Contraception: vaginal ring
What is the vaginal ring?
The vaginal ring (brand name NuvaRing) is a type of hormonal contraception. It is a thin, soft plastic ring that you place in the vagina, where it releases low doses of 2 synthetic hormones. These hormones, an oestrogen and a progestogen, mimic the natural female sex hormones.
When used properly, the vaginal ring is an effective and safe way of preventing pregnancy.
How it works
The vaginal ring contains the same type of synthetic hormones that are used in the combined oral contraceptive pill (the pill), and it works in the same way as the pill. Specifically, NuvaRing (the brand of vaginal ring available in Australia) contains the oestrogen ethinyloestradiol and the progestogen etonogestrel.
The vaginal ring continuously releases oestrogen and progestogen into the bloodstream, which stops ovulation (an egg being released from the ovaries each month). It also thickens cervical mucus (mucus made in the lower part of the uterus), making it difficult for sperm to pass into the uterus.
Effectiveness at preventing pregnancy
The effectiveness of a contraceptive method can be measured for perfect use and typical use.
- Perfect use is when instructions are followed precisely. The failure rate for perfect use of the vaginal ring during the first year of use is less than 1 per cent. So, when used perfectly, less than one woman in every 100 will become pregnant in the first year.
- Typical use is what tends to happen in reality. Typical use failures include failures due to incorrect use. The failure rate for the vaginal ring is about 9 per cent in the first year of typical use.
Advantages of the vaginal ring include the following.
- It is effective and reliable when used as directed.
- It may result in periods becoming lighter, less painful and more regular.
- It doesn’t affect sexual spontaneity.
- The vaginal ring can be used to manipulate the menstrual cycle (skip or delay periods for convenience).
- Fertility is not permanently affected, and usually returns soon after stopping use.
- It may help improve premenstrual syndrome, acne and the symptoms of polycystic ovary syndrome.
- The vaginal ring may help reduce the risk of several conditions, including ovarian cysts, ovarian cancer and endometrial cancer (cancer of the lining of the uterus).
- Unlike the pill, you don’t have to remember to take it daily, and the absorption of the hormones into your body is not affected by tummy upsets. Spotting (breakthrough bleeding) is also less common compared with using the pill.
There are several disadvantages associated with the vaginal ring.
- It is only available on prescription.
- The vaginal ring is not currently listed on the Pharmaceutical Benefits Scheme (PBS), and is relatively expensive compared with other forms of contraception.
- The vaginal ring does not protect against sexually transmitted infections (STIs).
- It cannot be used by some women, including women who have had breast cancer, a stroke, a heart attack, deep vein thrombosis (blood clots, usually in the legs), certain types of migraines, liver disease, unexplained vaginal bleeding and smokers aged over 35.
- It may not be recommended in women with high blood pressure, diabetes, high cholesterol, unexplained vaginal bleeding, and those who are overweight.
- The vaginal ring should generally not be used during breast feeding, as the oestrogen may suppress your milk supply.
Starting using the vaginal ring
You can start using a vaginal ring at any time in your menstrual cycle, but the best time is on the first day of your period.
Depending on where you are in your cycle, you may not be protected against pregnancy straight away. If you insert the ring on the first day of your period, you are protected. If you insert the ring at any other time in your cycle, you are not protected against pregnancy for the first 7 days of use and you’ll need to use backup contraception, such as condoms, for 7 days.
How is it used?
Before inserting the vaginal ring, wash your hands. To insert the ring, squeeze it between your thumb and index finger and gently push the ring into your vagina until it feels comfortable. Most women cannot feel the vaginal ring when it has been inserted correctly.
The vaginal ring should remain in place high up in the vagina for 3 weeks. At the end of the 3 weeks, remove the ring by gently hooking your finger around the ring and pulling it out. A new ring should be inserted after a 7 day break. Usually you will have a withdrawal bleed during the week between removing the ring and replacing it with a new one.
It’s important that you remember when you are due to change the ring – setting yourself a reminder is a good idea. If you are late changing the ring or the ring accidently comes out of your vagina, you should check the instructions on the packet for what to do. It’s also a good idea to check with your healthcare provider for advice on what to do.
What to do if you haven’t changed the ring according to instructions
The following is a general guide for what to do if you forget to change your vaginal ring on time. However, always check the instructions and ask your doctor or pharmacist what to do if you are not sure.
If you have left a vaginal ring in for longer than 3 weeks but less than 4 weeks, remove the ring as usual for the 7-day break and then insert a new ring. You will still be protected against pregnancy.
