Vaginal Contraceptive Ring Patient Information Fact Sheet

What is a vaginal contraceptive ring?
The vaginal ring is a small, flexible, plastic ring that is inserted into the vagina. The ring contains the same hormones (progestin and estrogen) found in most birth control pills. The hormones in the ring are released into the vagina and prevent pregnancy by keeping the ovaries from releasing eggs. They also cause the cervical mucus to thicken, which blocks sperm from meeting with and fertilizing an egg. Currently there is only one vaginal ring available for the prevention of pregnancy, Nuvaring (etonogestrel, ethinyl estradiol).

How effective is a vaginal ring?
Only 5 of 100 women who use this method each year are likely to get pregnant. The risk of pregnancy is much less for women who use the vaginal ring correctly. It may also not work as well for women who take certain medicines or St. John's Wort.

What are the advantages?

  • Safe and effective in preventing pregnancy
  • Do not have to think about birth control when you want to have sex
  • Your periods may be lighter when using the ring
  • Fewer menstrual cramps, less acne, and stronger bones
What are the disadvantages?
  • Does not protect against sexually transmitted infections (STIs)
  • Certain antibiotics and supplements may make the vaginal ring less effective
  • May take a month or two after stopping the ring before normal periods return
  • May experience vaginal discharge, swelling, or breast tenderness
  • Increased risk of blood clots, heart attacks, toxic shock syndrome, and strokes

How is the vaginal ring used?
Squeeze the ring between the thumb and index finger and gently push it into the vagina. The exact position inside the vagina is not important. Use back-up birth control such as a condom for the first seven days after the vaginal ring is inserted. Leave the ring in place while having sex.

It is important to pay attention and keep track of when the ring is inserted and removed. Leave the ring in place for three weeks (21 days) and then remove it for one week (7 days). Menstruation will occur during the week the vaginal ring is not inserted. After the off week, just start over and put a fresh ring in for 3 weeks. If removal takes place but the woman is unsure of how long the ring has been removed, consider the ring to have been removed for ≥48 hours since a ring should have been inserted or reinserted.
When switching from combination oral contraceptives insert 1 ring any time within 7 days after last tablet and no later than the day a new cycle of pills was to start (no back-up method needed).

What if the new ring insertion or reinsertion is delayed <48 hours?
When delaying the insertion of a new ring or a current ring <48 hours since a ring should have been inserted, insert ring as soon as possible. Keep the ring in until the scheduled ring removal day. No additional contraceptive protection is needed. Emergency contraception is not usually needed but can be considered if delayed insertion or reinsertion occurred earlier in the cycle or in the last week of the previous cycle.

What if the new ring insertion or reinsertion is delayed ≥48 hours?
When delaying the insertion of a new ring or current ring ≥48 hours since a ring should have been inserted, insert ring as soon as possible. Keep the ring in until the scheduled ring removal day. Use back-up contraception (eg, condoms) or avoid sexual intercourse until a ring has been worn for 7 consecutive days. If the ring removal occurred in the third week of use, omit the hormone-free week by finishing the third week of ring use and starting a new ring immediately. Also if unable to start a new ring immediately, use back-up contraception (eg, condoms) or avoid sexual intercourse until a new ring has been worn for 7 consecutive days. Emergency contraception should be considered if the delayed insertion or reinsertion occurred within the first week of ring use and unprotected sexual intercourse occurred in the previous 5 days. Emergency contraception may also be considered at other times as appropriate.

Further information:
Centers of Disease Control and Prevention: www.cdc.gov/mmwr/pdf/rr/rr6205.pdf
U.S. Department of health & Human Services: www.hhs.gov/opa/reproductive-health/contraception/vaginal-ring/index.html

Created July 2013