Vaginal ring

Vaginal ring

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this from happening by keeping the egg and sperm apart or by stopping egg production. One method of contraception is the vaginal ring.

The vaginal ring is a small, soft plastic ring that you place inside your vagina. It’s about 4mm thick and 5.5cm in diameter. You leave it in your vagina for 21 days, then remove it and throw it in the bin (not down the toilet) in a special disposal bag. Seven days after removing the ring, you insert a new one for the next 21 days.

The ring releases estrogen and progestogen. This prevents ovulation (release of an egg), makes it difficult for sperm to get to an egg, and thins the womb lining, so it’s less likely that an egg will implant there.

At a glance: facts about the vaginal ring

• If used correctly, the vaginal ring is more than 99% effective. This means that fewer than one woman out of every 100 who use the vaginal ring as contraception will become pregnant in one year.
• As humans make mistakes, in real world use at least 9 women in 100 a year become pregnant (91% effective).
• One ring will provide contraception for a month, so you don’t have to think about it every day.
• It doesn’t interrupt sex, because you can have sex with the ring in place.
• Unlike the pill, the ring is still effective if you have vomiting or diarrhoea.
• The ring may ease premenstrual symptoms, and bleeding will probably be lighter and less painful.
• Some women have temporary side effects, including more vaginal discharge, breast tenderness and headaches.
• A few women develop a blood clot (thrombosis) when using the ring, but this is rare.
• The ring can sometimes come out on its own, but you can rinse it in warm water and put it back in as soon as possible. You might need emergency contraception, depending on how long it has been out.
• The vaginal ring doesn’t protect against sexually transmitted infections (STIs). By using condoms as well as the ring, you’ll protect yourself against STIs.

How the ring works

The ring continually releases estrogen and progestogen, which are synthetic versions of the hormones that are naturally released by the ovaries. This:

• reduces ovulation (the release of an egg)
• thickens vaginal mucus, which makes it more difficult for sperm to get through
• thins the lining of the womb so that an egg is less likely to implant there

Using the vaginal ring

You can start using the vaginal ring at any time during your menstrual cycle. You leave it in for 21 days, then remove it and have a seven-day ring-free break. You’re protected against pregnancy during the ring-free break. You then put a new ring in for another 21 days.

The license for the vaginal ring states that:

• you will be protected against pregnancy straight away if you insert it on the first day of your period (the first day of your menstrual cycle)
• you won’t be protected from pregnancy if you start using it at any other time in your menstrual cycle, and you’ll need to use additional contraception (such as condoms) for the first seven days

You can discuss this with your doctor or nurse to decide when might be the best time for you to start using the ring.

To insert the ring:

• with clean hands, squeeze the ring between your thumb and finger, and gently insert the tip into your vagina
• gently push the ring up into your vagina until it feels comfortable

Unlike a diaphragm or cap, the ring does not need to cover your cervix (the entrance to your womb) to work.

If you can feel the ring and it is uncomfortable, push it a bit further into your vagina. There isn’t a right or wrong place for it to be, as long as it isn’t uncomfortable.

You should be able to check that the ring is still there using your fingers. If you can’t feel it, but you’re sure it’s there, see your doctor or nurse. The ring cannot get “lost” inside you.

After the ring has been in your vagina for 21 days (three weeks), you remove it. This should be on the same day of the week that you put it in.

To remove the ring:

• with clean hands, put a finger into your vagina and hook it around the edge of the ring
• gently pull the ring out
• put it in the special bag provided and throw it in the bin – don’t flush it down the toilet

Removing the ring should be painless. If you have any bleeding or pain, or you can’t pull it out, tell your doctor or nurse immediately.

When you’ve taken the ring out, you don’t put a new one in for seven days (one week). This is the ring-free interval. You might have a period-type bleed during this time.

After seven days without a ring in, you need to insert a new one. Put the new ring in even if you’re still bleeding. Leave this ring in for 21 days, then repeat the cycle.

You can have sex and use tampons while the ring is in your vagina. You and your partner may feel the ring during sex, but this isn’t harmful.

If you forget to take the ring out

If you forget to take the ring out after 21 days, what you should do depends on how much extra time the ring has been left in.

If the ring has been in for up to seven days after the end of week three:

• take the ring out as soon as you remember
• don’t put a new ring in – start your seven-day interval as normal
• begin your new ring after your seven-day interval as normal
• you’re still protected against pregnancy, and you don’t need to use additional contraception

If the ring has been in for more than seven extra days (more than four weeks in total):

• take the ring out as soon as you remember
• put a new ring in straight away

The license for the vaginal ring states that you should use additional contraception (such as condoms) until the new ring has been in for seven days.

Speak to your doctor or nurse about when you should use additional contraception.

You may need if you had sex in the days before changing the rings over. Talk to your doctor or nurse.

If you forget to put a new ring in

Put in a new ring as soon as you remember, and use additional contraception, such as condoms, for seven days.

You may need if you had sex before you remembered to put the new ring in, and the ring-free interval was 48 hours or longer than it should have been (nine days or more in total). If this is the case, talk to your doctor or nurse.

If the ring comes out by itself

Sometimes the ring may come out on its own (this is called expulsion). This is most likely to happen after or during sex, or when you’re constipated. What you should do depends on how long the ring is out for, and whether you’re in the first, second or third week of using it.

The license for the vaginal ring states that if the ring is out for more than three hours, you will not be protected against pregnancy. Discuss this with your GP or nurse.

The information below is based on the license information on what to do if the ring comes out.

If the ring is out for more than three hours in the first or second week of using it, rinse it and put it back in. You need to use additional contraception for seven days. You may need emergency contraception if you have had sex in the last few days – talk to your doctor or nurse.

If the ring is out for more than three hours in the third week of using it, don’t put it back in. Dispose of it in the normal way. You now have two options:

• You can put a new ring in straight away. You may not have a period-type bleed, but you may have spotting.

OR

• Don’t put a ring in and have a seven-day interval. You’ll have a period-type bleed, and you should put a new ring in seven days after the old one came out (you can only choose this option if the ring was in continuously for the previous seven days).

Whichever option you choose, you need to use additional contraception until the ring has been in for seven days in a row. You should also talk to your doctor or nurse.

Who can use the vaginal ring?

Some women cannot use the vaginal ring. Your doctor or nurse will ask about your medical history and your family’s medical history, to see whether the ring is suitable for you. The ring may not be suitable if you:

• have had a blood clot in a vein or artery
• have had heart or circulatory problems, including high blood pressure
• are 35 or older and smoke, or stopped smoking in the past year
• have severe migraine with aura (warning symptoms)
• have had breast cancer in the past five years
• have diabetes with complications
• are overweight
• take certain medicines
• have vaginal muscles that can’t hold a vaginal ring

If you don’t smoke and there are no medical reasons why you can’t use the ring, you can use it until you are 50 years old.