If you’ve left it in for longer than 4 weeks, remove the ring and insert a new ring straight away (skip the 7-day break). You should also use backup contraception* (such as male condoms) for 7 days. If you’ve had sex during the time that the ring was overdue for removal, there is a possibility you could be pregnant. Talk to your doctor about what to do next and whether you may need emergency contraception.
If you are late putting in a new ring after a 7-day break, put the ring in when you remember and use an extra form of contraception* for 7 days. Contact your doctor if you had sex during the ring-free period, as there is a possibility you could be pregnant.
*Don’t use a diaphragm, cervical cap or female condoms as backup contraception because the vaginal ring can interfere with the correct placement of these alternative contraceptives, making them less reliable.
What to do if the ring accidentally comes out
It is possible for the vaginal ring to come out accidentally. This usually happens if it hasn’t been put in properly, after having sex or when removing a tampon. If this happens, just rinse it in cold or warm water and put it back in. If it has been out of your vagina for more than 3 hours, refer to the instructions or talk to your doctor or pharmacist about what to do.
Because rings do occasionally come out, it’s a good idea to regularly check that yours is in place.
What to do with used rings
Dispose of used vaginal rings in the bin. It’s best to discard them using the sachet that comes with the packaging. Do not flush them down the toilet.
Using the vaginal ring to skip periods
It’s possible to avoid withdrawal bleeds (periods) by inserting a new ring every 3 weeks (thus skipping the ring-free, or hormone-free week). This may be done for several months in a row, but it’s best to seek advice from your doctor if you are planning on this. There is a risk of breakthrough bleeding or spotting when using vaginal rings back-to-back in this way.
Side effects associated with NuvaRing
Side effects are similar to those experienced with the combined oral contraceptive pill. Some users of the vaginal ring have also experienced vaginal discomfort, increased vaginal discharge and difficulty keeping the ring in place.
Possible side effects include:
- spotting or bleeding between periods;
- breast tenderness;
- reduced libido; and
- mood changes.
In rare instances, the vaginal ring can cause serious side effects such as:
- blood clots;
- heart attack;
- high blood pressure; and
- liver and gallbladder disease.
Taking other medicines while using a vaginal ring
Your doctor will ask about any medicines, including herbal and complementary medicines, when prescribing the vaginal ring. That’s because some medicines (such as medicines used to control seizures, certain antibiotics, antiviral medicines used to treat hepatitis C and HIV/AIDS, and St John’s wort) can reduce the effectiveness of the vaginal ring.
You should not use NuvaRing if you are taking certain antiviral medicines for hepatitis C.
Check with your doctor before changing any of your regular medicines.
Should I use a vaginal ring for contraception?
The vaginal ring may be a good choice for women who want an easy-to-use, reliable form of contraception and don’t want to have to remember to take a pill every day. The vaginal ring can also improve acne, premenstrual syndrome and heavy, painful periods – so may be chosen for these additional benefits.
However, combined hormonal contraceptives such as the vaginal ring are not suitable for all women and are associated with side effects. Your doctor will be able to talk you through the pros and cons of the vaginal ring to help work out if its the right option for you.
Check ups while using a vaginal ring
Your doctor will want to check your general health, including measuring your blood pressure, after a few months of using the vaginal ring. After that, yearly checkups are recommended. Let your doctor know at any time if you have side effects or other concerns about your vaginal ring.
Last Reviewed: 23/05/2018
Your Doctor. Dr Michael Jones, Medical Editor.
1. Hormonal contraception (published March 2014). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2018 Mar. https://tgldcdp.tg.org.au (accessed May 2018).
2. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Combined hormonal contraceptives (March 2016). https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Combined-hormonal-contraceptives-(C-Gyn-28)-Review-March-2016.pdf?ext=.pdf (accessed May 2018).
3. Family Planning Victoria. NuvaRing (vaginal ring) (updated Jun 2016). https://www.fpv.org.au/for-you/contraception/other-methods/nuvaring-vaginal-ring (accessed May 2018).
4. NHS Choices. Vaginal ring (updated 22 Jan 2018). https://www.nhs.uk/conditions/contraception/vaginal-ring/ (accessed May 2018).
5. Merck, Sharp & Dohme (Australia). NuvaRing: Consumer Medicine Information. Published by MIMS April 2018. http://www.mydr.com.au/medicines/cmis/nuvaring-controlled-release-vaginal-contraceptive-ring (accessed May 2018).
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