The contraceptive vaginal ring is a flexible, transparent plastic ring. It’s placed in the vagina where it releases two hormones – estrogen and progestogen. These are similar to the natural hormones produced by the ovaries and are like those used in the combined pill.
Contraceptive vaginal ring
How effective any contraceptive is depends on how old you are, how often you have sex and whether you follow the instructions.
If 100 sexually active women don’t use any contraception, 80 to 90 will become pregnant in a year.
If the vaginal ring is always used perfectly, according to instructions, it’s over 99% effective. This means that less than one ring user in 100 will get pregnant in one year.
If the vaginal ring is not always used according to instructions, about nine in 100 ring users will get pregnant in one year.
The vaginal ring releases a constant dose of hormones into the bloodstream through the vaginal wall. The main way it works is to stop the ovaries from releasing an egg each month (ovulation). It also:
- thickens the mucus from your cervix. This makes it difficult for a sperm to move through it and reach an egg
- makes the lining of the uterus (womb) thinner so it’s less likely to accept a fertilised egg.
You can go to a contraception or sexual health clinic, or a general practice. If you prefer not to go to your own general practice, or if they don’t provide contraceptive services, they can give you information about another practice or clinic. All treatment is free and confidential. You don’t need to have a vaginal or breast examination or cervical screening test when you’re first prescribed the vaginal ring.
Not everyone can use the vaginal ring so your doctor or nurse will need to ask you about your own and your family’s medical history. Do mention any illnesses or operations you’ve had. Some of the conditions which may mean you should not use the vaginal ring are:
- you think you might be pregnant
- you smoke and are 35 years old or over
- you’re 35 years old or over and stopped smoking less than a year ago
- you’re very overweight
- you take certain medicines
- you’re breastfeeding a baby less than six weeks old (see below, I've just had a baby. Can I use the vaginal ring?).
You have now or had in the past:
- thrombosis (blood clots) in any vein or artery or a member of your immediate family had thrombosis before they were 45 years old
- a heart abnormality or circulatory disease including hypertension (high blood pressure)
- heart disease or a stroke
- systemic lupus erythematosus with positive antiphospholipid antibodies
- breast cancer or you have the gene that’s associated with breast cancer
- migraines with aura
- active disease of the gall bladder or liver
- diabetes with complications
- you’re immobile for a long period of time or use a wheelchair
- you’re at high altitude (more than 4,500m) for more than a week.
If you’re healthy, don’t smoke and there are no medical reasons for you not to use the vaginal ring, you can use it until you’re 50 years old. You’ll then need to change to another method of contraception.
Some of the advantages of the vaginal ring are:
- you don’t have to think about it every day – you only use one ring a month
- it’s easy to insert and remove
- unlike the pill, the hormones don’t need to be absorbed by the stomach, so the ring isn’t affected if you vomit or have diarrhoea
- bleeding will usually become more regular, lighter and less painful
- it may help with premenstrual symptoms
- it may reduce menopausal symptoms
- it improves acne in some people.
There are some serious side effects (see below Are there any risks?). In addition:
- you may not feel comfortable inserting and removing it
- you may get temporary side effects at first including increased vaginal discharge, headaches, nausea, breast tenderness and mood changes
- breakthrough bleeding and spotting (unexpected vaginal bleeding on days you’re using the ring) may occur in the first few months of use
- the vaginal ring doesn’t protect you against sexually transmitted infections, so you may need to use condoms as well.
The vaginal ring can have some serious side effects, but these aren’t common. For most people the benefits of using the ring outweigh the possible risks. All risks and benefits should be discussed with your doctor or nurse.
- A very small number of ring users may develop venous thrombosis, arterial thrombosis, heart attack or stroke. If you ‘ve ever had thrombosis, you should not use the vaginal ring.
- The risk of venous thrombosis is greatest during the first year that you use the vaginal ring and if any of the following apply to you: you smoke, you’re very overweight, are immobile for a long period of time or use a wheelchair, or a member of your immediate family had a venous thrombosis before they were 45 years old.
- There appears to be a slightly higher risk of venous thrombosis in vaginal ring users compared to those using some combined pills.
- The risk of arterial thrombosis is greatest if you smoke, are diabetic, have hypertension, are very overweight, have migraines with aura, or a member of your immediate family had a heart attack or stroke before they were 45 years old.
- Research suggests that users of the ring appear to have a small increased risk of being diagnosed with breast cancer compared to non-users of hormonal contraception, which reduces with time after stopping the ring.
- Research suggests that there’s a small increase in the risk of developing cervical cancer with longer use of estrogen and progestogen hormonal contraception.
See a doctor straightaway if you have any of the following:
- pain in the chest, including any sharp pain which is worse when you breathe in
- you cough up blood
- painful swelling in your leg(s)
- weakness, numbness or bad ‘pins and needles’ in an arm or leg
- severe stomach pains
- a bad fainting attack or you collapse
- unusual headaches or migraines that are worse than usual
- sudden problems with your speech or eyesight
- jaundice (yellowing skin or yellowing eyes).
