Sexual Health D&G

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vaginal ring (Nuvaring)

The vaginal ring contains two hormones - oestrogen and progesterone.

How effective is it?

If the vaginal ring is used according to the instructions it is over 99% effective.
This means that less than 1 woman in a 100 will get pregnant in a year.

How does it work?

The main way the vaginal ring works is to stop the ovaries from releasing an egg each month (ovulation).

Where can I get the vaginal ring?

In Dumfries and Galloway you can get the vaginal ring from your GP, the local sexual health services or a C2U drop-in if you are under 20.

Can anyone use the vaginal ring?

Not everyone can use the vaginal ring. Although there are some medical conditions that would mean you should not use the vaginal ring, decisions often depend on a combination of age, smoking, the severity of any medical condition, whether there are other health problems and sometimes your family history of illness. Each woman’s situation is different and your doctor or nurse will be able to advise you.

Conditions which may mean you should not use the vaginal ring.

Many women who cannot use the vaginal ring are often able to use contraception which only contains the hormone progesterone. This can be taken as the progesterone only pill, implant, injection or hormone coil. There is also contraception that doesn’t contain any hormones such as a copper coil, condoms and diaphragms.

How old do I have to be to use the vaginal ring?

Once your periods have started you can use the vaginal ring.

Can I only use the vaginal ring for a certain length of time or have to stop at a certain age?

If you are well on the vaginal ring and nothing changes in your own or family medical history then there would be reason to stop the vaginal ring. In fact if you are healthy, do not smoke and there are no medical reasons for you not to use the vaginal ring you could use it until the age of 50.

What are the advantages of the vaginal ring?

Some of the good things about the vaginal ring are:

  1. Usually makes your periods regular, lighter and less painful
  2. May help with premenstrual tension
  3. Reduces the risk of cancer of the womb, ovary and bowel

What are the disadvantages of the vaginal ring?

  1. When you start the vaginal ring you may get headaches, nausea, breast tenderness, mood changes and some bleeding when you don‘t expect it. These normally stop within the first few months but if you are concerned or these symptoms continue then talk to a nurse or doctor about it.
  2. The pill may increase your blood pressure and this will be measured regularly.
  3. The pill does not protect you against sexually transmitted infections and many women choose to use condoms as well.

The vaginal ring can have some serious side effects which are not common.

These include:

Venous thrombosis

The risk of a venous thrombosis is greatest during the first year that you use the vaginal ring and if any of the following apply to you: you are very overweight, are immobile for a long period of time or use a wheelchair, have severe varicose veins or a member of your immediate family had a venous thrombosis before they were 45

Arterial thrombosis
The risk of arterial thrombosis is greater if you smoke, are diabetic, have high blood pressure, are very overweight, have certain sorts of migraines or a member of your immediate family had a heart attack or stroke before they were 45.
You should see a doctor straight away if you develop any of the following symptoms:

How do I insert the vaginal ring?

Your doctor or nurse should advise you on how to insert and remove the vaginal ring. With clean hands squeeze the ring between your thumb and finger and use one hand to insert it into your vagina. If necessary, spread your labia (vaginal lips) with your other hand. Push the ring into your vagina until it feels comfortable. It does not need to cover your cervix (entrance to the uterus) to work.

insert

How will I know the vaginal ring is in place?

The ring does not need to be in an exact position. Most women can’t feel the ring. If you can feel it and it is also uncomfortable, push the ring a little further into your vagina. You can check it’s still there with your fingers.
There is no danger that the vaginal ring can get lost inside the vagina – it is stopped by the cervix. However, if you are sure it’s inside you but you can’t feel it with your fingers, see a doctor or nurse.

Will I, or my partner, be able to feel the vaginal ring during sex?

Occasionally, you or your partner might be able to feel the ring during sex. This is not uncomfortable or unpleasant for most people. The ring is not likely to affect or harm your partner.

How do I remove the vaginal ring?

Remove the vaginal ring by hooking a finger under it, or by grasping it between your thumb and finger, and gently pulling it out.
If you experience pain or bleeding when trying to remove the ring, or cannot remove it, tell your doctor or nurse immediately.

remove

How do I use the vaginal ring?

