If 100 people who could get pregnant don’t use any contraception, 80 to 90 will get pregnant in a year.

If the vaginal ring is:

• Not always used perfectly, according to instructions, it’s about 93% effective. About 7 in 100 ring users will get pregnant in 1 year. Most people don’t use the ring perfectly all the time.

• Always used perfectly, it’s over 99% effective. This means that than 1 in 100 people who use the ring perfectly will get pregnant in 1 year.

The most effective methods of contraception are those you don’t have to remember, such as the implant, the hormonal IUD (hormonal coil) or the copper IUD (copper coil). These are known as long-acting reversible contraceptives (LARC). For more information, ask your healthcare professional or see FPA’s Your Guide to LARC.

The hormones in the vaginal ring:

• stop the ovaries from releasing an egg each month (ovulation)

• thicken the mucus from your cervix so it’s difficult for sperm to move through it and reach an egg

• make the lining of the uterus (womb) thinner so a fertilised egg is less likely to implant

You can get the ring for free from:

• a contraception or sexual health clinic
• some GP surgeries
• some young people’s services

In some areas of the UK, you can order the ring for free from an online sexual health service. They can send it by post and may offer a click and collect service. You usually need to be 16 or over and be able to give a recent blood pressure measurement.

All advice and treatment from these services is free and confidential.

You can also buy the ring from some online pharmacies, private online services or private clinics.

You don’t need a vaginal or breast examination or cervical screening (smear test) before you start using the ring.

Not everyone can use the vaginal ring. Your healthcare professional or online service will ask about your own and your family’s medical history to make sure the ring is suitable for you. Do mention any illnesses or operations you’ve had and any medicine you’re taking.

The ring may not be suitable for you if:

• you think you might be pregnant
• you smoke and are aged 35 or over
• you’re aged 35 or over and stopped smoking less than a year ago
• you’re very overweight, with a body mass index (BMI) of 35 or more
• you take certain medicines
• you’re breastfeeding a baby less than 6 weeks old – also see I’ve just had a baby. Can I use the vaginal ring?

The ring may not be suitable for you if you have now, or had in the past:

• thrombosis (a blood clot) in any vein or artery, including your lungs
• an immediate family member who had a blood clot before the age of 45
• heart disease or a stroke
• systemic lupus erythematosus with positive antiphospholipid antibodies
• a heart abnormality or circulatory disease including hypertension (high blood pressure)
• migraine with aura
• breast cancer or a gene mutation associated with breast cancer
• active disease of the gallbladder or liver
• diabetes with complications

The ring may not be suitable if you’re:

• immobile for a long period of time or use a wheelchair
• 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 aged 50. You’ll then need to change to another method of contraception until after the menopause.

Some of the advantages of the vaginal ring are:

• it usually makes your bleeds regular, lighter and less painful
• you can choose not to have a monthly bleed
• you don’t have to think about it every day – 1 ring is used for 3 weeks
• it may help with premenstrual symptoms
• it’s not affected if you vomit or have diarrhoea
• it reduces the risk of cancer of the ovary, uterus and colon
• it improves acne in some people
• it may reduce menopausal symptoms
• it may reduce the risk of recurrent endometriosis after surgery
• it helps with problems associated with polycystic ovary syndrome (PCOS)

There are some serious possible side effects – see Are there any risks? In addition:

• 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

• it doesn’t protect you from sexually transmitted infections, so you may want to use condoms too

• you may not feel comfortable putting the ring in and taking it out

The vaginal ring can have some serious side effects. These aren’t common but can happen to anyone. For most people, the benefits of the ring outweigh the possible risks.

Your ring provider will ask some questions to check whether you could be at higher risk.

• A very small number of ring users may develop a blood clot in a vein,a blood clot in an artery, pulmonary embolism (a blood clot in a lung), heart attack or stroke. If you’ve ever had a blood clot, don’t use the vaginal ring

• The risk of a blood clot in a vein is greatest if any of these apply: you smoke, are very overweight, have a thrombophilia (an increased risk of blood clots), are immobile for a long period of time or use a wheelchair, or an immediate family member had a blood clot in a vein before the age of 45

• The risk of a blood clot in an artery is greatest if any of these apply: you smoke, have high blood pressure, are very overweight, have migraine with aura, or are diabetic

• Research suggests ring users appear to have a small increased risk of being diagnosed with breast cancer compared to non-users of hormonal contraception. This risk reduces with time after stopping the ring and is undetectable 10 years later

• Research suggests there’s a small increase in the risk of developing cervical cancer with longer use of the vaginal ring.This reduces over time after stopping the ring and is undetectable 10 years later.

