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Birth Control Ring: Types, Efficacy, Benefits And Side Effects

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The birth control ring or the vaginal ring is a hormonal contraceptive device made of soft, flexible plastic about two inches around. The ring contains synthetic variants of female sex hormones estrogen and progesterone. These hormones are released when the device is placed in the vagina. The vaginal ring is an effective birth control method when worn and used correctly (1).

This post tells you the various types, functions, and benefits of birth control rings and their certain drawbacks.

What Are The Types Of Birth Control Rings?

There are two types of vagina rings or contraceptive rings based on the synthetic variant of the hormones present and the duration of hormone release.

  • NuvaRing comprises etonogestrel and ethinyl estradiol as estrogen and progesterone analogs, respectively. It is capable of releasing hormones continuously for three weeks. EluRyng is a generic version with the same composition as NuvaRing, available in the US.
  • Annovera contains segesterone and ethinyl estradiol as estrogen and progesterone analogs, respectively. It is capable of releasing hormones continuously for one year (2) (3).

How The Birth Control Ring Works?

Birth control rings contain a combination of synthetic forms of estrogen and progesterone. These hormones are naturally present in the body to control the menstrual cycle and pregnancy. The synthetic versions of these hormones in the ring prevent pregnancy by preventing ovulation. As a result, the egg or ovum does not come out of the ovaries, leaving no chance for a sperm to reach the egg and fertilize it.

Additionally, these hormones (4) (5):

  • Thicken the cervical mucus, making it difficult for sperms to enter the uterus in the first place
  • Make the uterine lining thin so that a fertilized egg or embryo cannot attach itself to it (prevents implantation)

The birth control ring is another combined hormonal contraceptive (CHC) device, and it does not protect from sexually transmitted diseases (STDs). It can be achieved only by the additional use of condoms during sexual intercourse.

How To Use A Vaginal Birth Control Ring?

If you start using the ring on the first day of your period, then it will be functional right away. Otherwise, you need to use male condoms and a spermicide during sexual activity for the first seven days, after which you may use the ring alone for contraception.

  • You have to choose your most comfortable insertion position, be it standing with one leg up, squatting, or lying down.
  • To insert any contraceptive ring, you have to squeeze it between your thumb and finger, insert the tip in the vagina and move it upwards till you feel comfortable.
  • A NuvaRing can be used continuously for 21 days (three weeks), after which you will have to remove it for disposal (dispose of with house waste and do not flush in a toilet). To do that, you have to insert your index finger inside the vagina, hook the edge of the ring, and gently pull it until it comes out.
  • A new ring has to be inserted after a seven-day ring-free gap, during which you will have your menstrual period (5).

Annovera remains active for one full year (13 menstrual cycles).

  • It has to be taken out once every three weeks, washed with cold to lukewarm water, stored in a compact case, and reinserted after a seven-day ring-free interval. You will have your period during this interval.
  • No refrigeration is required for storing an Annovera ring, and it can withstand up to 30°C of temperature (6).

The insertion days should be strictly followed for both types of rings, even if menstrual bleeding has not finished on that day.

Are There Any Concerns During Usage?

Any concerns related to the use of a birth control ring depend on the type of ring you use.

1. NuvaRing

If you forget to take the ring out on the removal day, after 21 days (three weeks) where the number of extra days is less than seven (total four weeks), then you may consider the following options (5).

  • Take the ring-free break for seven days immediately, if you wish, and then insert the ring.
  • Skip the ring-free break and insert a new ring. The ring will provide protection for the extra days, and no additional birth control method is required.

If the ring has been in for more than 28 days (four weeks), then:

  • Take the ring out and insert a new one immediately.
  • Use backup contraception, such ascondoms and spermicide, for the next seven days.
  • If you had unprotected sex during the days after completing four weeks without changing your contraceptive ring, take an emergency contraceptive pill to prevent pregnancy.

The ring is held on by the vaginal muscles and does not usually slip out if positioned properly. However, this may happen while removing a tampon, sexual intercourse, or while straining during bowel movements. The ring should be washed with water and reinserted as soon as possible or at least within three hours.

If the ring has been out for more than three hours, then you may consider the following options.

