Vaginal ring

How does it work?

The ring serves as a low dose hormonal contraceptive. Over the three weeks the ring is in place the hormones are absorbed directly into the bloodstream through the vaginal wall.

How effective is it?

The vaginal ring is 99% effective with perfect use; meaning in 1 year, 1 in 100 women who are using the contraceptive carefully and according to instructions will become pregnant.

Pregnancy can happen if an error is made in using the NuvaRing – especially if:

• The unopened package is exposed to very high temperatures or direct sunlight.
• It slips out of the vagina and is not replaced within three hours.
• It does not stay in the vagina for three weeks in a row.
• It is left in the vagina for more than three weeks.

Always remember to check the expiry date of each ring package before insertion.

Where do you get the vaginal ring?

This method of contraception requires a prescription from your family doctor or family planning centre. It is available on the GMS (medical card scheme) and can be purchased at pharmacies.

What are the advantages?

• It is inserted once a month meaning there is no need to remember daily pills.
• Natural cycles return quickly when you stop using the vaginal ring.
• Does not have to be fitted by a nurse or doctor and can be easily inserted by the woman herself.
• Does not interrupt sex.
• Neutral effect on weight.
• Not affected by vomiting or diarrhoea.

Please note that as this is a relatively new contraceptive method, long-term studies won’t be available for some time. Researchers assume that non-contraceptive advantages associated with the ring are similar to those known to be associated with the combined pill.

What are the disadvantages?

• May not be suitable for women who for medical reasons cannot take the pill.
• Women using it must be comfortable about inserting a ring into their vaginas.
• May sometimes be felt by her partner during sex.
• May cause increased vaginal discharge or irritation.
• Is more expensive than taking the combined pill orally.
• Does not protect against Sexually Transmitted Infections (STIs).
• May fall out (usually with bowel movement).

Who is it suitable for?

Not everyone can use the vaginal ring. Your doctor or nurse will need to ask you about your own and your family’s medical history to make sure the vaginal ring is suitable. Do mention any illnesses or operations you have had.

Some of the conditions which may mean you should not use the vaginal ring are:

• You smoke and are 35 or over.
• You are 35 or over and stopped smoking less than a year ago.
• You are breastfeeding.
• You are very overweight.

You have now or have had in the past:

• Thrombosis (blood clots) in any vein or artery.
• A heart abnormality or circulatory disease, including raised blood pressure (hypertension).
• Current breast cancer or breast cancer within the last 5 years.
• Migraines with aura.
• Disease of the liver or gall bladder.
• Diabetes with complications.

If you are healthy, don’t smoke and there are no medical reasons for you not to use the vaginal ring, you can use it until your menopause. At the age of 50 if you are still having periods, you may be advised to change your method.

How is it put in?

• After washing and drying your hands, take the ring from its packaging.
• Choose a position that’s most comfortable for you. Try lying down, squatting, or standing with one leg up.
• Hold the vaginal ring between your thumb and index finger and press the opposite sides of the ring together.
• Gently push the folded ring into your vagina. The exact position of the NuvaRing in the vagina is not important for it to work, and the muscles of the vagina should keep it securely in place.

Most women don’t feel it once it is in place. If you feel it you can use your finger to gently push it further in. There’s no danger of the ring being pushed too far up in the vagina or getting lost inside of you. Once inserted, keep it in place for three weeks in a row.

How is it taken out?

You can remove the ring by hooking the index finger under the forward rim or by holding the rim between the index and middle finger and pulling it out.

The Ring is removed for seven days to allow you to have your period. After the seven days a new ring is inserted for another three weeks.

What if it slips out?

The vaginal ring should be held in place by the vaginal muscles, but if it slips out, quickly re-insert it.

If the ring is out of the body for over 3 hours contact your doctor and use an additional form of contraception.

What if I am late inserting my new ring?

If you are less than 24 hours late, just insert it when you remember. No extra precautions are needed.

If you are more than 24 hours late, insert it when you remember, avoid sex or use condoms for seven days. If you have unprotected sex during this time, you may need emergency contraception.

What if I am late removing my ring?

If you are less than seven days late, just remove it and insert new ring on the day it would originally have been due (i.e. shorten the seven day break).

If you are more than seven days late, change it immediately and avoid sex or use condoms for seven days. You may need emergency contraception if you have had unprotected sex.

Are there any side-effects?

When starting the ring some women may experience: breast tenderness, skin irritation, mild headaches, a bloated feeling, or have some breakthrough bleeding (bleeding between periods). Although these can be a nuisance, they are not dangerous and should disappear within the first few months using this contraceptive.

However, a woman should see her doctor immediately if while using the patch she develops:

• Pain or swelling in her legs.
• Severe chest pain.
• Breathlessness or coughing up blood.
• A bad fainting attack or collapse.
• Unusual headaches or difficulty with speech or sight.
• Numbness or weakness of a limb.

What about other medications?

Some other medications may interfere with the hormones released by the ring.

Therefore it is important to inform doctor(s) treating you for any illness or injury, that you use the contraceptive ring.

Please note that the natural remedy St John’s Wort also interferes with the effectiveness of the ring and should not be used with it.

Pregnancy and the ring

If you become pregnant

There is a very slight chance you will become pregnant even if you use the ring. However, a missed period does not always mean you are pregnant, especially if you have used the ring correctly. See your doctor if you miss a second period. It is unlikely that using the ring during early pregnancy will increase the risk of defects in the fetus.

If you want to become pregnant

If you want to become pregnant, stop using the ring. If you want to plan the timing of your pregnancy, use another form of contraception until your period becomes regular. It usually takes about one to three months for your period to return to the cycle you had before using the ring.

After childbirth

You can start using the ring three weeks (21 days) after you gave birth. Starting on day 21 you will be protected against pregnancy straight away. If you start later than day 21, you will need to use an extra method of contraception for seven days.

If you are breastfeeding, using the ring may reduce your flow of milk. It is usually recommended that you use a different method of contraception.

After a miscarriage or abortion

You can start using the ring immediately after having an abortion or miscarriage. Use a backup method of birth control for seven days if you start the ring:

• More than five days after a vacuum aspiration abortion
• More than seven days after taking mifepristone