See a doctor straight away if you have any of the following:

• pain in the chest, including any sharp pain which is worse when you breathe in, breathlessness or coughing up blood
• painful swelling in your leg(s)
• weakness, numbness or bad ‘pins and needles’ in an arm or leg
• an unusual headache or migraine that is worse than usual
• sudden problems with your speech or eyesight

If you develop any new conditions, tell your healthcare professional so they can check it’s still safe for you to use the ring.

If you go into hospital for an operation or have an accident which affects the movement of your legs, tell the doctor you’re using the vaginal ring.

You may need to change to a different method of contraception or need treatment to reduce the risk of a blood clot.

If you’re given medicine by a healthcare professional, always tell them if you’re using the vaginal ring.

Commonly used antibiotics do not affect the ring.

Thrush treatment does not affect the ring.

Medicines called enzyme-inducers may make the ring less effective. These include some medicines used to treat epilepsy, migraine, HIV and TB. It also includes the herbal medicine St John’s Wort.

If you take any medicines that may affect the ring, talk to your healthcare professional. Consider changing to contraception that won’t be affected by the medicines you’re taking.

You won’t have your usual periods. The ring stops you from releasing an egg each month. It also stops the lining of the womb getting thicker each month. So your body doesn’t need periods while you’re using the ring.

The ring is designed to give you a 7-day hormone-free break each month. If you choose to have this break, you’ll usually still get some period-like bleeding. This is called a withdrawal bleed. It’s caused by a drop in your hormone levels after a few days without hormones from the ring. This causes your body to shed some blood from the womb lining.

Because the ring keeps the lining thin, a withdrawal bleed is often lighter, shorter and less painful than your usual periods.

You don’t need to have a 7-day break each month. You can choose a shorter 4-day break or miss the break completely and not have a withdrawal bleed. There are no known benefits of hormone-free breaks and no known risks to missing out a break and withdrawal bleed.

You can miss out the hormone-free break and withdrawal bleed every month or just occasionally.

Missing or shortening the hormone-free break:

• Could help if you get heavy or painful bleeding, headaches or mood swings during the break
• Could reduce your risk of pregnancy. This is because if you forget the ring just before or just after a break, you’re more at risk of pregnancy than at other times

Research hasn’t shown that the vaginal ring causes weight gain. You may find your weight changes throughout your cycle due to fluid retention or other reasons not related to the ring.

Bleeding is very common at first and isn’t usually anything to worry about. It may take up to 3 months to settle down.

It’s important to keep using the ring according to instructions, even if the bleeding is as heavy as a withdrawal bleed.

If you’re using the ring continuously it’s normal to get some bleeding – see How do I use the vaginal ring?.

Bleeding may also be due to other causes, such as not using the ring correctly or a sexually transmitted infection.

If bleeding doesn’t settle down or starts after you’ve used the ring for some time, seek advice.

If you used the ring correctly and haven’t taken any medicines that might have affected the ring), then it’s very unlikely you’re pregnant.

Keep using the ring as usual. If you’re worried, ask your healthcare professional for advice or do a pregnancy test. Using the ring won’t affect a pregnancy test. If you are pregnant, using the ring won’t end the pregnancy and won’t harm the fetus.

If you miss more than 1 expected bleed, always do a pregnancy test or speak to a healthcare professional.

You can usually start using the vaginal ring from 21 days after you give birth if you’re not breastfeeding, you feel comfortable putting it in your vagina, and if a healthcare professional has checked your risk of blood clots.

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 the first 7 days of using the ring.

If you’re breastfeeding a baby less than 6 weeks old, using the ring may affect your milk production. It’s usually recommended to use a different method of contraception until 6 weeks after the birth.

Yes. If you start the patch or ring on or before day 5 after a miscarriage or abortion, you’ll be
protected from pregnancy straight away.

If you start later than day 5, use additional contraception or avoid sex for the first 7 days.

When you stop using the ring, your fertility will go back to whatever’s normal for you. It’s possible to get pregnant before having your first period after stopping.

If you don’t want to get pregnant, it’s best to make sure you’ve used the patch or ring continuously without any breaks for at least 21 days before stopping.

If you don’t want to wait, ask your healthcare professional for advice because you can risk getting pregnant if you’ve had sex recently.

