The vaginal ring for contraception: between ease and effectiveness, advantages and disadvantages

In the world of contraception, every woman looks for the most comfortable, safe, and effective method to prevent unplanned pregnancy. This is where the vaginal ring comes in as an easy and convenient option.The vaginal ring is a modern hormonal contraceptive that provides continuous protection fo a month without the need to remember daily pills or deal with painful injections. It is simply inserted into the vagina, where it releases hormones that regulate the cycle and prevent ovulation, making it highly effective when used correctly.However, like any other contraceptive method, it has its pros and cons and may be more suitable for some women than others. In this article, we will discuss all the important details about the vaginal ring—how it works, how to insert and remove it, its benefits, potential side effects, and when you should consult your doctor if you experience any issues.If you're looking for a safe and easy-to-use birth control method, then you need to learn more about the vaginal ring!

What is the vaginal ring? The vaginal ring is a combined hormonal contraceptive method. It is a flexible, transparent ring placed inside the vagina. Its main function is to release certain hormones that prevent pregnancy in a way similar to combined birth control pills, but it is distinguished by the fact that it doesn't require daily use like pills.

What is it made of?

Main material: It is made of flexible medical plastic (non-dissolvable), such as Ethylene Vinyl Acetate (EVA), which makes it easy to insert and remove without causing pain or discomfort.

The hormones it contains:

Estrogen (Ethinyl Estradiol) → It prevents the maturation of the egg and stops ovulation, which prevents pregnancy.
Progesterone (Etonogestrel or Segesterone Acetate) → It works by preventing ovulation and also thickens the cervical mucus, which makes it harder for sperm to enter the uterus.

How the hormones are released: The ring releases a steady dose of these hormones daily, directly into the bloodstream through the vaginal wall. This consistent release helps maintain the hormone levels in the body, thus keeping its contraceptive effect active throughout the period of use.

Benefits of the vaginal ring: The vaginal ring is a hormonal contraceptive with many benefits, making it a suitable choice for many women. Let's look at its main advantages:

Highly effective in preventing pregnancy:
It has a success rate of over 99% if used correctly. It prevents ovulation by releasing estrogen and progesterone, which stop the ovaries from releasing an egg.
Easy to use and doesn’t require daily monitoring:
Unlike pills that need to be taken daily, the ring is inserted once a month (leave it for 3 weeks, remove it for 1 week). There’s no worry about forgetting it like pills.
Doesn’t affect sexual intercourse:
It doesn’t need to be removed before intercourse, and most men and women don’t feel it. If you feel discomfort, you can adjust its position inside the vagina or remove it and reinsert it after intercourse, but don’t leave it out for more than 3 hours.
Reduces menstrual pain:
It helps regulate the menstrual cycle and makes it lighter and less painful. It reduces cramps and the discomfort that occurs during menstruation.
Reduces acne:
Since it regulates hormones, it helps improve skin and reduces acne.
Reduces the risk of some women’s health issues:
It lowers the risk of cervical and ovarian cancer. It also reduces the chances of ovarian cysts and fibroids.
Great for women who forget pills:
Once you’ve inserted it correctly, you’re protected from pregnancy without having to think about it daily.
Doesn’t affect fertility after stopping it:
As soon as you remove it and stop using it, your body returns to normal quickly, and most women can get pregnant within a few months.
Reduces heavy bleeding:
If you suffer from heavy menstrual bleeding, the ring can significantly reduce it.
No complicated procedures required:
Unlike an IUD, which requires a doctor’s insertion, the vaginal ring can be easily inserted by yourself at home.

Required Tools:

Vaginal ring (available at pharmacies under names like "NuvaRing" or others).
Soap and water to wash your hands.
A comfortable place where you can stand or sit easily.

Insertion Steps:

Wash Your Hands Thoroughly
- Use soap and warm water to ensure your hands are clean before handling the ring.
Take the Ring Out of the Package
- You’ll find it soft and flexible, designed to fit most women.
Choose a Comfortable Position
You can:
- Stand with one leg raised on a chair.
- Squat down.
- Lie on your back.
Hold the Ring from the Sides
- Gently press it to form an oval shape.
Insert the Ring into the Vagina
- Slowly place it inside the vagina until you feel comfortable.
- It doesn’t need to be in a specific position, as long as it’s inside and not causing discomfort.
Make Sure It’s in Place
- If you feel any discomfort, try adjusting it with your fingers.
- Normally, you won’t feel it after some time.
Leave It in Place for 3 Weeks
- After 21 days, remove it and take a 1-week break—this is when your period occurs.
- After the ring-free week, insert a new one.

