The birth control ring is a soft, flexible ring that you insert into your vagina, where it releases hormonal contraception. You leave it in for 28 days, remove it for 7 days, and then reinsert a new one (if you’re using the NuvaRing) or the same one (if you’re using Annovera). Side effects are usually minimal and temporary, and – when used correctly – the ring is about 99 percent effective.
IN THIS ARTICLE
- What is the birth control ring?
- Are there different types of birth control rings?
- How do I use the birth control ring?
- How does the birth control ring work?
- How effective is the birth control ring?
- What are the side effects of the birth control ring?
- Where can I get the birth control ring?
- What are the pros and cons of the birth control ring?
- What happens if the birth control ring slips out or I forget to replace it?
- What happens if I forget to take the ring out on time?
- Who shouldn’t use the birth control ring?
What is the birth control ring?
The birth control ring is a type of hormonal contraception. It’s a soft, flexible transparent ring that measures about 2 inches in diameter and is less than a quarter of an inch thick. (The ring doesn’t contain latex.) You insert the ring into your vagina, where it releases a continuous low dose of synthetic estrogen and progesterone (progestin). These are the same two hormones you’d get from taking the combination pill (the Pill).
Are there different types of birth control rings?
There are two brands of birth control rings available, the Nuvaring and the Annovera. (There’s also a generic version of the NuvaRing called Elurying, which may be slightly less expensive than the brand-name version.) The main difference between the two is that when you take out your NuvaRing you replace it with a new ring, and when you take out your Annovera ring, you clean and reinsert the same device. (The Annovera contains enough hormones for an entire year.
How do I use the birth control ring?
At the beginning of your menstrual cycle, you insert the ring into your vagina and leave it there for three weeks. After three weeks, you take the ring out and leave it out for exactly one week, during which time you’ll get your period – usually two or three days after you take the ring out. You’re still protected against pregnancy during this hormone-free week and don’t need to use a backup method.
(You can start by inserting the ring any time during your cycle, but if it’s not during the first 5 days of your period you’ll need to use backup birth control for 7 days – until the ring becomes effective. If you insert it during the first 5 days of your period, it’s effective immediately.)
When you’ve completed the 28-day cycle (21 consecutive days with the ring in, followed by seven days without it), you insert a new ring the next day and begin again.
It’s possible to use a different schedule in order to avoid getting your period – while on vacation or for a special event, for example. In that instance, you’d replace your NuvaRing immediately after three weeks rather than leaving it out for a week (which is when you’d ordinarily get your period). If you have an Annovera ring, you would simply leave it in until you’re ready to get your period. Ask your healthcare provider for specific guidance if you have any questions about altering your usual schedule.
How does the birth control ring work?
The ring continuously releases low levels of estrogen and progestin, which enter into your system when they’re absorbed through the vaginal walls. Just as they do in combination pills, these hormones keep your ovaries from releasing eggs.
The progestin has other contraceptive effects, as well. It thickens your cervical mucus, making it more difficult for sperm to get into your uterus and fallopian tubes where one might fertilize an egg, if an egg were released. The changes in your mucus may also inhibit the process a sperm must undergo to be able to penetrate the tough outer coating of an egg.
Finally, progestin thins the lining of your uterus, making it less likely that an egg could implant there if it did get fertilized.
How effective is the birth control ring?
When used correctly and consistently, the ring is about 99 percent effective. This means that only one woman out of 100 who use the ring properly will get pregnant in the first year.
If you don’t use the ring exactly as prescribed – for example, you don’t keep it in continuously for three weeks or you wait too long to put in a new ring without using backup contraception – the likelihood that you’ll get pregnant is much higher. According to the Centers for Disease Control and Prevention, the typical failure use rate is 7 percent.
Although the ring is an excellent contraceptive method, it doesn’t offer any protection against sexually transmitted infections (STIs). So, if you’re at risk for STIs, you’ll need to use condoms as well.
What are the side effects of the birth control ring?
The dose of estrogen you get from the ring is lower than the dose in the Pill, so you’re less likely to have side effects from it. In fact, most women using the ring have no side effects.
If you do experience side effects, they’re most likely to occur during the first two or three months of use. Some women may have:
- Irregular periods
- Breakthrough bleeding (spotting or bleeding between periods)
- Nausea
- Headaches
- ማዞር
- የጡት ልስላሴ
- Mood changes
- Vaginal discharge, irritation or nonspecific vaginitis (inflammation). Yeast infection is also possible.
Finally, some women using combined hormonal contraception develop chloasma, or areas of darkened skin, usually on the face. Skin darkening is more likely to be an issue for you if you had chloasma during pregnancy.
You can lower your chances of getting chloasma by protecting your skin from the sun with sunscreen and clothing. If you do develop chloasma, there’s no risk to your health, but you’ll want to switch to another method of contraception that doesn’t contain estrogen. The skin darkening may worsen if you continuing using the ring.
The vaginal ring has some positive side effects for some women, too. Like other forms of hormonal birth control, it may help with premenstrual syndrome (PMS) and acne, for example.
And no, the vaginal ring won’t cause you to gain or lose weight.
