Vaginal ring

• The vaginal contraceptive ring is more than 99% effective when used in the right way.
  
  
• A ring is able to protect you for a month, thereby saving you the stress of thinking about it daily.
  
  
• You can have sex while the ring is in place.
  
  
• In contrast to the pills, its effectiveness is not altered by sickness (vomiting) or diarrhea.
  
  
• It may cause your monthly cycle to become lighter and less painful and also reduce your premenstrual symptoms.
  
  
• In some women, it causes certain side effects such as headaches, breast tenderness and vaginal discharge, although they are usually temporary.
  
  
• Although rare, very few women may develop a blood while using the ring.
  
  
• Sometimes, the ring may come get removed by itself, but you can always fix it back immediately after rinsing it thoroughly with warm water.
  
  
• It proffers no protection against sexually transmitted infections (STIs); therefore, you may need to make use of extra contraception such as condoms.

The contraceptive vaginal ring continuously releases certain hormones- artificial forms of progesterone and estrogen into your circulatory system and this prevents pregnancy by hindering your monthly ovulatory cycle (release of the ovum or egg).

In addition to this, it also increases production of thick cervical mucus thereby making movement of the sperm through the cervix difficult and thinning the mucosal lining of your womb, making it difficult for a fertilized egg to get implanted.

The contraceptive vaginal ring can be inserted at any time during your monthly cycle, given you are not pregnant or think you are.

The ring can be left in place for about 21 days and then taken out for 7 days, after which a new ring is fitted for another 21 days. Good part is, you remain protected against pregnancy even during the short 7 days break.

If the vaginal ring is inserted on the 1^st day of your monthly menstrual cycle, it would proffer you with complete protection against pregnancy immediately.

If the vaginal contraceptive ring is inserted any day after the first day of your monthly menstrual cycle, you may need to make use of extra contraception such as condoms for at least 7 days.

You can always consult your doctor or nurse to seek advice on the most suitable time for you to insert your vaginal ring and also teach you how to fix and remove the ring.

• • Wash your hands thoroughly, and then squeeze the sides of the vaginal ring between your thumb and another finger. Afterwards, carefully slide it into the tip of your vagina.
    
    
  • Push the ring upwards gently until you are comfortable with its position.

  In contrast to the diaphragm or cap, the ring doesn’t have a block or cover up your cervix to produce its effect.

  After it is inserted, you ought to be able to feel your vaginal ring to determine if it’s still in place or dislodged. If you stop feeling the ring, ensure you see you’re GP or nurse immediately, the ring can't get lost in your body.

  The vaginal contraceptive ring should be left in place for 21 days, after which it should be removed. The day you get it removed should be the same day of the week as that on which you had it inserted.

• Wash your hands properly, then insert your finger into your vagina, locate the ring and the edges and then hook your finger around the edge.
  
  
• Carefully pull the ring downwards and out.
  
  
• Keep it in the provided container and dispose of it in the bin. Avoid flushing it down the toilet.

This process should not cause you any pain or discomfort. However, if you experience any bleeding and/or pain or have difficulty finding or removing the ring, see your GP or nurse right away.

There’s usually a ring-free interval after removal of the ring, and this usually lasts a period of 7 days. During this break, you might experience some bleeding similar to that of your menses or period.

After the 7 days interval, insert a new ring. This can be done, even while you are still bleeding. Leave the ring in place for the next 21 days, and then keep on repeating the cycle.

If your vaginal ring has stayed in place for 28 days- 7 days after the end of the recommended 21 days;

• Remove the vaginal ring immediately, you remember.
  
  
• After removal, you wouldn’t need to insert a new ring until 7 days after (the 7 days interval).
  
  
• Get the new ring inserted once the seven-day interval is over.
  
  
• During this period, you still protection from pregnancy and will not need to use an extra contraceptive method.

• Remove the vaginal ring immediately remember to
  
  
• Get a new inserted at once.
  
  
• Make use of extra contraception such as condoms for the next 7 days, if you want to have sex.
  
  
• If you have had sex within the last few days before you had the ring replaced, you may need to get the emergency contraception immediately-consult your GP or nurse for advise.

Get a new ring fixed immediately you remember and also make use of extra contraception such as condoms for at least 7 days.

It may be necessary for you to make use of the emergency contraception, if you have engaged in sex with your partner, days after the ring-free interval (after 28 days), while the old ring or no ring is in place.

On a few occasions, your vaginal contraceptive ring can be expelled out of your body (expulsion) either after you have just had sex or if it isn’t fixed properly.

The next step to take is dependent on what week of your monthly cycle you are in and the period for which the ring has been out (how long).

If the vaginal ring has been outside your body for less than 3 hours (no matter what week of your monthly cycle it is):

• Rinse the vaginal contraceptive ring thoroughly with cool or lukewarm water
  
  
• Fix the vaginal ring immediately, at least within 3 hours.
  
