Contraceptive Vaginal Ring
The contraceptive vaginal ring is an effective method of contraception. It contains a combination of hormones, like the combined oral contraceptive (COC) 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 combined oral contraceptive (COC) pill. These hormones have effects on your body which prevent you from becoming pregnant.
How does the contraceptive vaginal ring work?
The contraceptive vaginal ring contains two hormones, an oestrogen and a progestogen. They are absorbed through the inside of your vagina. They work in three ways to prevent pregnancy:
- They change the body's hormonal balance so that your ovaries do not produce an egg (ovulate).
- 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 the contraceptive vaginal ring?
The contraceptive vaginal ring is effective. Between 3-90 women in 1,000 will become pregnant using this form of contraception for a year. It is about as effective as the COC.
How do I use the contraceptive vaginal ring?
When you first use the ring, you place a new ring into your vagina on the first day of your period. It is very flexible and you will be able to squeeze it easily in order to put it in. 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 extra precautions such as a condom for seven days. (You cannot count on it being effective so quickly if you do not start using it on day 1.)
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. (After the first time, put the new ring in a week after you took out the last one. It is only for the first time you use it that you should start on the first day of your period. When you first start using the ring, write down the day of the week somewhere you will remember. That day of the week will always be your "new ring day" every four weeks).
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 monthly periods tend to be well controlled with this method, compared to the COC. 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 slightly less often when using the contraceptive 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 vagina, rather than being swallowed as tablets and going through your gut. This means that your contraception is still effective even if you have an upset stomach - being sick (vomiting) or runny stools (diarrhoea). You are also slightly less likely to have tummy upsets as a side-effect of using the ring compared to the pill.
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.
- You may have side-effects such as those in the section below. These are uncommon and often settle after a short time.
- Sometimes the ring falls out. (Wash it under a tap with cold or lukewarm water and put it back in if it has been out for less than three hours. If it has been out for longer, see the section below about what to do.)
- Sometimes a ring may break whilst in the vagina. This is rare. If this happens, you should remove the broken ring and insert a new one. Use extra contraception, such as condoms, for seven days.
Other more serious health risks are much rarer and happen as often as with the COC. See separate leaflet called Combined Oral Contraceptive (COC) Pill for more details.
These serious but rare risks include:
- Blood clots in the blood vessels, lungs, heart or brain. It seems this risk is slightly higher if you use the contraceptive vaginal ring than if you use the COC but, in both groups, the risk is extremely small. If you have anything in your medical history or your family history which makes blood clots more likely, you would be advised not to use the ring by your doctor or nurse.
- There may be a very small increased risk of breast cancer and cancer of the neck of the womb (cervix.)
Does the contraceptive vaginal ring have side-effects?
Generally, the contraceptive vaginal ring is well tolerated. The most common side-effects are headaches, a sore vagina and vaginal discharge. Each of these side effects occurs 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 the ring has been in place for more than four weeks, its contraceptive effect may have been reduced. You should check that you are not pregnant before putting in another one. If the test is negative, put in a new ring but use additional contraception such as condoms for seven days. You may also need emergency contraception. If you are not sure, 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 (such as a condom) for seven days. You might become pregnant if you have sex when you have forgotten to put a new ring in place.
What if the ring comes out?
If the ring comes out for less than three hours, wash it and put it back. It will still be effective.
If the ring has been out for more than three hours in the first or second week:
- It may be less effective.
- Wash the ring and put it back as soon as you can.
- Use extra precautions such as condoms for seven days.
- See your doctor or nurse if you have had sex without a condom in the previous few days. You may also need emergency contraception.
If the ring has been out for more than three hours in the third week, throw the ring away and either:
- Put in a new ring and start a new three-week cycle; or
- Have a ring-free week and put in a new ring in seven days' time. (Only take this option if the ring has been in place continuously for the previous seven days.)
Whichever option you take, you should also use extra contraception such as condoms for seven days. You should also see your doctor or nurse if you think you may need emergency contraception as above.
Who cannot use this method?
If you have been advised that you should not use the COC then you should also not use the contraceptive vaginal ring. In some cases this may be because you are at higher risk from blood clots (venous thromboembolism).
If any of the following apply to you, then you should not use the contraceptive vaginal ring:
- If you have had a baby within the previous six weeks and are breast-feeding.
- If you are aged 35 or more and a regular smoker.
- High blood pressure (hypertension) that is not controlled with treatment.
- A venous thromboembolism in the past or one for which you are having treatment currently.
- 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.
- If you have ever had a stroke.
- If you have ever had angina or a heart attack.
- If you have ever had problems with the circulation of your legs (peripheral arterial disease.)
- If you have a history of migraine associated with a change in your eyesight before the headaches (aura).
- If you have complications from type 1 diabetes or type 2 diabetes.
- If you have breast cancer.
You would also be at higher risk and probably advised not to use the ring other than in exceptional circumstances if:
- You had a baby six weeks to six months previously and are breast feeding.
- You had a baby less than three weeks previously.
- You are overweight. Your doctor or nurse can work out your body mass index (BMI). You should not be using the ring if your BMI is over 35 kg/m2.
- High blood pressure (hypertension) which is controlled on treatment.
- A family history of a venous thromboembolism in a first-degree relative (for example, sister, mother) aged under 45 years.
- You have gallstones.
- If you are on certain medications, particularly for epilepsy.
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.
This is not a complete list of all the conditions which make it advisable to avoid use of the contraceptive vaginal ring. As long as your doctor or nurse is aware of all your medical history, and your family history, they will be able to advise if it is safe for you.
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
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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, November 2014
- Combined Hormonal Contraception; Faculty of Sexual and Reproductive Healthcare (2011 updated August 2012)
- Trussell J; Contraceptive failure in the United States, Contraception, 2011
- Lopez LM, Grimes DA, Gallo MF, et al; Skin patch and vaginal ring versus combined oral contraceptives for contraception. Cochrane Database Syst Rev. 2013 Apr 30;4:CD003552. doi: 10.1002/14651858.CD003552.pub4.
- Contraception - combined hormonal methods; NICE CKS, December 2014 (UK access only)
- UK Medical Eligibility Criteria for Contraceptive Use; Faculty of Sexual and Reproductive Healthcare (2009 - Revised May 2010)
- Lidegaard O, Nielsen LH, Skovlund CW, et al; Venous thrombosis in users of non-oral hormonal contraception: follow-up study, Denmark 2001-10. BMJ. 2012 May 10;344:e2990. doi: 10.1136/bmj.e2990.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Tim Kenny
Dr Mary Harding
Prof Cathy Jackson