How to Remove the Vaginal Ring?

Wash Your Hands Thoroughly
- Use soap and warm water to clean your hands before touching the ring.
Choose a Comfortable Position
You can:
- Stand with one leg raised on a chair.
- Squat down.
- Lie on your back—whichever is most comfortable.
Insert Your Finger into the Vagina ☝️
- Use your index finger to reach the ring.
Gently Pull the Ring Out
- Pinch it between your fingers and slowly pull it out.
Dispose of It Properly
- Do not flush it down the toilet, as it can clog pipes.
- Instead, place it in a sealed bag and throw it in the trash.
Don’t Worry If It Comes Out with Vaginal Discharge
- This is completely normal and not a cause for concern.

What If You Forget to Remove the Ring After 3 Weeks?

If It Stays in for an Extra 7 Days or Less:

Remove it as soon as you remember.
Do not insert a new ring immediately—take the usual 1-week break.
After the ring-free week, insert a new one as scheduled.

If It Stays in for More Than 7 Extra Days:

Remove it as soon as you remember.
Insert a new ring immediately.
Use a backup contraceptive method, like condoms, for 7 days to ensure protection.

What If the Ring Falls Out?

If It’s Out for Less Than 3 Hours:

Rinse it with lukewarm water and reinsert it as soon as possible.
No need for extra contraception.

If It’s Out for More Than 3 Hours During Week 1 or 2:

Rinse it with lukewarm water and reinsert it quickly.
Use a backup contraceptive, like condoms, for 7 days.

If It’s Out for More Than 3 Hours in Week 3:

Insert a new ring immediately without waiting.

Side Effects of the Vaginal Ring

Although the vaginal ring is an easy and effective contraceptive method, like any other birth control, it may have some side effects for certain women. Let’s go through them in detail:

You May Experience Some Initial Side Effects

During the first few months of use, your body might still be adjusting to the hormones, which can cause:

Mild headaches or migraines.
Nausea (feeling like vomiting).
Dizziness or fatigue.
Slight breast tenderness or water retention.

These symptoms usually disappear after two or three months of use.

It Can Cause Spotting Between Periods

Some women may notice light bleeding or spotting between periods, which is normal at first.
If the bleeding becomes persistent or heavy, consult your doctor.

Not Suitable for Everyone

If you have a history of blood clots, heart disease, or severe high blood pressure, you should not use the ring, as it affects blood clotting.
If you are over 35 and smoke, the ring may increase the risk of clots, so a doctor’s consultation is necessary.

May Increase Vaginal Discharge

Some women notice an increase in vaginal discharge, which is normal as long as there’s no unusual smell or color.
If you experience itching, irritation, or abnormal discharge, see your doctor to rule out infections.

It Can Move or Fall Out

In some cases, the ring might shift or come out during intercourse or if there’s strong pressure (such as during bowel movements).
If it falls out, rinse it with lukewarm water and reinsert it within 3 hours. If it stays out longer, its effectiveness may decrease.

Does Not Protect Against Sexually Transmitted Infections (STIs)

Unlike condoms, the ring does not protect against STIs like chlamydia or herpes.
If there’s a risk of infection, it’s best to use a condom along with the ring.

May Affect Libido in Some Women

Some women experience changes in sexual desire—either an increase or a decrease—which varies from person to person.
If you feel a negative impact on your relationship, consult your doctor about alternative methods.

May Cause Fluid Retention and Slight Weight Gain ⚖️

Some women notice their bodies retaining more water, leading to slight bloating or mild weight gain.
This effect varies from person to person, and most women adjust over time.

Can Cause Mood Swings

Some women may feel irritable or experience mood changes due to hormonal effects.
If mood swings are significantly affecting your daily life, consult your doctor for alternative options.

Not Suitable for Women Sensitive to Hormones

If your body reacts negatively to hormonal contraceptives (like birth control pills or patches), the ring may cause similar symptoms.
In that case, consult your doctor to find a more suitable contraceptive method.

Types of Vaginal Rings

Vaginal rings don’t come in many varieties since they all work the same way—by releasing hormones that prevent ovulation. However, there are slight differences between brands, such as the materials used and hormone concentrations.

1. NuvaRing

The most popular and widely used brand worldwide.
Contains Ethinyl Estradiol (estrogen) and Etonogestrel (progestin), which work together to prevent pregnancy.
Inserted for three weeks, then removed for one week (during your period), and then replaced with a new ring.
Flexible and easy to insert and remove.
Helps regulate menstrual cycles and relieve period pain.
Must be stored in the refrigerator before first use to maintain hormone effectiveness.

