The combined vaginal contraceptive ring
The 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.
Video – The combined vaginal ring
Would you like to find out everything you need to know about the ring? We’ve created this short explainer video, filled with information about the ring including:
– What it is
– How effective it is in protecting against pregnancy
– Advantages
– Disadvantages
– Risks
How to use the combined 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 monthly bleed.
Users of the vaginal ring have the option to have a monthly bleed or to skip or shorten their monthly bleed. It is not dangerous to take combined methods of contraception like the ring continuously, without taking a break. If you would prefer not to have a break at all, you can immediately replace your ring. Taking the ring in this way can also help if you usually experience unpleasant side effects during your break.
Whilst it isn’t medically necessary to have a break, taking this method continuously does mean that you have less control over when you have a bleed (you may occasionally still have a bleed, but won’t necessarily know when to expect this).
If you’d prefer to have more control over when you have a bleed, there are other ways of taking the ring available – for example, you could use the ring continuously for 9 weeks (using 3 rings) and then have a break for 4 or 7 days (this is called tricycling).
If you do not have a routine and think you may forget to replace the ring every three-four weeks, you may wish to consider a LARC (Long-Acting Reversible Contraception) method.
Effectiveness of the combined vaginal ring
The vaginal ring works well at preventing pregnancy. However, its ability to stop a pregnancy largely depends on a person using it properly.
Perfect use: more than 99% effective. Fewer than 1 in 100 people will get pregnant in a year when using the vaginal ring correctly.
Typical use: around 91% effective. Around 9 in 100 people using the ring will get pregnant in a year.
Advantages, disadvantages and risks associated with the combined 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.
Research has previously found that combined hormonal contraception is also associated with a significant decrease in the risk of endometrial and ovarian cancer, across lifestyle factors.
It reduces the risk of getting fibroids, ovarian cysts and non-cancerous breast disease.
It may reduce acne and improve your skin.
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.
If you are breastfeeding, talk to your medical provider to see if it is safe to use the vaginal ring.
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.
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.
Condoms are the only contraceptive method which protect against sexually transmitted infections. To ensure protection from both pregnancy and infection, we recommend “dual protection”. This means using a male or female condom in addition to the contraceptive method of your choice to prevent pregnancy.
The combined vaginal ring is associated with some rare risks. For most people, the benefits of taking the combined pill outweigh the possible risks, but it is essential that our clients have access to quality advice and information when it comes to contraception.
Some of the rare risks associated with combined contraceptive methods include the development of a blood clot in your leg or lungs, a heart attack, or a stroke.
Your clinician or contraception provider will ask you questions to check whether you could be at a higher risk, for example, if you smoke, have high blood pressure, are overweight, take certain medicines or have a certain family medical history.
Where can I get the combined vaginal ring?
In the UK, you can get the combined vaginal ring for free from sexual health clinics, some GP surgeries and some young people’s services.
At MSI UK, we primarily offer contraception services as part of your abortion care. We also offer contraception services in some parts of England for people who have not accessed our abortion services. From these clinics, people can access LARC (Long-Acting Reversible Contraception, such as the coils, the implant and the injection) with us without having had an abortion.
Follow the link to find out more: MSI UK Contraception Clinics
The combined vaginal ring and your period
One advantage of using the combined vaginal ring is that it can make your periods regular, lighter and less painful.
The combined vaginal ring also gives you more control over your periods: you can choose not to have a period, or to delay your period.
Learn more about contraception
Visit the pages below to find a comparison tool to help you find the right method for you, and to learn more about short-acting and long-acting reversible contraception.
Which method is right for me?
Find a contraception comparison tool that can help you find the right method for you.
Short-acting contraception
Short-acting methods include the contraceptive pill, patch and ring.
Long-acting contraception
Long-acting contraceptive methods include the coils, the injection and the implant.