Birth Control Bingo: the Vaginal Ring

One of the most recent of all available birth control⁠ options, the ring⁠ was first developed around the year 2000, and first approved for use in the Netherlands, in 2001.

The Vaginal Ring is:

  • 99.7% effective in one year of perfect use⁠ ; less than one out⁠ of every 100 people will become pregnant (Nuvaring)
  • 97.3% effective in one year of perfect use; less than 3 our of every 100 people will become pregnant (Annovera)
  • 92% effective in one year of typical use⁠ : 8 out of every 100 people will become pregnant (Nuvaring)

Additional Sources for Effectiveness Ratings and Use:

  • 91% typical use/99.7% perfect use: Contraceptive Technology, 20th Revised Edition; Hatcher, Trussell, Stewart, Nelson, Cates, Guest, Kowal: Ardent Media, 2011.
  • 92% typical use/over 99% perfect use: Planned Parenthood

The What, the Why, the Where, the When, and the How-to: Like combined oral contraceptives⁠ or the patch⁠ , the ring (either Nuvaring or Annovera) uses two synthetic hormones⁠ -- estrogen⁠ and progestin -- to prevent pregnancy⁠ . Those hormones work in three ways: to prevent ovulation⁠ , to thicken cervical mucus to make sperm⁠ less able to get into the cervix⁠ , and by making the lining of the uterus⁠ thinner and thus, less hospitable for a fertilized egg to implant in. It works in all three of those ways to basically provide backup in case one of its mechanisms doesn't work at a given time.

The two vaginal rings work similarly in that they both release these hormones that are absorbed by the vaginal tissues. The vaginal ring is inserted into the vagina⁠ , the same way you'd insert a tampon⁠ or menstrual cup⁠ , and left inside the vagina for three weeks. At the end of that three week cycle, it's removed and left out for seven days, though you remain protected from pregnancy in that week. With the Nuvaring, you properly dispose of the used ring and insert a new one after those 7 days. With the Annovera, you take out the ring, rinse it, and keep it safe and dry in its case. After those 7 days, you then wash your hands and reinsert that same ring for the next 3 weeks (and it's good for one year, or approximately 13 cycles!).

Most users of the ring and their partners do not feel the ring during intercourse⁠ , but if you prefer, the ring can be taken out for sexual⁠ activities so long as it is out of the vagina for no longer than three hours (Nuvaring) or two hours (Annovera) during the weeks it is supposed to be in.

When you first start the ring -- not every time, just when you first start using it as a method - you should use a backup method of birth control for at least one week, and we advise using a backup for the whole of your first cycle on the ring.

The vaginal ring contains a lower dose of estrogen than both the patch and than oral contraceptives: for those who want a hormonal method with estrogen, but want as low a dose as possible, the ring is a good choice. Those who have had issues with breast⁠ tenderness, nausea or headaches with other estrogen-based hormonal methods may find they experience less of those side effects with the ring. Other typical benefits of the ring include shorter, lighter periods, less menstrual⁠ cramping, a reduction of PMS⁠ symptoms, a more regular schedule of monthly bleeding, and the convenience of only needing to tend to your method once a month.

However, some people find that the ring causes vaginal irritation, vaginal odor, more frequent vaginal imbalances or infections, and other vaginal or vulval effects. And like most methods of hormonal contraception⁠ with estrogen, it is not advised for people who smoke, are over 35, are breastfeeding, diabetic, have a history of high blood pressure, cardiovascular disorders or high cholesterol. Those who suffer from headaches, especially migraines, or depression may also find that the ring makes either or both occur more frequently or intensely, and like any hormonal method, use may negatively impact vaginal lubrication, or sexual arousal⁠ or desire⁠ , and side effects may take a while to diminish after discontinuing the method. Rare but more serious side effects can include allergic reactions, blood clots, embolism or stroke, heart attack, gallbladder disease, thrombosis or eye problems. Be sure to discuss your health history and any current health issues with your healthcare provider⁠ so that they can be sure the ring is right for you.

To get the ring, you'll need to visit your sexual healthcare provider (who may also be your regular doctor) to obtain a prescription for the ring to fill at your pharmacy. Nuvarings tend to cost between $15 and $50 for each ring, while the out-of-pocket price for Annovera is much higher.

