The vaginal ring is a hormonal contraceptive device that is a small flexible plastic ring that contains hormones progestin and estrogen. These same hormones, which are present in combined oral contraceptive pills, are the principal female sex hormones that occur naturally and are responsible for women's menstrual cycles, secreting in a cyclic manner.
Vaginal rings that are approved by the U.S. Food and Drug Administration (FDA) for birth control and preventing pregnancy are available in two options: Annovera and NuvaRing. You must have a prescription from a healthcare provider to use either product.
The vaginal ring is inserted into the vagina and releases hormones continuously that are absorbed by the body. These hormones prevent pregnancy in two ways:
- They prevent the release of eggs from the ovary and thus, interrupting the fertilization process.
- They thicken the cervical mucus and prevent sperm from reaching the egg.
These hormones also decrease the thickness of the uterine wall and endometrium, such that implantation of a fertilized egg may be prevented.
How do you use a vaginal ring?
To insert a vaginal ring follow these steps:
- The vaginal ring is squeezed between two fingers and inserted into the vagina and pushed deep by inserting a tampon.
- The position will not change the effectiveness of the ring.
- It is left inside for three weeks and removed so that you may have your period.
- It is not necessary to remove the vaginal ring during intercourse, however, if you intend to remove it, you can do so for three hours, and then reinsert it.
- Most women who use a vaginal ring don't feel the ring once it’s in the vagina.
To remove a vaginal ring follow these steps:
- The rim of the ring is grasped with your index and middle fingers and pulled out gently.
- The used vaginal ring should be discarded.
- You may have your periods two to three days after removal of the vaginal ring and insert a new ring after one week of removal.
- You may still be bleeding while inserting a new ring but that should not stop you from replacing it.
If the vaginal ring falls out, it should be rinsed with cool or warm water and be inserted within two hours for Annovera and three hours for NuvaRing.
If the ring remains outside for more than two hours for Annovera and three hours for NuvaRing, you must do the following:
- If the expulsion happens during the first or second week of using a vaginal ring, reinsert the ring as soon as possible and use backup contraception for a week.
- The ring should be discarded if expelled during the third week, and a new ring should be inserted, but this may result in spotting or bleeding. Use backup contraception or condoms until the new ring is used continuously for seven days.
- If a vaginal ring is used continuously for seven days before its expulsion, you may:
- Discard the ring and insert a new one after seven days from the day of expulsion. You may observe withdrawal bleeding during this time.
- It is recommended to use backup contraception or condoms continuously for seven days until a new ring is used.
What are the side effects of vaginal ring usage?
The vaginal ring has a failure rate of one percent, which means 1 out of 100 women get pregnant within a year of using it. The ring does not protect you from sexually transmitted infections (STIs), so you should still use condoms with new partners.
Vaginal rings are generally well-tolerated, but there are some potential side effects, which include:
- Bleeding or spotting with initial use
- Headache or migraines
- Vaginal irritation or infection
- Vaginal discharge
- Abdominal pain
- Breast tenderness
- Decreased libido
- There is an increased risk of
Immediate medical attention is needed if you experience these severe side effects:
- Persistent leg pain
- Weakness or numbness in the arms and legs
- Severe pain in the chest
- A sudden attack of breathlessness
- Severe headache
- Trouble speaking
- Severe blood clotting
- Itching or foul smell in the vagina
- Missed two consecutive cycles of menstruation
- Any signs of pregnancy
A healthcare provider prescribes a vaginal ring after reviewing your medical history, considering all the medications or herbal products you are on and assessing your blood pressure. The doctor will suggest the appropriate time to use the vaginal ring based on your menstrual cycle and previous contraception methods.
A pregnancy test is done one week before using a vaginal ring. The ring can be used with other contraception except with the diaphragm because it displaces the ring. It is recommended to use tampons along with vaginal rings. An annual checkup for blood pressure is recommended if you use one.
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Center for Young Women's Health. Vaginal Hormonal Ring (NuvaRing®, Annovera™). https://youngwomenshealth.org/2012/11/20/vaginal-ring/
Roumen FJ. Review of the combined contraceptive vaginal ring, NuvaRing. Ther Clin Risk Manag. 2008;4(2):441-451. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2504064/
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