About Vaginal Rings
Summary
Vaginal rings are flexible rings inserted into the vagina that slowly release hormones over time. They work by preventing ovulation, thickening cervical mucus, and thinning the uterine lining.
Vaginal rings are small, flexible devices placed inside the vagina that release hormones continuously. The hormones prevent the ovaries from releasing an egg, thicken cervical mucus to block sperm, and make the uterine lining less suitable for pregnancy. Most rings are replaced monthly, however Annovera is designed to be reused for an entire year.
Why a Patient Might Choose This Method
A patient may choose a vaginal ring if they want a low-maintenance contraceptive that does not require daily attention. Most vaginal rings are replaced only once a month, and some options can be reused for an entire year. The ring delivers hormones continuously, which may result in more stable hormone levels and predictable bleeding patterns. It is a discreet, user-controlled option that can be inserted and removed without a healthcare provider.
How It Is Used
The vaginal ring is a small, flexible ring that is inserted into the vagina by the patient. Most vaginal rings are left in place for 3 weeks and then removed for 1 week, during which withdrawal bleeding typically occurs. After the ring-free week, a new ring is inserted to begin the next cycle. Some patients choose to use the ring continuously to reduce or eliminate menstrual bleeding. Once inserted, the ring works continuously and does not require daily attention, making it a convenient option for patients who prefer a low-maintenance form of birth control.
Vaginal Ring Options and Comparisons
Vaginal rings are combined hormonal contraceptives that provide continuous pregnancy protection without requiring a daily pill. Most rings are replaced monthly, while some are designed for repeated use over an entire year.
| Ring | Hormones | Type | Advantages | Potential Disadvantages |
|---|---|---|---|---|
| NuvaRing | Ethinyl Estradiol + Etonogestrel | Combined hormonal ring | Monthly dosing, low maintenance, predictable cycles | Estrogen-related clot risk, vaginal irritation or discharge, must be comfortable with vaginal insertion. |
| EluRyng | Ethinyl Estradiol + Etonogestrel | Generic NuvaRing | Same benefits as NuvaRing, often lower cost | Same risks and side effects as NuvaRing. |
| Haloette | Ethinyl Estradiol + Etonogestrel | Generic NuvaRing | Monthly dosing, convenient | Same risks and side effects as NuvaRing. |
| Annovera | Ethinyl Estradiol + Segesterone Acetate | Combined hormonal ring | One reusable ring lasts an entire year (13 cycles) | Estrogen-related clot risk, vaginal irritation, requires cleaning and storage between cycles. |
Hormones Used in Vaginal Rings
Vaginal rings contain one estrogen and one progestin. Together, these hormones prevent ovulation, thicken cervical mucus, and help regulate the menstrual cycle.
| Hormone | Class | Purpose |
|---|---|---|
| Etonogestrel | Progestin | Prevents ovulation and thickens cervical mucus. |
| Segesterone Acetate | Progestin | Prevents ovulation and thickens cervical mucus. |
| Ethinyl Estradiol | Estrogen | Suppresses ovulation and improves cycle control. |
Practical Use Details
How the Rings Are Used
NuvaRing, EluRyng, Haloette
- Insert ring and leave in place for 3 weeks
- Remove for 1 week
- Withdrawal bleeding usually occurs during the ring-free week
- Can also be used continuously to reduce bleeding
Annovera
- Insert ring for 21 days
- Remove for 7 days
- The same ring is reused for 13 cycles (1 year)
- Wash and store the ring during the ring-free week
Advantages of Vaginal Rings
- No daily pill to remember
- Lower hormone fluctuations than pills
- Predictable bleeding patterns
- Rapid return to fertility after discontinuation
- User-controlled and reversible
Potential Side Effects
- Spotting or breakthrough bleeding
- Breast tenderness
- Nausea
- Headache
- Vaginal irritation or increased discharge
- Rare but serious risk of blood clots due to estrogen
Clinical Pearl
The vaginal ring may be removed for a short period if necessary, such as during intercourse, but it should not remain out longer than the time recommended in the product instructions, as this may reduce contraceptive effectiveness.
Ready to discuss birth control options?
Choosing a birth control method can feel overwhelming, but you do not have to sort through the options alone. APNS can help you review your health history, preferences, and goals so you can make an informed decision with guidance from a healthcare provider.