Birth Control Option: Everything You Need to Know About Using Vaginal Rings

From what it feels like during sex to whether you’re more at risk for yeast infections, here are answers to the most common questions about the ring.

It’s been 60 years since the Food and Drug Administration (FDA) approved the first birth control pill, which became a staple of women’s health care ever since. But even though the pill is still widely used — about two-thirds of women between the ages of 15 and 49 currently take it, according to the Centers for Disease Control and Prevention (CDC) — other types of birth control are gaining in popularity.

One of these alternatives is the vaginal ring. According to the latest statistics from the CDC published in December 2018, contraceptive rings and patches are currently used by about 1 percent of women 15 to 49. A small, flexible plastic ring, it’s inserted into the vagina and removed once a month in order for a woman to have her period.

Like the birth control pill, vaginal rings contain progestin or a combination of progestin and estrogen. The estrogen prevents your ovaries from releasing an egg, while the progestin thickens cervical mucus to make it harder for sperm to reach the egg. (The progestin-only vaginal rings are primarily used for women who are breastfeeding and trying to avoid estrogen.)

“The ring is great for women who don’t like to take pills or for those who have trouble with or a distaste for daily compliance,” says Alyssa Dweck, MD, FACOG, a gynecologist at CareMount Medical, in Westchester County, New York.

The first vaginal ring (i.e., the etonogestrel/ethinyl estradiol vaginal ring) was approved by the FDA in 2001. In 2018 the FDA approved the first reusable vaginal ring (segesterone acetate and ethinyl estradiol vaginal system). Unlike the monthly ring, which is thrown out every month, the newer version can be reused for a year. During the week of your period, the ring is washed and stashed in a case.

How Effective the Vaginal Ring Is Compared With Other Birth Control Methods

The yearly ring has an estimated 2 to 4 percent failure rate, meaning of 100 women who use it, two to four will become pregnant within a year, according to the FDA. That’s similar to the failure rate of the monthly ring, in which an estimated one to three women will become pregnant.

The IUD and implant, by comparison, have a failure rate under 1 percent, according to the CDC. Birth control pills, which are taken daily, and patches, which are typically worn on the body for three weeks at a time, have a failure rate of about 7 percent.

Meanwhile, barrier methods, such as the diaphragm, cervical cap, spermicides, sponge, and male and female condoms, have a significantly higher failure rate of between 13 percent (male condoms) and 21 percent (female condoms and spermicides).

Before taking birth control, it’s important to talk to your doctor. While combined hormonal forms of birth control (ones that release estrogen and progestin in your body) — including pills, patches, and rings — are safe for most women, the American College of Obstetricians and Gynecologists (ACOG) notes that they are associated with a small increased risk for deep vein thrombosis (DVT), heart attack, and stroke. Combined hormonal birth control is not recommended for women over 35 who smoke or those who have certain preexisting conditions, including a history of DVT, stroke, or heart attack; breast cancer; uncontrolled high blood pressure; migraine with aura; or diabetes.

Vaginal Ring FAQs

Want to learn more about the ring? There is no such thing as a silly or embarrassing question — your doctor has heard it all before! Here are a few answers to some of your most pressing questions about vaginal birth control rings.

Can you lose the ring inside of yourself?

The vagina is a dead end: The cervix, or opening between the vagina and the uterus, is only a couple of millimeters wide (except, of course, when you’re giving birth), making it impossible for any object to make its way through. “In the same way a tampon can’t get lost, the ring can’t get lost,” says Ashley Brant, DO, a family doctor who specializes in obstetrics and gynecology at the Cleveland Clinic.

In other words, says Dr. Dweck, “there is nowhere for the ring to go other than out.”

What does the ring feel like when it’s in? Is it uncomfortable?

If the ring is correctly inserted and pushed up high enough, you shouldn’t feel anything at all. In fact, it’s only uncomfortable if it’s positioned wrong: “It’s like a tampon, where if it’s half in and half out, it’s uncomfortable,” says Dr. Brant.

Still, it might take you a try or two to insert it correctly. “If it is uncomfortable, consider taking it out and reinserting for adjustment,” says Jessica Shepherd, MD, FACOG, an assistant professor of clinical obstetrics and gynecology and director of minimally invasive gynecology at the University of Illinois College of Medicine, in Chicago.