  
• You remain protected from pregnancy, no need for extra contraception.

If the ring gets expelled from the body for more than 3 hours during the first or second week:

• Rinse the vaginal ring thoroughly with lukewarm or cool water.
  
  
• Fit in the vaginal ring as soon as you can.
  
  
• Get and make use of extra contraception for at least 7 days.
  
  
• If you have had sex with your partner recently, you may need to make use of the emergency contraception.

If it gets removed from your vagina for more than 3 hours within the third week, dispose of it and either:

• Reinsert a newly opened vaginal ring immediately-in this case, you may not experience the usual period-like bleeding, but may notice some spotting.
  
  
• Begin the 7-days interval (the short break) immediately-you will still experience the usual period-like bleedingI

If you choose to do the last option, a new vaginal ring should be inserted after the short 7 days break you take after the last one got expelled. This option is only suitable for you, if the vagina ring was still in place throughout the last week before the day it got expelled.

For the both options, you will need to make use of extra contraception for a period of 7 days and also consult a GP or nurse, if you have had sex recently, as you may need to make use of emergency contraception.

The vaginal contraceptive for certain women and you may fall in this category of women if you:

• Have or have had thrombosis in any vessel-blood clot in any vessel.
  
  
• Have or have had heart or circulatory conditions and also hypertension.
  
  
• Smoke or have recently quick smoking (even if it was the previous year) and you are 35 years old or older
  
  
• Have severe migraine that comes with warning signs.
  
  
• Have or have had breast cancer within the last 5 years.
  
  
• Have diabetes and its complications.
  
  
• Are overweight or obese.
  
  
• Are on certain medications that alter the rings effectiveness
  
  
• Cannot hold the ring firmly in your vagina.

Women, who aren’t smokers or have any medical conditions that can affect the use of the ring, can use it till they turn 50.

The vaginal contraceptive ring can be fixed on the 21^st day after delivery. Once inserted, it offers complete protection from pregnancy immediately.

If it is inserted after the 21^st day after your delivery, you will be required to make use of extra contraception such as condoms for the next 7 days, after the ring has been inserted.

However, if you are a breastfeeding mother with a baby under 6 months old, you may be advised to make use of another form of contraception. This is because the vaginal ring can affect and reduce the quantity of milk you are able to produce.

The vaginal contraceptive ring can be inserted right after a miscarriage or abortion and would not need to be used alongside another contraceptive method. If this is done, it would offer immediate and complete protection from pregnancy.

• It doesn’t interfere with sexual intercourse
  
  
• It is simple to fix and remove
  
  
• Saves you the stress of thinking about it daily or whenever you want to have sex
  
  
• The ring continues to remain effective even while you are sick or have diarrhea
  
  
• It may help to reduce your premenstrual symptoms.
  
  
• The period-type bleeding that occurs during the 7-day interval is usually lighter, regular and less painful.
  
  
• It may improve health, by reducing your risk of developing certain cancers.
  
  
• It doesn’t have any long-term effect on your normal fertility.

• Inserting and removing the vaginal ring may bring you some discomfort
  
  
• You may experience irregular period-type bleedings or spotting within the first few months of use.
  
  
• It may cause you certain side effects such as headaches, nausea, mood changes, breast tenderness and increased vaginal discharge.
  
  
• It proffers no protection against STIs.
  
  
• You need to remember to change it monthly. However, if you experience any difficulty remembering it, you can make use of longer-acting contraceptive methods such as contraceptive implants or the intrauterine device (IUD).
  
  
• Certain medicines can affect the effectiveness of the ring- to find out which medicines can affect it, consult your GP, nurse or pharmacist.

While using the hormone-based contraception such as the vaginal contraceptive ring, there’s a minor risk of developing serious side effects.

Nevertheless, for the majority of women who make us e of the ring, the benefits greatly outweigh the risks. You need to discuss all associated risks and benefits with you GP or nurse before deciding if you would like to use it.

Out of the numerous women who make use of the vaginal contraceptive ring, only a few of them may develop a blood clot (thrombosis) within a blood vessel- artery or vein. You will be advised against using the vaginal ring, if you have had a blood clot previously.

Research has revealed that women who make use of the vaginal contraceptive ring have a mildly increased risk of developing breast cancer in the future compared to those who don’t. But, the risk reduces gradually after you have stopped making use of it.

Research also shows that there is a mildly increased risk of developing cancer of the cervix, when women use hormone-based contraceptives (estrogen and progestogen) for a long period.

You can always get access to contraception at no cost, regardless of your age (even under 16). You can get from:

• All community contraception clinics
  
  
• Certain Genitourinary (GUM) clinics.
  
  
• Sexual health clinics
  
  
• Young people services

Note that some clinics would be unable to provide you with the vaginal ring, so you will need to check first.

When getting the prescription, you can only be given a supply for a maximum of 4 months; this is because of its short shelf life.

• You can find the sexual health clinic closest to you here.