If you need to go into hospital for an operation or you have an accident which affects the movement of your legs, you should tell the doctor that you’re using the vaginal ring. The doctor will decide if you need to stop using the ring or need other treatment to reduce the risk of developing thrombosis.
Research hasn’t shown that the vaginal ring causes weight gain. You may find your weight changes throughout your cycle due to fluid retention.
You can start using the vaginal ring any time in your menstrual cycle if you’re sure you’re not pregnant.
If you start the ring on the first day of your period you’ll be protected from pregnancy immediately.
You can also start to use the ring up to and including the fifth day of your period and you’ll be protected from pregnancy immediately. However, if you have a short menstral cycle with your period coming every 23 days or less, starting the ring as late as the fifth day of your cycle may not provide you with immediate contraceptive protection. This is because you may ovulate early in the menstral cycle. Talk to your doctor or nurse about whether you need additional contraception.
If you start the ring at any other time in your menstrual cycle you’ll need to use additional contraception, such as condoms, or avoid sex for the first seven days of using it.
If you feel comfortable, you can start to use the vaginal ring 21 days after you give birth, if you’re not breastfeeding. Starting on day 21 you’ll be protected from pregnancy straight away. If you start later than day 21 use additional contraception or avoid sex for seven days.
If you’re breastfeeding a baby less than six weeks old, the ring may affect your milk production. It’s usually recommended that you use a different method of contraception until six weeks after the birth.
You can start using the vaginal ring immediately after a miscarriage or abortion. You’ll be protected from pregnancy straight away.
Your doctor or nurse should advise you on how to insert and remove the vaginal ring. With clean hands, squeeze the ring between your thumb and finger and use one hand to insert it into your vagina. If necessary, spread your labia (vaginal lips) with your other hand. Push the ring into your vagina until it feels comfortable. 10 11 It doesn’t need to cover your cervix (entrance to the uterus) to work.
The ring doesn’t need to be in an exact position. Most ring users can’t feel the ring. If you can feel it and it’s uncomfortable, push it a little further into your vagina. You can check it’s still there with your fingers.
There’s no danger that the vaginal ring can get lost inside the vagina – it’s stopped by the cervix. However, if you’re sure it’s inside you but you can’t feel it with your fingers, see a doctor or nurse.
Occasionally, you or your partner might be able to feel the ring during sex. This isn’t uncomfortable or unpleasant for most people. The ring is not likely to affect or harm your partner.
Remove the vaginal ring by hooking a finger under it, or by grasping it between your thumb and finger, and gently pulling it out.
If you experience pain or bleeding when trying to remove the ring, or can’t remove it, tell your doctor or nurse immediately.
The vaginal ring should be left in the vagina for three weeks (21 days). After three weeks remove the ring on the same day of the week that it was inserted.
Stop using the ring for one week (seven days). This is known as the ring-free interval. During this week you get a bleed. You don’t have periods when you use the vaginal ring – you have a withdrawal bleed (which doesn’t always happen). It’s caused by you not taking hormones in the ring-free week.
New ring cycle
After the ring-free interval, insert a new ring on the eighth day. You should do this even if you’re still bleeding. Continue using the vaginal ring as you did in the last cycle.
Disposing of the vaginal ring
Put the used vaginal ring in the disposal sachet provided and place it in a waste bin. It must not be flushed down the toilet.
Yes. You’re protected if:
- you used the vaginal ring according to instructions during the last three weeks and
- you start the next ring cycle on time and
- you’re not taking medicines that will affect the ring (see below, If I take other medicines will it affect the vaginal ring?).
Seven days or less
If the ring has been left in for up to seven days
after the end of week three (up to four weeks in
As soon as you remember, remove the ring. Do
not put another ring in. Start your seven day,
ring-free interval. After the seven days insert a
new ring on the eighth day.
You don’t need to use additional contraception
and you’re protected from pregnancy.
More than seven days
If the ring has been left in for more than seven
days after the end of week three (more than four
weeks in total):
As soon as you remember, remove the ring and
insert a new ring immediately.
You must use additional contraception or avoid sex until the new ring has been in place for
seven continuous days.
Ask your doctor or nurse for advice if you’ve
had sex in the previous few days and weren’t
using a condom as you may need emergency
Insert a new ring as soon as you remember. If you put the new ring in 48 hours or more after your ring-free interval then you may not be protected from pregnancy. Use an additional method of contraception, such as condoms, or avoid sex for the next seven days. If you’ve had sex in the previous few days and weren’t using a condom ask your doctor or nurse for advice as you may need emergency contraception.
The muscles of your vagina hold the ring in place. Occasionally, however, the ring may come out of your vagina (expulsion), for example if it wasn’t inserted properly, during sex or a bowel movement, or while removing a tampon. If this happens often, you may want to consider another method of contraception.
