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    How to use the contraceptive ring (NuvaRing)

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      Contraceptive ring

      The contraceptive ring (NuvaRing) is a plastic ring which can be placed into the vagina and used as a contraceptive. It’s a type of combined contraceptive, which means like the combined pill, it contains 2 hormones – oestrogen and progestogen.  

      Some women choose NuvaRing if they’re worried about forgetting a pill each day. NuvaRing is changed every 3 weeks. Unlike the pill its not affected by sickness or diarrhoea. 

      NuvaRing is 99% effective when used correctly all the time. If it’s not always used correctly, 9 out of 100 users of the contraceptive ring will get pregnant.  

      How does the contraceptive ring work? 

      The contraceptive ring releases a continuous dose of hormones into the bloodstream through the vaginal wall. These hormones stop your ovaries from releasing an egg each month. But they also work to: 

      • Thicken the mucus from your cervix, making it difficult for sperm to travel through and reach an egg 
      • Thin the lining of the womb, making it harder for a fertilised egg to implant 

      NuvaRing insertion 

      The vaginal ring should be inserted with clean hands. Squeeze the ring between your finger and thumb and push the ring into your vagina until it feels comfortable.  

      A clinician can advise you on how to put it in and take it out.  

      Taking the NuvaRing out 

      Using clean hands, you can use your fingers to take the ring out. The ring can’t get lost inside you as it’s stopped by the cervix. But if you’re having any problems taking it out, or can’t feel it, you can speak to a clinician and they will be able to advise you.  

      When can I start using NuvaRing? 

      If you’re sure you’re not pregnant you can start using the vaginal ring at any point in your cycle. You’ll be protected from pregnancy: 

      • Immediately – if you start on the first day of your period 
      • Immediately – if you start anytime between the first and fifth day of your period (provided you don’t have a very short or irregular menstrual cycle) 
      • After 7 days – if you start the ring at any other time in your cycle. You’ll need to use other contraception, such as condoms, if you have sex during the first 7 days 

      How to use the contraceptive ring 

      NuvaRing was designed to be used for 3 weeks (21 days) straight, followed by a 4 or 7-day break. In this break you’ll have a withdrawal bleed. This is like a period but isn’t one. It’s just your body’s reaction to the break in hormones. After this break you insert a new vaginal ring and start the cycle again.  

      If you’d like to avoid the withdrawal bleed, or reduce the number of bleeds you have, there are different ways you can use Nuvaring: 

      • You can change your vaginal ring every 3 weeks for 9 weeks in a row and then have a break for 4 or 7 days. This is called tricycling. You’ll usually have a withdrawal bleed in your break. You then insert a new ring on the fifth or eighth day and start the cycle again.  
      • You can insert a new ring every 3 weeks with no break. This is called continuous use. You won’t have a withdrawal bleed, but you might get some bleeding. This should reduce as you use the vaginal ring over a long period of time. 
      • You can insert a new ring every 3 weeks for at least 3 weeks. If after this time you get bleeding that’s unacceptable to you for 3-4 days, you can take a 4-day break and then insert a new ring. Use this ring for at least 3 weeks before changing it. This is called flexible extended use. 

      Protection during your ring-free break 

      You’re protected from pregnancy during your ring-free break provided: 

      • You used the vaginal ring correctly during the last 3 weeks 
      • You start the next ring cycle on time 
      • You’re not taking any treatments that will affect the vaginal ring. Medicines that may affect the ring include St John’s Wort and those used to treat epilepsy, HIV and TB. Check with your clinician about using the ring if you’re on any of these treatments.  

      Considering contraception?

      View our contraception options


      What to do if the contraceptive ring comes out or you’ve used it incorrectly 

      Like all contraception, you should try and use it correctly at all times. But occasionally you might forget to change your vaginal ring or put a new one in. It’s important you know what to do in these situations. 

      1. Ring is removed outside of the ring-free break 
      If it’s been less than 48 hours since the ring came out, you need to: 

      • Insert the ring as soon as possible 
      • Keep it in until the day you were supposed to take it out 

      You don’t need to use any extra contraception if: 

      • You’re in the first week after the ring-free break and you used the ring correctly in the week leading up to the break 
      • You’re in any other week of your cycle and you used the ring correctly in the 7 days prior to it coming out 

      If it’s been more than 48 hours since the ring came out, you need to: 

      • Insert the ring as soon as possible 
      • Keep it in until the day you were supposed to take it out 

      If you’re in the first week after a ring-free break and had unprotected sex in this week or the ring-free break you might need emergency contraception. You may also want to take a pregnancy test in 3 weeks’ time. 

      If you’re in any other week of your pill cycle you don’t need emergency contraception, provided you use the vaginal ring correctly in the previous 7 days. 

      2. Ring has been left in longer than 3 weeks 
      If you’ve left the ring in for 3-4 weeks, you need to: 

      • Take your ring free break if you have one, insert a new ring after this and start the cycle as normal 
      • Insert a new ring straight away if you don’t take a break 

      You won’t need to use extra contraception, provided the ring was in place throughout the 4th week of use (days 21-28).  

      If you’ve left the ring in for 4-5 weeks, you need to: 

      • Insert a new ring as soon as possible, don’t take a break even if you usually have one 
      • Use condoms if you have sex until the new ring has been in place for 7 days 

      You won’t need to use extra contraception, provided the ring was in place throughout the 4th week of use (days 21-28).  

      If you’ve left the ring in for more than 5 weeks, you need to: 

      • Insert a new ring as soon as possible, don’t take a break even if you usually have one 
      • Use condoms if you have sex until the new ring has been in place for 7 days 

      If you had unprotected sex in week 5 or later you might need emergency contraception. You might also need to take a pregnancy test in 3 weeks.  

      3. Inserting the vaginal ring late after a break 
      If you inserted the ring more than 24 hours late after a 7-day break, or 96 hours later after a 4-day break, you need to: 

      • Insert a new ring as soon as possible 
      • Keep it in until it’s scheduled to be removed 

      If you had unprotected sex in the ring-free break you might need emergency contraception. You may also want to take a pregnancy test in 3 weeks’ time. 

      References 

      https://www.sexwise.org.uk/contraception/contraceptive-vaginal-ring  

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