What is the contraceptive vaginal ring?

Types of vaginal rings

NuvaRing is the only type of vaginal ring available in Australia.

How does the vaginal ring work?

Women can insert and remove a vaginal ring themselves. It should be inserted at the correct time during the menstrual cycle. Your doctor can help you determine the correct day to start.

Once inserted properly, the ring sits high in the vagina. It is left in place for 3 weeks to release the oestrogen and progestogen. Most women can’t feel it. Don’t remove the ring during sex or exercise — it should be left in place.

The hormones stop the ovaries from releasing eggs. They also thicken the mucus at the entrance to the uterus (womb), and change the lining of the uterus to prevent any fertilised eggs from attaching and developing.

After 3 weeks, the ring should be removed for a week to allow for a menstrual period, and then a new vaginal ring should be inserted. If you forget to remove your ring after 3 weeks, but you take it out before 4 weeks have passed, it will still protect you from pregnancy. If you leave the ring in place for more than 4 weeks, then there’s a greater possibility of you becoming pregnant. In this case, you should use another type of contraception and speak to your doctor before starting a new ring.

How well does the vaginal ring work?

The vaginal ring works fairly well at preventing pregnancy. If 100 women use the vaginal ring for 1 year, about 9 will still likely become pregnant.

The ring won't work at all if you forget to put it in, or don't take it out at the right time.

The vaginal ring can't protect you against sexually transmitted infections (STIs) — only condoms do that, and even condoms won't protect you against every kind of STI.

Advantages and disadvantages of the vaginal ring

The main advantages of the vaginal ring are that it:

• is safe for most women to use
• doesn't need to be fitted by a doctor
• has few side effects
• unlike the pill, it’s not affected by vomiting or diarrhoea
• allows control of periods — they will be lighter, and if you don’t want a period you can talk to your doctor about putting a new ring in straight after the old one
• allows your fertility to return quickly when the ring is removed
• it may improve pre-menstrual syndrome and acne

The main disadvantages are that:

• you need to remember to place it and remove it at the right time
• some women have trouble keeping it in place
• it can cause similar side effects to the pill, such as headache, nausea, bloating, tender breasts, acne, mood changes, loss of interest in sex, breakthrough bleeding, brown patches on the face
• it is more expensive than the pill
• there is a very small risk of heart attack, stroke and blood clots (or thrombosis)

The vaginal ring is not for women who are very overweight, have had a deep vein thrombosis, heart attack or stroke, a condition which increases the risk of blood clots, severe liver problems, some types of migraine, breast cancer or some types of lupus.

Some medications for epilepsy or some herbal preparations can stop the vaginal ring from working properly. You should not use the vaginal ring if you are over 35 and smoke, or 6 weeks after having a baby.

What could go wrong?

If the ring accidentally comes out, rinse it with water and put it back in straight away.

The vaginal ring won't protect you from getting pregnant if:

• you leave it in for longer than 4 weeks
• your ring is out for more than 3 hours (unless it's for the 1-week break)
• your 1-week break stretches past 1 week

If any of this happens, put in a new ring and use another type of contraception such as condoms for the next week. If you have unprotected sex during this time, you might consider taking emergency contraception, available from your doctor, chemist, health centre or family planning centre.

Resources and support

See Family Planning NSW and Jean Hailes for Women's Health.