2. Annovera

A newer type, designed for reuse for up to one year.
Contains the same hormones as NuvaRing but with slightly different concentrations.
Does not require refrigeration like NuvaRing.
Inserted for three weeks, removed for one week, but instead of throwing it away, you wash it with soap and water and reuse it for up to 12 cycles (one year).
Suitable for women who don’t want to visit the pharmacy every month.
More expensive initially, but cheaper in the long run since it's reusable.

NuvaRing vs. Annovera – Key Differences

Feature	NuvaRing	Annovera
Usage Duration	3 weeks, then replaced with a new ring every month	3 weeks, then removed, washed, and reused for up to a year
Storage	Must be refrigerated before first use	No refrigeration needed
Cost	Cheaper in the short term	More expensive upfront but cost-effective over time
Ease of Use	Very easy, but requires a new ring each month	Also easy, but requires washing and proper care

How to Choose the Right One for You?

If you want a simple, low-maintenance option, NuvaRing is a good choice.
If you prefer a long-term, cost-effective solution, Annovera is the better option.
Always consult your doctor if you have any health conditions like high blood pressure, clotting disorders, or a history of hormone-related issues.

Are There Other Types?
Currently, these are the most common types available on the market, and most vaginal rings use similar hormones. Some brands may vary by country, but they work in the same way.

Alternatives to the Vaginal Ring for Contraception

If the vaginal ring isn’t suitable for you or you prefer not to use it, there are other alternatives that provide the same result. These alternatives fall into two categories: hormonal and non-hormonal methods.

Hormonal Methods (Similar to the Vaginal Ring)

These methods use hormones like estrogen and progesterone to prevent pregnancy but differ in their mode of application.

1. Combined Oral Contraceptive Pills

Contain the same hormones as the ring (estrogen + progesterone).
Must be taken daily at the same time to remain effective.
Popular brands: Gynera, Yasmin, Marvelon, Microgynon.
Not ideal for those who often forget pills or have hormonal sensitivities.

2. Hormonal Patch (Evra Patch)

A skin patch applied to the back, abdomen, arm, or buttocks.
Releases the same hormones as the vaginal ring.
Changed weekly for three weeks, followed by a one-week break.
May cause skin irritation or be visible if you prefer discretion.

3. Contraceptive Injection (Depo-Provera or Mesigyna)

Contains only progesterone, with no estrogen.
Taken every 3 months and highly effective.
Can delay the return of fertility after stopping use.

4. Hormonal IUD (Mirena or Kyleena) ⚙

Inserted into the uterus and releases progesterone.
Works for 3 to 5 years with no daily effort.
Requires insertion by a doctor and may alter menstrual cycles.

Non-Hormonal Methods (Without Hormones)

1. Copper IUD

A long-term option, effective for up to 10 years.
Contains no hormones and prevents sperm from fertilizing the egg.
May cause heavier periods and cramps initially.

2. Male or Female Condoms

Provide immediate contraception with no hormones.
Also protect against sexually transmitted infections (STIs).
If torn or used incorrectly, pregnancy can occur.

3. Withdrawal Method (Pull-Out Method)

Involves the male partner withdrawing before ejaculation.
High failure rate since pre-ejaculatory fluid may contain sperm.

4. Natural Family Planning

Tracking ovulation days and avoiding intercourse during the fertile window.
Requires high accuracy and a regular menstrual cycle.

Risks of the Vaginal Ring

The vaginal ring is a safe and effective birth control method, but like any hormonal contraceptive, it comes with some potential risks that you should be aware of before using it. These risks don’t happen to everyone, but they are important to consider.

1. Increased Risk of Blood Clots

Since the ring contains estrogen and progesterone, it may increase the risk of blood clots in some women. Clots can occur in:

The legs (Deep Vein Thrombosis – DVT).
The lungs (Pulmonary Embolism – PE).
The brain (Stroke).

Women at higher risk include those who:

Have a personal or family history of blood clots.
Are smokers over 35 years old.
Have obesity or heart disease.

⚠ Seek medical attention immediately if you experience severe leg pain, swelling, or difficulty breathing.

2. Increased Blood Pressure

Some women may experience high blood pressure due to the hormones in the ring.
If you have hypertension or heart problems, consult your doctor before using it.

⚠ Symptoms to watch for:

Severe and persistent headaches.
Dizziness or blurred vision.
Heart palpitations or shortness of breath.

3. May Worsen Migraines

If you have a history of migraines, you might notice an increase in headaches when using the ring.
⚠ If you experience severe headaches, vision disturbances, or dizziness, consult your doctor immediately.

