Ring

vaginal contraceptive ringThe 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 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.
It 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.

Effectiveness

91%

Lasts for

Varies

Effect on period

Regular

Side effects

None

There are different ways of using the vaginal ring. The ring is designed to give you a withdrawal bleed once a month. A withdrawal bleed isn’t the same as your period. It’s caused by you not getting hormones on a ring-free break. Ring instructions tell you to take a seven day ring-free break but you can choose to shorten this break or to miss it and not have a withdrawal bleed.

Missing or shortening the ring-free break could help you if you get heavy or painful bleeding, headaches or mood swings on ring-free days.

The riskiest time to forget your ring is just before or just after the ring-free break. You’re more at risk of pregnancy so taking a shorter break or missing a break makes this less risky. You can use the ring in the following ways.

  • Leave the vaginal ring in for 21 days then remove it and wait for 4 or 7 days. This has been the standard way to use the ring. You’ll usually have a withdrawal bleed during the ring-free break. This is called a ring cycle. Start using the ring again on the fifth or eighth day, even if you’re still bleeding.
  • Leave the vaginal ring in for 21 days then remove it and insert a new one immediately. Leave that in for another 21 days. Remove it and insert a new one immediately. Leave that in for another 21 days. Take a break for 4 or 7 days before inserting a new one. This is called extended use or tricycling. You’ll usually have a withdrawal bleed during the ring-free break. Start using the ring again on the fifth or eighth day even if you’re still bleeding.
  • Leave the vaginal ring in for 21 days. Remove it and insert a new one immediately. Continue to remove and insert a new ring after 21 days with no breaks. This is called continuous use. You don’t have a withdrawal bleed but you may still get some bleeding which may be occasional or more frequent. Any bleeding you get is likely to reduce over time if you keep using the ring continuously.
  • Leave the vaginal ring in for at least 21 days. Remove it and insert a new one immediately. Continue to remove and insert a new ring after 21 days. If you get bleeding that’s unacceptable to you for 3-4 days then remove the ring for a four day ring-free break. This is called flexible extended use. Insert a new ring again on the fifth day even if you’re still bleeding. This can help manage the bleeding. Leave the ring in for at least 21 days before taking your next break.

You can use the ring continuously without a break for as long as you like, as long as your doctor or nurse doesn’t advise you to stop.

Disposing of the vaginal ring: Put the used vaginal ring in the disposal sachet provided and place it in a waste bin. It must not be flushed down the toilet.

Benefits:

• Easy to put in and take out yourself
• Doesn’t interrupt sex – can have sex with it in place
• You don’t need an examination before use
• Usually makes periods regular, lighter and less painful
• Contraception for a month, so you don’t need to think about it every day
• Fertility returns to normal when removed.

Disadvantages:

• You and your partner may feel it during sex, but this isn’t harmful.
• Does not protect you against STIs, so you may need to use condoms as well.
• A few women develop a blood clot (thrombosis) when using the ring, but this is rare.
• Some women have temporary side effects, including more vaginal discharge, breast tenderness and headaches.
• It 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.

How effective is it?

If the vaginal ring is used correctly and according to instructions it is over 99 percent effective. This means that less than one woman in 100 will get pregnant in a year. When used typically, the vaginal ring is 91% effective.

What makes it less effective?

• If the ring falls out and is not replaced after the 7-day break
• Use of some prescription medicines including some antibiotics, medicines used to treat epilepsy, HIV and TB and the complementary medicine St John’s Wort.

If you forget to take the ring out

If the ring is removed outside of a ring-free break, follow these instructions:

Less than 48 hours since ring came out

Insert the ring as soon as possible. Keep the ring in until the next scheduled ring-free break.

If you’re in the first week after a ring-free break - you don’t need to use any additional contraception as long you’ve used the ring correctly every other day this week and in the seven days before the ring-free break.

If you’re in any other week - you don’t need to use any additional contraception as long you’ve used the ring correctly for the previous seven days.

48 hours or more since ring came out

Insert the ring as soon as possible. Keep the ring in until the next scheduled ring-free break.

You may need emergency contraception now and a pregnancy test in three weeks if you’re in the first week after a ring-free break and had unprotected sex this week or during the ring-free break. Use condoms or avoid sex until the ring has been in place for seven days in a row.

You don’t need emergency contraception if you’re in any other week and the ring has been used correctly in the previous seven days. Use condoms or avoid sex until the ring has been in place for seven days in a row and if you’re within seven days of a ring-free break, omit it.

If you’ve left the same ring in for longer than three weeks, follow the instructions below

3-4 weeks (21-28 days)

If you have a ring-free break scheduled, take it now and insert a new ring afterwards. If you don’t take ring-free breaks, insert a new ring now. You don’t need additional contraception, as long as the ring was in place from day 21 to day 28  of use.

4-5 weeks

Don’t take the ring-free break. Insert a new ring as soon as possible. Use condoms or avoid sex until the ring has been in place for seven days in a row. You don’t need emergency contraception, as long as the ring was in place from day 21 to day 28 of use.

More than 5 weeks

Don’t take the ring-free break. Insert a new ring as soon as possible. Use condoms or avoid sex until the ring has been in place for seven days in a row. You may need emergency contraception now and a pregnancy test in three weeks, if you had unprotected sex during week 5 or later.

What if I insert the ring more than 24 hours late after a seven day ring-free break or more than 96 hours late after a four day ring-free break?

Insert a new ring as soon as you remember and keep it in until it’s scheduled to be removed. Use condoms or avoid sex until the ring has been in place for seven days in a row. You may need emergency contraception if you had unprotected sex during the ring-free break.

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.
The license for the vaginal ring states that if the ring is out for more than three hours, you will not be protected against pregnancy. The FSRH advises that you'll be protected for longer – up to 48 hours if the ring was in for seven continuous days before it came out. Talk to your doctor or nurse about whether you'll be protected against pregnancy or not.
The information below is based on the license information on what to do if the ring comes out.
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 two options:

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

Whichever option you choose, you need to use additional 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.

For more information visit: http://www.fpa.org.uk/