Vaginal Ring

What is the vaginal ring?
The vaginal ring is a flexible, transparent, soft plastic ring that you place inside your vagina, where it releases two hormones (oestrogen and progestogen).

How does the vaginal ring work?
The ring continuously releases two hormones - oestrogen and progestogen - into the bloodstream. One ring provides contraception for a month, so you don’t have to think about it every day.

It prevents pregnancy by:

  • Inhibiting ovulation.
  • Making the endometrium unfavourable for implantation; thinner, so it is less likely to accept a fertilised egg.
  • Making the cervical mucus impenetrable to sperm.


How effective is the vaginal ring?
When used correctly and according to the instructions, it is over 99% effective at preventing pregnancy.

When do I start the ring?
You can start using the vaginal ring any day you want if you are not pregnant. You leave it in for 21 days and remove it for a 7-day vaginal ring-free break. You are still protected from pregnancy during the break. After the break, you need to put a new ring in for another 21 days and repeat the cycle. Always discuss the following options with your medical practitioner and see which way is best for you.

  • If you start it on the first day of your menstrual period (cycle), you are protected immediately.
  • If you start using it at any other time in your menstrual cycle, you will need additional protection such as condoms for the first 7 days using it.

You can have sex and use tampons/menstrual cup while the ring is in your vagina. You and your partner may feel the ring during the sex.

How do I use the vaginal ring?
The ring is designed to give you a withdrawal period (not your usual period). However, you may wish to use it differently. Always discuss the following options with your medical practitioner and see which way is best for you. An example is as follows:

Standard Way

Apply a new ring once a week, every week for 21 days. Then you should stop inserting the ring for the next 4 or 7 days. You should have a withdrawal bleed during the ring-free break. Start a new ring on the 5th or 8th day, even if you are still bleeding.

Am I protected during ring-free days?
Yes, you are protected if you are using the ring according to the instructions.

How do I insert the ring?

  • Wash your hands.
  • Squeeze the ring between your thumb and finger and gently insert the tip into your vagina.
  • Gently put the ring up into your vagina until it feels comfortable.
  • Make sure that the ring is still there by using your fingers (the rings cannot get lost inside your vagina).


How do I remove the ring?
Removing the ring should not cause pain. If you bleed, feel any pain, or you cannot get it out, see your medical practitioner immediately.

  • Wash your hands.
  • Put your finger into your vagina and hook it around the edge of the ring.
  • Gently pull the ring out.
  • During your ring-free interval, you might have a period-type bleed.


What if the ring comes out?
If it does come out, you should consider:

  • How many days the ring was on before it came off.
  • How long it has been out.

Scenario 1:
If it has been less than 48 hours since ring came out

  • Insert it back as soon as possible and keep the ring until next ring-free break.
  • If you are in the first week after a ring-free break, there is no need for additional contraception as long as the ring has been used correctly this week and the previous 7 days before the ring-free break.
  • If you are in any other week, there is no need for additional contraception if the ring has been used correctly.

Scenario 2:
If it has been off for 48 hours or more

  • Insert it back as soon as possible and keep the ring until next ring-free break.
  • You may need additional contraception such as condoms or to avoid sex until ring has been in place for 7 days or if you are within the 7 days of ring-free break.

There are other scenarios especially if the ring has been in place for more than 21 days (3 weeks). Speak to your medical practitioner for advice and assistance. You may need additional contraception or to avoid sex completely or to make use of emergency contraception in case of unprotected sex.

I forgot to remove it after the 21 days.
If the ring has been in place for 7 days after the 21 days:

  • Take the ring out as soon as you remember.
  • Start the 7 days ring-free break.
  • After the 7 days of ring-free break, place a new ring.
  • You may not need additional contraception.

If the ring has been in place for more than 7 days after the 21 days:

  • Take the ring out as soon as you remember.
  • Place a new ring.
  • Use additional contraception or avoid sex completely.


I forgot to put a new one.

  • Put a new ring as soon as you remember.
  • Use additional contraception for the next 7 days.


What are the advantages of the vaginal ring?

  • You do not have to think about it every day, even if you have been vomiting or have diarrhoea.
  • Easy to insert and remove.
  • Does not interrupt during sex.
  • Decreases heavy or painful period - makes period more regular.
  • It can help with premenstrual symptoms.
  • Reduce the risk of some types of cancer.
  • No long-term effect on fertility.
  • It helps with PCOS (polycystic ovarian syndrome) problems.


What are the disadvantages of the vaginal ring?

