Birth control ring – is this contraceptive right for you?

What do women think about the vaginal ring?

“Vaginal ring birth control means you don’t need to remember a pill every day, and it’s something you control,” says Dr Ann Nainan, family doctor and Healthily expert. “It’s a type of contraception that’s perhaps not so well-known, but it’s highly rated by women who use it.”

In the US, research shows that only about 1% of women aged 15 to 49 using contraceptives choose the ring birth control. But in 1 trial, 98% of women who used it said they would recommend it to others. And in another study, women who usually used the combined pill tried the ring instead – and 81% preferred the ring after about 3 months.

How does the birth control ring work?

The vaginal birth control ring is a small, soft plastic ring that you place inside your vagina. It then steadily releases the hormones estrogen and progestin into your bloodstream.

These hormones prevent pregnancy by:

• stopping your ovaries from releasing an egg (ovulation) every month
• thickening the mucus that’s made by the entrance to your womb (cervix) – so sperm find it difficult to get in and fertilize an egg
• thinning your womb lining (endometrium) – so that if an egg is fertilized, it can’t settle in your womb and develop into a pregnancy

How effective is vaginal ring contraception?

If it’s used perfectly, the vaginal ring is more than 99% effective at preventing pregnancy.

But in real life, women don’t always use it perfectly every time. So with ‘typical use’, it’s about 91% effective – meaning that about 9 in 100 women who use it will become pregnant every year.

What is the NuvaRing?

The NuvaRing is a brand of birth control ring. It’s flexible, transparent, latex-free and colorless.

You usually keep it in your vagina for 21 days (3 weeks), then take it out and have a 7-day break – during which you’re likely to have a bleed.

After the ring-free week, you insert a new NuvaRing ring and repeat the cycle.

In the UK there’s also a brand called SyreniRing, which contains the same hormones and is used in the same way.

What is the Annovera ring?

The Annovera ring is the other brand of vaginal ring. It’s also flexible and latex-free, but it’s white rather than transparent.

As with the NuvaRing, you keep it in your vagina for 21 days, then take it out for 7 days. But unlike the NuvaRing, you can use the same Annovera ring for 1 year (13 cycles).

When you remove your Annovera ring, you simply clean it and store it in its case. Then, after 7 ring-free days, you put the same ring back in your vagina, repeating this cycle for a year.

What are the advantages of using the birth control ring?

As with any medication, it’s a good idea to talk to your healthcare provider about your personal situation, and the potential benefits and risks for you.

But in general, there are lots of potential advantages to using the birth control ring as contraception.

Effectiveness

• when used perfectly, it’s as effective as the pill at preventing pregnancy
• unlike the pill, the hormones don’t need to be absorbed through your stomach – so its effectiveness isn’t affected if you vomit or have diarrhea

Lifestyle

• you don’t have to think about contraception every time you have sex – you just need to remember when it’s time to change or replace your ring
• easy to put in and take out
• latex-free – so safe to use if you have a latex allergy

Health

• usually makes your periods more regular, lighter and less painful
• may help with with the symptoms of premenstrual syndrome (PMS)
• can reduce your risk of cancer of the ovary, womb and colon
• can sometimes help with acne symptoms
• may reduce your risk of ovarian cysts, fibroids and non-cancerous breast disease
• may lower your risk of pelvic inflammatory disease

What are the disadvantages of using the birth control ring?

Practicalities

• you might be able to feel that something is inside your vagina, or get discomfort during sex
• you may not feel comfortable inserting or removing it
• there’s a possibility of the ring breaking or falling out of your vagina. (Rings are more likely to break if you use products in your vagina such as non-water-based lubricants or antibiotics)
• you have to remember when it’s time to change your ring. If you’re worried you might forget, a birth control implant or hormonal intrauterine device (IUD) might be a good method of birth control for you

Health

• birth control ring side effects can include headaches, nausea, breast tenderness and an increase in vaginal discharge. Studies suggest these affect between about 2% and 6% of women using the ring, but they usually go away after a few months
• you may get spotting or bleeding between periods during the first 2 or 3 months
• there can be a delay in your periods returning after you stop using it – for some women, it takes a few months for their periods to come back. But it’s still possible to get pregnant as soon as you stop using the ring
• it doesn't protect against sexually sexually transmitted infections (STIs)– you’ll need to use male condomsas well if you want STI protection. Avoid using a diaphragm or cap or female condoms with a ring, as it can get in the way and stop them working properly

Who shouldn’t use the birth control ring?

Generally, you can usually use the ring until you’re 50, unless there are medical reasons why you can’t use it.

But you may not be able to use it if you:

• are over the age of 35 and smoke, or stopped smoking less than a year ago
• are overweight or obese
• get migraines with aura
• have high blood pressure
• have had a blood clot in an artery or vein
• have had heart or circulatory problems
• have had breast cancer
• have poorly controlled diabetes
• take a medicine that may reduce its effectiveness, such as some medications for epilepsy, HIV and tuberculosis (TB), or the Complementary medicines St John’s Wort
• are unable to hold the ring in position in your vagina – because of loose vaginal muscles or problems such as a vaginal prolapse

How to get the best results from your birth control ring

“Getting used to using a vaginal ring for birth control can be a different experience for different women,” says Dr Ann. “But there are various ways you can help ensure you get the best effectiveness from it.”

How to insert and remove a vaginal ring

It’s simple to put in a birth control ring, but it might take a bit of practice to learn to do it quickly and easily. “Don’t be put off if you find it unusual at first,” says Dr Ann. “But if you really struggle, talk to your doctor.”

