Contraceptive Ring

If this is your first time using the contraceptive ring or you are restarting:

• Insert the contraceptive ring on days 1-5 of your next period and you will have full contraceptive cover immediately.
• If you have not been sexually active since your last period, you can start using the contraceptive ring at any time of your cycle. You will need to use additional contraception if you have sex within the first 7 days after insertion.

Traditionally, the ring remains in place for 3 weeks and then it is removed for a 4-day hormone-free break. After this break, insert the new ring at the same time of day exactly one week after you removed the previous ring.

Tailored Use of The Contraceptive Ring
There is no medical reason to leave contraceptive rings out for a full 7 days before inserting a new one.

It is now recommended that contraceptive rings can be used in cycles as follows if preferred, to provide more reliable contraceptive cover and better bleeding control:

1. Insert a new ring and leave it in place for 3 weeks, then remove it and have a ring-free interval of 4 days only, before inserting the next new ring.
2. Insert a new ring every 3 weeks for 9 weeks (i.e. 3 times in a row without a break) and then have a ring-free interval of 4 days before inserting a new ring.
3. Continuous use of the ring (inserting a new ring every 3 weeks) until there is spotting for 2 days, then take a 4-day break and insert a new ring. Continue this pattern of use until spotting occurs again.

If you follow a set pattern of use and have a planned break, you will usually bleed during this time. Make sure you insert the next ring after the recommended ring-free break (see above) regardless of your bleeding pattern.

These options are not licensed (you will not see them detailed in the leaflet that comes with your medicine) but are recommended by The Faculty of Sexual and Reproductive Health (UK).

We can offer you further advice on this, just send us a message via your account when you have completed the request questionnaire.

Contraceptive rings are very flexible and you will be able to squeeze it easily when inserting it.

• Wash and dry your hands.
• Choose a comfortable position (e.g. standing with one leg up, squatting, or lying down.
• Compress the ring using your thumb and index finger and gently insert the ring  into the vagina until it feels comfortable.

If you can feel the ring or it is uncomfortable, you can use your finger to gently push it in further. Don’t worry, you will not push it in too far! The exact position of the ring does not affect how it works.

Each contraceptive ring remains in place for 3 weeks, during which time you should regularly check it is in place. 

Very rarely, a ring may break while in the vagina. In this case, you should remove the broken ring, insert a new one and use additional contraception for 7 days.

Further details on this (including images) are available on the information leaflet that comes with the contraceptive ring.

To remove a contraceptive ring:

• Wash and dry your hands.
• Hook your index finger under the rim and pull it out gently.
• Dispose of it in the bag provided.

If you are having difficulty getting it out or you have any bleeding or pain, please contact your local doctor, nurse or family planning clinic.

Contraceptive rings are generally very well- tolerated and most women do not experience side effects. In those that do, localised side effects are most common.

• You may be aware of the ring in your vagina and find this unpleasant.
• Your partner may feel the ring during sex.
• Sore/ irritated vagina.
• Increased vaginal discharge.

Other side effects include nausea, headaches and breast tenderness – these are the most common and usually settle quickly. Spotting between periods is also common and should settle within the first 3 cycles.

Occasionally skin changes, such as acne, decreased libido (sex drive), altered mood and fatigue are reported.

If you develop any of these symptoms and they are persisting, or you are concerned, please speak with your doctor. There are many alternative contraceptive options to consider.

The oestrogen in combined contraceptives can cause increases in blood pressure. It is not medically safe to use this type of contraception if you have high blood pressure. A blood pressure check should be performed every 6-12 months to monitor for this as you are unlikely to have any symptoms.

For full details of the potential side effects of these medications, please ensure that you read the patient information leaflet that comes with your medication before you start to use it.

Yes, using combined contraception, such as vaginal rings , can increase your risk of developing a potentially harmful blood clot, compared to non-users. 

