The contraceptive vaginal ring is an effective method of contraception. It contains a combination of hormones, like the combined pill. It is inserted into the vagina, where it stays for three weeks. You have exactly one ring-free week before you put a new ring in place. Common side-effects are headaches, a sore vagina and vaginal discharge. These happen in about 1 in 20 women.
What is the contraceptive vaginal ring?
It is a flexible, see-through ring which is just over 5 cm in diameter. It contains two hormones, just like the contraceptive pill. These hormones have effects on your body which prevent you from becoming pregnant.
How does it work?
The contraceptive vaginal ring contains an oestrogen and a progestogen. They are absorbed through the skin in your vagina. They work in three ways to prevent pregnancy:
- They change the body's hormonal balance so that your ovaries do not ovulate (produce an egg).
- They cause the mucus made by the neck of the womb (cervix) to thicken and form a mucous plug. This makes it difficult for sperm to get through to the womb (uterus) to fertilise an egg.
- They also make the lining of the womb thinner. This makes it less likely that a fertilised egg will be able to attach to the uterus.
How effective is it?
The contraceptive vaginal ring is effective. Between 3-90 women in 1000 will become pregnant using this form of contraception for a year. It is about as effective as the combined oral contraceptive pill (COCP).
How do I use it?
On the first day of your period, you place a new ring into your vagina. It is very flexible and you will be able to squeeze it, to put it in easily. Find a position for the ring that is comfortable for you. The position of the ring does not affect how well it works. If you are unsure of how to do this, you can either look at the leaflet that comes with the packet, or ask your practice nurse or GP for advice.
You can also insert the ring on day 2-5 of your period, but you should use a condom (as an extra precaution) for seven days.
You leave the ring in place for three weeks. During this time you should check regularly that it is there. You remove the ring by hooking it out with your finger. Exactly one week later put a new ring in again.
You can use tampons and have sex safely with it in place. If the ring falls out during sex, it must be replaced within three hours.
What are the advantages of using the contraceptive vaginal ring?
Your bleeding (periods) is well controlled with this method, compared to the COCP. Some women on the pill have what is called breakthrough bleeding. This means they have bleeding before their period is due. This tends to happen less often when you use the vaginal ring. Your bleeding will normally occur during the week when the contraceptive vaginal ring is not in your vagina.
Because you leave the ring in place for three weeks, you do not need to remember to take a pill every day. You only need to remember to take it out after three weeks and put in a new ring one week later.
The hormones are absorbed through the vaginal skin, rather than being swallowed as tablets and going through your gut. This means that an upset stomach (vomiting or diarrhoea) would not affect how effective your contraception is.
Are there any disadvantages to using it?
- Your partner may feel the ring during sex. Do not regularly remove the contraceptive vaginal ring or it may become less effective.
- You may be aware of the ring in your vagina. Some people may find this unpleasant.
- Sometimes the ring falls out. Wash it under a tap with cold or lukewarm water and put it back in. If you have used the ring properly for seven days before it came out, the ring can be out for up to 48 hours, without needing to have extra contraception. If you do need extra contraception (such as your partner using a condom), you should use it until the ring has been in place for seven days. If the ring falls out in week 3 (before your ring-free week), you could miss the ring-free week out and put in a new ring instead.
- Sometimes a ring may break whilst in the vagina. If this happens, you should remove the broken ring and insert a new one.
- If this happens, you will be at risk of pregnancy and should contact your family planning nurse or doctor.
These are the most common complaints. These reasons make up to 1 in 3 women who use the contraceptive vaginal ring decide to give up.
Other more serious health risks are much rarer and happen as often as with the COCP. See separate leaflet called Combined Oral Contraceptive Pill for further details.
Does it have side-effects?
Generally, the contraceptive vaginal ring is well tolerated. The most common side-effects are headaches, a sore vagina and vaginal discharge. These occur in about 1 in 20 women.
What if I forget to change the ring?
If you leave the contraceptive vaginal ring in place for up to four weeks, take it out as soon as you remember. Have one week without it, then replace with a new ring as normal.
If you leave the contraceptive vaginal ring in place for more than four weeks, its contraceptive effect may have been reduced. You should remove the ring as soon as you remember and put in a new contraceptive vaginal ring without having a break. Extra precautions such as using a condom during sex are recommended for seven days if you used the ring for five weeks or more. If it is less than five weeks you will not need extra precautions. If you are unsure, ask your practice or family planning nurse or your doctor.
What if I forget to put the new ring in?
If you forget to insert a new ring after the seven-day break, you should put in a new ring as soon as you remember. You should also use additional contraception (a condom) for seven days. You might become pregnant if you have sex when you have forgotten to put a new ring in place.
Who cannot use this method?
If you have been advised that you should not use the COCP, then you should also not use the contraceptive vaginal ring. This may be because you have risk factors for venous thromboembolism (blood clots). If you have two or more of the following risk factors then you should not use it:
- A family history of venous thromboembolism (blood clot) in a first-degree relative (eg, sister, mother) aged under 45 years.
- Being overweight. Your doctor or nurse can work out your body mass index (BMI). This measures how much you weigh related to your height. If your BMI is above 30 kg/m2 and you have other risk factors for blood clots, you may be advised to find another method. You should not be using the ring if your BMI is over 39 kg/m2, even if you do not have any other risk factors.
- If you are not very mobile for a long period of time - for example, if you are in a wheelchair or have your leg in a plaster cast.
- History of superficial thrombophlebitis (where the veins on the surface of your legs become red and sore).
If you have risk factors for arterial disease (circulation problems) then you may also be advised not to use the contraceptive vaginal ring. If you have two or more of the following risk factors then you should not use it:
- A family history of arterial disease (circulation problems) in a first-degree relative (eg, sister, mother) aged under 45 years.
- Diabetes mellitus: if you have had diabetes for more than 20 years you should not use the ring, even if you have no other risk factors.
- Hypertension: high blood pressure that is not controlled with treatment.
- Smoking: you should not use the ring if you smoke 40 or more cigarettes a day, even if you have no other risk factors.
- Age over 35 years: you should not use the ring at all if you are aged over 50 years.
If you have a vaginal prolapse, you may find it difficult to keep the ring in place. If you have a problem with constipation, you may also find it difficult to keep the ring in place.
Who can advise me?
Your GP, practice nurse, family planning clinic and pharmacist are good sources of information if you have any queries.
Further help & information
Further reading & references
- Summary of Product Characteristics (SPC) - NuvaRing® 0.120 mg/0.015 mg per 24 hours, vaginal delivery system; Merck, Sharpe and Dohme Limited, electronic Medicines Compendium, May 2012
- Lopez LM, Grimes DA, Gallo MF, et al; Skin patch and vaginal ring versus combined oral contraceptives for Cochrane Database Syst Rev. 2008 Jan 23;(1):CD003552.
- Combined Vaginal Ring (NuvaRing®), New Product Review; Faculty of Sexual and Reproductive Healthcare (2009)
- Combined Hormonal Contraception, Faculty of Sexual and Reproductive Healthcare (2011 updated August 2012)
- Contraception - combined hormonal methods; NICE CKS, June 2012
- Trussell J - Contraceptive Efficacy, In Hatcher RA, Trussell J, Nelson AL, Cates W, Kowal D, Policar M. Contraceptive Techology: Twentieth Revised Edition. New York NY: Ardent Media, 2011.
|Original Author: Dr Tim Kenny||Current Version: Dr Hayley Willacy||Peer Reviewer: Dr Colin Tidy|
|Last Checked: 05/11/2012||Document ID: 13860 Version: 3||© EMIS|
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