To insert a vaginal ring:

• make sure it’s safe to use by checking the expiry date on the package – if the date has already passed, don’t use it

• wash your hands with soap and water

• take it out of its wrapper or case. If you’re using an Annovera ring, wash it with mild soap and lukewarm water, then dry it with a clean paper towel

• squeeze the sides of the ring together with your fingers, then gently push it deep into your vagina

• don’t worry too much about the exact placement in your vagina – the general rule is that if you can’t feel it when you’re walking around, it’s in correctly. (Unlike a diaphragm or cap, a ring doesn't need to cover your cervix to work)

• if it feels uncomfortable, or you notice it when you move, try pushing it in a little further or moving it with your finger

• remember that it can't be in too deep, or get ‘lost’ in your vagina

• To take out a vaginal ring:

• wash your hands with soap and water

• put a finger into your vagina and hook it around the edge of the ring

• gently pull it out – this should be painless

• if you’re using a NuvaRing, put it in the bag provided and throw it in the trash – don’t flush it down the toilet. If you’re using an Annovera ring, clean it and store it in the case that comes with it

Tips for remembering to replace your ring

• see if your healthcare provider offers any reminder services for repeat prescriptions
• add reminders to your calendar or phone for when to take it out and when to put it back in
• try sticky-note reminders left somewhere you’ll see them, such as your bedside table or bathroom mirror
• ask your partner (or a trusted friend) to help you get started with your routine – sometimes 2 minds are better than one

What to do if you’re late replacing your contraceptive ring

If you make a mistake with using your ring – such as forgetting to put it back in – it’s best to speak to your healthcare provider for advice. The tips below can also help you work out what to do next.

If you forget to reinsert your NuvaRing after your 7-day break:

• if it’s less than 8 days since you removed it – just insert your new ring straight away and continue using it as normal
• if it’s more than 8 days since you removed it – insert your new ring and continue using it as normal, but also use another form of birth control, such as condoms (or avoid having sex) for the next 7 days
• if you’ve had unprotected sex, you might need emergency contraception and a follow-up pregnancy test

If you forget to reinsert your Annovera ring after your 7-day break:

• reinsert it as soon as you remember, then use another form of birth control for the next 7 days
• if you’ve had unprotected sex, you might need emergency contraception and a pregnancy test

What to do if leave your birth control ring in too long

If you’ve left your NuvaRing in for more than 21 days:

• if it’s been 28 days or less, just take your planned ring-free break, then continue using as usual
• if it’s been more than 4 weeks and up to 5 weeks, put a new ring in straight away, don’t have a ring-free break, and use another form of birth control or avoid sex until the new ring has been in place for 7 days
• if it’s been more than 5 weeks, put a new ring in straight away, don’t take a ring-free break and use another form of birth control or avoid sex for 7 days. You may need emergency contraception if you had unprotected sex during week 5 or later, and may also need a pregnancy test now or in 3 weeks

If you’ve left your Annovera ring in for more than 21 days:

• remove it as soon as you remember, have your planned ring-free break, then continue using it as usual
• you shouldn’t need to use another form of birth control or emergency contraception – but it may depend on how long you left the ring in for, so it’s best to talk to your doctor

What to do if your birth control ring falls out

If your NuvaRing falls out:

• if it’s been out 48 hours or less – just rinse it in lukewarm water and put it back in. You’re protected from pregnancy and you don’t need to use additional contraception
• if it’s been out more than 48 hours in the first week of use – rinse it and put it back in as soon as possible. Use additional contraception until it has been in place for 7 days. You may also need emergency contraception if you’ve had sex in the last few days
• if it’s been out more than 48 hours in the second or third week of use – put a new ring in as soon as possible (if you’re due to start a ring-free break, skip this). Use additional contraception until your new ring has been in place for 7 days. You don’t need emergency contraception if you’ve used the ring correctly for the previous 7 days

If your Annovera ring falls out:

• if it’s been out 2 hours or less – just wash it and put it back in
• if it’s been out more than 2 hours – wash it and put it back in as soon as possible. Use another type of contraception until it has been in place for 7 days. You may also need emergency contraception if you’ve had sex since it fell out, or don’t wait 7 days for the protection to start again

When to see a doctor

Once you’ve started using the ring, if you notice side effects or don’t feel comfortable, discuss this with a doctor. They can give you advice and, if needed, help you consider other birth control methods that might suit you.

If you get any pain or bleeding when you remove your ring, or you can’t pull it out, speak to your doctor as soon as possible.

You should also see a doctor if:

• you’re thinking about starting to use the birth control ring
• you have – or develop – any conditions that mean the birth control ring may not be suitable for you
• you feel your ring is affecting your mood
• you have vaginal spotting, bleeding between your periods or bleeding after sex
• you have headaches or are concerned about any other side effects
• you want to discuss other contraception options
• you notice a lump in your breast, any nipple changes or skin changes around your nipples, or a lump in your armpit

For most people, the risk of serious health problems when using the vaginal ring is very small, and any side effects (if you get them) will be mild and temporary. But you should get urgent medical advice or go to your local emergency department if you have any of these symptoms:

• sudden back/jaw pain along with nausea, sweating or trouble breathing
• chest pain or discomfort
• unexplained pain in your leg
• trouble breathing
• severe pain in your belly (abdomen)
• a sudden, very bad headache – or headaches that are different, worse or happen more often than usual

Your health questions answered

Can I use the vaginal ring without a 7-day break?

“With the NuvaRing, you can choose to have a shorter ring-free break, or skip the break altogether,” explains Dr Ann. “To do this, you simply replace your NuvaRing with a new ring after 3 weeks. It’s safe to use the ring this way, and many women find they don’t have a bleed if they do so. But it’s best to speak to your nurse or doctor first, to check if it’s right for you.”