The Contraceptive Ring: How It Works, Advantages and Disadvantages

The contraceptive ring is a small, flexible ring, usually made of soft plastic or silicone, which releases oestrogen and progestogen once inserted into the vagina – hormones that prevent pregnancy.

The vaginal ring is one of the combined hormonal contraceptive methods and only needs to be inserted once a month. This makes it a convenient alternative to taking the contraceptive pill every day. Stay with us until the end of the article and find out how the contraceptive ring works, when and how it is used, how reliably it protects against unwanted pregnancy, and what its advantages and disadvantages are compared with other contraceptive methods.

In brief:

• The contraceptive ring is a small ring that is inserted into the vagina and prevents pregnancy by releasing oestrogen and progestogen.
• As a rule, the ring is worn for 21 days, followed by a seven-day break each month.
• When used correctly, vaginal rings are 99% effective. According to the United States Centers for Disease Control and Prevention (CDC), however, typical-use effectiveness is around 93% – meaning that 7 in 100 women using a vaginal ring will become pregnant.
• The ring is for contraception only. It does not protect against sexually transmitted infections.

What is the contraceptive ring?

The contraceptive ring is a small, flexible, slim ring that you can insert into your vagina to prevent unwanted pregnancy. It is usually made of soft plastic or silicone and continuously releases oestrogen and progestogen – contraceptive hormones that suppress ovulation and alter cervical mucus to reduce the likelihood of fertilisation.

Because the ring releases these two contraceptive hormones, it works on a similar principle to the contraceptive pill and belongs to the group of combined hormonal contraceptive methods. The difference lies in how it is used and how often. The pill has to be taken orally every day without fail, whereas the ring is inserted vaginally just once a month.

Some vaginal rings are reusable, while others are intended for single use only. As a general rule, it is recommended that you wear the ring for three weeks each month, followed by a ring-free week – usually the week in which your period starts.

Single-use rings are discarded straight after the three weeks. With reusable rings, there are versions you can use for up to a year.

How does the contraceptive ring work?

To decide whether it suits you, and to use it effectively, it's important to understand how the contraceptive ring works. In short: it slowly releases oestrogen and progestogen – contraceptive hormones that your body absorbs through the vaginal lining and which together prevent pregnancy:

• It prevents ovulation by acting on the ovaries and stopping an egg from being released.
• It thickens the cervical mucus, making it harder for sperm to reach the egg.
• It thins the lining of the womb, so that an egg cannot implant.

One advantage of vaginal administration is that only low doses of hormones need to be released. The fluctuations typical of the pill don't occur, which means hormone levels in the body remain more stable.

What's more, because the hormones don't pass through the digestive tract, their effectiveness doesn't depend on digestion – so vomiting or diarrhoea won't directly affect absorption.

How and when is the contraceptive ring used?

The standard regimen is to insert the ring into the vagina and leave it there for 21 days, followed by a seven-day ring-free interval. These days usually coincide with your period. Once the 7 days are up, you insert a new ring – regardless of whether the bleeding has completely stopped or not.

Here's how to handle the ring:

1. Wash your hands and get into a comfortable position, just as you would when inserting a tampon.
2. Squeeze the ring between your fingers and push it into the vagina. It doesn't have to sit in any particular spot to work – simply push it in until it feels comfortable.
3. To remove it, insert a finger into the vagina, hook it around the edge of the ring and gently pull it out.

When the ring starts working depends on which day you insert it. It's best to discuss the ideal approach with your gynaecologist – taking into account the contraceptive methods you used previously. As a general rule, however:

• If you start on the first day of your period, you're protected straight away.
• If you insert it between days 2 and 5 of your cycle, you should use an additional method of contraception for the first 7 days to be reliably protected.

But what happens if the contraceptive ring accidentally slips out? First, work out how long you were without it. If the time span stated in the patient information leaflet hasn't been exceeded, you simply need to reinsert it – the effectiveness is maintained. If the time span has been exceeded, however, you should use additional contraception for the first 7 days after reinserting it. It's best to check the patient information leaflet or ask your doctor about your individual situation.

How reliable is the contraceptive ring?

When used correctly, the contraceptive ring is around 99% effective at preventing pregnancy. That's a high level of protection, comparable with that of the combined contraceptive pill.

This effectiveness can also be expressed using the Pearl Index – a figure indicating how many out of 100 women become pregnant within a year despite using a particular contraceptive method. When the ring is used correctly, the Pearl Index is generally below 1. In other words: at most 1 in 100 women will become pregnant within a year.

In practice, however, mistakes happen that reduce effectiveness. You might forget to change the ring, or exceed the recommended wear time. According to the United States Centers for Disease Control and Prevention (CDC), the effectiveness of vaginal rings is around 93%. Other statistics put typical-use effectiveness at roughly 91% – that equates to around 7 to 9 pregnancies per 100 women within a year.

Advantages of the contraceptive ring

Compared with other contraceptive methods, particularly those requiring daily use, the contraceptive ring removes a few inconveniences and offers several important benefits:

• Convenience: You use it according to the regimen stated in the patient information leaflet, generally once a month – so there's no need to think about it daily.
• Low hormone doses: The contraceptive hormones are released gradually in small amounts, so your hormone levels stay stable.
• Discretion: It's inserted into the vagina and isn't visible in everyday life.
• Reversibility: Fertility usually returns immediately after you stop using it, and you can conceive without difficulty.
• Latex-free: Some rings are made from latex-free materials and are therefore also suitable for people with such allergies.
• Possible benefits for your periods: Like other hormonal contraceptive methods, such as the pill, the ring can help make cycles more regular and sometimes lighter.
• Easy to use: Inserting and removing it is relatively straightforward – similar to a tampon – and can be done conveniently at home, with no medical procedure required.

