Vaginal Ring

What is a vaginal ring?

A vaginal ring, or birth control ring, is a hormonal birth control method to prevent pregnancy in women or people assigned female at birth (AFAB). It’s a small, flexible ring that’s worn inside your vagina. The ring releases estrogen and progestin into your body through your vaginal lining. These two hormones work together to prevent pregnancy by:

• Stopping your ovaries from releasing an egg.
• Changing your cervical mucus to prevent sperm from reaching an egg.

A vaginal ring is worn for three weeks, then removed for one week to allow bleeding to occur. When used properly, it’s a highly effective form of birth control.

There are three vaginal rings approved for use as hormonal contraceptives in the United States. You’ll need a prescription from a healthcare provider to use these products:

• Ethinyl estradiol; etonogestrel: Brand names are NuvaRing® and EluRyng®.
• Segesterone acetate; ethinyl estradiol: Brand name is Annovera®.

How does a vaginal ring work for birth control?

A birth control ring works by slowly releasing estrogen and progestin into your body. You wear the ring inside your vagina and absorb the hormones through your vaginal lining. Estrogen prevents ovulation, which means you don’t release an egg for sperm to fertilize. Progestin thickens the mucus around your cervix which makes it harder for sperm to get inside. It also thins the lining of your uterus, so a fertilized egg can’t implant itself.

You will place the ring in your vagina for 21 days (three weeks and then take it out for one week). Once the week is over (seven days), you insert a new vaginal ring and a new cycle begins.

A healthcare provider must prescribe a vaginal ring.

Who should not use a vaginal ring for birth control?

Using a vaginal ring can carry some health risks. You should avoid using the ring if you:

• Smoke and are over age 35.
• Have blood clots.
• Have had breast, uterine or liver cancer.
• Have had a heart attack or circulatory problems.
• Get migraines with aura (seeing flashing lights or zigzags).
• Have high blood pressure.
• Have unmanaged diabetes.
• Have liver disease.
• Have unexplained vaginal bleeding.
• Take medicines that interact with the vaginal ring.

Share your medical history with your healthcare provider so they can determine if the birth control ring is safe for you.

Why do women use a vaginal ring for birth control?

The birth control ring is one of the most effective forms of contraception when used correctly. A lot of people choose to use a vaginal ring for birth control because it’s easy to use and effective. Unlike a daily birth control pill, you don’t have to remember to take it. There are many forms of birth control available. Talk with your healthcare provider about what method will work best for you.

What are the types of vaginal rings?

There are two hormonal vaginal rings approved for use by the U.S. Food and Drug Administration (FDA). Both vaginal rings work by releasing estrogen and progestin into your vagina. They’re both worn for 21 days (or three weeks), then removed for seven days (one week). There are a few distinct differences between the two vaginal rings:

NuvaRing or EluRyng:

• These are one-time use. You’ll wear the ring for three weeks (21 days), then remove it for one week (seven days). After seven days without a ring in your vagina, you will put in a new ring. This starts a new cycle.
• Each ring has enough hormones to last five weeks (35 days).
• There may be some flexibility if you want to delay your period week by one or two weeks — due to vacation, a wedding or other planned event. Some people may wait four or five weeks to remove the ring.
• NuvaRing and EluRyng are prescribed to be worn for three weeks. Speak with your healthcare provider before “skipping” your period week or wearing it for four or five weeks.

Annovera:

• This vaginal ring is reusable. You’ll remove it after 21 days, wash it with mild soap and water, and pat it dry. Then, you store it in its container for seven days (one week). At the end of seven days, you insert the same ring back into your vagina.
• It has enough hormones to last one year. This doesn’t mean you keep the ring inside your vagina for a year. It’s prescribed to be taken out every three weeks.

Speak with your healthcare provider before getting started to make sure you understand how and when to insert and remove your vaginal ring. Hormonal birth control rings will only be effective if they’re worn properly.

What do you do to prepare for getting a vaginal ring?

Before getting a prescription for a vaginal ring, your healthcare provider will most likely conduct a medical evaluation and pelvic exam. You’ll discuss your medical history and any concerns you have about the vaginal ring and make sure you know how to insert and remove the ring.

How do you insert a vaginal ring?