  • You may not feel comfortable inserting or removing it from your vagina.
  • Temporary headaches, nausea, breast tenderness and mood changes.
  • Irregular bleeding and spotting for the first few months.
  • Some medicines may make the ring less effective (speak to your medical practitioner before taking any new medicines that might interact with your vaginal ring).
  • You need to remember to replace the ring and put in a new one.


What are the risks of the vaginal ring?
All risks should be discussed with your medical practitioner before starting a new contraceptive. The vaginal ring can have the following side-effects:

  • High-risk blood clot (deep vein/artery thrombosis) if:
    • It is your first year of using the patch.
    • You smoke.
    • You are overweight.
    • You have thrombophilia (tendency of blood clotting).
    • You are unable to move (immobile) or use a wheelchair.
    • Severe varicose veins.
    • You have diabetes.
    • You suffer from migraines.
    • Close family member who has had a heart attack, a stroke, or a blood clot before the age of 45 years.

Research also suggests that contraceptive patch users are of a small increased risk of breast cancer and cervical cancer

It is important to speak to your doctor as soon as you experience the following symptoms:

  • Chest pain.
  • Painful swelling in your leg(s).
  • Weakness and numbness in the arm or leg.
  • Unusual headaches or migraines.
  • Sudden slurring of speech or other speaking difficulties.
  • Eyesight problems.

N.B. Always mention that you are using the contraceptive patch to your doctor even in emergency situations.

Who can use the vaginal ring?
Not everyone can use the patch. Your medical practitioner needs to know your medical history and other information related to illnesses. If you do not have any of the following conditions or any other medical reasons, you can make use of the patch. However, the patch may not be suitable for you if:

  • You smoke and are over 35 years of age.
  • You are 35 years and over and stopped smoking less than a year ago.
  • You are overweight or more than 90kgs.
  • You are taking certain medication.
  • You are breastfeeding a baby less than 6 weeks old.
  • You have/had or any of your immediate family members have/had a thrombosis in a vein or an artery before 45 years of age.
  • Heart disease or stroke.
  • Heart abnormalities.
  • Hypertension.
  • Circulatory problems.
  • Migraine aura.
  • Breast cancer or you have a gene that is associated with breast cancer.
  • Diabetes with complications.
  • You are immobile for a long period of time (such as when using a wheelchair).
  • You are at high altitude (more than 4,500m) for more than a week.


Can rings break inside my vagina?
It is very rare and unlikely for the ring to break. Make sure to remove the broken ring and insert a new one immediately. Continue the cycle as you were.

If I take other medicines, will it affect my vaginal ring?
Antibiotics
Commonly used antibiotics do not affect the vaginal ring. The antibiotics rifampicin and rifabutin (medicines that treat tuberculosis and meningitis) can reduce the effectiveness of the combined pill. You may need additional contraception such as condoms while taking the antibiotic or sometime after. Other antibiotics should not have an effect.

Epilepsy and HIV medicine, and St John’s Wort treatment
These types of drugs are called enzyme-inducers (as they speed up the breakdown of hormones by your liver) and may make the pill less effective.

Can I bleed when I start the vaginal ring?
Yes, bleeding is very common at first. Make sure that you are using the vaginal ring according to the instructions. If you are bleeding more than normal or it is something you are not comfortable with it, speak to your medical practitioner.

Can I switch to another method of contraception?
Yes, you can change the ring to another contraceptive. Speak to your medical practitioner for advice and guidance accordingly.

Can I get pregnant when I remove the vaginal ring?
When you stop using the ring, your fertility comes back to what is normal for you. You may not have periods immediately, but you should get it back in a few months.

Can I put a contraceptive patch after a miscarriage?
You can start applying the contraceptive patch immediately after a miscarriage.

I have just had a baby. When can I start the vaginal ring?
You can usually start to use the ring from the 21st day after you gave birth if you are not breastfeeding. If you started after 21 days, you need additional contraception such as condoms to protect you from pregnancy, or avoid sex completely for the next 7 days. The ring may affect your breast milk production. Therefore, you should not start the ring before the baby is 6 weeks old.

Do I gain weight?
Research has not shown that you will gain weight with the contraceptive patch. Weight gain may be due to fluid retention and other reasons beyond the use of the patch.

How often should I go for a check-up?
Your medical practitioner will provide guidance on your next appointment. Your doctor may need to check your blood pressure and weight once a year, however, do not wait for the next appointment if:

  • You think you may be pregnant.
  • You could have an STI or HIV/AIDS.
  • You experience severe pain in the lower abdomen.
  • You experience bleeding or another symptom mentioned in risks of the contraceptive patch.


If I have the contraceptive patch, am I protected from Sexually Transmitted Infections?
No, only male and female condoms (when you used correctly and consistently) protect you from STIs.