Vaginal rings are a convenient contraceptive option

All You Need to Know About Vaginal Rings (NuvaRing)

What is a vaginal ring?

It’s one of many birth control options and, just like the pill and contraceptive patches, it’s based on two hormones, namely estrogen and a progestin (ethinylestradiol and etonogestrel, to be precise). As the name already says, it’s a rubber ring that’s inserted into the vagina. It’s most famous brand version is Nuvaring, but it’s also available generically in some countries. Like almost all contraceptive medication, it’s only available through a doctor’s prescription.

The hormonal combination stops ovulation and thickens your mucus, which makes it more difficult for sperms to advance inside the uterus. A third effect is the thinning of the uterine lining, which makes it harder for eggs to stay in the uterus. Like other contraceptive medication, positive side effects of the vaginal ring are a lighter and less irregular period and weaker PMS symptoms.
 
As with any drug, there also are negative side effects. In five studies with a total of 2,500 women, the most common problems associated with the ring were vaginitis (14%) and headache (10%). In up to 6% of vaginal ring users, there’s also a chance that they experience breakthrough bleeding. One rare side effect can be an increased risk of blood clots. 

This risk profile is similar to other birth control options (pills and patches), as they all apply the same hormonal treatment. When you ask a doctor for a vaginal ring prescription, make sure to talk about the potential side effects and contraindications.

In terms of efficiency, i.e., its protection against unwanted pregnancies, the vaginal ring is as safe as hormonal pills or patches. The efficiency achieved in trials is above 99% and in typical use, it offers 93% protection. This is even better safer than the protection you get from condoms in typical use (~85%).  

The big benefit of the ring is that you don’t have to think about it every day. It’s changed only once every four weeks, including a one-week break period. In contrast, the pill you need to take daily and birth control patches are changed weekly.

How is a vaginal ring used?

The ring is inserted into the vagina for a three-week period, where it will be held in place by the vaginal muscles. Even during sexual intercourse and physical exercise it very rarely falls out. In the unlikely event of such an accident, rinse the ring and reinsert it properly. Don’t wait too long. If the ring is outside your vagina for more than three hours, your pregnancy protection isn’t guaranteed any longer. If for some reason you leave it outside the vagina for more than three hours before reinserting, you’ll need to use back up protection for the next seven days, such as condoms or refraining from sexual activity altogether. 

And there’s really no need to remove the ring. You won’t feel it’s there and your partner most likely won’t either. Studies show that ~85% of men don’t notice the ring at all during sex. 

Similar to birth control pills and patches, after the three-week period, you’ll have one hormone-free week. Take out the ring and after seven days insert a new ring. Then you repeat this 3+1 cycle. During the fourth week without a ring, you’ll get your period. Not in the first month, as your body still is adapting to the hormone treatment. However, in the following months, you’ll experience a regular and comparatively light period in the fourth break week of the cycle. 

You can start using a vaginal ring at any time of your monthly cycle. It will take a few days for the hormones to do their work. Therefore, doctors recommend that during the first week of using a ring, you also use backup protection, such as condoms, or stop having sexual intercourse. 

What should I do if I lose the ring or forgot when I inserted it?

 Losing the ring is difficult, but it can happen. It’s also possible to mix up your ring schedule and forget when you should insert a new ring — although it should always be the exact same weekday. No need to worry, though. Just insert a new ring as soon as you can and apply the aforementioned seven-day backup protection rule. 
 

References:

Roumen, Frans JME. “Review of the Combined Contraceptive Vaginal Ring, NuvaRing®.” Therapeutics and Clinical Risk Management, vol. 4, no. 2, 1 Apr. 2008, pp. 441–451, www.ncbi.nlm.nih.gov/pmc/articles/PMC2504064/. Accessed 13 Mar. 2020.

Guida, Maurizio, et al. “Effects of Two Types of Hormonal Contraception--Oral versus Intravaginal--on the Sexual Life of Women and Their Partners.” Human Reproduction (Oxford, England), vol. 20, no. 4, 1 Apr. 2005, pp. 1100–1106, www.ncbi.nlm.nih.gov/pubmed/15608030, 10.1093/humrep/deh686. Accessed 13 Mar. 2020.

Oddsson, Kristjan, et al. “Efficacy and Safety of a Contraceptive Vaginal Ring (NuvaRing) Compared with a Combined Oral Contraceptive: A 1-Year Randomized Trial.” Contraception, vol. 71, no. 3, Mar. 2005, pp. 176–182, 10.1016/j.contraception.2004.09.001. Accessed 13 Mar. 2020.
 

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