How does the vaginal ring work?

The elusive vaginal ring. If used properly, it’s as effective as the pill—so why doesn’t it get anywhere near as much airtime? A quick search on Instagram alone shows more than 31,000 mentions of #thepill in comparison to a whispered 100 mentions of #vaginalring. 

And so, we’re here to clear up any confusion and answer all your questions surrounding this mysterious birth control, including what it actually is, how it works, and if it’s painful.

So, what is a vaginal ring?

Let’s start with the basics. The not exactly poetically-named vaginal ring (aka the birth control ring/the contraceptive ring) is a type of combined hormonal contraceptive (CHC). It contains both a synthetic (wo)man-made estrogen and a progestin—the type depends on which brand you go for (or are prescribed).

And it looks kind of funny. As the name suggests, it’s circular, like a thick rubber elastic band, almost like a female condom without the sheath. On first look, you may doubt its sperm-fighting capabilities. Depending on the type of ring, it’s diameter ranges from 54mm to 56mm(1,2), so about the size of a business card.

And how does the vaginal ring work?

It may look weird, but as the old saying goes, don’t judge a book by its cover. Here’s a rundown of how the vaginal ring actually works (spoiler: it’s clever):

1. It delivers a controlled, continuous, and steady dose of hormones over an extended time period(3).

2. The hormones in the ring (much like in other forms of CHC, like the pill) stop your ovaries from releasing an egg (in technical terms, it stops ovulation).

3. It creates a backup plan by thickening your cervical mucus (otherwise known as vaginal fluid), which makes it trickier for any wayward sperm to fertilize an egg if you do happen to release one(4).

How many people use the vaginal ring?

The concept of controlled drug release like this started back in the 60s(5)—another parallel to the pill, and it was first accepted by the U.S. Food and Drug Administration (the FDA) back in 2001(6).

Despite this, as you can see below, the number of people with cycles opting for the vaginal ring remains pretty low(7). 

How effective is the vaginal ring?

Like most hormonal birth control methods, the effectiveness, or ‘efficacy’ of the vaginal ring depends on how you take it.

1. Perfect use: ~99%
   This is when you take it, well, perfectly, according to the pack instructions and never pop it in too late, for example. It means if 100 people with cycles take the vaginal ring perfectly for a year, 1 will get pregnant(8).

2. Typical use: ~91%
   This is when you’re a bit, shall we say, liberal with the pack instructions from time to time. Perhaps you pop your ring in a bit later than the instructions say or you misplace it in your makeup bag. This means that if 100 women use the birth control ring, typically, 9 will get pregnant in a year(8).
   

How to use the vaginal ring

The all-important question! As with all things birth control, there isn’t exactly a simple answer as it depends on the vaginal ring you’re using. Here’s a rundown of two popular types.

Nuvaring (Ethinyl Estradiol 0.015 mg + Etonogestrel 0.12 mg / 24 hours)(2)
Size: 54 mm in diameter and 4mm thick(2)

• You keep each ring in for 3  weeks at a time(9).

• You have a ring-free week (or skip the ring-free week and insert a new ring straight away)(9).

• You then insert a new ring(9).

Annovera (Ethinyl Estradiol 0.013 mg + Segesterone Acetate 0.15 mg / 24 hours)(10)
Size: 56mm in diameter and 3mm thick(1)

• You keep each ring in for 3 weeks at a time(9). 

• You have a ring-free week(9). You're protected against pregnancy during the ring-free break.

• Instead of inserting a new ring after the ring-free week, the same ring can be re-inserted and used again in the following cycles (for up to a year)(9).

So, how do you insert and remove the vaginal ring?

Unlike hormonal and non-hormonal IUDs, you don’t need a health practitioner to insert the ring—the power is literally in your hands!

So, if you wanna ace ring-life, here’s what you gotta do:

1. Wash and dry your hands before touching the ring. Hygiene first, folx.

2. Remove the ring from the package and wash it with mild soap and lukewarm water before drying it with a clean cloth, towel, or paper towel. 

3. Gently insert it into your vagina. You don’t have to ensure it covers your cervix (womb opening) like you do with a diaphragm/cap. It’s kind of like inserting a tampon, but you pinch the ring first so it’s easier to insert.

4. When you take the ring out using the attracted string to pull it out, you’ve also got to make sure those hands of yours are clean!

5. Depending on the type of ring you have, you either put it in the bag it came with and throw it in the bin or put it in the carry case ready to be used after your ring-free week.

6. Using your fingers, check regularly that the ring is still there. If you can't feel it but you're sure it's there, see a healthcare professional. The ring can't get "lost" inside you.

What are the benefits of using the vaginal ring?

