NDSU Student Health Service
Choices Program

Your Reproductive Health - The Vaginal Ring

 

The Vaginal Ring

The vaginal ring is a thin, flexible ring about 2 inches in diameter that is inserted into the vagina and left in place for 3 weeks in a row. During the fourth week, you do not wear the ring. During this time, your period should begin. Then you would insert a new ring for the next 3 weeks and so on.

Once the ring is inserted it releases a continuous low dose of hormones (similar to those in the pill or patch) into your body. The hormones prevent ovulation by stopping the release of an egg from your ovaries. It also thickens the cervical mucus, making it more difficult for sperm to enter.

• Risks and Side Effects of the Ring
• How to Use the Ring

Benefits of the Vaginal Ring

The vaginal ring is 98% to 99% effective when used correctly. One ring provides one month of protection. You insert and remove the ring yourself, which you can do with your fingers, and it is easy and painless. The ring is a very discrete and private method of birth control. Neither you nor your partner should feel any discomfort.

In addition, some women may experience the following benefits:

• Less menstrual cramping
• More regular periods
• Less low blood counts
• Less pain at ovulation
• Less acne
• Less menstrual bleeding

You may have a decreased risk of developing:

• Pelvic inflammatory disease (PID)
• Ovarian cancer
• Ectopic (tubal) pregnancy
• Endometrial cancer
• Benign breast tumors or ovarian cysts

Risks/Side Effects of the Vaginal Ring

• Vaginal infection or irritation
• Vaginal discharge
• Spotting between periods
• Elevated blood pressure
• Darkening of skin color
• Worse acne
• Depression
• Breast tenderness
• Headache
• Weight gain or loss
• Nausea

  The contraceptive vaginal ring may be associated with blood clots in the legs or lungs, strokes, heart attacks, gallbladder disease, or liver tumors. These conditions rarely result in death. The risks of heart attack increase for women over 35 who smoke. To decrease the chance of developing serious problems, go to the Student Health Service, clinic, or emergency room if you have any of the following symptoms (note that the first letters of the words spell out the word ACHES):

• Abdominal pain (severe)
• Chest pain or shortness of breath
• Headaches (severe)
• Eye problems - blurred vision, flashing lights or blindness
• Severe leg pain in the calf or thigh
  
  (click here for a map to all clinics and emergency rooms in Fargo)

How to use the Vaginal Ring

1. Insert one ring in the vagina and keep it in place for three weeks in a row. Remove it for a one-week break and then insert a new ring. During the one-week break, you will usually have your menstrual period.

2. When to start using the ring:

• Count the first day of your menstrual period as "day one," insert your first ring between day one and day five of the cycle, but at the latest on day five, even if you have not finished menstruating. During this first cycle, use a backup method of birth control such as male condoms or spermicide, for the first 7 days of ring use.
• Consult your health care provider about when to start the ring when switching from another birth control method.

3. How to insert the ring:

• Each ring comes in a reclosable foil pouch. After washing and drying your hands, remove the ring from the pouch. Keep the pouch for proper disposal of the ring after use.
• Choose the position that is most comfortable for you. For example, lying down, squatting, or standing with one leg up.
• Hold the ring between your thumb and index finger and press the opposite sides of the ring together.
• Gently push the ring into your vagina. The exact position in the vagina is not important for the ring to work.

4. Most women do not feel the ring once it is in place. If you feel discomfort, the ring is probably not inserted back far enough in the vagina. Use your finger to gently push the ring further into your vagina. There is no danger of the ring being pushed too far in the vagina or getting lost. The cervix will block the ring from going any further.

5. Once inserted, leave the ring in place for three weeks in a row.

6. Remove the ring three weeks after insertion on the same day of the week as it was inserted, at about the same time.

7. To remove the ring, hook your index finger under the forward rim or hold the rim between the index and middle finger and pull it out. Place the used ring in the foil pouch and properly dispose of it in a waste receptacle out of the way of children and pets. Do not flush it down the toilet.

8. Your menstrual period will usually start two to three days after the ring is removed and may not have finished before the next ring is inserted. To continue to have pregnancy protection, you must insert the new ring one week after the last one was removed, even if your menstrual period has not stopped.

9. If the ring slips out of the vagina and it has been less than three hours, you should still be protected from pregnancy. The ring should be rinsed with cool to lukewarm (not hot) water and reinserted as soon as possible, within no longer than 3 hours. If you have lost the ring, you must insert a new ring and use it on the same schedule as you would have used the lost ring. If the ring has been out of the vagina for more than three hours, you may not be adequately protected from pregnancy. You must use a backup method of birth control until the ring has been back in place for seven days in a row.

10. If you miss a menstrual period, you must check to be sure you are not pregnant if:

• The ring was out of the vagina for more than three hours during the three weeks of ring use.
• You miss a period and you had waited longer than one week to insert a new ring
• You have followed all instructions but you miss two periods in a row.
• You have left the ring in place for longer than four weeks.

11. The ring is unlikely to cause an overdose because the ring holding the medicine releases a steady amount of contraceptive hormones. Do not use more than one ring at a time. Overdose of combination hormonal contraceptives may cause nausea, vomiting or vaginal bleeding.

12. While using the ring, you should not use a diaphragm as a backup method of birth control because the ring may interfere with the correct placement and position of the diaphrahm.

13. When you are seen by a medical provider for other reasons or are admitted to a hospital, be sure to mention that you are using the ring.

14. You will be given an extensive pamphlet about the vaginal contraceptive ring to read. The pamphlet is produced by your ring manufacturer. Read the whole pamphlet carefully.

15. It is your responsibility to learn the side effects of the ring and the danger signals. Do not ignore these problems or wait to see if they go away. Call the Student Health Service (701-231-7331) or your doctor immediately and explain your problem. Note that the first letters of the danger signs spell out the word ACHES.