The use of combination oral contraceptives is associated with increased risks of several serious side effects, including blood clots, which may lead to stroke or heart attack. It is unknown if the risk of blood clots is different with NuvaRing® use than with the use of certain birth control pills. Cigarette smoking increases the risk of high blood pressure and heart disease.

Q. How do I use it; how do I insert and remove it?
A. Here are the steps to follow when you use the ring, (in case you forget what your health care provider told you):
1. First, wash your hands. Put a new ring into your vagina. Leave it in for 3 weeks in a row.
To insert the ring: Take the ring out of its package. You can squat, stand with one leg up on a chair, or lie down.
Gently slide the ring into your vagina. When it is in correctly you shouldn't notice it. If it feels uncomfortable, push it farther in, so it rests on your pubic bone, but it can be anywhere in the vagina that is comfortable for you.
Wash your hands to wash off any hormones left on your fingers. You don't want to share those hormones with anyone else accidentally.
2. At the end of 3 weeks:
* Take the ring out of your vagina on the same day of the week as you put it in.
* Throw the used ring away. (Do not flush it down the toilet.)
3. Go 7 days without wearing the ring. You should get your period during that week.
4. After 1 week without wearing a ring, put in a new ring on the same day of the week as you did before. Put it in even if you are still spotting or bleeding from your period.
5. Never go more than 7 days without wearing a birth control ring. If you do, you could get pregnant.
Important: Always be sure to put the ring in and take it out on the same day of the week, and at about the same time. For example, if you put it in on Sunday at 9:00 am, take it out 3 weeks later on Sunday at about 9:00 am.
To remove the ring:
1. Wash your hands.
2. Put one finger into your vagina until you feel an edge of the ring. Curl your finger over the rim and pull gently. The ring will fold and slide out.
3. Wrap the ring in plastic wrap and throw it away.
4. Wash your hands again to remove any hormones that might be left on it.
The ring can be used with condoms if you don't know the sexual history of the person you are involved with. Make sure you get that person tested for STDs including HIV. In a monogamous relationship you could use just the NuvaRing after you both test negative for all STDs.
Always ask your health care provider any unanswered questions you might have, it's important to be able to talk openly with them. See the NuvaRing® web site for additional information.