Use another method of contraception as soon as you stop using the ring.

If you want to get pregnant, aim to start pre-pregnancy care – such as taking folic acid and vitamin D, and stopping smoking and drinking alcohol – before you stop using the ring. Ask your healthcare professional for advice or see tommys.org/pregnancy-information.

You stop at any time and try to get pregnant straight away. You can also wait until you’ve had your first period after stopping so it’s easier to work out when you got pregnant.

Don’t worry if your periods don’t start straight away. For some people it can take a few months after stopping the ring”

It’s easy to change from the vaginal ring to a different method.

Talk to your healthcare professional. You may need to miss out a ring-free break or use other contraception for a short time.

Also see our guide to contraception.

When you first start the vaginal ring or you get new supplies, you’ll be advised when to get your next review.

You can be given up to 12 months’ supply of the method at a time, but some people may need a review earlier than this.

Your medical history, blood pressure and weight need to be checked at least once a year while you’re using the ring.

A review may be done face to face or may be done online or by phone for some people. For online and phone reviews, you’ll need to give recent height, weight and blood pressure measurements. Your blood pressure could be taken by a healthcare professional (for example at a pharmacy or GP surgery), at a self-testing station (for example at a GP surgery or sexual health clinic) or using a home blood pressure machine (check with your healthcare professional which machines are OK to use).

It’s important to get advice as soon as possible if you have any problems or concerns, develop new health problems or want to change to a different method of contraception. You don’t need to wait until your next review.

No. You don’t need a break and the hormones do not build up. There are no known benefits to your health or fertility from taking a break.

You can start the 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

• up to and including the fifth day of your period, you’ll be protected from pregnancy immediately; if you have a very short cycle or a cycle that changes, talk to your provider about whether you may need additional contraception at first

• at any other time in your menstrual cycle, use additional contraception, such as condoms, or avoid sex for the first 7 days of using the ring

Your ring provider should advise you on how to insert and remove the ring.

• With clean hands, squeeze the ring between your thumb and finger
• 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
• 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 ring can get lost inside the vagina – it’s stopped by the cervix.

If you’re sure it’s inside you but you can’t feel it with your fingers, see a doctor or nurse.

Remove the ring by hooking a finger under it, or grasping it between your thumb and finger, and gently pulling it out.

If you have pain or bleeding when trying to remove the ring, or can’t remove it, talk to a doctor or nurse immediately.

Put used rings in the bin, in the bag provided. Do not flush them down the toilet.

You keep each ring in your vagina for 3 weeks (21 days). After 21 days take it out. This will be on the same day of the week that you put it in.

Ring instructions tell you to take a 7-day break before putting in a new ring. The ring-free break is not needed. You can choose to have it if you want to, or you can have a shorter 4-day break or miss out the break.

Having no break or a shorter break can help lower your risk of getting pregnant. This is because if you forget a ring just before or just after a break, you’re more at risk of pregnancy than at other times.

If you have a break, you’ll usually have a withdrawal bleed. If you don’t have a break, you won’t usually have a withdrawal bleed – see Will my periods change? Having no break or a shorter break can help if you get heavy or painful bleeding, headaches, or mood swings during the break.

There are different ways to use the ring, so you can choose a bleeding pattern that works for you.

• Leave the ring in for 21 days then remove it and have no ring for 4 or 7 days.

• You’ll usually have a withdrawal bleed during the ring-free break. Put in a new ring on the fifth or eighth day, even if you’re still bleeding. You can miss out a ring-free break at any time, if you don’t want a withdrawal bleed that month.

• Use a new ring every 21 days for 9 weeks (3 rings) and then no ring for 4 or 7 days.

• This is called extended use or tricycling. You’ll only have a bleed once every 10 weeks. It works like this: leave ring 1 in for 21 days then remove it and insert ring 2 immediately. Leave ring 2 in for 21 days then remove it and insert ring 3 immediately. Leave ring 3 in for 21 days then remove it. Wait 4 or 7 days before inserting a new ring. This will be ring 1 of a new 9-week cycle. You’ll usually have a withdrawal bleed during the ring-free break. Put in a new ring on the fifth or eighth day even if you’re still bleeding.

• Leave the ring in for 21 days. Remove it and insert a new ring immediately. Continue changing to a new ring every 21 days, with no breaks.