  • You should reinsert it as soon as you remember and use an additional protection method of condoms and spermicide if this has occurred during the first or second week.
  • If it is the third week of use, you should discard it and insert a new one immediately (periods will be skipped) or allow a seven-day ring-free interval (periods will occur) and go for a new one.

2. Annovera

Annovera birth control ring stays for one full year, and you only remove it once in three weeks for washing. The following concerns may arise related to the ring when it is removed or when it accidentally slips out (7).

  • If the ring remains out of the vagina for more than seven days after completing 21 days inside, the protection against pregnancy decreases. You should reinsert it as soon as you remember and use backup contraception for the next seven days.
  • If the ring slips out accidentally, you may wash it with mild soap and water, pat dry, and reinsert within two hours.
  • If more than two hours have passed or even if the total duration due to multiple expulsions in a 21-day span exceeds two hours, then clean and reinsert as soon as possible and use condoms and spermicide for the next seven days.

Only water-based and no oil-based or silicone-based vaginal lubricant should be used for insertion (4).

The FDA does not recommend using any other combined hormonal contraceptive (CHC) as an alternative or backup method of preventing pregnancy in those using the birth control ring.

How Effective Are Birth Control Rings?

The failure rates of birth control rings are low. The effectiveness of contraceptive methods is measured in terms of the number of pregnancies per 100 women, per year. According to the WHO, the effectiveness of a combined contraceptive ring when used consistently and correctly is 99.7%, with a pregnancy rate of 0.3 women per 100, per year. The common use of the ring without emphasis on correct use leads to an effectiveness of 93%, with a pregnancy rate of seven women per 100, per year (8).

What Are The Benefits Of The Birth Control Ring?

The vaginal contraceptive ring offers the following benefits to its users (2) (4).

  • Reversible contraceptive with ovulation resuming after discontinuing use
  • A woman can use it without doctor’s help
  • Easy to use and maintain
  • No risk of decreased effectiveness due to vomiting or diarrhea as with oral contraceptive pills
  • Only periodic changes are required, so no need of remembering everyday
  • Provides consistent quantity of hormones in the blood by releasing them slowly
  • May help make periods lighter and less painful
  • May help manage symptoms of premenstrual syndrome (PMS), polycystic ovary syndrome, and acne (5)

Are There Side Effects Of The Birth Control Ring?

Birth control rings could cause some side effects on initial use, and these may reduce with regular use.  However, if the severity increases, consult your doctor immediately. Some common side effects experienced by women who use contraceptive rings are (9) (10):

  • Headache (including migraine)
  • Nausea and vomiting
  • Fungal infections in the vagina
  • Urinary tract infection (UTI)
  • Abdominal pain
  • Abnormal menstruation
  • Vaginal discharge
  • Pain, redness, or tenderness in breasts
  • Diarrhea
  • Altered sexual desire
  • Altered mood

The contraceptive ring may increase the risk of deep vein thrombosis, clotting disorders, heart attack, and stroke in some women. You may stop the use of the birth control ring and consult a doctor to avoid the risk of developing potentially harmful side effects.

Who Should Not Use The Birth Control Ring?

The contraceptive ring is contraindicated in women who smoke and are more than 35 years of age. It is also avoided in women who have the following conditions or have a history of any of them (9).

  • Deep vein thrombosis or clotting disorders
  • Stroke
  • Coronary artery disease
  • Increased blood coagulation
  • Cardiac arrhythmias
  • Uncontrolled high blood pressure
  • Migraine with auras
  • Diabetes with vascular complications
  • Liver disease or tumors
  • Unexplained uterine bleeding
  • Breast cancer or any other estrogen- or progesterone-sensitive cancer

The FDA provides the following recommendations under some special circumstances (9).

  • The contraceptive ring should only be used after at least four weeks of childbirth if the woman is not breastfeeding.
  • It should not be used by breastfeeding mothers until after weaning. The ring contains hormones that are likely to be secreted in the milk and could reduce milk production.

Women contraindicated for birth control ring use may consider other contraceptive alternatives, such as condoms and spermicide.

Do Birth Control Rings Interact With Other Drugs?

