Contraceptive vaginal ring

What is the vaginal ring?

It is a soft plastic ring that you place into the vagina once a month. It is left in place for 3 weeks and taken out for a week. Once inserted the ring slowly releases two artificial hormones (oestrogen and progestogen) which prevent pregnancy. The hormones are the same as those used in the Pill, but at a lower dose.

There is one brand currently available in Australia, called NuvaRing.

How does the ring work?

The ring works by:

• stopping ovulation so no egg is released
• thickening the mucus (sticky fluid) at the cervix so that sperm can't get through
• changing the uterine lining so a fertilised egg can't grow

How effective is it?

The ring is a very effective method of contraception if used correctly (99%).

What are the benefits of using the ring?

The ring has all the benefits of the Pill:

• Periods are usually regular, shorter, lighter and less painful. The timing of bleeding can also be controlled.
• As the ring contains the same hormones as the Pill it should also reduce the chance of cancer of the uterus and ovaries, benign breast disease, endometriosis and ovarian cysts.
• It can improve acne.

In addition:

• The ring contains a lower dose of hormones than the Pill and so side effects such as nausea, sore breasts and breakthrough bleeding are reduced.
• The hormones are absorbed directly into the bloodstream. They don't go through the stomach and so are not affected by vomiting or diarrhoea.
• You don't have to remember to take a pill every day.

What are the possible side effects?

The ring has few side effects because of the low dose of hormones. However, some women experience:

• sore breasts
• mood changes
• headaches (more than normal)
• breakthrough bleeding
• chloasma - brown patches on the face (rare)
• increased vaginal discharge
• weight change

Some of these side effects will settle within the first 2 or 3 months of using the ring. If they persist discuss them with your doctor.

Who should not use the ring?

The ring is safe for most women. However, women who have had a blood clot, stroke, heart attack, diabetes with vascular complications, certain types of migraine, liver disease including active viral hepatitis, breast or genital cancer, are having a major operation or are pregnant or breastfeeding SHOULD NOT use the ring. It is also not recommended for women over the age of 35 who smoke.

It MAY NOT be suitable for women with diabetes, gall bladder disease, who are significantly overweight, have high blood pressure or have chronic constipation or vaginal prolapse.

What are the possible serious complications of using the ring?

Thrombosis is an extremely rare but serious complication. Stop using the ring immediately and seek medical attention if you have:

• severe and unexplained pain in the chest
• severe headaches
• sudden blurred vision or loss of sight
• severe calf pain or swelling in one leg

How do I get the ring?

The ring is available on prescription from your doctor or SHine SA clinics.

How do I use the ring?

• To insert the ring squeeze it between your thumb and index finger, and then gently insert it into your vagina. Remember, the exact position is not important for the ring to work. If you feel discomfort simply slide it further into your vagina. Your vaginal muscles will keep the ring securely in place, even during sex and exercise. Anyone who is able to insert a tampon should be able to insert the ring.
• To remove the ring simply put your finger into your vagina, hook it inside the rim of the ring and pull it out.
• Your first ring should be inserted on any day in the first 5 days of your period starting, so that pregnancy protection is immediate. If you insert it after 5 days of your period starting, you will need to use other forms of contraception for 7 days till the ring takes effect.
• After insertion, the ring is left in place for 3 weeks, then removed and a new ring inserted a week later. A withdrawal bleed occurs in the week when there is no ring. It is important to replace with a new ring no more than 7 days after removal of the previous one, even if you have not stopped bleeding.
• Though it is not necessary the ring can be removed during sex if desired. It must be reinserted within 3 hours to maintain the contraceptive effect.
• It is important to store and use the ring according to the manufacturer's instructions. It needs to be kept cool and only lasts for 4 months after you get it from the pharmacy.

When is the ring not effective?

The ring is not effective if:

• you have forgotten to insert a ring for the next cycle (more than 7 days since your last ring was removed)
• your ring has been removed from the vagina for more than 3 hours
• your ring has been left in place continuously for more than 4 weeks

Use a barrier method of contraception and consult your doctor or SHine SA clinic as soon as possible. You may need emergency contraception.

Some medications interfere with the ring. Always check with your doctor, Shine SA clinic or Sexual Healthline.

The ring does not protect against sexually transmitted infections (STIs). Practise safer sex. Condoms reduce the risk of STIs.

This information is available to download in leaflet format as Contraceptive vaginal ring (PDF).