Birth Control: Vaginal Ring

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A vaginal ring (Picture 1) is a birth control you place in your vagina. The ring contains estrogen and progestin. These are like the hormones made naturally in your body.

Vaginal Ring

It prevents pregnancy by stopping the egg from being released by the ovary. The ring also changes the mucus at the cervix to keep sperm from reaching an egg. 

Advantages of the Ring 

  • More than 91% effective with typical use
  • Lighter and more regular periods
  • May improve premenstrual syndrome (PMS)
  • May improve menstrual cramps
  • Can improve acne
  • Can decrease risk of uterine and ovarian cancer

Disadvantages of the Ring

  • Possible side effects include breast tenderness, nausea, unusual bleeding, headaches, and mood changes. Many of these symptoms improve with time.
  • The ring may interact with certain antibiotics, anti-seizure, and HIV medicines. 

How to Use It

  • Place the ring in your vagina and leave it there for 3 weeks. On the 4th week, remove the ring for 1 week and get your period.
  • Place your ring on time every 4 weeks. This is very important.
  • If you use Annovera®, the ring lasts 1 year. Wash the ring with mild soap and lukewarm water, and pat dry with a clean towel or paper towel before each insertion.

What to Do for Unexpected Expelled or Removed Ring

Annovera®

  • If your Annovera is out of the vagina for more than 2 hours during weeks 1, 2, or 3, rinse off the ring and put it back in as soon as possible. Use a back-up contraception, like condoms, or avoid sex for 7 days after putting the ring in.
  • If your Annovera is out of the vagina for more than 1 week or an unknown amount of time, take a pregnancy test before putting in the new ring. Use back-up contraception, like condoms, or avoid sex for 7 days after putting the ring in.
  • Consider using emergency contraception (EC) if you do not want to become pregnant and unprotected intercourse occurred during the first week of ring use. DO NOT use ulipristal acetate (Ella®) for EC. It can make the ring not work.

NuvaRing®

  • If your NuvaRing is out of the vagina for less than 48 hours, rinse off the ring and put it back in as soon as possible. No back-up contraception is needed.
  • If your NuvaRing is out of the vagina for more than 48 hours during week 1 or 2, rinse off the ring and put it back in as soon as possible. Use back-up contraception, like condoms, or avoid sex for 7 days after putting the ring in.
  • If your NuvaRing is out of the vagina for more than 48 hours during week 3, reinsert the ring to finish the 3rd week, then omit the ring-free week and go right to the next ring.
  • If your NuvaRing is out of the vagina for more than 1 week or an unknown amount of time, take a pregnancy test before putting in the new ring. Use back-up contraception, like condoms, or avoid sex for 7 days after putting the ring in.
  • Consider using emergency contraception (EC) if you do not want to become pregnant and unprotected intercourse occurred during the first week of ring use. DO NOT use ulipristal acetate (Ella®) for EC. It can make the ring not work.

Risks With the Ring

  • Blood clots: Increased risk of stroke or heart attack. Blood clots can develop in veins (deep vein thrombosis) and in the lungs (pulmonary embolism). These conditions are rare, but can be life‐threatening.
  • High blood pressure: Possible small increase in blood pressure. For most people, this increase is small and does not affect one’s health.
  • Nicotine products (vape pens, cigarettes, or chewing tobacco): These products can increase your risk for heart attack and stroke. This risk increases as you get older. 

Who Cannot Use It

Do not use a ring if you have:

  • High blood pressure
  • Severe liver disease
  • Had a baby in the last 3 weeks
  • Had a baby in the last month and are breastfeeding
  • Blood clotting disorder
  • History of blood clot(s), stroke, or heart disease
  • Some type of migraine headaches

When to Call the Health Care provider

Call the doctor or health care provider if you:

  • Think you are pregnant
  • Have depression or change in mood
  • Think you may have a sexually transmitted infection (STI)
  • Have new or worsening headaches
  • Miss a period or have a late period

When to Call 911

Call 911 or go to the nearest emergency room if any of the following occurs:

  • Sudden change in vision
  • Severe headache
  • Unusual pain in your chest
  • Problems breathing or speaking
  • Weakness or numbness
  • Unusual pain or swelling in the legs

Preventing STIs

The ring does not protect against sexually transmitted infections (STIs). Condoms are the best way for sexually active people to reduce the risk of infection. Always use a condom when you have sex. Get yearly health check-ups, including testing for STIs.

Birth Control: Vaginal Ring (PDF), Somali (PDF), Spanish (PDF)

HH-IV-190 10/17, Revised 1/22 Copyright 2017, Nationwide Children's Hospital