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Contraceptive vaginal ring

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.

Here are some key facts:

  • The contraceptive vaginal ring is over 99% effective at preventing pregnancy when used correctly
  • You wear one ring for 21 days with a seven day interval
  • It protects against pregnancy but not sexually transmitted infections (STIs). To protect against STIs you will also need to use a barrier method of contraception such as condoms
  • You don’t have to think about it every day, you only have to replace the ring every 21 days
  • You usually experience a monthly ‘withdrawal bleed’
  • It can help with heavy periods and pre-menstrual symptoms (PMS)
  • It can help with acne
  • The contraceptive vaginal ring is not affected by diarrhoea or vomiting because the hormones don't need to be absorbed by the stomach
  • Some medicines can affect how well it works
  • It contains two hormones called oestrogen and progestogen which are similar to the hormones naturally produced in women’s ovaries

Find out more information if you have forgotten to change or insert your contraceptive ring and think you may not be protected.

How does the contraceptive vaginal ring work?

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:

  • stopping ovulation
  • thickening the mucus around the cervix, which makes it harder for sperm to get through
  • making the lining of the womb thinner so that a fertilised egg cannot implant

Although the contraceptive vaginal ring protects against pregnancy, it doesn’t protect against sexually transmitted infections (STIs). To be protected against STIs, barrier methods such as condoms should be used in addition to the contraceptive vaginal ring.

If it’s used correctly, the contraceptive vaginal ring is over 99% effective at preventing pregnancy. This means that less than one woman in 100 will get pregnant in a year.

 

How do I get the contraceptive vaginal ring?

The contraceptive vaginal ring is available free of charge from:

Find your nearest Brook service or if there is no Brook service near you, search sexual health services on NHS Choices or SXT.

When you go to get the contraceptive vaginal ring, you will be asked a few questions about your medical and family history. This is to work out if the contraceptive vaginal ring is most suitable for you, or if another form of contraception would be more suitable. You will also need to let the doctor or nurse know about any other medicines you are taking as this can make the contraceptive vaginal ring less effective. The doctor or nurse will take your blood pressure and they may weigh you. You will not be required to have a breast examination or smear test for the contraceptive vaginal ring.

When you first start the contraceptive vaginal ring you will usually be given a supply to see how you get on. You will then only need to have follow up appointments and reviews for further supplies and to have your blood pressure checked, providing there are no issues. You can always return to the clinic at any time if you are worried about anything or would like to discuss changing to a different method contraception. If you wish to change to a different method, talk to your doctor or nurse as you may need to miss out the ring-free interval or use additional contraception.

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.

How do you use the contraceptive vaginal ring?

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.  

Most women have a bleed at some point during the seven day break. This isn’t a proper period – it is called a ‘withdrawal bleed’ and it can start at any point during the seven day break. This bleeding occurs as a result of the reduction in hormones from not having a ring in place during the seven day break. After a ring-free interval of seven days a new ring should be inserted.

Your doctor or nurse will advise how to insert and remove the contraceptive vaginal ring, some guidance is included below.

To insert the contraceptive vaginal ring:

  • With a clean hand, squeeze the contraceptive vaginal ring between your thumb and finger, and insert the tip into the vagina
  • Push the contraceptive vaginal ring into your vagina until it feels comfortable. It doesn’t need to cover the cervix, or be in an exact position to work
  • If you can feel it or it is uncomfortable push it a bit further into your vagina – it will be stopped by the cervix so there isn’t a danger of it getting lost inside the vagina

After the contraceptive vaginal ring has been in your vagina for 21 days you remove it.

To remove the contraceptive vaginal ring:

  • The contraceptive vaginal ring is removed by hooking a finger under the ring and gently pulling it out
  • Throw the contraceptive vaginal ring away (in a bin) in the bag provided - don’t flush it down the toilet
  • Removing the contraceptive vaginal ring should be pain-free, if you experience any discomfort or bleeding tell your doctor or nurse

After removing the contraceptive vaginal ring, you have a ring-free interval for seven days, and then insert a new contraceptive vaginal ring. Most women will have a bleed at some point during those seven days. This isn’t a proper period, it is called a 'withdrawal bleed', and happens because of a reduction in hormone levels. You will be protected from pregnancy during this ring free interval as long as you used the contraceptive vaginal ring correctly during the last three weeks and you start the next ring cycle on time.

After the seven day ring-free interval you should insert a new ring, even if you are still bleeding. This ring then stays in for 21 days.

Starting the contraceptive vaginal ring and when you are protected from pregnancy

If you insert the ring at the beginning of your period (day one) you will be protected straight away. You can also insert the ring up to, and including, the fifth day of your period and you will be protected from pregnancy immediately.

If you have a short menstrual cycle, where your period normally comes every 23 days or less, starting the contraceptive vaginal ring as late as the fifth day of your period may mean you are not immediately protected (because you might ovulate early in your menstrual cycle). You should discuss this with your doctor or nurse about the need for using additional contraception.

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.

What if I forget to take the contraceptive vaginal ring out or put a new ring in?

If you forget to take the contraceptive vaginal ring out:

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

If the ring has been left in for up to seven days after the end of week three (up to four weeks in total), remove the ring as soon as you remember. Don’t put in another ring, but start your seven day ring-free interval. Insert the new ring after the seven day interval and start your new cycle. You don’t need to use additional contraception and you will be protected from pregnancy.

If the ring has been left in for more than seven days after the end of week three (more than four weeks), remove the ring and insert a new ring as soon as you remember. You will need to use additional contraception until the new ring has been in place for seven days. 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 forget to put a new contraceptive vaginal ring in:

If the ring-free interval was 48 hours longer than it should have been, insert a new ring as soon as you remember and use an additional method of contraception such as condoms for seven days. You may also need to use emergency contraception if you have had sex in the previous few days – speak to your doctor or nurse.

