Vaginal Ring

A vaginal ring (also called a birth control ring) is a type of hormonal birth control. It’s a small, flexible ring that you wear inside your vagina. You wear the ring for three weeks, then take it out for one week. This is when you get your period.

There are three vaginal rings approved in the U.S. You need a prescription for them:

• NuvaRing®
• EluRyng®
• Annovera®

Vaginal rings are 91% to 99% effective. How well they work depends on if you use them correctly.

How does a vaginal ring work?

A vaginal ring works by slowly releasing estrogen and progestin. You wear it inside your vagina. Your body absorbs the hormones through your vaginal lining. These hormones work together to prevent pregnancy by:

• Stopping your ovaries from releasing an egg (ovulation)
• Thickening your cervical mucus so sperm can’t reach an egg
• Thinning the lining of your uterus so an egg can’t implant

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

What are the types of vaginal rings?

There are two hormonal vaginal rings with U.S. Food and Drug Administration (FDA) approval. Both vaginal rings work by releasing estrogen and progestin. You wear them for 21 days (or three weeks), then remove them for seven days (one week). There are a few differences between the two rings:

NuvaRing or EluRyng

• These are one-time use. You 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 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 due to a planned event, like a vacation or a wedding.
• NuvaRing and EluRyng are prescribed to be worn for three weeks. Speak with your healthcare provider before “skipping” your period week or wearing it longer.

Annovera

• This vaginal ring is reusable. You 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.

How do you insert it?

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

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

Your vaginal ring should feel comfortable inside your vagina. If it feels uncomfortable, try pushing it up higher into your vagina.

Talk 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 are only effective if they’re worn properly.

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

You leave a vaginal ring in for three weeks (21 days). After three weeks, remove the ring for one week (seven days).

How do you take out a vaginal ring?

You 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.

How long does it take for the vaginal ring to be effective?

How long it takes depends on whether you were on birth control before.

If you haven’t been using hormonal birth control:

• Insert it on day one of your period: It’s effective immediately.
• Insert it on days two through five of your period: Use an additional birth control method for the seven days.

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

• Insert the ring when you would start your next pill pack or apply your next patch.
• No backup method is necessary.

If you’re switching from progestin-only birth control like a minipill, 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 it less effective?

Several things can make it 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’re given with your prescription to make sure you’re using the vaginal ring correctly.

What are the risks of the vaginal ring?

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 in your leg or lungs
• 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

The ring doesn’t protect against sexually transmitted infections (STIs).

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

What are the side effects?

You may have mild side effects that last a few months. If you have too many side effects, a vaginal ring may not be the right birth control for you.

The most common side effects are:

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

What is the biggest advantage of getting a vaginal ring?

A lot of people choose a vaginal ring because it has benefits over pills or other hormonal birth control. Some advantages are:

• It’s 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 if you have a latex allergy.
• It can be removed at any time if you want to get pregnant.
• It’s private and discreet.
• It has fewer hormonal side effects than other birth control methods.

Can it fall out on its own?

Yes, a vaginal ring can slip out. This might happen during:

• Sex
• Straining to poop
• Using or removing a tampon

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 another form of 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 probably won’t get your period.
• Don’t put a ring in and start your seven-day ring-free period.

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 may take a few months to get back to a typical menstrual cycle. 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 from your usual headache)
• Foul vaginal odor or a change in vaginal discharge
• Numbness in your arms or legs
• Heavy bleeding when it’s not your period week
• A missed period

Can your partner feel the NuvaRing?

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.

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.

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.
• An IUD can be slightly more effective in preventing pregnancy.
• There’s a hormone-free IUD option (all vaginal rings contain hormones).
• Vaginal rings also contain estrogen, and IUDs don’t.