Drug interactions apply to vaginal rings as well. Drugs that increase the metabolism of the hormones and reduce contraceptive effectiveness are (11):

  • Antifungals (Griseofulvin)
  • Antiepileptics (Phenytoin, carbamazepine)
  • Antibiotics (Rifampin)
  • Herbal preparations containing St. John’s Wort

Drugs such as vitamin C, acetaminophen, fluconazole, itraconazole, and foods such as grapefruit juice, may increase hormone concentrations.

Frequently Asked Questions

1. How much does a birth control ring cost?

A NuvaRing can cost about$43 per month and one Annoveraring about $2200 per year, depending on your health insurance coverage (12) (13).

2. What is better between the birth control pill and ring?

Each woman has different requirements and different individual responses to a particular formulation. Both methods are almost equally effective in preventing pregnancy (8). Ring users do not need to take daily pills and have fewer reports of adverse effects than those who use oral contraceptive pills (OCPs). However, some studies report more chances of vaginal infection, irritation, and discharge than women on OCPs (14). Therefore, you may make a choice after weighing the risks and benefits and consulting a gynecologist.

3. Do I gain weight with the birth control ring?

Some studies do show weight gain in some women with the use of birth control rings. However, the WHO attributes it to multiple factors rather than contraceptive use alone (15). You may check for other factors in your life, such as an unbalanced diet and lack of physical activity, first to determine the reason for weight gain.

The contraceptive ring can be availed on prescription from a doctor, from a pharmacy, or a contraception clinic. It is an effective method to prevent pregnancy which can be easily self-managed. Although safe, it is not free from side effects. You should consult your physician if any discomfort persists. A few food and drug interactions are also involved with its usage, so it becomes very important that your healthcare provider is always aware of your contraceptive use status.

References:

MomJunction's articles are written after analyzing the research works of expert authors and institutions. Our references consist of resources established by authorities in their respective fields. You can learn more about the authenticity of the information we present in our editorial policy.
  1. Birth Control.
    https://www.fda.gov/consumers/free-publications-women/birth-control#ShortActingHormonalMethods
  2. FojanRafiei et al.; Development of Hormonal Intravaginal Rings: Technology and Challenges.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8277443/
  3. Ethinyl Estradiol and Etonogestrel.
    https://www.mskcc.org/cancer-care/patient-education/ethinyl-estradiol-and-etonogestrel
  4. Contraception – vaginal ring.
    https://www.betterhealth.vic.gov.au/health/healthyliving/contraception-vaginal-ring#how-does-a-vaginal-ring-work
  5. Vaginal Ring.
    https://www.nhs.uk/conditions/contraception/vaginal-ring/
  6. FDA approves new vaginal ring for one year of birth control.
    https://www.fda.gov/news-events/press-announcements/fda-approves-new-vaginal-ring-one-year-birth-control
  7. ANNOVERA (segesterone acetate and ethinyl estradiol vaginal system).
    https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/209627s000lbl.pdf
  8. Family planning/contraception methods.
    https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception
  9. NuvaRing (etonogestrel/ethinyl estradiol vaginal ring).
    https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/021187s022lbl.pdf
  10. Estrogen and Progestin (Vaginal Ring Contraceptives).
    https://medlineplus.gov/druginfo/meds/a604032.html
  11. NuvaRing.
    https://www.accessdata.fda.gov/drugsatfda_docs/label/2005/021187s012lbl.pdf
  12. Segesterone Acetate and Ethinyl Estradiol Vaginal Ring (Annovera) for Contraception.
    https://www.aafp.org/afp/2020/0515/p618.html
  13. Vaginal Ring.
    https://americanpregnancy.org/unplanned-pregnancy/birth-control-pills-patches-and-devices/vaginal-ring/
  14. Skin patch or vaginal ring compared to pills for birth control.
    https://www.cochrane.org/CD003552/FERTILREG_skin-patch-or-vaginal-ring-compared-to-pills-for-birth-control
  15. Family Planning: A global handbook for providers
    https://apps.who.int/iris/bitstream/handle/10665/260156/9780999203705-eng.pdf?sequence=1
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Dr. Joyani Das

Dr. Joyani Das is a PhD in Pharmacology with over two years of experience in academics. Previously, she worked as an associate professor, faculty of Pharmacology. With her research background in preclinical studies and a zeal for scientific writing, she joined MomJunction as a health writer. Her research work was published in international journals and publications, such as Elsevier, Current... more