Vaginal ring

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method of contraception is the vaginal ring.

The vaginal ring is a small, soft plastic ring that you place inside your vagina. It’s about 4mm thick and 5.5cm in diameter. You leave it in your vagina for 21 days. Then you remove it and throw it in the bin (not down the toilet) in a special disposal bag. Seven days after removing the ring, you insert a new one for the next 21 days.

The ring releases oestrogen and progestogen. This prevents ovulation (release of an egg), makes it difficult for sperm to get to an egg and thins the womb lining, so it’s less likely that an egg will implant there.

At a glance: facts about the vaginal ring

If used correctly, the vaginal ring is more than 99% effective. This means that fewer than 1 woman out of every 100 who use the vaginal ring as contraception will become pregnant in one year.

In real world use at least 9 women in 100 a year become pregnant (91% effective).

One ring will provide contraception for a month, so you don’t have to think about it every day.

It doesn’t interrupt sex, because you can have sex with the ring in place.

Unlike the pill, the ring is still effective if you have vomiting or diarrhoea.

The ring may ease premenstrual symptoms. Bleeding will probably be lighter and less painful.

Some women have temporary side effects. These include more vaginal discharge, breast tenderness and headaches.

A few women may develop a blood clot (thrombosis) when using the ring, but this is rare.

The ring can sometimes come out on its own, but you can rinse it in warm water and put it back in as soon as possible. You might need emergency contraception, depending on how long it has been out.

The vaginal ring doesn’t protect against sexually transmitted infections (STIs). By using condoms as well as the ring, you’ll protect yourself against STIs.

How the ring works

The ring continually releases oestrogen and progestogen, which are synthetic versions of the hormones that are naturally released by the ovaries. This:

• reduces ovulation
• thickens vaginal mucus, which makes it more difficult for sperm to get through
• thins the lining of the womb so that an egg is less likely to implant there

Using the vaginal ring

You can start using the vaginal ring at any time during your menstrual cycle. You leave it in for 21 days, then remove it and have a 7-day ring-free break. You’re protected against pregnancy during the ring-free break. You then put a new ring in for another 21 days.

You’ll be protected against pregnancy straight away if you insert it on the first day of your period (the first day of your menstrual cycle). You won’t be protected from pregnancy if you start using it at any other time in your menstrual cycle. You’ll need to use extra contraception (such as condoms) for the first 7 days

You can discuss this with your doctor or nurse to decide when might be the best time for you to start using the ring.

Inserting the ring

1. Save the foil pouch the ring comes in to put the ring in when you throw it away.
2. With clean hands, squeeze the ring between your thumb and finger, and gently insert the tip into your vagina.
3. Gently push the ring up into your vagina until it feels comfortable.

Unlike a diaphragm or cap, the ring does not need to cover your cervix (the entrance to your womb) to work.

If you can feel the ring and it’s uncomfortable, push it a bit further into your vagina. There isn’t a right or wrong place for it to be, as long as it isn’t uncomfortable.

You should be able to check that the ring is still there using your fingers. If you can’t feel it, but you’re sure it’s there, see your doctor or nurse. The ring cannot get ‘lost’ inside you.

After the ring has been in your vagina for 21 days (3 weeks), you remove it. This should be on the same day of the week that you put it in.

Removing the ring

1. With clean hands, put a finger into your vagina and hook it around the edge of the ring.
2. Gently pull the ring out.
3. Put it in the foil pouch provided and throw it in the bin – don’t flush it down the toilet.

Removing the ring should be painless. If you have any bleeding or pain, or you can’t pull it out, tell your doctor or nurse immediately.

When you’ve taken the ring out, you don’t put a new one in for 7 days (1 week). This is the ring-free interval. You might have a period-type bleed during this time. You’ll still be protected against pregnancy during these 7 days.

After 7 days without a ring in, you need to insert a new one. Put the new ring in even if you’re still bleeding. Leave this ring in for 21 days, then repeat the cycle.

You can have sex and use tampons while the ring is in your vagina. You and your partner may feel the ring during sex, but this isn’t harmful.

If you forget to take the ring out

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

If the ring has been in for up to 7 days after the end of week 3:

• take the ring out as soon as you remember
• don’t put a new ring in – start your 7-day interval as normal
• begin your new ring after your 7-day interval as normal
• you’re still protected against pregnancy, and you don’t need to use extra contraception

If the ring has been in for more than 7 extra days (more than 4 weeks in total):

• take the ring out as soon as you remember
• put a new ring in straight away

Use extra contraception (such as condoms) until the new ring has been in for 7 days.

Speak to your doctor or nurse about when you should use extra contraception.

You may need emergency contraception if you had sex in the days before changing the rings over. Talk to your doctor or nurse.

If you forget to put a new ring in

Put a new ring in as soon as you remember, and use extra contraception, such as condoms, for 7 days.

You may need emergency contraception if you had sex before you remembered to put the new ring in, and the ring-free interval was 48 hours or more longer than it should have been (9 days or more in total). If this is the case, talk to your doctor or nurse.

If the ring comes out by itself

Sometimes the ring may come out on its own. This is called expulsion. This is most likely to happen after or during sex, or when you’re constipated. What you should do depends on how long the ring is out for, and whether you’re in the first, second or third week of using it.