The longer the ring has been out of the vagina, the higher the risk of pregnancy. You may also experience breakthrough bleeding. If the ring comes out of the vagina for:
Less than three hours:
- Rinse the ring with cool or lukewarm water (not hot) and re-insert the same ring as soon as possible within three hours.
More than three hours in the first or second week of use:
- Rinse the ring with cool or lukewarm water (not hot) and re-insert the same ring as soon as possible.
- You must use additional contraception or avoid sex until the ring has been in place for seven continuous days.
- Ask your doctor or nurse for advice if you’ve had sex in the previous few days and weren’t using a condom as you may need emergency contraception.
More than three hours in the third week of use:
Throw the ring away and choose one of the following two options:
1. insert a new ring immediately and start a new ring cycle. You may not experience a withdrawal bleed but breakthrough bleeding or spotting may occur, or
2. don’t insert a new ring. Start your seven day, ring-free interval. You’ll have a withdrawal bleed. Insert a new ring seven days from the time the previous ring came out of the vagina. This option can only be chosen if the ring was used continuously for the previous seven days.
In both cases, you must use additional contraception or avoid sex until the ring has been in place for seven continuous days and ask your doctor or nurse for advice if you’ve had sex in the previous few days and weren’t using a condom as you may need emergency contraception.
If you lose the vaginal ring insert a new one and continue with the cycle that you were on.
This is very rare and it’s unlikely to affect how the ring works. It won’t harm you. Remove the broken ring and insert a new one as soon as possible. Continue with the cycle that you were on.
If you’re given medicines by a doctor, nurse or hospital always say you’re using the vaginal ring. Commonly used antibiotics don’t affect the vaginal ring. Medicines such as some of those used to treat epilepsy, HIV and TB and the complementary medicine St John’s Wort may make it less effective. These types of drugs are called enzyme-inducers. If you take these medicines, talk to your doctor or nurse about how to use the vaginal ring - you may need to use a different method of contraception.
Treatments for thrush don’t affect the effectiveness of the vaginal ring.
This is called breakthrough bleeding. It’s very common when you first start to use the vaginal ring and isn’t usually anything to worry about. It may take up to three months to settle down. It’s important to continue using the ring correctly even if the bleeding is as heavy as your withdrawal bleed.
You can use a tampon while the ring is in place; this isn’t harmful. However, try to make sure that the ring doesn’t come out accidentally when removing the tampon.
Bleeding may also be caused by not using the vaginal ring correctly or by a sexually transmitted infection. If it carries on or starts after you’ve used the ring for some time, seek advice.
If you used the ring according to instructions and haven’t taken any medicines that might’ve affected the ring (see above, If I take other medicines will it affect the vaginal ring?), then it’s very unlikely that you’re pregnant. Start your next ring cycle at the right time. If you’re worried, ask your doctor or nurse for advice or do a pregnancy test. Using the ring doesn’t affect a pregnancy test. Always take a test or speak to a health professional if the ring hasn’t been used properly, or if you miss more than one withdrawal bleed. If you do become pregnant, there’s no evidence to show that using the ring harms the baby.
Yes. This isn’t harmful. Remove the ring after three weeks and immediately insert another without having the seven day, ring-free interval. You may experience breakthrough bleeding but this is nothing to worry about. If you’re using the ring correctly you’ll still be protected from pregnancy.
It’s easy to change from the vaginal ring to another method of contraception. Get advice from your doctor or nurse. You may need to miss out the ring-free interval or use additional contraception.
Ideally, it’s easier if you stop using the vaginal ring at the end of the ring cycle and don’t insert a new ring after your withdrawal bleed. If you don’t want to wait until this time, ask your doctor or nurse for advice because you can risk becoming pregnant if you’ve had sex recently. If you don’t want to become pregnant you should use another method of contraception as soon as you stop using the ring. Your normal periods may not come back immediately. For some people it can take a few months.
If you want to try for a baby it helps to wait for one natural period after stopping the ring before trying to get pregnant. This means the pregnancy can be dated more accurately and you can start pre-pregnancy care such as taking folic acid and stopping smoking. Ask your doctor or nurse for advice. Don’t worry if you get pregnant sooner, it won’t harm the baby.
No. You don’t need to take a break because the hormones don’t build up. There are no known benefits to your health or fertility from taking a break.
When you first start using the vaginal ring you’ll be given a supply to see how it suits you. After that you should go back to the doctor or nurse to get new supplies and to have your blood pressure checked. If there are no problems, you can be given a further supply of vaginal rings.
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This booklet can only give you general information. The information is based on evidence-guided research from the World Health Organization and The Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists.
All methods of contraception come with a Patient Information Leaflet which provides detailed information about the method. Remember - contact your doctor, practice nurse or a sexual health clinic sexual health clinic if you’re worried or unsure about anything.
INFORMATION LAST UPDATED JUNE 2017. NEXT PLANNED REVIEW 2018.
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