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Contraception

Contraceptive Ring: The Vaginal Ring

The contraceptive vaginal ring is a soft, flexible, plastic ring that goes into the vagina. It releases the hormones oestrogen and progestogen into the bloodstream to prevent pregnancy by controlling your fertility.

Quick guide

Hormones

Contains oestrogen and progestogen

Mood/Emotions

Usually helps with feeling low or anxious

STIs

No protection against STIs

Visibility

Only people involved in the sexual activity might see it

Periods

Usually makes periods regular, lighter and less painful

Lasts for

Lasts as long as you use it

Acne/Skin

Can improve skin appearance

Preventing pregnancy

More than 99% effective if used without mistakes

Starting on this method

Requires a prescription from a doctor or nurse. You may have to use additional contraception for seven days depending where you are in your cycle when you first start using the ring.

Maintenance

Remembering to take out the ring on day 21 and insert a new one after the ring-free week

How the vaginal ring works

The contraceptive vaginal ring is a soft, flexible, plastic ring that goes into the vagina. It is about 4mm thick and 5.5cm diameter. The brand name of the contraceptive vaginal ring is Nuvaring.

Pregnancy happens when sperm reaches an egg and fertilises it. The contraceptive vaginal ring releases the hormones oestrogen and progestogen through the vaginal wall into the bloodstream, which works in three ways to interrupt fertilisation:

  1. Stopping an egg being released (ovulation)
  2. Thickening the mucus around the cervix, which makes it harder for sperm to get reach an egg
  3. Thinning the lining of the womb so that a fertilised egg cannot implant
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Pros and Cons

Pros

  • Over 99% effective at preventing pregnancy
  • No interruption to sex
  • Can make periods lighter, more regular, and reduce period pains
  • Don’t have to think about it every day – each ring stays in place for 21 days
  • Unaffected by diarrhoea or vomiting because the hormones don’t need to be absorbed by the stomach
  • Can help improve acne in some people
  • Additional health benefits, e.g. reducing the risk of some cancers

Cons

  • No protection against sexually transmitted infections (STIs)
  • Temporary side effects during the first few months are common. These can include headaches, nausea, breast tenderness, mood swings, breakthrough bleeding or spotting
  • Some people can experience vaginal irritation and discharge
  • Some people may not feel comfortable inserting or removing it

Periods and the ring

The vaginal ring can make periods lighter, more regular, and reduce period pains.

During your ring-free week you will get a bleed. This isn’t a proper period, but is called a ‘withdrawal bleed’ and is caused by you not taking hormones in the ring-free week. Bleeds usually become shorter, less painful and more regular.

This can happen at any point during this ring-free week, and you should insert your ring on time whether or not you are still bleeding.

It is also possible to insert a new ring instead of having a ring-free week. This means you are unlikely to get a withdrawal bleed. Speak to your doctor or nurse to see what is right for you.

You can have spotting and bleeding in the first few months but this isn’t usually anything to worry about and should settle down within 3 months. If you are worried, talk to a doctor or nurse for advice.

How to get the ring

The vaginal ring is available free of charge from a range of services including contraceptive clinics, GUM clinics, your GP and Brook. Find your nearest one using our find a service tool.

Contraception and sexual health services such as Brook are free and confidential, including for people under the age of 16. Health professionals work to strict guidelines and won’t tell anyone else about your visit unless they believe you’re at serious risk of immediate harm. Find out more about Brook’s confidentiality policy.

At the appointment

When you go to get the vaginal ring, an appointment will typically include:

  • A few questions about your medical and family history, to work out what would suit you best
  • You’ll discuss other medicines you are taking in case they make the vaginal ring less effective
  • The doctor or nurse will take your blood pressure and weigh you

You will usually be given a four month supply to see how you get on. You only need to return for further supplies and to have your blood pressure checked.

You will not be required to have a breast examination or smear test for the vaginal ring.

When to start the vaginal ring

If you insert the ring in the first five days of your period you will be protected straight away.

If you have a short menstrual cycle, where your period is normally 23 days or less, you will need to start taking the vaginal ring in the first four days to be immediately protected (because you might ovulate early).

If you start using the contraceptive vaginal ring at any other time in your menstrual cycle you will need to use additional contraception such as condoms for the first seven days.

Starting the vaginal ring after pregnancy

You can get an IUS fitted after a birth, abortion or miscarriage but when you can get it fitted does vary.

After giving birth

You can become pregnant from as little as three weeks after giving birth.
If you are not breastfeeding, it’s likely you can start the pill on day 21 after the birth (check with a doctor). If you start after day 21, you will need to use alternative contraception for the first seven days.
If you are breastfeeding, you’re not advised to start on the ring until six weeks after the birth and use additional contraception in the meantime and for seven days after you start on the ring.

After an abortion or miscarriage

You can become pregnant from two weeks after an abortion or miscarriage.
If you start on the ring within five days of the abortion of miscarriage you are protected from pregnancy straight away
Any later than day five and you will need to use additional contraception for the first seven days.

Speak to your midwife, GP or a nurse at a sexual health clinic to find out if this method is right for you

How to use the vaginal ring

One hand holding a vaginal ring in it's natural shape - a transparent circular tube about the size of a bracelet. Second hand squeezing the ring into an oval shape showing it's flexible texture.

A ring is inserted into the vagina and left in continuously for 21 days. The ring is then removed and you have a seven day break. After this break a new ring should be inserted.

