Contraceptive Ring: The Vaginal Ring

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

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

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.

Instead of having a ring-free week, you could also insert a new ring straight away. 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.

The vaginal ring is available free of charge from a range of services including contraceptive clinics, GUM clinics, your GP and Brook.

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.

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

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.

You may choose to use the ring continuously instead of having a ring-free week. To do this, you insert the new ring immediately after the old one. Using the ring in this way should 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.

The vaginal ring and sex

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. It is best if you reinsert the ring immediately, but if you forget don’t worry – you’re still protected as long as it’s inserted within 48 hours.

Insert a new ring straight away.

You will need to use additional contraception such as condoms until the new ring has been in place for seven days

If you have had sex within the last few days, you may need to use emergency contraception – speak to a pharmacist, nurse, or doctor.

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.

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