What is the contraceptive ring?
It is a combined hormonal contraceptive that contains two hormones: estrogen and progestogen, hormones identical to those present in oral pill.
It is ring-shaped, soft-textured, comfortable, transparent and flexible, about 5 cm in diameter and easy to apply to the vagina.
One of the main advantages of this method is the convenience of use, as the application is only once a month.
How does the contraceptive ring work?
The ring inhibits ovulation (the same mechanism of action as the combined oral pill) by transferring a daily dose of hormones (oestrogen and progestogen) through the vagina into the bloodstream.
Thus, it acts in two ways:
- inhibits ovulation (egg release)
- thickens the cervical mucus, making it harder for sperm to enter the uterus
What are the advantages of the contraceptive ring?
The main advantages of the contraceptive ring are:
- doesn't require a daily or weekly commitment, so you're less likely to forget
- easy to place, discreet and convenient
- You only have to think about contraception once a month
- does not interfere with sexual intercourse or everyday life
- effectiveness is not affected by vomiting or diarrhea
- It is also effective in reducing menstrual pain and periods become more regular and predictable
- does not lose effectiveness with the use of some medications
- a good option for women with diseases of the digestive system (diseases of absorption and after surgery to treat obesity – bariatric surgery – procedure with malabsorption)
- may be an option for women who experience nausea with the use of pill
- It is possible to do the gynecological examination without having to remove the ring
What are the disadvantages of the contraceptive ring?
Can be disadvantages:
- may be more difficult to use for women who have difficulty touching themselves
- does not prevent sexually transmitted infections
- Not to be used exclusively during breastfeeding (like other combined hormonal methods)
- Not recommended for smokers over 35 years old
- not recommended for women with high blood pressure, thrombosis or liver failure
- Its effectiveness may be affected by some medicines as well as other hormonal contraceptives (oral, patch, implant and injectable)
How is the contraceptive ring used?
The use of the contraceptive ring should take into account the following steps:
- The ring is inserted into the vagina, by the woman herself, on the first day of menstruation where it should remain for 3 weeks. After this time, the woman must remove it
- This is followed by a 7-day interval until a new ring is placed (on the 8th day). During this period, withdrawal bleeding occurs, better known as menstruation
The contraceptive ring is easy to put on and is effective as long as it is correctly placed inside the vagina. If you feel the ring, just push it a little further.
If you don't want to wait for the first day of your period, you can put it on another day of your cycle, but you should use a non-hormonal contraceptive method (condom) during the first week of wearing the ring.
Is it hygienic to wear the ring for 3 weeks straight?
Yes. No problem. The vagina has an excellent local defense system.
Do I need to use another method of contraception during the break week?
No, as long as the contraceptive ring is used according to the information in the package leaflet, you do not need another contraceptive method in the week of pause.
How should the vaginal ring be placed?
The ring is very easy to put on. You should press it with your fingers and gently insert it into the vagina. Push the ring until you feel comfortable. If necessary, the vaginal lips can be pulled apart with the other hand. You should not feel the ring, as it should be placed in the upper part of the vagina which is insensitive to touch.
If you need to, you can use an applicator, which is very similar to the tampon applicator.
Placing the ring is simpler than a plug, as the ring is thin and its smooth surface makes it easier to slide.
After I put on the vaginal ring, do I feel it? Does it cause any discomfort?
The ring when it is correctly placed in the vagina, does not sit. The ring is placed at the top of the vagina, which has no sensitivity to touch. However, if you feel discomfort, just gently push it into your vagina.
Is it possible to lose the ring inside the body?
No. The cervix connects the uterus to the vagina, but it is a very narrow passage, less than 1 mm, making it impossible for the ring to pass through and be "lost inside the body".
What do I do if the ring comes out of the vagina?
If the ring comes out of the vagina, just rinse it with cold or lukewarm water (never hot water) and put it back on, keeping in mind that the ring cannot be out of the vagina for more than 3 hours.
Can the contraceptive ring fall off on a daily basis?
No. The ring does not fall out inadvertently because the vagina is not a vertical tube. The position of the vagina, as well as the muscles around the lower part of the vagina, prevent this from happening. However, accidental expulsion can occur, for example, if it has not been properly placed, for example during sexual intercourse or when removing a tampon.
How effective is the vaginal ring?
The vaginal contraceptive ring is 99% effective.
Does the position of the ring affect its effectiveness?
No. The exact position of the ring in the vagina does not affect its effectiveness. Once placed in the vagina, the effectiveness of the ring does not depend on the position adopted. Thanks to its elasticity, it adapts to the woman's anatomy.
I started using the ring. From what point is it effective?
When you start wearing the ring, the time from which it starts to be effective depends on the day of the cycle you put it on and the method of contraception you were or were not using. That is, if the use of the ring has begun:
- On the first day of the cycle (first day of menstruation) its effectiveness is immediate
- outside the first day of the cycle (in the middle of the cycle) you should use another method (e.g.) condom for the first 7 days of use.
You should refer to the package leaflet explaining whether additional contraceptive measures need to be taken during the first 7 days of wearing the first ring.
What are the benefits of a vaginal administration?
