What Is a Vaginal Ring?
A vaginal ring is a hormonal birth control option that you wear inside your vagina. It’s a small, flexible contraceptive ring, about the size of a silver dollar. There are three options currently available: Annovera, NuvaRing, and EluRyng.
NuvaRing was the first vaginal ring approved for use. It has etonogestrel (a synthetic progestin) and ethinyl estradiol and requires you to use a new ring each month.
EluRyng is the first FDA-approved generic version of the NuvaRing. It’s made by Amneal Pharmaceuticals and works the same way as the brand name option, but generic drugs tend to cost less.
Annovera is a contraceptive vaginal ring that releases segesterone acetate, a synthetic progestin, and ethinyl estradiol. It's the first product to contain segesterone. The same Annovera ring can be used for an entire year, but you have to remove it for 1 week every month.
How Does a Vaginal Ring Work?
A vaginal ring has the same hormones as many birth control pills. You put it in your vagina, where it sends a steady, low dose of hormones into your system. You absorb them through your vaginal wall.
The birth control ring prevents pregnancy by mimicking hormones your body makes. Those are:
Estrogen. At certain levels, this hormone helps prevent ovulation (when your ovary releases an egg). It also stabilizes your uterine lining. (This is why you bleed a few days after you remove the vaginal ring.)
Progestin. This is a manmade version of progesterone, the hormone that supports your period and helps in the early stages of a pregnancy. Progestin typically stops you from ovulating, but it also thickens cervical mucus, which keeps sperm from entering your uterus if you do release an egg. Progestin also makes it hard for an egg to grow in the uterine lining if it gets fertilized.
There are two ways to use the vaginal ring:
Cyclic use. Insert it and leave it in place for 3 weeks, then remove it for 1 week, during which you have bleeding similar to a period. If you use NuvaRing or EluRyng, you’ll put a new ring in at the end of week 4. If you use Annovera, you’ll use the same ring for a year. Remove, wash, and store it in its case during your period.
Continuous use. Leave the ring in for 4 weeks, then replace it right away with a new one without leaving a week for your period. This is what’s called an off-label use. Your doctor might suggest doing this if you want fewer days of bleeding and constant birth control protection. But you may have some breakthrough bleeding with continuous use.
How to Use a Vaginal Ring
If you’ve ever used a tampon, the process is similar.
Follow these steps for inserting a vaginal ring:
- Wash and dry your hands.
- Either lie down with your knees bent, squat, or stand with one leg on a chair.
- Open the foil and remove the ring. If you use disposable rings, you can save the foil package to wrap it in and throw it away later.
- Hold the ring between your thumb and index finger.
- Pinch the sides together so they touch in the center.
- Insert the ring as far into your vagina as it will go.
NuvaRing makes a tampon-like applicator to help with the placement of the vaginal ring. You can also put the ring in an empty tampon applicator to help with insertion.
To remove the vaginal ring:
- Wash and dry your hands.
- Insert your index finger into your vagina.
- Hook your finger under the ring or grab the edge with two fingers.
- Slowly pull out the ring.
Put the vaginal ring back in the foil pouch (if you kept it) and toss it in the trash. Don’t flush it down the toilet or put it somewhere pets or kids can get to it.
Vaginal Ring Effectiveness
If you use it perfectly, the vaginal ring prevents pregnancy for more than 99% of the time. That means only 1 out of 100 users might still get pregnant when they're trying not to.
With typical or real-world use (which accounts for human error), it may be closer to 91% effective. That means up to nine users may get unintentionally pregnant if they don’t use the vaginal ring exactly as prescribed.
Here are some tips to make your vaginal ring more effective:
- Insert it on the first day of your period.
- Store your unopened rings at a temperature below 86 F.
- Replace it every 3-4 weeks (NuvaRing, EluRyng) or once a year (Annovera).
- If your ring falls out or you remove it, put it back in within 2 hours (Annovera) or 3 hours (NuvaRing, EluRyng).
- Use a water-based lubricant for sex.
Things that can make your vaginal ring less effective include:
- Leaving it in longer than you’re supposed to
- Your ring falls out or is removed for too long
- Storing unopened vaginal rings where they are exposed to heat or direct light
- Using oil or silicone-based lubricants
Some medications or supplements can interact with the vaginal ring and make it less effective. Those medicines can include:
- Antibiotics, including rifampicin (Rifadin) and some anti-tuberculosis drugs
- Drugs used to treat hepatitis C, such as boceprevir (Victrelis)
- Some combinations of meds to treat HIV
- Certain medications used for fungal infections, including griseofulvin (Grifulvin V)
- Some anti-seizure drugs, including topiramate (Topamax), carbamazepine (Tegretol and Curatil), oxcarbazepine (Trileptal), and phenytoin (Dilantin)
- Medications used to treat high blood pressure in the lungs, such as bosentan (Tracleer)
- The anti-nausea medicine aprepitant (Emend) used during cancer treatment
- St. John’s wort supplements
Your doctor may want you to use a backup form of birth control if you use any of these medications.
How long does it take the vaginal ring to become effective?
