The vaginal ring is a thin, flexible, transparent ring with a diameter of about 54 mm and a thickness of 4 mm.

It is inserted in the vagina and remains in place for 3 weeks. As soon as the vaginal ring is inserted it continuously releases constant amounts of estrogen and progestin.

After three weeks the ring is removed, on the same day of the week as it was inserted. For example, if the ring was inserted on a Wednesday at 6 pm it should be removed on the Wednesday three weeks later at about 6 pm.

After an interval of one week, during which a period normally occurs, a new ring must be inserted on the same day of the week as in the previous cycle. Menstruation usually begins 2-3 days after removal of the ring and may not have finished when the next ring is inserted.

Action and effectiveness of the vaginal ring

The vaginal ring is a reliable method of contraception. The sex hormones enter the circulation through the vaginal lining and suppress the release of hormones by the hypothalamus and the pituitary. This means that there is no impulse for ovulation. If no egg is released, you cannot become pregnant.

In addition, the build-up of the uterine lining is suppressed. so that implantation of an egg in the uterus cannot take place.

The hormones in the vaginal ring also make the cervical mucus thick and sticky. Sperm are therefore unable to enter the uterus.

You also have contraceptive protection during the ring-free interval of one week.

If you forget to insert a new vaginal ring or if the ring is outside the vagina for more than three hours the contraceptive action may be diminished. There are concrete rules for these situations. It may be necessary to take additional precautions for a time. Speak to your doctor.

Remember that the vaginal ring does not provide protection against HIV or other sexually transmitted diseases. If you want to have sex with someone you know little about you should use a condom.

Advantages of the vaginal ring

You do not need to think about contraception for three weeks while the vaginal ring is in place.

Side-effects and risks of the vaginal ring

The vaginal ring is a potent medical device which can also have unwanted side-effects. The following information gives a general outline of the side-effects and risks of the vaginal ring. However, in case of conflicting information the product information of the preparation you have been prescribed always takes precedence. It is therefore important to read the pack insert carefully and follow any advice given by your doctor.

Some women experience a foreign body sensation. The ring sometimes interferes with sexual intercourse. Effects of the ring on the sexual partner (possible uptake of hormones from the vaginal ring through the skin of the penis) have not been investigated. Appropriate hygienic measures should therefore be taken after every intercourse.

The ring can be expelled, e.g. when you pass feces or change a tampon. There are also medical conditions which can make it difficult to use the vaginal ring, e.g. constipation or uterine prolapse. These problems make involuntary expulsion of the vaginal ring more likely.

Sometimes there can be back pain or pelvic pain, genital itching, inflammation of the cervix, the bladder or the urinary tract.

Otherwise the side-effects, risks and contraindications of the vaginal ring are essentially the same as those of other estrogen-progestin contraceptives. Further information may be found in the section 'Side-effects and risks of the combined oral contraceptive'.