Also be aware that certain medications and substances may interfere with the effectiveness⁠ of the ring. If you are using or have, in your current ring cycle, used, any of the following it's best to use a backup method of birth control (like a condom⁠ ) until your next new cycle:

  • Barbituates
  • Tetracycline
  • Cloribrate
  • Neomycin
  • Rifampin
  • Chloramphenicol
  • Nitrofuratonin
  • Griseofulvin
  • Benzodiazepines
  • Fluconazole
  • Anti-migraine medications
  • Anti-seizure medications

The prescribing information for Annovera recommends that users only use water-based lube as other types of lube (silicone, etc) may damage the ring over time. This applies to external lube (coming from a packet or bottle) as well as any lubricant⁠ included in whatever barrier methods you use (condoms, etc).

What will/might you need to discuss or negotiate with a partner⁠ ?

  • That you're using the ring, so they know it's inside the vagina, and they may potentially feel it or, as happens now and then, have it come off on the penis⁠ . Or, if you like to remove it during intercourse or any other sex, that it still works when removed for less than three/two hours, depending on the type (see above).
  • Possible semen⁠ /fluid allergies or sensitivities (it is currently estimated as many as around 10% of people may have them), if not using condoms
  • How you/they feel about ejaculation⁠ inside the vagina if condoms are not also being used
  • STI⁠ status and history, if the ring is not being combined with condom use

Some questions and answers about the ring: 

Or, click on the tag for ring for a larger list.

When Good Birth Control Does Bad Things: The ring may fail if it is not used on schedule, or left out during the off-week for longer than seven days, if used with certain medications that can reduce effectiveness, if it has slipped out without being noticed, and/or has been left out for more than three hours. The ring also should only be rinsed, if you must, with cold water, not warm or hot water, and packs of rings should be stored in cool places out of sunlight to assure they remain effective.

Personally, I think it's more cute than bad, but sometimes when the ring slips out, a partner can end up looking like an X-rated version of a game of horseshoes, with a ring around their penis. If you or your partner do not have a good sense of humor when it comes to sex, that may not be as appreciated as it might be otherwise. If you like laughter in your sex life, it may be a perk.

Other methods which can be used as a backup method with the vaginal ring:

Other methods you might like if you like the vaginal ring:

Why would the vaginal ring be a good option for me? If any of the following are true:

  • You want a method which is highly effective when used properly
  • You want some of the possible benefits the ring may offer, like shorter, lighter periods, decreased PMS symptoms and regulated monthly bleeding.
  • You are looking for a method which you are completely in charge of yourself, where you don't have to rely on a partner to help with birth control
  • You are looking for a hormonal method with a low dose of estrogen
  • You know you can't take pills on time every day, or want something you have to think about far less frequently
  • You are comfortable touching your own genitals⁠
  • You don't want a method you have to think about at the time you're going to have sex
  • (Annovera only) You want birth control coverage for a year that doesn't require refills or getting a device implanted

This is part of Scarleteen's Birth Control Bingo. Need to start over?

Don't forget: Statistically, sexually active⁠ young adults⁠ are as, if not more, likely to acquire a sexually transmitted infection⁠ (STI) as you are to become pregnant. Although 15-24-year-olds represent only one-quarter of the sexually active population, they account for nearly half of all new STIs each year, and of the 18.9 million new cases of STIs each year, 9.1 million (48%) occur among 15-24-year-olds (AGI). Often people have some funny ideas about who is most likely to get an STI, but the fact of the matter is that younger people -- of any sexual orientation⁠ , any economic class, any kind of relationship⁠ -- have been the highest risk group for some time now.

Condoms are the only method of birth control which also provide protection against STIs. It's pretty typical for younger people to ditch condoms if they have another method of birth control, so just remember that STIs are still a risk if you're using another method. You can read all about safer sex⁠ here -- Safe, Sound & Sexy: A Safer Sex How-To -- but the rule of thumb most medical experts and prevention organizations suggest, which we also encourage at Scarleteen is six months of safer sex, six months of sexual monogamy, and then TWO full STI screenings for each partner -- once at the start of that six months, once at the end -- before ditching latex barriers.

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