You’ll be protected right away if you put the vaginal ring in on the first day your period starts. You’ll need to use a backup birth control method (such as a condom) for at least 7 days if you insert it at any other point during your menstrual cycle or if you’re not sure when your last period was.
The vaginal ring should prevent pregnancy immediately if you switch straight from birth control pills or the patch. Just make sure you put it in on the same day you’re due for a new pill or patch.
It’s a good idea to use backup birth control for 7 days if you switch from progestin-only birth control, such as the minipill, implant, injection, or IUD. But that’s something you should talk to your doctor about.
Vaginal Ring Side Effects
Like tampons, most people can’t feel their vaginal ring if it’s inserted correctly. But there’s a chance you might know it’s there. Discomfort and hormone-related side effects tend to get better after a few months. Tell your doctor if they don’t.
The most common side effects of the vaginal ring are:
- Migraine or other type of headache
- Weight gain
- Nausea
- Breast tenderness
- Vaginal irritation
- Depression
- Mood swings
Some users might have:
- Spotting or bleeding
- Vaginal discharge
- Changes in vision or trouble wearing contact lenses
- Bellyache
- Vomiting
- Lower sex drive
Many people have fewer menstrual cramps and less blood flow when they use the vaginal ring than with other forms of hormonal birth control. Tell your doctor if your pain or bleeding gets worse while you're using the ring.
Serious side effects of the vaginal ring are rare. However, talk to your doctor about the likelihood of any adverse effects happening to you. Ask them what signs and symptoms you should watch for and what might signal an emergency.
Who Shouldn’t Use the Vaginal Ring?
Because the vaginal ring can cause health problems in certain people, it's not recommended for everybody.
The vaginal ring might not be a good option if you:
- Have a history of blood clots, heart attack, or stroke
- Have breast cancer or other hormone-sensitive cancers
- Are pregnant or think you might be
- Are over 35 and smoke cigarettes
- Have hepatitis or liver problems
- Have high blood pressure that isn’t controlled
- Have diabetes
- Have vaginal bleeding your doctors can't explain
- Take medicines that can interact with the vaginal ring
- Are allergic to any of the ingredients
- Have migraines
Talk to your doctor if any of these situations apply to you.
Vaginal Ring Risks
Like other types of hormonal birth control, the vaginal ring can increase your risk of rare but more serious side effects, such as:
- Blood clots
- Heart attack
- Stroke
- Toxic shock syndrome (TSS)
- Gallstones (if you have a history of gallbladder disease)
- High blood pressure
- Noncancerous liver tumors
Vaginal Ring Pros and Cons
Some of the advantages of using a vaginal ring include:
- It's easy and comfortable to use (you don't need to think about it every day)
- It's safe and effective when you use it as prescribed
- You can easily remove it anytime if you decide to get pregnant
- It's safe even if you have latex allergies
- You don't have to interrupt sex to put it in
- It's private; nobody has to know you have it
- Bleeding from periods usually gets lighter
- It may help ease menstrual cramps
- It may reduce your risk of fibroids, ovarian cysts, and certain breast diseases
Of course, the vaginal ring isn't without disadvantages. They include:
- It doesn’t protect against sexually transmitted infections (STIs)
- It can be ineffective if you don't use it correctly
- Temporary side effects, such as spotting, nausea, and breast tenderness
- You and your partner might have irritation, infections, or both
- It can come out
How Do You Get a Vaginal Ring?
To get a vaginal ring, you need to get a prescription from a doctor or other health provider. People who can prescribe the birth control ring include:
- Gynecologists or OB-GYNs
- Nurse practitioners
- Primary care doctors
- Telehealth or telemedicine providers
If you don’t have a regular doctor, ask your local health department or family planning center how you can get access to birth control such as the vaginal ring.
Vaginal Ring Cost
The vaginal ring can cost you anywhere from zero to $200 a month. How much you’ll pay depends on several things, including your insurance provider and where you get the ring.
Federal law requires that most private and public health insurance plans (such as Medicaid) cover the cost of contraception such as the vaginal ring as well as appointments about birth control. You may not have to pay anything, but you’ll need to call your insurer to find out what’s covered under your plan.
To lower your out-of-pocket costs, ask your insurance provider if you need to go to a certain doctor or hospital. They can give you a list of their in-network health providers.
If you need help paying for the vaginal ring, you may be able to get free or no-cost birth control through:
- Local health departments or family planning clinics
- Federally qualified health centers
- Medicaid health plans
Takeaways
A vaginal ring is a small, flexible ring that you insert into your vagina as a form of birth control. It uses two types of hormones, estrogen and progestin, to prevent you from getting pregnant. When you use it as prescribed, a vaginal ring is highly effective and has few side effects.
Vaginal Ring FAQs
Can I use tampons with the vaginal ring?
Yes. You can use tampons when you have a vaginal ring. Just be careful you don't pull it out when you're taking out your tampon.
Can my partner feel the vaginal ring?
Your partner might or might not feel your vaginal ring. If they do and it's irritating or uncomfortable, be sure you've inserted it properly. You can take it out during sex. Just remember how long your vaginal ring remains effective after you take it out (2 hours for Annovera and 3 hours for NuvaRing or EluRyng). Put it in a clean spot, and wash it in warm water before you put it back in.