To insert the contraceptive vaginal ring:

  1. With clean hands, squeeze the ring between your thumb and finger, and gently insert the tip into your vagina
  2. Gently push the ring up into your vagina until it feels comfortable

After 21 days you should remove the ring:

  1. Hook a finger under the ring and gently pull it out
  2. Throw the vaginal ring away (in a bin) in the bag provided – don’t flush it down the toilet
  3. Removing the vaginal ring should be pain-free, if you experience any discomfort or bleeding tell your doctor or nurse

If you are having a ring-free week, you will have a withdrawal bleed. You can use both towels and tampons whilst using the vaginal ring.

The ring is designed to stay in the vagina during sex. It is completely safe although you or your partner may be able to feel the ring. The less you take the ring out the better but if you do take it out during sex remember to wash the ring with lukewarm water and insert it again when you’re done. The sooner you reinsert the ring, the better but if you forget don’t worry you’re still protected from pregnancy as long as you remove it for less than 48 hours.

Continuous use
You may choose to use the ring continuously instead of having a ring-free week, you insert the new ring immediately after the old one. Using the ring in this way will likely prevent any bleeding. It is safe to use the ring continuously. You should talk to a doctor or nurse to find out what’s best for you.

What to do if it falls out or I forget

What to do if you forget to take the ring out or put in a new ring

Left in for up to 7 extra days (up to 4 weeks in total)
  • Remove the ring as soon as you remember
  • If you were planning on having a ring-free week, start this week now and insert the new ring after the seven day interval and start your new cycle
  • If you weren’t planning on having a ring-free week, insert the new ring now
  • You don’t need to use additional contraception and you will be protected from pregnancy
Left in for more than 7 extra days (more than 4 weeks in total)
  • Remove the ring and insert a new ring as soon as you remember
  • You may also need to use emergency contraception depending how long the ring has been in for and if you have had sex in the previous few days – speak to your doctor or nurse
Forgot to put the new ring in 48 hours or more after when it should have been inserted
  • Insert a new ring as soon as you remember
  • You may also need to use emergency contraception if you have had sex in the previous few days – speak to your doctor or nurse if you’re unsure

What to do if the vaginal ring falls out

The contraceptive vaginal ring is held in place by the muscles of your vagina. Occasionally it may come out (expulsion) and what you need to do depends on how long the vaginal ring has been out for, and where you are in your ring-cycle.

The ring has been out for less than 48 hours

If you’ve been using that ring for less than 3 weeks

  • Rinse the contraceptive vaginal ring (cool or lukewarm water) and re-insert the same ring
  • You are protected from pregnancy and you don’t need to use additional contraception if it has been used correctly in previous weeks. Speak to a doctor or nurse if unsure
The ring has been out for more than 48 hours in the first week of use
  • Rinse the vaginal ring and put it back in as soon as possible
  • You will need to use additional contraception such as condoms until the ring has been in place for seven days
  • You may also need emergency contraception if you have had sex in the previous few days – ask your doctor or nurse for advice
The ring has been out for more than 48 hours in the second or third week of use
  • Insert a new ring as soon as possible
  • If you are in your third week and due to start a ring-free break, skip it and insert a new ring. (You may not experience a withdrawal bleed but you may have some breakthrough bleeding or spotting)
  • Use additional contraception until the vaginal ring has been in place for seven days
  • You do not need emergency contraception if you have used the ring correctly for the previous 7 days. Speak to a doctor or nurse if unsure

If you lose the vaginal ring insert a new one and continue with the cycle that you were on.

Factors impacting its effectiveness
Some medicines can reduce its effectiveness such as those used to treat epilepsy, HIV and TB and the complementary medicine St John’s Wort

Stopping use of the vaginal ring

How quickly the hormones leave your system:
There is no delay in the return of fertility when you stop using the contraceptive vaginal ring. The hormones from the ring will usually leave your body within a couple of days – no matter how long you have been using the ring for.
How quickly you can get pregnant:
This will vary, and will depend on when ovulation (releasing an egg) starts up again – for some people, it may be days or weeks, while for others it could take up to three months. Fertility levels should return quite rapidly to the levels they were before you started using the ring.
What happens to your periods:
If you find you have irregular periods after stopping using the ring and are worried, or if it’s taking a long time for your periods to start again, you can ask your GP for advice.
What physical changes there might be:
Everyone reacts slightly differently when they stop using the contraceptive vaginal ring. Some people may find they have skin problems initially, although as your hormone levels self-regulate over the course of a few weeks or months, symptoms may subside once again.

FAQs

Can you have sex with the ring still in?

Yes, it’s completely fine to keep the ring in while you have sex. Your partner may be able to feel it but it shouldn’t be uncomfortable. You can take the ring out while you have sex but you need to remember to wash and insert it again as soon as possible.

Can you feel the ring when it’s in?

As it’s flexible and smooth you shouldn’t be able to feel the ring at all. If you can feel it it might be that you haven’t inserted it high enough.

Can you lose the ring inside your vagina?

It’s not possible to lose the ring inside your body as the cervix is no way near wide enough to allow the ring through to your uterus. However, it can be tricky to find the ring if you’re not used to it – it can help if you put one leg up or squat.

Will the ring come out by itself at all?

The walls of your vagina will hold the ring in place even during exercise. It is possible for the ring to come out or move further down, for example if you’re straining when having a poo. Follow the guidance above about what to do if the ring falls out.

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