However, the overall risk of developing a blood clot is very small and is significantly lower than during pregnancy or the postpartum period. But, blood clots are potentially very serious and in very rare cases can be fatal. 

You should see a doctor immediately if you develop any of the following symptoms when using a contraceptive ring:

• Pain or swelling in the legs.
• Severe chest pain.
• Breathlessness or coughing up blood.
• Bad fainting attack or collapse.
• Unusual headaches or difficulty with speech or sight.
• Numbness or weakness of a limb.

The potential risk of developing a blood clot when using combined contraception varies between different contraceptive products. Current evidence suggests that the contraceptive ring may have up to twice the risk compared to some other combined contraceptive products. 

The risk of developing a blood clot is greatest in the months immediately after starting combined contraception (patch, ring or any of the combined pills), or when restarting after a break of at least one month. This risk reduces over the first year of use and then remains stable. It is for this reason that frequent starting and stopping of combined contraceptive methods should be avoided. 

• If a blood clot develops in the leg, it can cause deep vein thrombosis (DVT).
• If it travels to the lung, it can cause a pulmonary embolism (PE).
• If it travels to the heart, it can cause a heart attack.
• If it travels to the brain, it can cause a stroke.

Other things that can increase your risk of developing a blood clot when using the contraceptive ring include: 

• Being overweight.
• Smoking.
• Increasing age (from 35 years and older).
• Having a family member with a blood clot ages <45 years.
• Postpartum (6-12 weeks post-delivery).
• Reduced mobility (even temporarily).

The more of these risk factors that apply to you, the greater your risk.

Seek additional advice if you are:

• Having a procedure or surgery (of any type).
• Planning a long-haul flight.
• Planning a holiday to an area of high altitude.
• Immobilised for a prolonged period of time.

Further information about blood clot risk and the contraceptive ring is included in the patient leaflet that comes with your medication. Please read this information before you use this medication so you can make an informed choice.

Some women will experience breakthrough bleeding when using more than 2 vaginal rings in a row without a break.

If your ring comes out and it has been out for less than 3 hours, rinse it in warm (not hot) water and put it back in. You will still be in full contraceptive cover. 

If it has been out for more than 3 hours, what to do depends on what stage of your cycle you are in.

Week One

The contraceptive cover may be reduced. 

1. Rinse the ring and reinsert it as soon as you can. 
2. Use additional contraceptive cover for 7 days.
3. If you have had unprotected intercourse in the previous week, speak with your doctor as you may need emergency contraception. 

Week Two or Three

Dispose of the ring that slipped out and either:

Insert a new ring and begin a new 3-week cycle (from this time).

OR 

Have your ring-free break and insert a new ring 7 days after the ring came out. Only choose this option if a ring has been in place continuously for the previous 7 days.

Regardless of which option you select, use additional protection for 7 full days.

Make sure you seek medical advice if you are unsure what to do.

If you are more than 7 days late removing the ring, change it immediately and use additional contraception for 7 days. If you have had unprotected sex during this time, speak with your doctor for advice as emergency contraception may be required.

If you are less than 24 hours late, insert the new ring when you remember. No additional contraception is required.

If you are more than 24 hours late, insert a new ring as soon as you remember and use additional contraception for 7 days. If you have had unprotected sex during this time, speak with your doctor for advice as emergency contraception may be required.

Some medications (prescribed and over the counter), herbal remedies and supplements can interact with the contraceptive ring. This can cause contraceptive failure and increase the possibility of potential side effects.

Please seek advice from a healthcare professional (e.g. doctor, pharmacist or nurse):

• Before starting any new medications, herbal remedies or supplements if you are using the contraceptive ring.
• If you are taking regular medication and are planning to start using the contraceptive ring (or any contraceptive).

Examples of some medications that can interact with the contraceptive ring include certain emergency contraceptive pills, St John’s wort, antiviral medications used to treat HIV/ AIDs, some epilepsy medications, and a small number of antibiotics and antifungal treatments.