What if the contraceptive 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 contraceptive vaginal ring has been out for, and where you are in your ring-cycle.

Less than three hours:

  • Rinse the contraceptive vaginal ring (cool or lukewarm water) and re-insert the same ring 
  • You are protected from pregnancy and don’t need to use additional contraception 

More than three hours in the first or second week of use:

  • Rinse the contraceptive vaginal ring and put it back in as soon as possible
  • You will need to use additional contraception 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 

More than three hours in the third week of use:

Throw the ring away and either:

  • Insert a new ring straight away and start a new ring cycle. You may not experience a withdrawal bleed but you may have some breakthrough bleeding or spotting 
  • Do not insert a new ring. Start your seven day, ring-free interval. You will have a withdrawal bleed. Then insert a new ring seven days from the time the previous ring came out of the vagina (you can only choose this option if the ring was used continuously for the previous seven days)

In either case you will need to use additional contraception until the contraceptive vaginal ring has been in place for seven days. You may also need emergency contraception if you have had sex in the previous few days – speak to your doctor or nurse.

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

Advantages of the contraceptive vaginal ring

  • It doesn’t interrupt sex
  • It can help makes periods lighter and more regular, and reduce period pains
  • It is easy to insert by yourself and stays in place for three weeks
  • You don’t have to think about it every day – each ring stays in place for 21 days
  • The ring is not affected by diarrhoea or vomiting because the hormones don’t need to be absorbed by the stomach
  • No evidence that it causes additional weight gain
  • No long term effects to your fertility
  • Can help make bleeds lighter and more regular, and reduce period pains
  • May also help reduce premenstrual symptoms
  • It can help improve acne in some women
  • The contraceptive vaginal ring can also have additional health benefits, e.g. reducing the risk of some cancers

Disadvantages of the contraceptive vaginal ring

Any medication can have some side effects and a very small number of women may develop complications, but discussing you and your family’s medical history with the doctor or nurse will help reduce the risk of negative side effects.

For most women the benefits will outweigh the possible risks. Things to watch out for include:

  • It’s common to experience temporary side effects during the first few months, like headaches, nausea, breast tenderness and mood swings
  • Some women can experience vaginal irritation and discharge
  • You may experience breakthrough bleeding or spotting during the first few months of use
  • It doesn’t protect against sexually transmitted infections (STIs)
  • You may not feel comfortable inserting or removing it

What can make the contraceptive vaginal ring less effective?

  • If you forget to put a new ring in after your seven day break
  • Some medicines can reduce the effectiveness of the contraceptive vaginal ring, such as those used to treat epilepsy, HIV and TB and the complementary medicine St John's Wort. 
  • Commonly used antibiotics do not reduce the effectiveness of the contraceptive vaginal ring, but it is always best to check with the doctor, nurse or pharmacist first

Remember, if you remove the ring for more than 48 hours you could be at risk of pregnancy. Use condoms until you know that your contraception is definitely protecting you again.

How will it affect my periods?

At some point during your ring-free week most women will have a bleed. This isn’t a proper period, it is called a 'withdrawal bleed' (which doesn’t always happen) and it can start at any point during the seven-day interval. This bleeding is brought on by the reduction in hormones, from not wearing a ring during the seven-day interval.

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

In the first few months of using the contraceptive vaginal ring there can be some breakthrough bleeding or spotting. This should settle down after around three months and it is important to continue using the contraceptive vaginal ring correctly.

You can use both towels and tampons whilst using the contraceptive vaginal ring.

Can I miss out the ring-free interval?

Some people do this when they want to put off bleeding, for example if they are going on holiday or want to have sex. You can miss out the ring-free interval by using another ring straight away. This isn’t harmful and you will still be protected against pregnancy. Sometimes you will still get bleeding.

What happens when you stop using the contraceptive vaginal ring?

There’s lots of reasons why you might want to stop using the contraceptive vaginal ring. Maybe you want to get pregnant; maybe you’d like to use a form of long acting reversible contraception that doesn’t involve changing a ring every week. Whatever the reason, you may have a few questions about what happens when you stop using the contraceptive 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 a matter of days or weeks, while others may find that it takes up to three months for ovulation to happen again. But generally speaking, fertility levels should return quite rapidly to the levels they were before you started using the ring, so it’s important to use condoms or another method of contraception if you don’t want to get pregnant.
 
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. If symptoms of acne persist or worsen please see your GP for help and advice. As for weight fluctuations, there is no evidence to suggest that contraceptive ring causes weight gain. It is important to remember to have a well-balanced diet and exercise regularly to maintain a healthy weight.
 
If you stop using the contraceptive vaginal ring but don't want to become pregnant remember to use another method of contraception. You may want to consider the injection, implant or IUD or IUS, which are long-acting reversible methods, so take away the task of changing a ring every week. Condoms when used correctly also offer effective protection against sexually transmitted infections (STIs).

Using the contraceptive vaginal ring after having a baby

You can start using the contraceptive vaginal ring 21 days after you have given birth if you feel comfortable. If you start using the contraceptive vaginal ring on day 21, you will be protected against pregnancy. If you start after this point you will need to use a barrier method of contraception (such as condoms) for seven days.

If your baby is under six months old and you are breastfeeding, it is usually recommended that you use a different method of contraception as the contraceptive vaginal ring can reduce your flow of milk.

Using the contraceptive vaginal ring after an abortion or miscarriage

You can start using the contraceptive vaginal ring immediately after a miscarriage or abortion and you will be protected from pregnancy straight away.