Disadvantages and side effects of the contraceptive ring

Effectiveness isn't the only factor that counts when choosing a contraceptive method. Your comfort, the extent of the protection and how well the method fits your lifestyle matter just as much. In this respect, the vaginal ring also has a few drawbacks:

• It doesn't protect against sexually transmitted infections.
• It's only as reliable as your adherence to the regimen. If used incorrectly, you can become pregnant.
• Many women need a little time to get used to handling it.
• The ring can shift and accidentally fall out.
• Sometimes your partner can feel the ring during sex.
• Because it contains oestrogen, it isn't suitable for all women.
• You need to follow the manufacturer's storage instructions, as the ring can be sensitive to heat and light.

Side effects can also occur, such as nausea, headaches, breast tenderness, weight gain, mood swings, spotting, increased discharge, acne or reduced sex drive. More rarely, serious complications such as blood clots, cardiovascular events or raised blood pressure can occur.

Seek medical help immediately if you notice any of the following warning signs while using the contraceptive ring:

• Sudden pain or swelling in the calf
• Shortness of breath
• Chest pain
• Sudden or unusual migraine
• Sudden numbness or weakness

• Heavy bleeding

  

Who shouldn't use the contraceptive ring (contraindications)

As already mentioned, the vaginal ring slowly releases oestrogen and progestogen. For this reason it isn't suitable for all women, and it's important to seek medical advice before using it. Your doctor will review your medical history, your blood pressure and your risk factors to determine whether there are any contraindications.

In general, the method isn't recommended for women who:

• smoke and are over 35
• have previously had blood clots or clotting disorders
• have had a heart attack or stroke, or suffer from certain circulatory disorders
• suffer from migraine with aura
• have uncontrolled high blood pressure
• have certain types of cancer (breast, womb or liver cancer)
• have diabetes mellitus with vascular complications
• have severe liver disease
• have unexplained vaginal bleeding
• are already pregnant

These are just some of the reasons why the contraceptive ring may not be advisable. The final decision should therefore always be made together with your doctor.

The contraceptive ring compared with other methods

As already mentioned, several aspects come into play when choosing a contraceptive method – beyond effectiveness alone. How often do you have to use it? How easily can you stop? Are hormones involved? How quickly does fertility return if you want a baby? Depending on these considerations, some contraceptive methods may suit certain stages of life better than others.

Contraceptive ring or the pill?

The key difference lies in how often you use them. Both can contain oestrogen and progestogen, but you use the ring on a monthly schedule, whereas you take the contraceptive pill daily. In this respect, the ring reduces the risk of forgetting a dose.

Contraceptive ring or contraceptive patch?

Both are combined hormonal methods and neither requires oral administration. Here too, the frequency of use differs: you generally need to change the patch once a week, whereas the ring is changed once a month.

Contraceptive ring or coil (IUD)?

Here the differences are more pronounced. The coil gives you reliable protection for several years without any need for monthly changes – although it has to be fitted and removed by a doctor. Another advantage: you can choose between a hormonal coil and a hormone-free copper coil. The ring, on the other hand, you can insert yourself and stop using whenever you like – but it is a hormonal method.

Frequently asked questions

Would you like to know more about how using the ring might affect your body? Are you curious about other women's experiences with the contraceptive ring? Of course, you should always follow your doctor's advice first and foremost. Even so, we've put together clear answers to some of the most common questions about the contraceptive ring.

How does the contraceptive ring work?

The ring is inserted into the vagina and gradually releases oestrogen and progestogen – hormones that prevent ovulation, thicken cervical mucus and thin the lining of the womb in order to prevent pregnancy.

When is the contraceptive ring inserted?

The standard regimen is to insert the ring and leave it in place for 21 days, followed by a seven-day break, which usually coincides with your period.

How reliable is the contraceptive ring?

When used correctly, it's around 99% effective. In practice, however, mistakes happen – such as wearing the ring for longer than recommended – so typical-use effectiveness is around 91 to 93%.

Can you get pregnant while using the contraceptive ring?

No contraceptive method is 100% reliable. There is a real 7 to 9% risk of becoming pregnant if you don't use the ring according to the instructions.

Does the contraceptive ring make you put on weight?

Some women notice changes in weight after starting to use it. Weight gain isn't a universal side effect, however, and when it does occur it can't always be attributed directly to the ring.

Can your partner feel it during sex?

Yes, it's possible for your partner to feel the ring during sex – in fact, that's one of the most commonly cited drawbacks. If it's uncomfortable for you or your partner, you can remove it temporarily under certain conditions and in line with the instructions.

What happens if the ring falls out or slips out of the vagina?

If the ring accidentally slips out, check the patient information leaflet to see how long protection lasts without it. If that period has been exceeded, you'll need to use additional contraception to avoid pregnancy.

Does the contraceptive ring protect against sexually transmitted infections?

No. The contraceptive ring protects only against pregnancy, not against sexually transmitted infections. To reduce the risk of infection, you should also use a condom.

Does the contraceptive ring affect fertility in the long term?

There is no evidence that using the contraceptive ring has any lasting effect on your fertility. On the contrary: you can generally become pregnant soon after removing the ring.

Who shouldn't use the contraceptive ring?

The contraceptive ring is contraindicated with certain health problems, including previous blood clots, migraine with aura, uncontrolled high blood pressure or certain types of cancer. It's best to discuss with your gynaecologist whether the method is right for you.

Image sources: Pexels.com