The inception of the engagement ring itself can be tied to the Fourth Lateran Council presided over by Pope Innocent III in 1215 . Innocent declared a longer waiting period between betrothal and marriage; plain rings of gold, silver or iron were used earliest. Gems were important and reassuring status symbols to the aristocracy. Laws were passed to preserve a visible division of social rank, ensuring only the privileged wore florid jewels. As time passed and laws relaxed, diamonds and other gems became available to the middle class.

At one time, engagement rings mounted sets of stones. One traditional sentimental pattern mounted six to celebrate the joining of two families: The birthstones of the bride's parents and the bride (on the left), and the birth stones of the groom and his parents (on the right). The parents' stones were mounted with the mother to the left of the father. The bride and groom's birthstones would be adjacent in the center. Another similar pattern, for four stones, mounted the birthstone of the parents' marriages, and the birthstones of the bride and groom. These token rings often disassembled, to expose a channel in which a lock of the suitor's hair could be treasured.

A Victorian tradition was the Regards ring, in which the initials of the precious gems used spelled out the word 'regards'. Another Victorian tradition was the DEAREST Ring, which spelt the word Dearest using the first letter of every jewel.

The first recorded diamond engagement ring was presented by the Archduke Maximillian of Austria to Mary of Burgundy as a betrothal gift in 1477. However, the diamond engagement ring did not become the standard it is considered today until after an extensive marketing campaign by De Beers in the middle of the 20th century, which came to include the most famous advertising slogan of the 20th century “A Diamond is Forever”.