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Contraception

Contraceptive ring

What it is

The contraceptive vaginal ring is a flexible, transparent, plastic ring. It is placed in the vagina where it releases two hormones – estrogen and progestogen. These are similar to the natural hormones that women produce in their ovaries and are like those used in the combined pill.

How it works

The vaginal ring releases a constant dose of hormones into the bloodstream through the vaginal wall. The main way it works is to stop the ovaries from releasing an egg each month (ovulation). It also:

  • Thickens the mucus from your cervix. This makes it difficult for a sperm to move through it and reach an egg.
  • Makes the lining of the uterus (womb) thinner so it is less likely to accept a fertilised egg.

Advantages

Some of the advantages of the vaginal ring are:

  • you don't have to think about it every day – you only use one ring a month
  • it is easy to insert and remove
  • unlike the pill, the hormones do not need to be absorbed by the stomach, so the ring is not affected if you vomit or have diarrhoea
  • bleeding will usually become more regular, lighter and less painful
  • it may help with premenstrual symptoms
  • it may reduce the risk of cancer of the ovary, uterus and colon
  • it may reduce menopausal symptoms
  • it improves acne in some women.

Disadvantages

There are some serious side effects of the vaginal ring (see below, Are there any risks?). In addition:

  • Some women may not feel comfortable inserting and removing it.
  • You may get temporary side effects at first including increased vaginal discharge, headaches, nausea, breast tenderness and mood changes.
  • Breakthrough bleeding and spotting (unexpected vaginal bleeding on days you are using the ring) may occur in the first few months of use.

How effective is it?

  • How effective any contraceptive is depends on how old you are, how often you have sex and whether you follow the instructions.
  • If 100 sexually active women don’t use any contraception, 80 to 90 will become pregnant in a year.
  • If the vaginal ring is used correctly and according to instructions it is over 99 per cent effective. This means that less than one woman in 100 will get pregnant in a year.
  • If the vaginal ring is not used according to instructions, more women will become pregnant.

Are there any risks?

The vaginal ring can have some serious side effects, but these are not common. For most women the benefits of using the ring outweigh the possible risks. All risks and benefits should be discussed with your doctor or nurse.

  • A very small number of women may develop venous thrombosis, arterial thrombosis, heart attack or stroke. If you have ever had thrombosis, you should not use the vaginal ring.
  • The risk of venous thrombosis is greatest during the first year that you use the vaginal ring and if any of the following apply to you – you smoke, you are very overweight, are immobile for a long period of time or use a wheelchair, or a member of your immediate family had a venous thrombosis before they were 45 years old.
  • There appears to be a slightly higher risk of venous thrombosis in vaginal ring users compared to those using some combined pills.
  • The risk of arterial thrombosis is greatest if you smoke, are diabetic, have hypertension, are very overweight, have migraines with aura, or a member of your immediate family had a heart attack or stroke before they were 45 years old.
  • Research suggests that users of the ring appear to have a small increased risk of being diagnosed with breast cancer compared to non-users of hormonal contraception, which reduces with time after stopping the ring.
  • Research suggests that there is a small increase in the risk of developing cervical cancer with longer use of estrogen and progestogen hormonal contraception.

See a doctor straightaway if you have any of the following:

  • pain in the chest, including any sharp pain which is worse when you breathe in
  • breathlessness
  • you cough up blood
  • painful swelling in your leg(s)
  • weakness, numbness or bad ‘pins and needles’ in an arm or leg
  • severe stomach pains
  • a bad fainting attack or you collapse
  • unusual headaches or migraines that are worse than usual
  • sudden problems with your speech or eyesight
  • jaundice (yellowing skin or yellowing eyes).

If you need to go into hospital for an operation or you have an accident which affects the movement of your legs, you should tell the doctor that you are using the vaginal ring. The doctor will decide if you need to stop using the ring or need other treatment to reduce the risk of developing thrombosis.

The vaginal ring does not protect you against sexually transmitted infections, so you may need to use condoms as well.

Can anyone use this method?

The contraceptive ring is not suitable for all women. A doctor or nurse will need to know about a woman's medical history and any illnesses suffered by immediate members of her family to find out if there are any medical reasons why it might not be suitable.

For more information visit: http://www.fpa.org.uk/contraception-help/contraceptive-vaginal-ring