If you can insert a tampon, you shouldn’t have a problem inserting a vaginal ring. Follow these steps for inserting a vaginal ring:

• Wash and dry your hands.
• Lie down, squat or stand with one leg up on a chair.
• Remove the ring from the wrapper.
• Hold the ring between your thumb and index finger.
• Pinch your fingers together so the sides of the ring touch.
• Insert the ring as far into your vagina as you can.

How long do you leave a vaginal ring inside the vagina?

You’ll leave a vaginal ring in for three weeks (21 days). After three weeks, remove the ring for one week (seven days). If you decide you want to become pregnant, it’s easy to stop using the vaginal ring to try and conceive.

How do you take out a vaginal ring?

You’ll remove the vaginal ring by inserting a clean finger into your vagina (usually your index finger). Once you find the ring, hook your finger through it and then gently pull it out.

What are the side effects of a vaginal ring?

Most people have mild side effects that go away after a few months of use. The most common side effects are:

• Breast tenderness.
• Headaches.
• Weight gain.
• Nausea and vomiting.
• Depression or mood changes.
• Spotting.
• Increased vaginal discharge.
• Acne.
• Decreased sex drive.

What are the risks of a vaginal ring?

If you use a vaginal ring, you might be at increased risk for the following problems:

• Blood clots.
• Heart attack.
• Stroke.
• Gallbladder disease.
• High blood pressure.
• Toxic shock syndrome (TSS).

What is the biggest advantage of getting a vaginal ring?

A lot of people choose to get a vaginal ring because it offers benefits over oral pills or other hormonal forms of birth control. Some of the greatest advantages of a vaginal ring are:

• Easy to use and comfortable to wear.
• You don’t have to remember to take it daily.
• It’s flexible enough to fit all vaginas.
• It’s safe for women with latex allergies.
• It can be removed at any time if you wish to get pregnant.
• It’s private. No one sees you take it like they would a pill.
• Less hormonal side effects than other contraceptives.

Are there any disadvantages to getting a vaginal ring?

Like most medications, the vaginal ring can have side effects. It also doesn’t protect against sexually transmitted infections (STIs) and can be ineffective if not used correctly.

Can you leave your vaginal ring in as long as you want?

No, you can’t leave a vaginal ring in as long as you want. Vaginal rings are prescribed to be worn for three weeks and removed for one week. The NuvaRing and EluRyng deliver enough hormones to last five weeks. The Annovera ring has enough hormones to last an entire year. This gives people the false idea that they can delay menstruation. Speak with your healthcare provider before skipping your period or deciding not to use the vaginal ring as directed.

How effective is a vaginal ring in preventing pregnancy?

Vaginal rings are 91% to 99% effective. The effectiveness can be reduced if you don’t use it the correct way.

How long does it take for the vaginal ring to work?

The amount of time it takes for the vaginal ring to begin preventing pregnancy depends on if you were previously on birth control.

If you haven’t been using hormonal birth control and start using a vaginal ring:

• If you insert it on day one of your menstrual period, it becomes effective immediately and you don’t need a backup birth control method.
• If you insert a ring on days two through five of your period, you should use an additional birth control method for the seven days.

If you’re switching to a vaginal ring from birth control pills or a patch:

• Insert the ring when you’d start your next birth control pill pack or put on your next patch.
• You shouldn’t need a backup birth control method.

If you’re switching from progestin-only birth control, including a minipill, implant, injection or intrauterine device (IUD):

• Insert the ring when you’re due for your next pill pack, implant, injection or IUD.
• Use a backup method of birth control for seven days.

Does anything make a vaginal ring less effective?

Several factors can make the vaginal ring less effective:

• The ring isn’t in your vagina for three weeks in a row.
• The ring falls out of or is removed from your vagina and isn’t replaced within two (Annovera) or three (NuvaRing and EluRyng) hours.
• You don’t remove the ring as directed.
• The ring is exposed to direct sunlight or high temperatures.

Follow the instructions you are given with your prescription to make sure you are using the vaginal ring correctly.

Can a vaginal ring fall out on its own?

