Combined vaginal ring

The combined contraceptive vaginal ring is a small soft ring that you insert into your vagina. It contains two hormones, progestogen and oestrogen, similar to the hormones in your body.

The hormones primarily prevent an egg from being released each month. They also make it difficult for sperm to get to an egg and thin the uterus (womb) lining to make it difficult for a fertilised egg to implant there.

The ring is kept in the vagina continuously night and day for three weeks and then taken out for a week if you want to have a monthly bleed. A new ring needs to be inserted immediately after a week to maintain contraceptive protection.

  • How good is the vaginal ring at preventing a pregnancy?
    • The vaginal ring works well at preventing pregnancy. However, its ability to stop a pregnancy largely depends on a person using it properly.
    • With typical use up to 7 out of 100 users will become pregnant
    • If you think you will not be able to remember to replace the ring once every 3-4 weeks, it may not be the right method for you.
  • What are the advantages of the vaginal ring?
    • It can make your periods regular, lighter, and less painful
    • It gives you the choice not to have a monthly bleed or control when you have a bleed
    • One ring provides contraception for a month, so you don’t have to think about it every day
    • It is not required to be used just before sex so will not affect spontaneity of sex
    • It doesn’t interrupt sex, because you can have sex with the ring in place.
    • Your fertility will return to normal immediately after the you stop using the ring
    • Unlike contraceptive pills, the ring remains effective even if you have vomiting or diarrhoea.
    • It helps protect against some forms of cancer (ovary, uterus (womb) and colon).
    • It reduces the risk of getting fibroids, ovarian cysts and non-cancerous breast disease
    • It may reduce acne and improve your skin.
  • What are the disadvantages of the vaginal ring?
    • It may not be suitable if you don’t feel comfortable inserting or removing it from your vagina.
    • Spotting and irregular bleeding while the ring is in your vagina can occur in the first few months.
    • The ring has to be left inside the vagina continuously for most of the month. Taking it out and forgetting to put it back within 3 hours (for sex or cleaning) could make it fail.
    • You may not be suitable for the vaginal ring if you have high blood pressure or complicated diabetes, or if you are a smoker over the age of 35. Please talk to your medical provider about conditions that may make you ineligible for the ring.
    • If you are breastfeeding, talk to your medical provider to see if it is safe to use the vaginal ring.
    • Unlike condoms, the vaginal ring does not protect from sexually transmitted infections. You must use both to protect yourself against STIs.
    • The most common side effects are disturbances in monthly bleeding in the first few months. You can also have headaches, breast tenderness, nausea, mood changes, vaginal irritation and vaginal discharge.
    • Use of some medications, such as those for seizures, some HIV medicines or those for tuberculosis, can stop the ring from working.  Check with your medical provider if your medications are compatible with use of the ring.
    • A few women can develop a blood clot (thrombosis), heart attack or stroke when using the ring, but this is rare. 
    • The ring can sometimes come out on its own, but you can rinse it in warm water and put it back in as soon as possible. You will need additional protection if the ring has been out for more than 3 hours. 
  • How do I use the vaginal ring?
    • With clean hands, squeeze the ring between your thumb and finger and use one hand to insert it into your vagina. If necessary, spread your labia (vaginal lips) with your other hand. Push the ring into your vagina until it feels comfortable
    • The ring needs to be replaced with a new one every 3-4 weeks depending on whether you want to have a withdrawal bleed that month
    • Users of the vaginal ring have the option to have a monthly bleed or to skip or shorten their monthly bleed
  • What are the possible risks of using the vaginal ring?
    • The combined vaginal ring is associated with some rare risks. For most people the benefits outweigh the possible risks.
    • Your provider will ask you questions to check whether you could be at higher risk (e.g. if you smoke, have high blood pressure, or are overweight etc.)
    • There are some rare risks associated with combined methods:
      • Development of a blood clot in your leg or lungs
      • Heart attack
      • Stroke