The main benefits of vaginal contraception are:
- The female genital organ is an excellent route of absorption, allowing the reception of constant levels of hormones and the use of really small doses, when compared to the usual ones
- absorption being vaginal, its use is not affected by gastrointestinal disorders such as diarrhoea and/or vomiting. It is, therefore, a great option for women who feel nauseous with the use of the combined pill
- convenience of use is also an advantage, as it only needs to be placed once a month
How long should I have the ring on?
From the day you place the ring in your vagina, the ring should remain in the vagina without interruption for 3 weeks. After 3 weeks, the ring should always be removed on the same day of the week. For example, if you put on the vaginal ring on a Wednesday, you should remove it 3 weeks later, also on a Wednesday.
How do I remove the vaginal ring?
Removing the ring is also very simple. By inserting your finger, you will be able to find it. Pull it gently, without fear. Removal can be done by attaching the index finger to the edge of the ring, or by grabbing the ring between the index and middle fingers, and pulling it out.
I forgot to take the ring off at the right time. When can I put on a new ring again?
The effectiveness of wearing the ring is 21 days. If you have forgotten to remove the ring after 3 weeks of use, and have had unprotected sex, you should do emergency contraception. In this situation, remove the ring and keep the day of placement to which you were accustomed.
Will my partner feel the contraceptive ring?
There are a lot of men who don't feel it. Studies show that 80% did not notice any difference during the sexual act.
What if the contraceptive ring comes out of the vagina during intercourse?
If by accident the ring comes off during sexual intercourse, you should rinse it with cold, soap-free water and put it back on within 3 hours so as not to compromise contraceptive effectiveness.
Can I take off the ring during sex?
The vaginal ring should not be removed during sexual intercourse and can even be used in conjunction with lubricant or condom.
Can I use the ring in conjunction with a condom?
Yes. The ring is a hormonal method of contraception and does not protect against any sexually transmitted disease.
Do I need to remove the ring to do the gynecological exam?
No. There is no need to remove the ring to perform cervical morphology cytology, colposcopy examinations, or transvaginal pelvic ultrasound.
Can I swim with the vaginal ring? Exercise? Going to the gym?
Yes, no problem. The ring does not fall off easily and water does not enter the vagina, so swimming has no effect on the effectiveness of the ring.
I started using the ring. Will menstruation be altered?
During the use of the first ring, especially if you were not previously using any hormonal contraception, menstrual bleeding may vary slightly. There is a small group of women in whom the bleeding disappears shortly after the ring is placed. Another group has a more prolonged bleeding than usual and the vast majority do not show major initial changes.
In any case, efficacy is not compromised and the usual regimen of 3 weeks of use and one break should be followed. With the time of use of the ring, it will be possible to observe that menstruation appears during the week of interval and the volume and duration of it decrease, offering better control of the cycle.
Can I delay my period with the vaginal ring?
Yes. To delay the menstruation, you should remove the previous ring after 3 weeks and, immediately after, put on a new one, without taking the week of pause.
The second ring should be worn in the same way, i.e. during the 3 weeks, after that remove it and make the week break.
Important to note that you can't wear the same ring for more than 3 weeks.
Can I use tampons with the ring?
Yes. In exceptional cases where menstruation coincides with the use of the ring, you don't have to worry and you can wear the ring at the same time as the tampon.
You just have to take care of inserting the ring first and then the cap. When removing the cap, you should be careful not to drag the ring. However, if this happens, you should wash the ring with water (without soap) and put it back on.
Is it necessary to take breaks from using the vaginal ring?
No. As with other contraceptive methods, the vaginal ring also does not need pauses, as there are no benefits to stopping.
Only if you want a pregnancy should you interrupt the placement of the contraceptive ring.
Can I stop using the contraceptive whenever I want and start trying to get pregnant right away?
Yes. This is a reversible method of contraception, which means that when a woman stops using it, she regains fertility.
Can the contraceptive ring cause infection?
No. In fact, the estrogen present in the ring, when released, increases by 2.6 times the amount of microorganisms that have the function of balancing the health of the genital organ.
There may even be an increase in vaginal discharge, which is very beneficial for some women, especially those who are perimenopausal.
Do antibiotics interfere with the vaginal ring?
No. Commonly used antibiotics do not interfere with the effectiveness of hormonal contraceptives.
Can I use the vaginal ring and put on a vaginal antifungal cream at the same time?
Yes. The use of antimycotic creams, gel or cream lubricants or spermicides do not reduce the contraceptive efficacy of the vaginal ring and can be used simultaneously.
Where can I find the contraceptive ring?
The contraceptive ring can be:
- purchased free of charge at the family planning consultation at the health centre and/or at a National Health Service hospital
- purchased from community pharmacies on prescription
How much does the contraceptive ring cost?
There are several values depending on the brand of contraceptive. The price per box can range from 9 to 50 euros (for one month or 6 months, respectively).
How should I store my vaginal ring after I buy it?
Once you have purchased the contraceptive ring, you do not need to store it in the refrigerator, except for NuvaRing®, which should be stored in the refrigerator. The ring can be stored for up to 4 months at a temperature not exceeding 30 degrees.
You should not use the ring after the date indicated on the packaging, i.e. 4 months after the date of purchase and no later than the printed date followed by the letters "VALID" (expiry).
Is there a system that alerts me to ring placement and removal?
Yes. The woman can join a free alert system to be notified of the days of donning and removal of the ring. Just send an SMS to 4421 with the message NUVA.
Source: Sociedade Portuguesa da Contracepção (SPDC)