Birth Control Pill vs. the Ring: What to Know

Medically Reviewed by Nivin Todd, MD on June 08, 2022
5 min read

Birth control pills and vaginal rings are both good ways to keep you from getting pregnant when you’re having sex without using condoms. You also can use them along with condoms for even better protection against pregnancy and infections. Doctors refer to them as combined-hormonal contraceptives because they usually have two hormones: estrogen and progestin. (Some pills only have progestin.) When you use either the pills or ring the right way, both do a really good job of preventing pregnancy. So how do you choose which is better for you? What are their pros and cons?

When you use either birth control pills or the ring in the way you’re supposed to, you’re not likely to get pregnant. Less than 1 in 100 people – 0.3% – who use either type of birth control as intended will get pregnant.

If you sometimes forget and don’t use them quite right, you have a 9 in 100 or 9% chance of getting pregnant. Birth control pills and vaginal rings work essentially the same way and are about equally effective. Note: Some birth control pills work a little differently because they only have progestin in them. They’re a good idea for people who shouldn’t or don’t want to take estrogen.

Either method is most likely to fail if you forget to use it at the right time. So the method that will work better for you is the one you’ll remember to stick to. If you think it’s easiest to take a pill every day, then birth control pills will work best. If you’d rather not have to do anything daily, a ring might work better for you.

Since they have the same hormones in them and work similarly well, the biggest difference between birth control pills and rings is how you use them. Birth control pills are taken once a day, every day. It’s best to take them at the same time every day. There are many brands you can choose from.

The vaginal ring is made of flexible plastic with hormones in it. You put it in your vagina and your body absorbs the hormones over time. It shouldn’t be hard to get it in and you shouldn’t feel it. There are two brands of vaginal rings: NuvaRing and Annovera. They work the same way. You keep the vaginal ring in for 3 weeks. Then, you take it out for a week before putting it back in. Annovera can be used for up to a year using this process.

Since these are two ways to deliver the same hormones, the side effects of birth control pills and vaginal rings are similar.

Side effects may include:

  • Nausea
  • Breast tenderness
  • Mood changes
  • Spotting or irregular bleeding

Side effects happen most often at first. Usually, they get better after the first few months.

More serious side effects don’t usually happen. They used to happen more when birth control pills had more hormones in them. These include:

  • Migraine
  • High blood pressure
  • Blood clots in leg, arm, or lung
  • Liver tumors that aren’t cancerous
  • Gallbladder disease
  • Heart attack
  • Stroke

While these aren’t likely to happen, you should get to a doctor or emergency room right away if you notice:

  • Abdominal pain that’s severe
  • Yellow skin or eyes
  • Severe headaches
  • Vision loss or disturbances
  • Severe arm or leg pain
  • Swelling in arms or legs

Neither birth control pills nor the ring will protect you against sexually transmitted infections (STIs). For protection against an infection, you’ll need to use a condom.

If you have a health condition, such as migraine, breast lumps, diabetes, or a blood clotting disorder, or you smoke or take medicines or supplements, make sure your doctor knows. They can help you understand your risks. Smoking makes serious side effects more likely, especially if you are older than 35.

You can start in different ways, depending on your preference and how quickly you want to be protected. It’s the same for birth control pills vs. the ring.

  • You can start right away by taking the first pill or inserting a ring. You can stop using other forms of protection after 7 days. This is a fine method if you are sure you’re not pregnant.
  • If you aren’t sure, you can start on the first Sunday after you get your period. If it’s been more than 5 days since you’ve gotten your period, wait 7 days before you stop using condoms or other methods to prevent pregnancy.
  • Take your first pill or place your ring on the first day you get your period. You’ll be protected right away.

Birth control pills and rings work best if you use them as intended. If not, they may not protect you well. If you miss one pill, you can take it when you remember. If you miss two or more, start taking one a day again as soon as you realize. You’ll also need to use condoms or another method for 7 days.

If you forget to put the ring in on time, put a new one in as soon as you remember. You’ll need to wait 7 days to be sure it’s working. If the ring falls out by accident, you can put it right back in. Don’t leave it out for 3 hours or more or it won’t work as well. If it falls out in week 3, you can just go ahead and put a new ring in.

If your timing is off with either method and you are worried you might get pregnant, you could also take emergency contraception pills, which you can get from a drugstore or your doctor. Take a pregnancy test if you aren’t sure whether you’re already pregnant.

You can switch from one brand of birth control pills to another without doing anything special. If you want to switch from the pill to a ring or vice versa, timing is important. Ask your doctor when to make the switch and how long you should use condoms or another backup method.

If you want to stop using birth control pills or the ring to get pregnant or for another reason, you can stop at any time. Neither should make you less likely to get pregnant when you’re ready. You will likely be able to get pregnant after stopping either one pretty quickly. Your period should come back to normal after a short time. See a doctor for advice if you want to stop using birth control so you can get pregnant.

If you’re still not sure how to choose, here are some questions you can ask your doctor:

  • How well do birth control pills vs. the ring work?
  • Is there any reason you think one or the other would be better for me?
  • Can I stop using it anytime I want?
  • Will I see changes in my period with either method? What are they?
  • Are there any differences in side effects I should know about?
  • How much does it cost?