Contraceptive 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:

• 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

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.

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.

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. The vaginal ring is removed by hooking a finger under the ring and gently pulling 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

You will usually bleed at some point during the seven day break. This isn’t a period – it is called a ‘withdrawal bleed’. This bleeding occurs as a result of the reduction in hormones from not having a ring in place during the break. You will be protected from pregnancy during this break.

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

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 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.