Weeks 1–3: The vaginal ring should be left in the vagina for three weeks (21 days). After three weeks remove the ring on the same day of the week that it was inserted.
Ring-free interval: Stop using the ring for one week (seven days). This is known as the ring-free interval. During this week you may get a bleed. You don’t have periods when you use the vaginal ring – you have a withdrawal bleed (which doesn’t always happen). It is caused by you not taking hormones in the ring-free week.
New ring cycle: After the ring-free interval, insert a new ring on the same day of the week that you took the previous one out. You should do this even if you are still bleeding. Continue using the vaginal ring as you did in the last cycle.
Disposing of the vaginal ring: Put the used vaginal ring in the disposal sachet provided and place it in a waste bin. It must not be flushed down the toilet.

Am I protected from pregnancy during the seven day, ring-free interval?

Yes. You are protected if:

What if I forget to take the vaginal ring out at the end of week three?

Seven days or less

Up to seven days.
If the ring has been left in for up to seven days after the end of week three (up to four weeks in total):

More than seven days
If the ring has been left in for more than seven days after the end of week three (more than four weeks in total):

What if I forget to put a new vaginal ring in at the end of the ring-free interval?

Insert a new ring as soon as you remember and use additional contraception until a new ring has been in place for seven continuous days. Ask your doctor or nurse for advice if you have had sex in the previous few days and were not using a condom as you may need emergency contraception.

What should I do if the ring comes out of my vagina for a short time?

The longer the ring has been out of the vagina, the higher the risk of pregnancy. You may also experience breakthrough bleeding. If the ring comes out of the vagina for:

Less than three hours:

More than three hours in the first or second week of use:

More than three hours in the third week of use:

Throw the ring away and choose one of the following two options:

  1. insert a new ring immediately and start a new ring cycle. You may not experience a withdrawal bleed but breakthrough bleeding or spotting may occur, or
  2. do not insert a new ring. Start your seven day, ring-free interval. You will have a withdrawal bleed. Insert a new ring seven days from the time the previous ring came out of the vagina. This option can only be chosen if the ring was used continuously for the previous seven days.

In both cases, you must use additional contraception until the ring has been in place for seven continuous days and ask your doctor or nurse for advice if you have had sex in the previous few days and were not using a condom as you may need emergency contraception.
If you lose the vaginal ring insert a new one and continue with the cycle that you were on.

Can the ring fall out of my vagina?

The muscles of your vagina hold the ring in place. Occasionally, however, the ring may come out of your vagina (expulsion), for example if it wasn’t inserted properly, during sex or a bowel movement (having a poo), or while removing a tampon. If this happens often, you may want to consider another method of contraception.
Research shows that the ring is not more likely to come out if you have had children.

What if the ring breaks inside my vagina?

This is very rare and it is unlikely to affect how the ring works. It will not harm you. Remove the broken ring and insert a new one as soon as possible. Continue with the cycle that you were on.

If I take medicines will it affect the vaginal ring?

There are a few medicines that make the vaginal ring less effective. You should tell a doctor or nurse that you are using the vaginal ring if you are prescribed any new medication so that they can check to see if there are any interactions.

Commonly prescribed antibiotics do not affect the vaginal ring. However some drugs can reduce the effectiveness of the vaginal ring and increase the chance of getting pregnant. These include certain drugs used to treat HIV, TB and epilepsy as well as the herbal preparation St. John’s Wort. If you are taking any of these tablets you should speak to your doctor about the contraceptive options available to you. Ella-One should be avoided if you are on hormonal contraception and if you are given Ella-One because you haven’t used your ring for a few days, you should not restart your ring for another 5 days. It will then take a further 7 days until you have effective contraception so you should abstain or use condoms for this time

Treatments for thrush do not affect the effectiveness of the ring.

Finally

It is important that you are happy with the type of contraception you choose to use. Doctors and nurses are trained to work with you to find a method of contraception that suits you. Do not be afraid to discuss any concerns you may have.