There are a fair few! As with most things birth control, more research is needed (here are 9 reasons why it’s lacking). Read on for what we know so far:

1. You don’t have to remember to take it/use it every day. This makes it a good option for people with busy lifestyles and/or a tendency to forget to take the pill!

2. You can use the vaginal ring to skip your bleed which may suit those who suffer from heavy, long, and/or painful periods(11).

3. As the hormones are released in your vagina, if you happen to throw up or get the treat that is diarrhea, it won’t reduce the efficacy of this contraceptive method (unlike birth control pills).

4. Most people with cycles report an improvement in their bleeding when they use the ring on a standard regimen with a ring-free break each cycle (1). However, if you decide to use the ring without a ring-free break, you may experience spotting or irregular bleeding in your first 4 cycles(11).

Some things to remember when using the vaginal ring

Here at Tuune, it’s our goal to equip you with all the info you need so you can make your own decisions about your body and the birth control you choose to use. Here are a few points to consider when making your mind up about the vaginal ring:

1. It doesn’t protect against STIs. Therefore, it’s recommended for vaginal rings to be used with condoms (this will also further increase your protection from pregnancy). The ring can sometimes come out on its own, but you can rinse it in cold or warm water and put it back in as soon as possible.

2. Some people with cycles report vaginal discomfort when using the ring. It’s also possible for your partner to feel the ring during sex, but guidelines recommend you don’t remove the ring often as your hormones won’t be released steadily and therefore you’re risking ovulation and therefore pregnancy.

3. A question that many people ask is ‘is the vaginal ring painful’? When you first start using the vaginal ring, you may experience some vaginal discharge or irritation. However, this is usually temporary and it’s because something foreign has been inserted up there and your body hasn’t got used to it yet.

4. A few people with cycles have reported a blood clot, however this is very rare (8.3 per 10, 000)(12). Studies have shown a similar risk of blood clots among those who use the vaginal ring  and those who use combined pills (9.2 per 10, 000)(12).

5. Localized birth control methods like the ring contain a lower dose of estrogen than most birth control pills, however a decrease in estrogen-related side-effects like tender breasts, headaches and nausea, haven’t been seen(2,13).

Who is the vaginal ring not safe for?

Worry not, if you’ve taken our Tuune 360 online health assessment to work out which birth control is right for you and fit into any of the below groups, it’s likely you won’t be recommended CHCs like the vaginal ring.

• If you suffer from migraines (especially migraines with aura).

• If you have a high BMI.

• If you’re over 35 and smoke.

• If you’re recently postpartum (due to increased blood clot risk).

• If you’ve had a blood clot in a vein or artery.

• If you’ve had heart or circulatory problems, including high blood pressure,  you would need to speak to a specialist.

• If you have breast cancer or have had breast cancer in the past 5 years.

• If you have diabetes with complications.

• If you take medicines that may interact with the ring.

• If you can't hold the ring in your vagina.

To summarize:

We believe it’s time to talk about all birth control methods out there, rather than just the ones that are most familiar. There are plenty of pros with the vaginal ring birth control,  like it being very effective at protecting against pregnancy (especially if used ‘perfectly’ rather than ‘typically’!). Also depending on your lifestyle, it can be a relatively straightforward option—one that you don’t have to think about every day, and that you can insert and remove yourself rather than needing to wait for a health professional.

However, as with many things within the world of birth control, there’s no one size fits all approach and how well it works for you will depend on many factors, including your medical history, lifestyle factors like whether you smoke, plus your baseline hormone levels. At Tuune, we’re here to fight against the gamble that many of us have been forced to take for generations, and instead work with you to understand whether this birth control would be a good fit for you—and let you know the reasons why! Don’t forget, we’re completely agnostic so will look at all the options out there before filing you in our recommendations.

Written by

Hermione Wright (she/her)

An NCTJ-qualified journalist, Hermione writes for national and local publications in addition to creating thought leadership for brands with a purpose. Passionate about telling the stories that matter, she helps our community make their own clued-up choices about their healthcare.

Medically reviewed by

Dr. Arushee Prasad, GP, MBBS (she/her)

Dr Arushee Prasad is a GP for NHS England with an MBBS in Medicine and Surgery, and an MRCGP from the Royal College of General Practitioners. Passionate about digital health and algorithmic medicine, Arushee was previously an Algorithmic Medical Doctor for Docly.

Scientifically researched by

Hannah Durrant (she/her)

Hannah is a Biomedical Content Writer at Tuune, with a BSc in Biomedical Sciences from University College London. She is passionate about bringing together the scientific community and the general public by disseminating modern science via digestible, engaging and thought-provoking content.