Call you provider right away if you have any unusual symptoms after using the ring, such as unusual discharge or bleeding, severe headaches, abdominal or pelvic pain or pain during sex, yellowing of your eyes or skin, or unexplained fever or chills.
If you have signs of a blood clot, such as chest pain, trouble breathing, pain in a lower leg, weakness, tingling, trouble speaking, or vision problems, go to the ER or call 911.
Where can I get the birth control ring?
You’ll need to see your caregiver for an exam. If you’re an appropriate candidate for the ring – that is, you have no health risks and feel comfortable inserting the ring in your vagina – your health practitioner will write you a prescription. There’s no fitting necessary: One size fits all, and you’ll insert it yourself.
Thanks to the Affordable Care Act, insurance plans must cover all prescription contraceptive methods completely – with no cost to you. Plans that existed on March 23, 2010 – and some religiously affiliated employers – are exempt, but many are complying with the changes anyway.
If you’re paying out of pocket, you can expect to spend between $30 and $200 a month, plus the cost of the exam. The ring may be available at some family planning clinics for less.
What are the pros and cons of the birth control ring?
Benefits of the birth control ring include that it:
- Is low maintenance. There’s no need to remember to take a pill every day or to think of protection during sex.
- Is very effective when used correctly.
- Is easy to use – as long as you’re comfortable inserting and removing it.
- Has fewer side effects than oral contraceptives.
- May result in shorter, lighter periods.
- Is unobtrusive. Most partners say they can’t feel the ring during intercourse.
- Is easy reversible. All you have to do to reverse the effects of the ring is to stop using it. For most women, fertility returns soon after they stop using the ring, typically within two to four weeks.
Disadvantage of the birth control ring:
- It doesn’t protect against STIs.
- Side effects are possible.
- It increases the risk of blood clots, which can lead to serious heart, lung, and brain complications. That’s why new moms should wait six weeks after giving birth to use the ring. (New moms have a particularly high risk for blood clots during the early postpartum weeks, and the estrogen in the ring increases this risk even more.) Smoking cigarettes while using the ring can further increase the risk of blood clots, so if you use the ring, don’t smoke.
What happens if the birth control ring slips out or I forget to replace it?
Although it doesn’t happen often, a ring can slip out of your vagina while you’re removing a tampon or straining during a bowel movement.
A ring may be more likely to slip out if you have a condition affecting the structure of the vagina, such as a prolapsed uterus or very relaxed vaginal muscle tone.
If the ring comes out of your vagina, rinse it with cool to lukewarm (not hot) water and reinsert it as soon as possible. You’ll continue to be protected against pregnancy if you put it back in place within three hours.
If the ring has been out of your vagina for more than three continuous hours:
- During the first or second week of use – rinse it off, reinsert it and leave it in place. Use backup birth control for the next seven days.
- During the third week of use – discard it and insert a new ring, starting a new 28-day cycle. Or wait seven days so you can have your period, then insert a new ring. Use backup birth control for the next seven days, or wait a week to resume intercourse.
If you lose a ring when it comes out, just insert a new one and start a new cycle. If the rings come out repeatedly, call your healthcare provider. You might need to switch to another method of birth control.
If the ring has been out for more than three hours and you’ve had unprotected intercourse during this time, consider using emergency contraception to decrease your odds of becoming pregnant.
What happens if I forget to take the ring out on time?
If your NuvaRing has been in for no longer than 28 days, you’re still protected against pregnancy. Take the ring out and insert a new one after seven days.
However, if the ring has been in for more than four weeks, you’re no longer protected against pregnancy. If you haven’t had sex or you used a backup method during this time, you can insert a new ring right way. When you do insert the new ring, you’ll need to continue to abstain or use backup contraception for the next seven days.
If you had sex without backup contraception after the ring has been in for four weeks, consider using emergency contraception immediately. You’ll need to make sure that you’re not pregnant before you insert a new ring. Use backup contraception until the new ring has been in for seven days.
If you have an Annovera ring, it will provide protection for a year. There’s no need to worry if you forget to take it out on schedule. You can take it out and start a new schedule at any time.
Who shouldn’t use the birth control ring?
Women who aren’t able to use combined oral contraception won’t be able to use the vaginal ring either, because it contains the same hormones. Talk with your healthcare provider about another option if you:
- Smoke and are over 35 years of age
- Have a high risk of blood clots
- Have a hormone-sensitive cancer, such as breast cancer
- Have liver disease
- Have abnormal uterine bleeding
- Have severe high blood pressure
Another method might also be better for women who are having trouble breastfeeding or who are taking certain medications.
If breastfeeding is going well after six weeks postpartum, it’s okay for you to use the ring. If you’re not producing as much milk as you’d like, or if your baby is having any trouble nursing, though, the ring may not be a good choice for you, because it may reduce the amount of milk you produce by a bit.
Most medications won’t interfere with the effectiveness of the ring – and the ring won’t interfere with the effectiveness of most medications – but some do. Be sure to tell your healthcare provider what medications you’re taking when you ask for your prescription for the ring. And tell any healthcare provider you see that you’re using the ring.
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