The Vaginal Ring (NuvaRing®)(VHR)
The Vaginal Hormonal Ring – VHR – The Vaginal Ring – NuvaRing® – The Contraceptive Ring – Birth Control Ring
The following is a © extract from
“Sexplained Two – For Changing Times”
by Helen J Knox
Used Here With Permission
What is the Vaginal Hormonal Ring? (VHR)
The vaginal hormonal ring (VHR) is an increasingly popular choice of disposable combined hormonal delivery system which is inserted into the vagina by a woman once a month.
It contains a low dose of both female hormones, oestrogen (ee-stro-gen) and progestogen (pro-ges-toe-gen), in the same way as in the combined oral contraceptive pill (the COC Pill) and The Patch (Evra®/OrthoEvra®).
The hormones are delivered through a slow release mechanism, which activates when the ring is in contact with the woman’s vaginal mucosemembrane (vaginal lining).
The oestrogen,ethinylestradiol (ethi–nile–eestro-diol) in The VHR is the same as that used in many other combined hormonal methods of contraception.
The progestogen, etonogestrel (eto-no-ges–trel), is the same as that used in the progestogen implant, Nexplanon®/ Implanon®.
Here, the combination is called The Vaginal Hormonal Ring or VHR.
How effective is The VHR?
The Vaginal Hormonal Ring is over 99% effective when it is used correctly.
In other words, extremely reliable, with less than 1 woman in 100 who use it becoming pregnant each year.
Who can use The VHR?
The VHR is a combined method of contraception, therefore women who are medically safe to use The COC Pill or The Patch can choose to use it.
According to the manufacturer, the risk of getting blood clots may be slightly greater with the type of progestogen in NuvaRing® (etonogestrel) than with the progestogens used in some low-dose combined oral contraceptive pills.
How do I use The VHR?
This relates to the first and best known monthly vaginal ring, called NuvaRing®:
Starting on day one of your menstrual cycle (first day of your period), squeeze the ring and insert in to your vagina and you will be protected against pregnancy immediately.
Starting on days two to five, insert as above but you must use extra protection or avoid sex for the first seven days.
Unlike the contraceptive diaphragm or cap, The VHR is a standard size and ‘one size fits all’ women, so you do not have to worry about fitting it correctly inside the vagina. It cannot get lost or go too far because the vagina is an enclosed space, with the cervix at the internal end.
Leave it in place for 21 days, then remove and dispose of it in household waste, inside the pouch it came in.
After two to three days without The Ring in your vagina, you should expect a withdrawal bleed (induced period).
After a 7-day break, known as a ‘ring free interval’ (whether you are still bleeding, or not) insert your next (a NEW) Vaginal Hormonal Ring on the eighth day (now day one again) and continue with this 21-7-21-7 routine to
maintain your contraceptive protection.
How can I check that it is still there?
You can check that The VHR is there by inserting a finger in to your vagina and feel it.
Will we notice it during sex?
During sex, you, or your partner, may notice that it’s there but it’s rarely a problem.
Some men enjoy the sensation produced as their penis passes over it.
If the sensation is a problem, The VHR can be removed for up to three hours, and then replaced.
Does it hurt to put it in or remove it?
No. It should not hurt to insert or remove The VHR.
To remove it, just insert your finger and hook the device, then pull it out.
If it does hurt, mention this to your doctor or nurse.
Am I protected from pregnancy during the seven-day interval?
Yes. You’re protected from pregnancy during the 7-day interval, as long as you put the next VHR in on time.
If you don’t plan to do this, you must use another method of contraception as soon as you remove your VHR.
Can The VHR fall out of my vagina?
No. The VHR is held in place by your vaginal muscles.
If in doubt, check, as before.
What if I forget to take it out?
If you forget to take it out and have unprotected sex, you may require emergency contraception if you do not change it before the 28th day (in the same way as missed or late COC Pills).
What if I forget to put a new VHR in on time?
If you are late inserting your next Ring, follow the rules as if you were restarting your COC Pill late.
Insert as soon as possible and use extra protection (a condom) or avoid sex for seven days.
If you had sex during the break between rings, seek medical advice as you may require emergency contraception to prevent pregnancy.
NOTE: There are very clear instructions on each box of NuvaRing®, so make sure you read this when you start to use the method and keep the leaflet handy, for reference.
- The leaflet explains what to do if you encounter situations that could put you at risk of pregnancy.
- It also explains what to do if you are using certain medication, experience bleeding at unexpected times or don’t bleed when you expect to.
- There is no need to stop using the method to give your body a break from the hormones. They disappear from your body by the end of your ring free interval.
- If you are ever concerned about using this method, please speak to your prescriber.
- Each month, many women use it, very happily, around the world.
A 12-month vaginal ring is expected to become available soon, which will give many women increased contraceptive freedom.