Vaginal Ring (NuvaRing)
What is the vaginal ring?
In Australia the only contraceptive vaginal ring you can buy is called a NuvaRing®.
It is a soft plastic ring that contains the hormones oestrogen and a progestogen, similar to the Combined Oral Contraceptive Pill (the Pill). It is placed in your vagina and the hormones are absorbed into the body to stop you getting pregnant.
How Does It Work?
The main way that the vaginal ring works is to stop your ovaries from releasing an egg. The vaginal ring works in a similar way to the Pill. The difference is the way the hormones are absorbed.
You put the vaginal ring in your vagina. The vaginal ring stays in for three weeks. Then you take it out for one week. At the end of that week you put a new ring in your vagina. Most women cannot feel the vaginal ring once it is in place. Your doctor or family planning nurse will tell you the best time to put the first ring in your vagina.
How Well Does It Work?
With perfect use the vaginal ring is more than 99% effective. This means that if 100 women use it correctly for one year, less than one will become pregnant. With typical or ‘real life’ use it is less effective with up to nine women in every hundred becoming pregnant in a year. You need to remember to take it out and put a new one in again at the right time. You can set a reminder on your phone or sign up for a text reminder.
Who Can Use The Vaginal Ring?
Most women can use the vaginal ring. It may suit you if you find it hard to remember to take a pill every day, and is an alternative to the implant, injection or an IUD.
Who Should Not Use The Vaginal Ring?
You should not use the vaginal ring if:
• you have had a deep venous thrombosis (blood clot in a vein), stroke or heart attack
• you have severe liver problems
• you have certain types of migraine
• you are over 35 and smoke
• you have had breast cancer
You also may not be able to use it if:
• you have unusual bleeding from your vagina that has not been diagnosed
• you are breast feeding
• you have high blood pressure, diabetes, high cholesterol, heart disease affecting your heart valves, active liver disease, lupus, or a family history of blood clots
Some medications can also reduce the effectiveness of the vaginal ring so make sure you talk to the doctor about any medications you are using.
If any of these things apply to you, talk it over with your doctor who will help you decide if you should use the vaginal ring.
The vaginal ring is a very effective method of contraception.
You don’t need to remember to take a pill every day.
It does not need to be ‘fitted’ by a doctor; there is only one size.
The vaginal ring provides a relatively low dose of hormones compared to most combined contraceptive pills.
When you stop using the vaginal ring your fertility goes back to its normal level very quickly.
The vaginal ring gives good control of your periods. You will get a withdrawal bleed, like a lighter period in the week that a ring is not in the vagina. You can avoid this bleed by ‘skipping’ the ring-free week and putting a new ring in straight away.
You have to be comfortable putting something in your vagina, leaving it in for three weeks and remembering to put a new ring in after one week without the ring.
The vaginal ring can be more expensive than the Pill because it is not PBS listed.
Some women have trouble keeping the ring in place.How Is The Vaginal Ring Inserted?
Squeeze the ring between your thumb and index finger (figure 1). Gently insert the ring into your vagina (figure 2). It doesn't have to be in any exact position. If it feels uncomfortable, slide it further into your vagina. Your vaginal muscles will keep it in place, even during exercise and sex.
How Is It Taken Out?
To remove the ring simply put your finger into your vagina, hook it around the ring and pull it out (figure 3).
FIgures 1-3 reproduced with permission of MSD Oss B.V., a subsidiary of Merck & Co., Inc., Whitehouse Station, New Jersey, USA. All rights reserved. NuvaRing® is a registered trademark of MSD Oss B.V.
What If I Am Late Putting It In After The Ring-Free Week?
If you are more than 24 hours late inserting the vaginal ring after the week without it, insert it as soon as you remember and use another form of contraception (such as condoms) for seven days. In this case, if you have had unprotected sex during the ring free week you may be at risk of pregnancy and should consider the Emergency Contraceptive Pill (ECP), available from a pharmacy without needing a prescription.
What If The Ring Accidentally Comes Out Of The Vagina?
The vaginal ring should be left in the vagina for three weeks. If the ring is accidentally expelled, it can be rinsed with water and should be put back in immediately.
If the vaginal ring has been out of the vagina for less than 24 hours you should rinse it with water and put it back in as soon as possible. You will still be covered for contraception.
If the vaginal ring has been out of the vagina more than 24 hours you should rinse it with water and put the ring back in as soon as you remember. You should use another form of contraception (such as condoms) for seven days.
If the ring has been out of the vagina for more than 24 hours during the third week, you should put in a new ring immediately – this will start the next three weeks of use. You may not get your usual period-like bleed, but you may get some spotting.
What If I Forget To Take The Ring Out After Three Weeks?
If the ring has been left in for more than three weeks, you should remove it and put the new one in when you were meant to (this will mean less than the usual seven days without a ring in your vagina).
If the ring was left in for more than four weeks, immediately replace it with a new one and use another form of contraception (such as condoms) for seven days. In this case, if you have had unprotected sex you may be at risk of pregnancy and should consider the Emergency Contraception Pill (ECP), available from a pharmacy.
If you are unsure what to do, discuss it with a doctor or Family Planning nurse or call Family Planning NSW Talkline on 1300 658 886 for advice.
Where Can I Get The Vaginal Ring?
You need to see a doctor to get a script for the vaginal ring. You can then take the script and buy your vaginal rings from a pharmacy. The Nuvaring® is not listed on the PBS so is not as cost effective as some other forms of contraception.
For More Information
• Contact the Family Planning NSW Talkline on 1300 658 886 or go to www.fpnsw.org.au/talkline
• NRS (for deaf) 133 677
• Visit your nearest Family Planning clinic