If the ring is out for more than 3 hours, you will not be protected against pregnancy. Discuss this with your GP or nurse.

If the ring is out for more than 3 hours in the first or second week of using it, rinse it and put it back in. You need to use additional contraception for 7 days. You may need emergency contraception if you have had sex in the last few days – talk to your doctor or nurse.

If the ring is out for more than 3 hours in the third week of using it, don’t put it back in. Dispose of it in the normal way. You now have 2 options, either:

• you can put a new ring in straight away – you may not have a period-type bleed, but you may have spotting
• don’t put a ring in and have a 7-day interval – you’ll have a period-type bleed, and you should put a new ring in 7 days after the old one came out (you can only choose this option if the ring was in continuously for the previous 7 days)

Whichever option you choose, you need to use extra contraception until the ring has been in for 7 days in a row. You should also talk to your doctor or nurse if you’ve had sex in the last few days, as you may need emergency contraception.

Who can use the vaginal ring?

The vaginal ring is not suitable for everyone. If you’re thinking of using it, your doctor or nurse will need to ask you about your health and your family’s medical history, to make sure the ring is suitable for you. It’s very important to tell them about any illnesses or operations you have had, or medications you are currently taking.

You should not use the ring if you:

• are pregnant or think you may be pregnant
• are breastfeeding
• smoke and are 35 or over
• are 35 or over and stopped smoking less than a year ago
• are very overweight
• take certain medicines such as some antibiotics, St John’s Wort or medicines used to treat epilepsy, tuberculosis (TB) or HIV

You will also not be able to use the ring if you have (or have had):

• thrombosis (blood clots) in a vein or artery
• a heart problem or a disease affecting your blood circulatory system (including high blood pressure)
• migraine with aura (warning signs)
• breast cancer
• disease of the liver or gallbladder
• diabetes with complications, or diabetes for more than 20 years

If you don’t smoke and there are no medical reasons why you can’t use the ring, you can use it until you are 50 years old.

After giving birth

You can start using the vaginal ring 21 days after giving birth, and you’ll be protected against pregnancy straight away.

If you start the ring more than 21 days after giving birth, you need to use extra contraception for 7 days after you insert the ring.

After miscarriage or abortion

You can start using the ring immediately after a miscarriage or abortion, and it’ll work straight away. You don’t need to use extra contraception.

Advantages and disadvantages of the ring

Some of the advantages of the vaginal ring include:

• it doesn’t interrupt sex
• it’s easy to put in and remove
• you don’t have to think about it every day
• the ring is not affected if you vomit or have diarrhoea
• it may help with premenstrual symptoms
• period-type bleeding usually becomes lighter, more regular and less painful
• it may reduce the risk of cancer of the ovary, uterus and colon
• it may reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease

Some of the disadvantages of the vaginal ring include:

• it may not be suitable if you don’t feel comfortable inserting or removing it from your vagina
• spotting and bleeding while the ring is in your vagina can occur in the first few months
• it may cause temporary side effects, such as increased vaginal discharge, headaches, nausea, breast tenderness and mood changes
• the ring does not protect against STIs

The vaginal ring with other medicines

Some medicines may interact with the vaginal ring, meaning it doesn’t work properly. If you want to check that your medicines are safe to take with the vaginal ring, you can:

• ask your GP, practice, pharmacist or sexual health clinic
• read the patient information leaflet that comes with your medicine

The vaginal ring can interact with medicines called enzyme inducers. These speed up breakdown of progestogen by your liver, reducing the effectiveness of the ring.

Examples of enzyme inducers are:

• the epilepsy drugs carbamazepine, oxcarbazepine, phenytoin, phenobarbital, primidone and topiramate
• St John’s Wort (a herbal remedy)
• some antiretroviral medicines used to treat HIV
• antibiotics called rifampicin and rifabutin, which can be used to treat illnesses including tuberculosis (TB) and meningitis

Your GP or nurse may advise you to use an alternative or additional form of contraception while taking any of these medicines.

Risks of using the vaginal ring

There are some serious side effects, but these are not common. They include:

• developing a blood clot in a vein or artery
• having a heart attack or stroke

Research into the risk of breast cancer and hormonal contraception is complex and contradictory. It suggests that all women who use hormonal contraception appear to have a small increased risk of being diagnosed with breast cancer, compared with women who don’t use hormonal contraception.

Research suggests there is a small increase in the risk of developing cervical cancer with longer use of oestrogen and progestogen hormonal contraception. Some research suggests a link between oestrogen and progestogen hormonal contraception and a very rare liver cancer.

Where can you get the vaginal ring?

Most types of contraception are available for free in the UK. Contraception is free to everyone through the NHS. Places where you can get contraception include:

• some GP practices – talk to your GP or practice nurse
• sexual health clinics – they also offer contraceptive and STI testing services

Contraception services are free and confidential, including for people under the age of 16.

If you’re under 16 and want contraception, the doctor, nurse or pharmacists won’t tell your parents (or carer). They’ll provide you with contraception as long as they believe you fully understand the information you’re given and are able to use the contraception safely.

Doctors and nurses have a responsibility to make sure that you are safe and free from harm. They’ll encourage you to consider telling your parents (or carer), but they won’t make you. The only time that a professional will not be able to keep confidentiality is if they believe you’re at risk of serious harm, such as abuse. If this was the case they would usually discuss it with you first.