Your vaginal ring may fall out of your vagina on its own. Having sex, taking out a tampon or straining to have a bowel movement are common reasons a vaginal ring slips out. You should rinse it off with lukewarm water and reinsert it as soon as you can.

What do I do if my vaginal ring falls out?

If the ring is out for more than two hours (Annovera) or three hours (NuvaRing and EluRyng) between days seven to 14 of your cycle:

• Rinse it with cool or lukewarm water.
• Reinsert the same ring as soon as possible.
• Use back up birth control (like a condom) for seven days.

If the ring is out for more than two hours (Annovera) or three hours (NuvaRing and EluRyng) between days 15 and 21 of your cycle, there are two options:

• Put in a new ring (NuvaRing and EluRyng) or wash and replace your ring (Annovera). Spotting may occur, but you will likely not get your usual period.
• Don’t put a ring in and start your seven-day ring-free period.

How do I know if something is wrong with my vaginal ring?

Your vaginal ring should feel comfortable inside of your vagina — you should eventually forget it’s there. If it feels uncomfortable to you, try pushing it up higher into your vagina. If you experience too many side effects from a vaginal ring, it might mean that it isn’t the right birth control method for you.

Is it easy to get pregnant after using a vaginal ring?

Using a vaginal ring shouldn’t impact any plans you have for pregnancy. You should begin ovulating regularly after removing the ring. It takes some people a few months to have a normal cycle because their bodies are still adjusting. Speak with your healthcare provider if you don’t get your period within three months.

When should I call my doctor?

There are risks and side effects of using a vaginal ring. You should contact your healthcare provider right away if you have:

• Leg pain that doesn’t go away.
• Shortness of breath.
• Chest pains or chest pressure.
• Sudden migraines (different than your usual headache).
• Foul vaginal odor or change in vaginal discharge.
• Numbness in arms or legs.
• Heavy bleeding when it’s not your period week.
• A missed period.

Which birth control ring should I use?

There are three birth control rings approved for use in the U.S. They all contain similar hormones and are worn inside the vagina for three weeks, then removed for one week. The Annovera ring is washed and reused for one year. The NuvaRing and EluRyng are one-time use (you will throw it away and open a new one each cycle).

Can my partner feel my vaginal ring?

Your partner may be able to feel your vaginal ring, but not always. If your partner has a negative reaction to your vaginal ring, speak with your healthcare provider about other birth control options. If you remove your ring for sexual intercourse, it needs to be put back in within two (Annovera) or three (NuvaRing and EluRyng) hours or it loses its effectiveness.

Should I use birth control pills or a vaginal ring?

The method of birth control you use is a decision between you and your healthcare provider. All forms of birth control are only effective if used correctly. Both methods can follow a cycle of three weeks of hormones and one week of menstruation. Birth control pills can be hard to take at the same time each day. Some people feel more comfortable taking oral birth control instead of having something inside their vaginas.

What is the difference between a vaginal ring and an IUD?

An IUD (intrauterine device) is a T-shaped device worn in your uterus. Some of the biggest differences between an IUD and a vaginal ring are:

• An IUD can be worn for up to 12 years depending on which one you use.
• A healthcare provider inserts and removes an IUD. You insert and remove your vaginal ring.
• An IUD can be slightly more effective in preventing pregnancy. This is because there is less room for error when inserting it.
• There’s a hormone-free IUD option. All vaginal rings contain hormones.
• The hormonal composition is different. Progestin is in both vaginal rings and IUDs. Vaginal rings also contain estrogen. IUDs don’t contain estrogen.

Does a vaginal ring protect against sexually transmitted infections?

No, a vaginal ring doesn’t protect against sexually transmitted infections (STIs). A condom offers the best protection from most STIs.

Can I take my vaginal ring out for sex?

Yes, you can take your vaginal ring out for sex. The ring is still effective for up to three hours (NuvaRing and EluRyng) or two hours (Annovera) if left outside your vagina. Be sure to set it down in a safe spot and rinse it off with lukewarm water before putting it back in.

A note from Cleveland Clinic

Vaginal rings are an effective form of birth control when you use them correctly. Speak with your healthcare provider about using a vaginal ring to prevent pregnancy. Share any concerns you have about inserting or removing the ring. They can make sure you understand how to use it as well as the side effects to watch for.