Article provided by NHS Choices
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 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 one woman out of every 100 who use the vaginal ring as contraception will become pregnant in one year.
- 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, and bleeding will probably be lighter and less painful.
- Some women have temporary side effects, including more vaginal discharge, breast tenderness and headaches.
- A few women 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 (the release of an egg)
- 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 seven-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 can get contraception at:
- most GP surgeries
- community contraception clinics
- some GUM clinics
- sexual health clinics
- some young people's services
The licence for the vaginal ring states that:
- you will 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, and you'll need to use additional contraception (such as condoms) for the first seven days
However, guidance from The Faculty of Sexual and Reproductive Healthcare (FSRH) differs slightly, advising that the ring will protect against pregnancy straight away if you start it up to day five of your menstrual cycle. This is because a study found that ovulation was suppressed in women who started using the vaginal ring on day five of their cycle.
You can discuss this with your doctor or nurse to decide when might be the best time for you to start using the ring.
To insert the ring:
- with clean hands, squeeze the ring between your thumb and finger, and gently insert the tip into your vagina
- 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 is 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 (three weeks), you remove it. This should be on the same day of the week that you put it in.
To remove the ring:
- with clean hands, put a finger into your vagina and hook it around the edge of the ring
- gently pull the ring out
- put it in the special bag 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 seven days (one week). This is the ring-free interval. You might have a period-type bleed during this time.
After seven 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 seven days after the end of week three:
- take the ring out as soon as you remember
- don't put a new ring in - start your seven-day interval as normal
- begin your new ring after your seven-day interval as normal
- you're still protected against pregnancy, and you don't need to use additional contraception
If the ring has been in for more than seven extra days (more than four weeks in total):
- take the ring out as soon as you remember
- put a new ring in straight away
The licence for the vaginal ring states that you should use additional contraception (such as condoms) until the new ring has been in for seven days.
The FSRH advice is different. Talk to your doctor or nurse about when you should use additional 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 in a new ring as soon as you remember, and use additional contraception, such as condoms, for seven 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 (nine 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.
The licence 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 licence information on what to do if the ring comes out.
If the ring is out for more than three hours in the first or second week of using it, rinse it and put it back in. You need to use additional contraception for seven 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 three 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.
- 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 seven 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?
Some women cannot use the vaginal ring. Your doctor or nurse will ask about your medical history and your family's medical history, to see whether the ring is suitable for you. The ring may not be suitable if you:
- have had a blood clot in a vein or artery
- have had heart or circulatory problems, including high blood pressure
- are 35 or older and smoke, or stopped smoking in the past year
- have severe migraine with aura (warning symptoms)
- have had breast cancer in the past five years
- have diabetes with complications
- are overweight
- take certain medicines
- have vaginal muscles that can't hold a vaginal ring
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 will be protected against pregnancy straight away.
If you start the ring more than 21 days after giving birth, you need to use additional contraception for seven days after you insert the ring.
The vaginal ring may reduce your flow of milk if you're breastfeeding a baby under six months old. It's usually recommended that you use a different method.
After miscarriage or abortion
You can start using the ring immediately after a miscarriage or abortion, and it will work straight away. You don't need to use additional contraception.
Advantages and disadvantages
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 or each time you have sex
- 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 nurse or pharmacist
- 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.
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 you can get the vaginal ring
Most types of contraception are available for free in the UK. Contraception is free to all women and men through the NHS. Places where you can get contraception include:
- most GP surgeries - talk to your GP or practice nurse
- community contraception clinics
- some genitourinary medicine (GUM) clinics
- sexual health clinics - they also offer contraceptive and STI testing services
- some young people's services (call 0300 123 7123 for more information)
Find your nearest sexual health clinic by searching by postcode or town.
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 pharmacist won't tell your parents or carer as long as they believe you fully understand the information you're given and your decisions. Doctors and nurses work under strict guidelines when dealing with people under 16.
They'll encourage you to consider telling your parents, but they won't make you. The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first.
Article provided by NHS Choices
Record managed by Oxfordshire Family Information Service