Will sex feel different for me or my partner with the vaginal ring in?

It’s highly unlikely that you or your partner will feel the ring during sex. “It’s smooth, round, and flexible, so it shouldn’t cause discomfort or pain,” says Brant. Still, it’s possible that you could notice it during intercourse; if that’s the case, you can remove it.

Can you have sex with the vaginal ring in? Or should you take it out?

While the ring is meant to be left in place during sex, it’s OK to take it out if it does cause discomfort, says Brant. Just be sure to rinse it, pat it dry with a clean towel, and reinsert it as soon as you’re done having sex.

Also keep in mind that if you accidentally leave your ring out for more than two to three hours — how long depends on the type of ring you have, so check the label — it’s essential to use a backup form of birth control (like a condom) for the next seven days to protect against accidental pregnancy.

Will jogging or other vigorous exercise make the ring fall out?

Unless you’ve already given birth and were diagnosed with a condition known as pelvic floor prolapse, your pelvic floor muscles should be strong enough to hold the ring in place during normal activities like jogging or vigorous sports, says Brant.

Will the ring fall out when I poop?

For the most part, the ring should stay in place until you pull it out. “But every so often with significant straining, the ring can be expulsed during a bowel movement,” says Dweck.

“If it does slip out, it is very easy to reinsert,” adds Dr. Shepherd.

If you’re in a private bathroom at home and don’t mind the ick factor, you can wash the ring off according to the instructions and reinsert it, but it’s preferable to simply head to the pharmacy for a new one. If you remain ringless for more than two or three hours, depending on the form of vaginal ring you have, use a backup form of birth control (like a condom) for the next seven days.

Should I be able to feel the ring with my finger? What if I can’t?

You should be able to feel the ring with your finger; after all, you need to be able to remove it at the end of the month on your own. If you have a hard time finding the ring, Dweck recommends sitting, crouching, or elevating one leg to help reach it.

Does the ring cause more vaginal discharge? Why?

Women commonly notice a clear, non-foul vaginal discharge when they start using the ring.

“Some women may experience more discharge due to the change in hormones; however, many women can stay consistent,” says Dr. Shepherd.

Does the ring cause more yeast infections?

Hormonal contraception in general may make some women more prone to infection, but it doesn’t cause infection. The change in hormones causes some women’s vaginal pH levels to change, which can sometimes increase the likelihood of infections including bacterial vaginosis and yeast infection, explains Shepherd.

What happens if you forget and leave the ring in for longer than recommended?

Fortunately, you have a grace period of a few days if you don’t take your ring out after 21 days. In fact, some women intentionally leave the ring in for a full 28 days before immediately swapping for a new ring in order to skip their periods. But if you forget to switch out the ring after 28 days, it may make it slightly less effective at preventing pregnancy, says Brant, so be sure to use a backup form of birth control for the next week or so.

Can you skip your periods by leaving the ring in for 28 days and immediately inserting a new one?

There’s no medical reason to have “periods” on birth control, says Brant, so it’s safe to use the ring continuously if you’d like to avoid monthly bleeding.

That said, you may get unexpected breakthrough bleeding (i.e., spotting), especially for the first few cycles. Most women experience random light spotting mid cycle, although some bleed as much as they do on their period.

Is the ring more likely to cause anxiety or mood swings than other forms of birth control?

The jury is still out on whether all types of hormonal contraception are associated with depression or anxiety. “For some women, PMS and its related emotional symptoms improve with hormonal contraception,” says Dweck. “For others, already existing symptoms might be exacerbated.”

“For any individual, it’s impossible to predict how she’ll respond,” says Brant.

Other potential side effects of all forms of combined hormonal birth control may include sore breasts, nausea, headaches, or spotting between periods, according to ACOG. “These side effects usually go away after 2 or 3 months,” says Shepherd.

While the ring isn’t for everyone, many women prefer it, especially if feeling in control of their contraception is high on their list of priorities. “People who tend to be most happy with the ring are those who are comfortable touching their own bodies and appreciate the ability to regulate their periods with more control,” say Brant.

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