Vaginal Contraception 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 vaginal ring is easy to insert and remove. You insert the ring into your vagina by squeezing it together and pushing it as far into the vagina that you can. You may also remove a tampon from its applicator and put the ring into the applicator and insert into the vagina. You will leave the ring in the vagina for 3 weeks. You then reach into the vagina and hook the ring with your finger to 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 two 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 Progestasert 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.

How do I use the vaginal ring?

To insert the ring:

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.

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.

Hold the ring between your thumb and first or second finger and press the opposite sides of the ring together.

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.

Once inserted, keep the ring in place for 3 weeks in a row.

To remove the ring:

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 10:00 PM, remove the ring on the Sunday 3 weeks later at about 10:00 PM.

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.

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.

What are the benefits of the vaginal ring?

The benefits are:

• The vaginal ring is 98 to 99% effective in preventing pregnancy. This means that, for every 100 women who use the ring for a year, 1 or 2 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.
• 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.
• Most women can get pregnant 2 months after they stop using the vaginal ring.

What are the disadvantages of the vaginal ring?

• There is a chance of the ring falling out. Other problems you may have while you are using the ring are:
• nausea or vomiting
• changes in your menstrual period or missed menstrual periods
• swelling of the hands, ankles, or abdomen
• weight gain
• breast swelling or tenderness
• headaches
• jaundice (yellow eyes and skin)
• rash
• depression
• infections of the vagina (mainly yeast infections)
• vision changes.
• You may increase your risk of problems such as heart disease, blood clots, stroke, and gallbladder disease.
• The patch does not protect you from getting AIDS or other sexually transmitted disease.
• 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.
• Some people with chronic diseases or other problems should not use the vaginal ring.

Your health care provider will discuss your medical history with you. Tell your health care provider if you have ever had:

• an allergic reaction to medicine
• blood clots in your legs, lungs, or eyes
• depression
• diabetes
• disease of the heart valves
• epilepsy
• gallbladder or kidney disease
• headaches along with symptoms such as vomiting, double vision, unsteadiness, weakness, or personality changes
• heart attack or stroke
• high blood pressure or high cholesterol
• known or suspected breast cancer or cancer of the lining of the uterus, cervix, or vagina (now or in the past)
• liver disease
• unexplained vaginal bleeding or irregular periods
• yellowing of the eyes or skin (jaundice) during pregnancy or during past use of hormones for birth control
• recent long period of bed rest after major surgery or a broken bone in a cast.

You should not smoke. Women who use hormones for birth control pills and smoke, especially those over 35 years old, have an increased risk of severe problems such as heart disease and blood clots.

When should I call the office?

Call the office if:

• You start having severe headaches.
• You have chest pain.
• You have redness, swelling, or pain in your legs.
• You have abnormal vaginal bleeding.
• You become jaundiced (your skin looks yellow).
• You think you might be pregnant.