4. Mood Changes

Some women experience mood swings, mild depression, or irritability due to hormonal effects.
If it negatively affects your daily life or you start feeling depressed, consider switching to another method.

5. Liver or Gallbladder Problems

Rarely, the ring can increase the risk of gallstones or worsen liver conditions in women with a history of these issues.
⚠ Seek medical advice if you experience:

Upper abdominal pain.
Severe nausea.
Yellowing of the skin (jaundice).

6. Increased Vaginal Discharge or Infections

Some women notice an increase in vaginal discharge, which is normal with the ring.
In some cases, it may lead to vaginal or urinary tract infections (UTIs).

⚠ If your discharge has an unusual odor, dark color, or is accompanied by itching or burning, see a doctor.

7. Possible Weight Changes

Some women experience water retention or slight weight gain while using the ring.
This is usually temporary, but if it persists and concerns you, consult your doctor about alternative options.

8. Irregular Bleeding

Light spotting between periods is common in the first few months.
If you experience heavy or prolonged bleeding, consult your doctor.

Does Not Protect Against Sexually Transmitted Infections (STIs)

The vaginal ring does not protect against STIs like chlamydia, gonorrhea, or HIV/AIDS.
If there is a risk of infection, it’s best to use a condom along with the ring for protection.

The Ring Might Fall Out

The ring needs to stay inside the vagina to work properly, but in some cases, it may fall out during sex or after using the toilet.

If it falls out, you must put it back within 3 hours to maintain effectiveness.
If it keeps falling out frequently, you may need to consider a different contraceptive method.

When Should You See a Doctor Immediately While Using the Vaginal Ring?

If you experience any of the following serious symptoms, stop using the ring immediately and seek emergency medical attention:

1. Severe Leg Pain or Swelling

???? Possible Blood Clot (Deep Vein Thrombosis - DVT)

Intense pain, warmth, or redness in one leg.
Noticeable swelling, especially below the knee.
Difficulty walking or a heavy sensation in the leg.

⚠ Risk: The clot can travel to the lungs, causing a life-threatening condition (Pulmonary Embolism).

2. Shortness of Breath or Chest Pain

???? Possible Blood Clot in the Lungs (Pulmonary Embolism - PE)

Sudden, severe difficulty breathing.
Sharp chest pain, especially when taking a deep breath.
Extreme dizziness or fainting.
Coughing up blood.

⚠ Risk: This can be life-threatening—seek emergency medical help immediately.

3. Severe Migraine with Blurred Vision

???? Possible Stroke or Serious Neurological Effect

Extremely severe headache that is unlike your usual migraines and doesn’t improve with painkillers.
Blurred vision or temporary loss of vision.
Numbness or weakness on one side of the body.
Difficulty speaking or concentrating.

⚠ Risk: This could be a stroke, which requires urgent medical intervention.

4. Severe Abdominal Pain or Yellowing of the Skin

???? Possible Liver or Gallbladder Problem

Persistent or intense pain in the upper right side of the abdomen.
Yellowing of the skin or the whites of the eyes (jaundice).
Severe nausea or sudden loss of appetite.

⚠ Risk: This may indicate liver inflammation or gallbladder disease, requiring immediate medical attention.

5. Heavy or Prolonged Bleeding

???? Possible Hormonal Imbalance or Blood Clotting Disorder

Unusually heavy bleeding that is not normal for your cycle.
Bleeding that lasts for a long time without stopping.
Extreme dizziness or fatigue due to excessive blood loss.

Rapid or Irregular Heartbeat ❤️

???? Possible Effect of Hormones on the Heart or Blood Pressure

Strong palpitations or very fast heartbeats.
Sudden dizziness or feeling like you might faint.
Chest pain or a feeling of pressure in the chest.

⚠ Risk: This could be a sudden spike in blood pressure or a heart issue. Seek medical attention immediately.

If You Experience Any of These Symptoms, Don’t Wait! Seek Medical Help Immediately.

Which Specialist to See Based on Your Symptoms?

Leg pain or swelling: Vascular specialist or Emergency Room (possible blood clot).
Shortness of breath or chest pain: Emergency Room or Pulmonologist (possible pulmonary embolism).
Severe headache with blurred vision: Neurologist (possible stroke or neurological issue).
Abdominal pain or yellow skin: Gastroenterologist or Hepatologist (possible liver or gallbladder problem).
Heavy bleeding: Gynecologist.
Heart palpitations or fast heartbeat: Cardiologist or Vascular Specialist.