Birth Control: Birth Control Rings

What Is the Birth Control Ring?

The birth control ring is a soft, flexible ring. Hormones in the ring help prevent pregnancy. It is inserted into the vagina, where it slowly releases the hormones through the vaginal wall into the bloodstream.

How Does the Birth Control Ring Work?

The combination of the hormones progestin and estrogen in the birth control ring prevent ovulation (the release of an egg from the ovaries during the monthly menstrual cycle). If an egg isn't released, pregnancy can't happen because there's no egg for the sperm to fertilize.

The hormones in the ring also thicken the cervical mucus (made by cells in the cervix). This makes it hard for sperm to enter the uterus and reach any eggs that may have been released. The hormones in the ring can also sometimes affect the lining of the uterus so that an egg will have a hard time attaching to the wall of the uterus.

Like the birth control pill or patch, use of the birth control ring is based on the monthly menstrual cycle:

• The ring is put into the vagina (much like putting in a tampon) on the first day of a girl's menstrual cycle or before day 5 of the menstrual cycle, where it stays in place for 3 weeks in a row.
• At the end of the third week, on the same day of the week it was put in and about the same time of day, she removes it. Within a few days her menstrual period should start. 
• At the end of the fourth week, on the same day of the week the last ring was inserted, she puts in a new ring and the process begins again. The new ring should be placed on that day, even if a girl still has her period.

Because the hormones in the ring don't take effect right away, another form of birth control (such as a condom) should be used for 7 days when someone first starts using the ring. After 7 days, the ring can be used alone to prevent pregnancy. But continuing to use condoms will protect against sexually transmitted diseases (STDs).

The exact position of the ring in the vagina is not critical as long as it feels comfortable. If it doesn't feel comfortable, it can be pushed further back or removed and reinserted. Most women do not feel the ring after it is in place.

The ring is held in place by the vaginal muscles, so it's unlikely that it will fall out. If it does, it can be rinsed under cool water (not hot) and reinserted within 3 hours. If more than 3 hours pass without the ring in the vagina, there's a risk of pregnancy and an additional form of birth control should be used until the ring has been in place for 7 days.

If the ring is out for more than 3 hours during someone's third week of wearing it, she should call the doctor for advice. The doctor may say to put a new ring in, or not to replace it, so that the period starts early. Either way, an additional form of birth control should be used.

How Well Does the Birth Control Ring Work to Prevent Pregnancy?

The effectiveness of the vaginal birth control ring seems to be similar to other hormonal methods of birth control, like the patch or the Pill. Over the course of a year, about 9 out of 100 typical couples who use the ring to prevent pregnancy will have an accidental pregnancy. Of course, the ring must be used correctly. Delaying or missing a monthly insertion or removing a ring too early reduces its effectiveness.

In general, how well each type of birth control method works depends on many things. These include whether a woman has any health conditions or is taking any medicine that might affect its use.

Although using the ring means not having to remember to take a pill every day or replace a patch, it still needs to be removed and replaced on time. Otherwise, it loses its effectiveness.

Does the Birth Control Ring Help Prevent STDs?

No. The vaginal ring does not protect against STDs. Couples having sex must always use condoms along with the vaginal ring to protect against STDs.

Are There Any Problems With the Birth Control Ring?

The vaginal ring is a safe and effective method of birth control. Most people who use the ring have no side effects.

If side effects do happen, they're similar to those of the birth control pill. These may include:

• irregular menstrual bleeding
• nausea, headaches, dizziness, and breast tenderness
• mood changes

Other possible side effects include:

• vaginal irritation or infections
• vaginal discharge
• problems with contact lens use, such as a change in vision or inability to wear the lenses

Many of these side effects are mild and tend to disappear after 2 or 3 months.

The birth control ring increases the risk of blood clots. Blood clots can lead to serious problems with the lungs, heart, and brain. Smoking cigarettes while using the birth control ring can increase the risk of blood clots. So anyone who uses this type of birth control should not smoke.

Who Is the Birth Control Ring Right for?

The vaginal ring may be a good choice for someone who has trouble remembering to take a pill every day or who has trouble swallowing pills. A girl must feel comfortable inserting the device into her vagina.

Some medical conditions can make using the ring less effective or riskier (for example, severe high blood pressure and some types of cancer). Those who have had unexplained vaginal bleeding (bleeding that is not during their periods) or who might be pregnant should talk to their doctors, stop using the ring, and use another form of birth control in the meantime.

Where Is the Birth Control Ring Available?

A doctor or a nurse practitioner must prescribe the birth control ring, and will probably ask questions about a girl's health and family medical history  They may do an exam, including a blood pressure measurement and, possibly, a pelvic exam. If the ring is prescribed, the doctor will also provide instructions on how to use it.

After a few months, the doctor might want to do a blood pressure check and make sure there are no problems. After that, the doctor may recommend routine exams once or twice a year or as needed.

How Much Does the Birth Control Ring Cost?

The ring usually costs between $30–$200 a month, although health and family planning clinics (such as Planned Parenthood) might sell them for less. Also, the vaginal ring and doctor's visits are covered by many health insurance plans.

When Should I Call the Doctor?

Someone using the birth control ring should call the doctor if they:

• might be pregnant
• have a change in the smell or color of their vaginal discharge
• have unexplained fever or chills
• have belly or pelvic pain
• have pain during sex
• have heavy or long-lasting vaginal bleeding
• have yellowing of the skin or eyes
• have severe headaches
• have signs of a blood clot, such as lower leg pain, chest pain, trouble breathing, weakness, tingling, trouble speaking, or vision problems