Vaginal Contraceptive Ring

What is the vaginal contraceptive ring?

The vaginal contraceptive ring is a type of birth control for women. It is a flexible ring inserted into the vagina. It contains the female hormones estrogen and progesterone. These are hormones also used in birth control pills. Low doses of the hormones are continuously released into your body from the ring. The ring must be prescribed by your healthcare provider.

The vaginal ring is easy to insert and remove. You insert the ring into your vagina and leave it there for 3 weeks. You then remove it and wait 1 week until you insert a new ring. During the 1-week break, you will usually have your menstrual period. The ring protects against pregnancy but not against AIDS or other sexually transmitted diseases.

How does the vaginal ring work?

The 2 hormones in the ring are absorbed through the vagina into the bloodstream. The hormones stop the ovary from releasing an egg, so that pregnancy does not occur. The hormones also prevent pregnancy by causing thickening of the mucus on the cervix, making it hard for sperm to enter the uterus. The ring also changes the lining of the uterus, which helps prevent a fertilized egg from growing in the uterus.

When can I start using the vaginal ring?

If you have not been using a hormonal form of birth control (such as the pill, Norplant, Depo-Provera, or a Mirena IUD), you start using the ring by inserting it into the vagina between days 1 and 5 of your menstrual period. As long as you insert the ring at this time, it doesn't matter if your period has stopped or you are still bleeding. (Day 1 is the first day of your menstrual period.) When you start using the vaginal ring, you should use an additional form of birth control, such as male condoms or spermicide, until the ring has been in place for 7 days.

If you are switching from another form of birth control that uses hormones, the instructions for starting the ring and using extra methods of birth control are somewhat different. The instructions may also be different if you are using the ring after a first-trimester termination of pregnancy (also called TOP or abortion) or miscarriage. Discuss this with your healthcare provider.

If you are recovering from the birth of a child or a second-trimester miscarriage or TOP, or if you are breast-feeding, talk with your healthcare provider about when you can start using the vaginal ring.

How do I use the vaginal ring?

To insert the ring:

1. After you wash and dry your hands, remove the ring from its foil pouch. Keep the foil pouch for disposal of the ring after use.
2. Choose the position that is most comfortable for you for insertion. You may lie down, squat, or stand with one leg up. You may feel most comfortable using the same position you use for inserting tampons, if you use them.
3. Hold the ring between your thumb and first or second finger and press the opposite sides of the ring together.
4. Gently push the folded ring into your vagina. The exact position of the ring in the vagina is not important for it to work. However, the more deeply you insert the ring into your vagina, the less likely it is that you will feel it or that your partner will feel it during intercourse. It is also less likely that the ring will come out accidentally.
5. Once inserted, keep the ring in place for 3 weeks in a row.

To remove the ring:

1. Remove the ring 3 weeks after you put it in, on the same day and at the same time as you put it in. For example, if you inserted the ring on a Sunday at about 10 PM, remove the ring on the Sunday 3 weeks later at about 10 PM.
2. Remove the ring by hooking your first or second finger under the forward rim or by holding the rim between your index and middle finger and pulling it out.
3. Place the used ring in the foil pouch and put it in the trash out of the reach of children and pets. Do not flush it down the toilet.

Your menstrual period will usually start 2 to 3 days after you remove the ring. To continue to be protected against pregnancy, you must insert a new ring 1 week after the last one was removed, even if your menstrual period has not stopped. If the vaginal ring is left in your vagina for an extra week or less (4 weeks total or less), remove it and insert a new ring after a 1-week break without the ring.

If a ring is left in place for more than 4 weeks, you may no longer be protected from pregnancy. In this case, before you insert a new ring, check to make sure you are not pregnant. Use an extra method of birth control, such as male condoms or spermicide, until a new ring has been in place for 7 days in a row.

What should I do if the ring accidentally comes out?

The ring may accidentally come out of the vagina:

• if it was not inserted properly
• when you remove a tampon
• when you strain with a bowel movement
• during sexual relations

If the ring comes out, rinse the ring with cool or lukewarm water (not hot water) and put it back into the vagina as soon as possible. If the ring has been out of the vagina more than 3 hours before you reinsert it, the ring may no longer help to prevent pregnancy for the next several days. You will need to use another means of birth control until the ring has been in your vagina for 7 days in a row.

Most women can get pregnant soon after they stop using the vaginal ring unless they had irregular menstrual periods before using the ring. If you want to get pregnant, it is best to wait until you have had 2 normal periods after stopping birth control. This will help your healthcare provider know when your baby is due.

What are the benefits of the vaginal ring?

The benefits are:

• The vaginal ring can be 99% effective in preventing pregnancy. This means that, for every 100 women who use the ring for a year, 1 woman may become pregnant by the end of the year. Your chance of getting pregnant increases if you do not use the ring exactly according to the directions.
• You do not have to remember to take a pill for birth control every day or change a birth control patch every week.
• You do not have to interrupt lovemaking to use a birth control device or spermicide.
• Periods become regular and usually lighter. Menstrual cramps may be less severe.
• Long-term use lowers the risk of cancer of the ovary.
• The vaginal ring may reduce symptoms of premenstrual syndrome (PMS).

What are the disadvantages of the vaginal ring?

There is a chance of the ring falling out. Some of the problems you may have while you are using the ring are:

• irregular vaginal bleeding or spotting
• nausea or vomiting
• swelling of your hands or ankles
• severe pain, swelling, or tenderness in the abdomen
• breast lumps or tenderness
• weight gain
• dizziness
• headaches
• rash (caused by an allergic reaction)
• jaundice (yellowing of the skin or whites of the eyes)
• vaginal infection (usually yeast)
• vision or contact lens problems
• mood swings
• acne
• trouble sleeping, weakness, lack of energy, fatigue, or depression

You should not smoke. Smoking increases the risk of serious side effects, such as heart attack, stroke, and blood clots. This is especially true if you over 35 years old and smoke 15 or more cigarettes a day.

The ring may not protect you against pregnancy if you are taking certain medicines, such as some antibiotics or seizure medicines. Tell your provider about all medicines or natural remedies that you are taking.

The ring does not protect you from getting AIDS or other sexually transmitted disease.

Some women with chronic diseases or other problems should not use the vaginal ring. For example, women who have blood clots, abnormal menstrual bleeding, high blood pressure, certain cancers, or a history of heart attack or stroke should not use the ring. You should not use the vaginal ring if you think you are pregnant. Your healthcare provider will discuss your medical history with you.

When should I call my healthcare provider?

Call your provider right away if you have:

• sharp chest pain or sudden shortness of breath or are coughing up blood
• sudden severe headache or vomiting, dizziness or fainting, or problems with vision or speech
• sudden partial or complete loss of vision
• yellowing of the skin or whites of the eyes (jaundice), especially with fever, tiredness, loss of appetite, dark urine, or light-colored bowel movements
• unexplained pain, weakness, swelling, or numbness in one of your legs
• severe pain, swelling, or tenderness in the abdomen

Call during office hours if:

• You need help or advice from your provider for side effects or problems with the ring.
• You have problems with your menstrual periods, such as bleeding between periods, prolonged periods, or 2 missed periods, or you think you are pregnant.
• You have more headaches than you used to have.
• You have severe mood changes.
• You have vaginal discharge with itching.
• You develop a rash.