing) compared with a combined oral contraceptive in Chinese women: a 1-year randomised trial.

The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception, 2016

Research

The combined contraceptive vaginal device (NuvaRing): a comprehensive review.

The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception, 2005

Research

High acceptability and satisfaction with NuvaRing use.

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

Guideline

Vaginal Hormonal Ring for Women with ADHD

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.