Contraceptive vaginal ring

How does the contraceptive vaginal ring work?

On the first day of your period you insert a new ring into your vagina, where it sits, held in place by the vaginal wall muscles. The hormones it releases have several effects. The main way it works is by preventing you producing an egg (ovulating) every month, although it also makes the mucus in your cervix thicker, preventing sperm from reaching any egg that’s released, and it makes the lining of the uterus thinner, making it hard for any egg that’s fertilised to implant and grow.

Used on the first day of your period it’s immediately effective, although you can start it at other times of the month but you won’t be protected for seven days. After three weeks, you remove the ring and have a ring-free seven days, during which you’re still protected as long as you start again with a new ring no more than seven days later. You’ll have a withdrawal bleed, similar to a period, during this week.

Are there advantages or risks to the contraceptive vaginal ring?

The ring has advantages over the oral combined contraceptive pill in that you only have to insert it once a month, so you don’t have to remember to do something every day, and you’ll absorb it even if you have a tummy upset. Like the combined pill it should:

• Make your periods lighter and less painful
• May help pre-menstrual symptoms

There’s some evidence that it may reduce the risk of cancer of the ovary, uterus and colon as well as fibroids, ovarian cysts and non-cancerous breast disease.

If you find that you don’t have a withdrawal bleed during the ring-free week, but you used it correctly, this doesn’t necessarily mean you’re pregnant but you should talk to your doctor. Like the combined pill use, it’s possible to occasionally miss out the ring-free week, simply by changing from one ring to the next, to avoid a withdrawal bleed at times such as an important event or holiday, but do discuss this with your doctor.

It’s important to remember that the ring will not protect you against sexually transmitted infection, so if you’re at risk you need to also use a condom.

There are some possible side-effects. Although research shows you shouldn’t put on weight when you use it, you may notice some monthly cyclical fluid retention. Other temporary side-effects can include:

• Increased vaginal discharge
• Headaches
• Nausea
• Breast tenderness
• Mood changes

Breakthrough bleeding and inter-menstrual spotting can also occur in the first few months but should settle.

As for the combined pill offering similar hormone treatment, serious side-effects are uncommon but the risk of venous thrombosis, arterial thrombosis, heart attack or stroke must be considered.

Your doctor will discuss with you whether you’re at high risk and so should not use the ring, taking into account whether you or your close family have ever had thrombosis, if you’re a smoker, are very overweight or have reduced mobility.

Similarly, the risk of arterial thrombosis is highest in smokers, diabetics, those with high blood pressure or migraines with aura, the overweight and those with a relevant family history. The possible link to breast cancer and cervical cancer isn’t clear but research suggests that hormonal contraception use appears to show a small increased risk of breast cancer compared to other methods.

How reliable is the contraceptive vaginal ring?

If the vaginal ring is used correctly and according to instructions it’s over 99 per cent effective. This means that less than one woman in 100 will get pregnant in a year.

Can anyone use the contraceptive vaginal ring?

There are people for whom the risks are considered too high, such as smokers over the age of 35, or those with a history of thrombosis but your doctor will assess your risk level. If they consider it suitable, they’ll discuss issues such as how to insert and remove it and how to deal with any problems such as if it falls out or you forget to remove it after three weeks.

Once inserted, you shouldn’t be able to feel it and there should be no discomfort. Occasionally your partner may notice it when making love but it will not harm him. Certain medicines, such as some of those used to treat epilepsy, HIV and TB, and complementary medicines such as St John’s Wort can affect how it works so tell your doctor about any medication you take.

Where can I get the contraceptive vaginal ring?

You can go to any contraception or sexual health clinic (look in the phone book for ‘Family planning clinics’, or to your general practice). If you prefer not to go to your own GP, or if they don’t provide contraceptive services, they will give you information about another practice or clinic. All treatment is free and confidential. There’s no need for a breast examination or cervical screening test when you’re first prescribed the vaginal ring.