A Guide to the Birth Control Ring

Woman's hand holding a birth control ring

Making a decision about birth control options can be confusing. If you are interested in a form of hormonal birth control, the birth control ring may be a good option for you. The ring is placed deep into the vagina for three weeks at a time and can be very effective at preventing pregnancy.

Understanding the Birth Control Ring

The rings works similarly to the pill, the patch, and the birth control shot. There is currently one brand available in the US, called NuvaRing. A new ring must be inserted each month, and most people cannot feel the ring during sexual intercourse. The ring is effective at preventing pregnancy; however, it does not protect against sexually transmitted diseases (STDs).

How the Ring Works

The birth control ring contains two synthetic hormones: progestin and estrogen. The ring slowly releases these hormones, and they are absorbed into the bloodstream through the vaginal tissue.

Progestin is similar to progesterone, which is made by a woman's ovaries during the menstrual cycle. The ovaries also make estrogen. The combination of estrogen and progestin prevents a woman's ovaries from releasing an egg. The release of an egg, which is called ovulation, normally happens once during each menstrual cycle. If no egg is released, the woman cannot become pregnant.

The ring also causes a woman's cervical mucus to become thicker. The cervix is the entrance to the uterus. Sperm must swim through mucus made by the cervix in order to reach the uterus and fertilize an egg. Thicker mucus makes it harder for sperm to get through.

How to Use the Ring

To use the ring, you need to stay on schedule to most effectively prevent pregnancy. Your physician may suggest when you should insert the first ring; typically, this is within 5 days of the start of your period so you can be protected from pregnancy immediately. If you wait longer than that, you will need to use a back-up form of birth control, like condoms or spermicide, for seven days.

To insert the ring, you need to perform the following steps:

  1. Wash your hands with soap and water.
  2. Press the sides of the ring in.
  3. Gently insert the ring into the vagina and release. The position of the ring does not matter.

In three weeks, you should remove it by hooking your finger under the rim of the ring and gently pulling the device out. Since the ring still contains some hormones, you should wrap it up in the original foil wrapping before throwing it into the garbage can. After one week, you can insert a new ring. You will usually have your period during the week that the ring is not in.

Who Should Not Use the Ring?

Most women can use the birth control ring. However, women who are not comfortable inserting the ring into the vagina may want to choose another method of birth control. Women who have had problems with hormonal methods of birth control in the past may not be good candidates for this as well.

Specific health conditions increase the risk of side effects with the use of the birth control ring. The ring should not be used if any of the following apply to you:

  • Are pregnant or think they might be
  • Have ever had blood clots in the legs, lungs, or eyes
  • Have ever had a heart attack or stroke, suffer from angina pectoris (a kind of chest pain related to heart disease), or have complications from heart valve disease
  • Have very high blood pressure
  • Have complications from diabetes
  • Have headaches which cause neurological symptoms
  • Have ever had breast, uterine, cervical, or vaginal cancer
  • Have unexplained vaginal bleeding
  • Have liver disease
  • Are on prolonged bed rest
  • Have any allergies to the ingredients in the ring

For other women, the decision may not be as black and white. In these cases, your physician may allow you to use the ring but it will be an individual decision. If you are interested in the ring, you should discuss the possibility with your physician if any of these conditions apply to you:

  • Are a smoker
  • Are breastfeeding
  • Have recently given birth
  • Had a miscarriage or abortion recently
  • Are taking other medications

Important Considerations When Choosing the Ring

Selecting the ring as birth control means that you should have a good understanding about effectiveness and potential risks. Talk to your doctor about any concerns or questions you may have.

Effectiveness

The birth control ring works about as well as the pill to prevent pregnancy. It is 99% effective if used consistently and correctly. The ring may fail to prevent pregnancy if any of the following happen:

  • The ring comes out of your vagina for more than three hours.
  • The ring does not stay in place for three weeks in a row.
  • The ring stays in longer than three weeks.
  • You forget to put a new ring in place for more than one week.

The ring is still fairly new, so no one knows for sure how well it works with what's called "typical use," including common errors like starting at the wrong time or removing it too early or too late. However, once you realize that you have made an error, it would be a good idea to use back-up birth control like condoms or spermicide.

Side Effects

Some women find that they have fewer side effects with the birth control ring than with other hormonal methods. This may be because the levels of hormones in the ring are low. These are the most common side effects:

  • Infection or irritation of the vagina
  • Increased discharge from the vagina
  • Headache
  • Weight gain
  • Nausea

According to the manufacturer, women also reported increased upper respiratory tract infections (like colds and sinusitis).

Women using hormonal methods of birth control also sometimes have the following side effects as well:

  • Bleeding or spotting between periods
  • Breast tenderness
  • Mood changes

Blood Clots and the Ring

Hormonal birth control that contains estrogen, including the birth control ring, increases the risk of developing a condition called deep vein thrombosis (DVT). DVT is the formation of blood clots in the legs, which can move to the lungs or other parts of the body and cause serious problems. Women who are over thirty-five and smoke are at especially high risk.

Legal Concerns

Blood clots have always been a concern with any type of hormonal birth control; some studies published in 2009 and 2011 have suggested that this risk may be heightened with newer forms of progestin and estrogen. A recent study that was funded by the company that markets the ring did not find an increased risk of blood clots in ring users when compared to women who used oral contraceptives. Several lawsuits have been filed claiming that the ring has caused harm or in some cases death. If you are interested in using this form of birth control, you should discuss it with your physician to make sure you are a good candidate; even with this conflicting evidence, the risk of developing a dangerous blood clot is small.

Getting Pregnant After Using the Ring

According to the manufacturer, a woman's regular menstrual cycle, including ovulation, should resume within about a month of stopping the birth control ring. That means that using the ring should not hurt your ability to become pregnant after you stop using it.

Making an Appropriate Choice for You

Like many types of hormonal birth control, the birth control ring can be an effective form of birth control when used properly. Your physician can help you decide if this is appropriate and safe for you.

A Guide to the Birth Control Ring