Contraceptive ring
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Medically reviewed by
Dr Daniel Atkinson
GP Clinical Lead
on August 02, 2022.
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How does the contraceptive ring work?

The contraceptive ring is one of several methods of combined hormonal contraception. Other examples include the combined pill and the contraceptive patch.

Over the course of your menstrual cycle, hormone levels rise and fall naturally which triggers certain reactions in the body. An egg is released, ready to receive sperm, and the uterus lining thickens, ready to receive a fertilised egg. Two hormones that are key in facilitating this process are oestrogen and progesterone.

The NuvaRing contains lab-made versions of oestrogen and progesterone, called ethinyl estradiol and etonogestrel respectively. When you use NuvaRing, these synthetic hormones are released which affects natural hormone levels and changes how the body deals with its menstrual cycle.

For example – ovulation won’t happen, vaginal mucus thickens which can block the passage of sperm and the uterus walls remain thin, creating an environment that makes implantation of fertilised eggs difficult.

What is a NuvaRing?

NuvaRing is the main brand of contraceptive ring used here in the UK (Syreni Ring is an alternative brand). It’s available privately and on the NHS. It’s placed inside the vagina and releases hormones over the course of 21 days.

On this page, we’ll discuss how contraceptive rings work, how to use them, their effectiveness and their pros and cons.

What is a vaginal ring and how is it applied in the body? Firstly, the vaginal ring is a small, soft, plastic ring that’s placed inside the vagina.

To apply the vaginal ring, using clean hands, gently insert the vaginal ring inside the vagina – you can squeeze or clench the ring to help with application. It should fit comfortably over the entrance of the cervix. Unlike the diaphragm or cap – the vaginal ring doesn’t need to cover or block passage to the cervix because it isn’t a barrier method of contraception.

You use NuvaRing for 21 days. Occasionally use your fingers to check it hasn’t fallen out. After 21 days, you remove the ring for seven days. You’re still protected from pregnancy in this ‘ring-free’ week. You’ll be provided with disposable sachets when you use NuvaRing, place your old ring inside and then place it in the bin. On the eighth day, you’re ready to apply a new ring and start a new cycle.

You might experience bleeding or spotting during your ‘ring-free’ week, called withdrawal bleeding, and this is normal. You need to apply a new ring after one week even if you continue to bleed.

When to start NuvaRing

You can start using NuvaRing whenever you like, but there are some things to be aware of when you decide to start using it.

If you insert the vaginal ring between day one and five of your period – you’ll be protected against pregnancy from the get-go. If you experience short periods of short menstrual cycles, speak to a doctor or nurse about whether you’ll need to use additional methods of contraception when you start using NuvaRing.

If you start using NuvaRing on day six of your period, or any day before you get your next period, you’re not protected from pregnancy for seven days of using NuvaRing. Make use of additional contraception, like condoms, for this first week.

Forgetting to remove or replace NuvaRing

One of the advantages of the NuvaRing over the pill is that you don’t have to remember it each day, but you may forget to remove it or replace it at the right intervals.

If you forget to remove the ring after 21 days and you’ve remembered within seven days following this – take the ring out and start your seven day break, if you were planning on having a ‘ring-free’ week. If you weren’t planning on taking a ‘ring free’ break, remove the ring and insert a new one straight away. In these circumstances, you’re still protected from pregnancy.

If you forget to remove the ring after 21 days and you’ve not remembered it for seven days (the ring hasn’t been removed for four weeks or longer) – remove the old ring and insert a new one immediately. Make use of additional contraception, like barrier methods, for seven days.

Try to remember the simple cycle – three weeks in, one week out. Four weeks in total. Repeat.

How effective is the birth control ring?

The ring is a highly effective method of birth control, but it’s important to make a distinction between ‘perfect use’ and ‘typical use.’

Perfect use means you never forget when to change and replace your ring, and it never falls out. If you use NuvaRing perfectly, it’s more than 99% effective.

Typical use refers to how the average woman uses the ring. It’s protection rate drops to around 92% if used typically, meaning 9 out of every 100 women who use NuvaRing typically will get pregnant. Typical-use contraceptive cover is still high, but to reduce the risk of unintended pregnancy it’s important to use NuvaRing as perfectly as you can.

Can you get pregnant with NuvaRing?

Unfortunately, no single method of contraception can guarantee pregnancy will never happen. When used perfectly, NuvaRing is over 99% effective at stopping pregnancy.

If you want to reduce the risk even further, you can make use of additional methods of contraception, like condoms, while using hormonal birth control. This will also protect you against certain sexually transmitted infections, which NuvaRing does not.

Advantages of the contraceptive ring

  • You might prefer the contraceptive ring if you don’t like taking pills
  • You don’t have to apply NuvaRing every day, unlike the pill
  • Is inserted directly into the vagina and so is not impacted by sickness or vomiting
  • NuvaRing can alleviate premenstrual symptoms and bleeding may become lighter and less frequent
  • Easy application
  • Doesn’t interrupt sex the same way a condom might

Disadvantages of the contraceptive ring

  • The insertion and removal of the ring might not suit everyone
  • During the first few months of using the contraceptive ring, you may experience bleeding or spotting 
  • You might experience temporary side effects while using NuvaRing - this can include mood changes, breast tenderness, nausea, headaches and discharge
  • You’re not protected against STIs when you use NuvaRing
  • If you struggle remembering when to remove and replace Nuvaring - you might benefit from a long-life contraceptive method like the implant
  • Certain medications may affect the contraceptive ring’s effectiveness
  • When you stop using NuvaRing, it may take a while before you’re fully fertile again

Can you feel the NuvaRing?

While you might be aware that NuvaRing is in place, you shouldn’t feel it once it’s inserted. However, it is possible that during sex you or your partner may feel the ring. But you should be able to have sex and apply tampons while using NuvaRing, and neither should feel uncomfortable.

Who can use NuvaRing?

NuvaRing can be considered as a contraceptive option by many women, but it isn’t always suitable for everybody to take. Before you use NuvaRing, tell your doctor or prescriber about any medical conditions you have or have had in the past.

You can’t use NuvaRing if you have or have ever had:

  • a blood clot in your legs or lungs
  • certain clotting disorders
  • an operation that means you have to be off your feet for a while
  • a heart attack or stroke
  • angina
  • migraine with ‘aura’
  • pancreatitis
  • severe liver disease
  • a benign or malignant tumour in the liver
  • cancers of the breasts or genitals
  • unexplained vaginal bleeding

If you’re allergic to the ingredients in NuvaRing or if you have a condition that increases your risk of blood clots you shouldn’t use this contraceptive.

Using hormonal contraceptives such as NuvaRing can slightly increase the risk of blood clots, it’s important to be aware of this and have a basic understanding of how to recognise blood clots. If you’re worried or concerned about the risk of blood clots and the NuvaRing, speak to your doctor or pharmacist for more advice.

How to store NuvaRing

Make sure NuvaRing is stored away from children. Keep it in its original packaging, in a dry environment less than 30 degrees. You shouldn’t use NuvaRing more than four months after it was dispensed to you. You’ll need new contraceptive rings after four months.

If you notice the colour of NuvaRing has changed, do not use it, and never use any medication after the expiry date provided on your packaging.

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This page was medically reviewed by Dr Daniel Atkinson, GP Clinical Lead on August 02, 2022. Next review due on August 01, 2024.

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