How a vaginal ring works for birth control: Know its advantages and disadvantages

The world of contraception has undergone a paradigm shift over the years. From medicines to condoms and specialised devices, people are turning to multiple birth control methods to prevent pregnancy. People also use a vaginal ring, which is a thin, flexible ring inserted into the vagina. Once it is inserted, it releases hormones for about three weeks. It is an easy-to-use birth control method, which has its set of benefits and side effects.

What is a vaginal ring?

A vaginal ring is a small, flexible, circular device used as a method of contraception. It iss made of plastic and is designed to be inserted into the vagina, where it releases hormones to prevent pregnancy. The ring typically releases a combination of estrogen and progestin, similar to those found in birth control pills. “These hormones work by stopping ovulation, making the cervical mucus thick so that it can block sperm, and thinning the uterine lining to prevent implantation,” explains gynaecologist Dr Ritambhara Bhalla. The vaginal ring is usually worn for three weeks, followed by a one-week break during which menstruation occurs, after which a new ring is inserted.

The vaginal ring works by releasing a steady, low dose of hormones, typically estrogen and progestin, into the bloodstream through the walls of the vagina. These hormones prevent pregnancy in the following ways:

• The hormones prevent the ovaries from releasing an egg each month.
• The progestin in the ring thickens the mucus in the cervix, making it difficult for sperm to swim through the cervix and reach an egg if one were released.
• The hormones also thin the lining of the uterus, making it less likely that a fertilised egg can implant and grow.

If you use it in a correct manner, the vaginal ring can be more than 99 percent effective in preventing pregnancy, as per the UK’s National Health Service.

What are the types of vaginal rings?

There are primarily two types of vaginal rings used for contraception:

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1. Etonogestrel/ethinyl estradiol ring

It is the most widely known and used vaginal ring, which is flexible, and transparent, and is about 2 inches in diameter. “It is typically worn inside the vagina for three weeks, followed by a one-week break during which menstruation occurs,” says the expert. After a week’s break, a new ring is inserted into the vagina. It releases a combination of estrogen (ethinyl estradiol) and progestin (etonogestrel) to prevent pregnancy.

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2. Segesterone acetate/ethinyl estradiol ring

It is a reusable vaginal ring that can be used for up to one year. The ring is made from silicone and has a slightly larger diameter than the etonogestrel/ethinyl estradiol ring. The reusable ring is inserted for three weeks and removed for one week, during which periods occur. After the one-week break, the same ring is reinserted. This cycle can be repeated for 13 cycles (one year). A combination of estrogen (ethinyl estradiol) and progestin (segesterone acetate) hormones are released.

How to insert a vaginal ring?

Follow these steps to make sure your vaginal ring works well:

• Before inserting the ring, ensure your hands are clean to prevent infection.
• Find a comfortable position, such as standing with one leg up, lying down, or squatting.
• Squeeze the ring between your thumb and index finger to compress it. Gently insert the ring into your vagina, pushing it up until it feels comfortable and is positioned correctly.

It is important to insert the new ring on the same day of the week as the previous ring to maintain the contraceptive’s effectiveness. “If you delay reinserting the ring beyond the seven-day break, its effectiveness may be reduced, and you might need to use a backup method of contraception, like condoms, for the first seven days after reinsertion,” says Dr Bhalla.

Can you have sex with a vaginal ring?

Yes, you can have sex with the vaginal ring in place. “This birth control device is designed in such a way that it can stay in place even during sex and so, it does not need to be removed,” says the expert. Most women do not feel the vaginal ring during sex. It is soft, flexible, and sits high enough in the vagina that it typically doesn’t interfere with sexual activity. Some men might feel the ring, but it is usually a mild sensation.

Here’s what to do if it’s uncomfortable:

• Gently push the ring higher into the vagina to reduce any sensation.
• If you remove the vaginal ring to have sex, it should be put back in within three hours to maintain its effectiveness. If you forget to reinsert it within three hours, use a backup method of contraception.

What are the side effects of vaginal rings?

Common side effects of a vaginal ring include headaches, nausea, and vomiting, according to research published in the Therapeutic Advances In Reproductive Health in 2023. Women may also experience yeast infections, pain in the abdomen, dysmenorrhea or painful periods, breast tenderness, irregular periods, and vaginal itching, according to the US. Food and Drug Administration.

These side effects may be experienced by any woman wearing the ring. “But women with uncontrolled hypertension should not use the ring due to the risk of further increasing blood pressure,” says Dr Bhalla.

The vaginal ring is an effective method to prevent pregnancy, but don’t forget when to reinsert it into the vagina. It can be worn during sex, as it is flexible and soft.