• This is called continuous ring use. You won’t have a withdrawal bleed but you may still get some bleeding. This may be occasional or more frequent. Any bleeding you get is likely to reduce over time if you keep using the ring continuously.

• Leave the ring in for 21 days. Remove it and insert a new ring immediately. Continue changing to a new ring every 21 days. If you get bleeding that’s unacceptable to you for 3 to 4 days then have a 4-day ring-free break.

• This is called flexible extended use. Put in a new ring on the fifth day even if you’re still bleeding. This can help manage the bleeding. After the ring has been in for 21 days, either change to a new ring or have another ring-free break.

You can use the ring continuously without a break for as long as you like, as long as a healthcare professional doesn’t advise you to stop.

Yes. You’re protected if:

• you used the vaginal ring according to instructions during the last 21 days and
• you start the next ring cycle on time and
• you’re not taking medicines that will affect the ring – see If I take other medicines, will it affect the vaginal ring?

See below – What if I haven’t used the ring correctly?

Occasionally, you or a partner might be able to feel the ring during sex. This isn’t uncomfortable or unpleasant for most people. The ring isn’t likely to affect or harm your partner.

Yes. It’s safe to use tampons or a menstrual cup while the ring is in place.

The muscles of your vagina hold the ring in place.

Occasionally, 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 or menstrual cup.

Rinse the ring with cool or lukewarm (not hot) water straight away before you put it back in.

If the ring often falls out, you may want to consider another method of contraception.

What to do next, depends on how long the ring has been out your vagina for. See below – What if I haven’t used the ring correctly?

This is very rare and 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.

I’m late restarting after a ring-free break

• If it’s LESS THAN 8 full days since you removed your last ring:
  • Insert a new ring now
  • Continue using the ring as normal

• If it’s 8 OR MORE full days since you removed your last ring:
  • Insert a new ring now
  • Keep this ring in until the day you usually change it
  • Use condoms or avoid sex for the next 7 days
  • You may need emergency contraception and a follow-up pregnancy test if you had unprotected sex in or after the ring-free break. Talk to a doctor, nurse or pharmacist as soon as possible

If it’s up to 48 hours since the ring came out (and it’s not a planned break)

• Insert the ring as soon as possible.
• Keep it in until the day you usually change it.

If you’re in the first week after a ring-free break, you don’t need additional or emergency contraception, as long as you’ve used the ring correctly every day so far this week and in the week before the ring-free break.

If you’re in any other week, you don’t need additional contraception or emergency contraception as long as you’ve used the ring correctly for the previous 7 days.

If it’s 48 hours or more since the ring came out (and it’s not a planned break)

• Insert the ring as soon as possible
• Keep it in until the day you usually change it

If you’re due to start a ring-free break in the next 7 days, don’t take the break.

Use condoms or avoid sex until you’ve had a ring in place for 7 days in a row.

You may need emergency contraception now and a pregnancy test in 3 weeks if:

• you’re in the first week after a ring-free break and
• you had unprotected sex this week OR in the break.

If you’re in any other week you don’t need emergency contraception as long as you’ve used the ring correctly for the previous 7 days.

I’ve left a ring in for too long (longer than 21 days – what to do now depends on how long the ring has been in)

• If the ring has been in for 28 days or less:
  • Take your planned ring-free break OR insert a new ring now if you don’t want a break.
  • You don’t need additional or emergency contraception as long as the ring was continuously in place after day 21.

• If the ring has been in more than 4 weeks and up to 5 weeks:
  • Insert a new ring now.
  • Use condoms or avoid sex until the ring has been in place for 7 days in a row.
  • If you’re due to start a ring-free break, don’t take it.
  • You don’t need emergency contraception as long as the ring was continuously in place for the last 7 days.

• The ring has been in more than 5 weeks:
  • Insert a new ring now.
  • Use condoms or avoid sex until the ring has been in place for 7 days in a row.
  • If you’re due to start a ring-free break, don’t take it.
  • You may need emergency contraception now and may need a pregnancy test now or in 3 weeks if you had unprotected sex during week 5 or later.

Important: If you think you might forget more rings, talk to your doctor or nurse about contraception you don’t have to remember

Yes. This isn’t harmful. There are no known benefits to withdrawal bleeds and no known risks to missing them. There’s no need to have a withdrawal bleed unless you want one – also see How do I use the vaginal ring?

Sometimes you do still get bleeding. This is nothing to worry about. If you’ve used the ring correctly, you’ll still be protected from pregnancy.