Overview

The vaginal ring is a hormonal birth control (contraceptive) device for women. It's a flexible, latex-free plastic ring that's inserted into the vagina. It contains the hormones estrogen and progesterone, which are released over a three-week period. You wear the vaginal ring for three weeks, and then remove it — allowing menstruation to occur — and then insert a new ring after a week.

Similar to combination birth control pills, the vaginal ring prevents pregnancy by releasing hormones into your body. The hormones suppress ovulation — keeping your ovaries from releasing an egg.

The hormones in a vaginal ring might also:

  • Thicken cervical mucus to keep sperm from reaching an egg
  • Thin the lining of the uterus (endometrium) to prevent implantation of a fertilized egg

There are two vaginal ring hormonal contraceptives approved by the Food and Drug Administration and available in the United States: NuvaRing and Annovera. To use these products, you'll need a prescription from your health care provider.

Why it's done

Vaginal rings help prevent pregnancy. Among various benefits, they:

  • Are comfortable and easy to use
  • Don't require the need to remember a daily pill
  • Don't require a personalized fitting
  • Eliminate the need to interrupt sex for contraception
  • Can be removed at any time, followed by a quick return to fertility
  • Are safe for women with latex allergies
  • Don't appear to cause weight gain
  • Are less likely to cause irregular bleeding than are oral combination hormone birth control pills
  • Deliver a smaller level of hormones throughout the body than do some other types of contraceptives, which may reduce the risk of side effects

Vaginal rings aren't appropriate for everyone. Your health care provider may discourage use of vaginal rings if you:

  • Are older than age 35 and smoke
  • Are sensitive to any components of the vaginal ring
  • Are taking certain medications for hepatitis C
  • Are about to be immobilized for a prolonged period due to major surgery

Vaginal rings also aren't recommended if you have certain health conditions, including:

  • Diabetes with complications related to your blood vessels
  • A history of blood clots
  • A history of breast, uterine or liver cancer, or other liver disease
  • A history of heart attack or stroke
  • Migraines with aura or, if you're over age 35, any migraines
  • Uncontrolled high blood pressure
  • Unexplained vaginal bleeding

In addition, tell your health care provider if you smoke or have:

  • A history of toxic shock syndrome
  • Any condition that makes you susceptible to vaginal irritation
  • Depression
  • Gallbladder or heart disease
  • High cholesterol or high triglycerides
  • High blood pressure

Risks

About 1 out of 100 women will get pregnant in a typical year of using a vaginal ring. The vaginal ring doesn't offer protection from sexually transmitted infections.

Vaginal rings are generally very well-tolerated, but possible side effects include:

  • Breakthrough bleeding or spotting
  • Vaginal infection or irritation
  • Increased vaginal discharge
  • Headache
  • Nausea
  • Depression
  • Decreased sex drive
  • Breast tenderness
  • Abdominal pain
  • Diarrhea
  • An increased risk of blood-clotting problems, heart attack, stroke, liver cancer, gallbladder disease and toxic shock syndrome

Call your health care provider right away if you have:

  • Leg pain that doesn't go away
  • Sudden shortness of breath
  • Severe pain or pressure in your chest
  • Sudden, severe headache unlike your usual headaches
  • Weakness or numbness in an arm or leg, or trouble speaking
  • Foul vaginal odor or vaginal itching
  • Two missed periods or other possible signs of pregnancy

How you prepare

Your health care provider will review your medical history and check your blood pressure. Talk to your health care provider about any medications you're taking, including nonprescription and herbal products.

Your health care provider will determine the appropriate timing for you to start using a vaginal ring based on your menstrual cycle and your previous birth control method. You may need to take a pregnancy test and use a nonhormonal backup method of contraception for one week when you start using a vaginal ring.

A backup method of contraception may not be necessary if you previously used combination birth control pills or the skin patch (Xulane), and you insert a vaginal ring on any day up to the day you would have started your new pack of pills or applied a new skin patch.

What you can expect

To insert a vaginal ring:

  • Find a position that's comfortable, such as standing with one leg up, squatting or lying down. Separate your labia with one hand. With your other hand, squeeze together the opposite sides of the vaginal ring between your thumb and index finger.
  • Gently push the vaginal ring deep inside your vagina. An applicator, similar to a tampon, can help with insertion. The exact placement of the ring doesn't change its effectiveness.
  • If you feel discomfort, try pushing the vaginal ring deeper inside your vagina.
  • Keep the ring in place for three weeks.
  • You don't need to remove the vaginal ring during sex. But if you prefer, you can remove the ring for up to three hours and then reinsert it.

To remove a vaginal ring:

  • Hook your index finger under the rim of the ring or grasp the ring between your index finger and middle finger and gently pull it out.
  • Discard the used vaginal ring. Don't flush it down the toilet.
  • Wait one week to insert a new ring. Withdrawal bleeding usually begins two to three days after removing the ring. You may still be bleeding when you insert the new ring.

If the vaginal ring accidentally falls out, rinse the ring with cool or warm — not hot — water and reinsert it within two hours for Annovera or three hours for NuvaRing.

If the vaginal ring remains outside of your vagina for longer than two (for Annovera) or three (for NuvaRing) hours:

  • Reinsert the vaginal ring as soon as possible and use backup contraception for a week, if the expulsion occurs during the first or second week of vaginal ring use.
  • Discard the ring if the expulsion occurs during the third week of using the vaginal ring. You can start using a new ring right away, which might cause breakthrough spotting or bleeding. Use a backup method of contraception until you have used the new ring continuously for seven days.

Or, if you used the vaginal ring continuously for at least seven days prior to expulsion, you can:

  • Discard the ring and wait up to seven days from the time the ring was removed or expelled to insert a new ring. You'll have withdrawal bleeding.
  • Use a backup method of contraception until you use the new ring continuously for seven days.

Your doctor will probably recommend that you check regularly to make sure the vaginal ring is in place, for example, before and after intercourse. If a ring breaks, discard it and use a new ring.

You can use a tampon while using a vaginal ring. But don't use a diaphragm as a backup method of birth control while using a vaginal ring because the ring can interfere with the placement of the diaphragm.

Your health care provider might recommend an annual blood pressure check while you use the vaginal ring.

Feb. 12, 2020
  1. Hatcher RA, et al., eds. Contraceptive patch and vaginal contraceptive ring. In: Contraceptive Technology. 21st ed. Ayer Company Publishers; 2018.
  2. Kerns J, et al. Hormonal contraceptive vaginal rings. https://www.uptodate.com/contents/search. Accessed Oct. 13, 2019.
  3. Melmed S, et al. Hormonal contraception. In: Williams Textbook of Endocrinology. 13th ed. Elsevier; 2016. https://www.clinicalkey.com. Accessed Oct. 13, 2019.
  4. NuvaRing (prescribing information). Whitehouse Station, N.J.: Merck & Co. Inc.; 2019. https://www.nuvaring.com/prescribing-information/. Accessed Oct. 13, 2019.
  5. Annovera (prescribing information). Boca Raton, FL: TherapeuticsMD; 2019. https://www.annoverahcp.com/?_ga=2.187971873.881390990.1572116215-746732437.1571006681. Accessed Oct. 13, 2019.