Birth Control Ring

What is a birth control ring?

A birth control ring is also known as the vaginal ring or the ring. It is a small soft, flexible circular plastic ring that is placed inside your vagina.

How does a birth control ring work?

• The birth control ring contains hormones (oestrogen and progesterone). It releases a continuous dose of the hormones into the bloodstream to prevent pregnancy. 

• The hormones in the ring will prevent the release of an egg each month (stop ovulation). When there is no ovulation, no fertilisation will occur, thus preventing from pregnancy.

• The hormones also thicken the cervical mucus, making the sperm more difficult to enter the uterus.

• The ring also affecting the uterus lining, making it becomes thinner, thus implantation of a fertilised egg is less likely to happen.

What are the types of birth control rings?

There are two main types of rings:

1. NuvaRing

2. Annovera ring

NuvaRing

Each NuvaRing lasts for up to 5 weeks. You may change it about once every month.

Annovera ring

Each Annovera ring lasts for 1 year (13 cycles). It is reusable, as it is intended for use over a 13-cycle (13-month) period before needing replacement as compared to NuvaRing. You may insert it in your vagina for 21 days (3 weeks), then take it out for 7 days (ring-free week). After the ring-free week, you can reinsert the Annovera ring into your vagina to continue the contraception.

How effective is the birth control ring?

A birth control ring is a safe and convenient birth control method that works really well if you use it correctly. The effectiveness of the birth control ring seems to be similar to other hormonal methods of birth control, like the patch or the pill.

If used correctly, the birth control ring is more than 99% effective at preventing pregnancy. However, if you forget to put a new ring in on time, use it incorrectly, it might only be 93% effective.

How to insert and remove a birth control ring?

1. To insert/put in

   • Check the expiration date on the package, make sure the ring hasn’t expired.

   • Wash your hands with soap and water.

   • Take the ring out of the wrapper or case.

   • If you are using an Annovera ring, you need to wash the ring with mild soap and lukewarm water, then pat it dry with a clean cloth towel or paper towel. Do this every time you put in your Annovera ring.

   • Squeeze the sides of the ring together with your fingers and gently push it deep into your vagina till it feels comfortable.

   • You will need to regularly check using your fingers to make sure the ring is still there.

2. To remove/take out

   • Wash your hands with soap and water.

   • Put a finger into your vagina and hook it around the edge of the ring, then gently pull the ring out.

   • Put it in the bag provided and throw it in the bin.

   • Removing the ring should be painless. If you have any bleeding or pain or you can’t pull it out on your own, see a doctor/GP immediately.

When does the ring start to work?

• If you insert the ring within the first 5 days of your menstrual cycle, you will be protected against pregnancy straight away, no additional contraception is needed.

• If you insert the ring at any other time in your menstrual cycle, you will need to use additional contraception (such as condoms) for the first 7 days after putting in the ring.

What are the pros and cons of birth control rings?

Pros of birth control ring

• The ring doesn’t need to be fitted by a doctor – you can put it in yourself (self-insert).

• It doesn’t interrupt sex.

• It is easy to put in and take out.

• It helps to improve acne.

• It helps to reduce the period pain.

• It may ease the premenstrual symptoms.

• Period-type bleeding will probably become lighter, more regular and less painful.

Cons of birth control ring

• You may not feel comfortable inserting or removing it from your vagina.

• You can have spotting and bleeding, or having irregular periods in the first few months.

• The ring may cause temporary side effects, such as increased vaginal discharge, headaches, nausea, breast tenderness and mood changes.

• It doesn’t protect you against STIs.

• It can be more expensive than oral contraceptive pills.

• It is a small risk of blood clots (or thrombosis), heart attack and stroke associated with using the birth control ring.

How much does a birth control ring cost in Singapore?

A ring in Singapore can cost around $60 per month.

FAQs

Who are not suitable for using birth control ring?

As the birth control ring contains both oestrogen and progesterone, it is not recommended if you:

• are over 35 years of age and a smoker as the ring will increase the risk of cardiovascular and Venous thromboembolism (VTE) risk. VTE is a condition that occurs when a blood clot forms in a vein. 

• have ever had a deep vein thrombosis, heart attack or stroke

• have had heart or circulatory problems, including high blood pressure

• have a condition that increases your risk of blood clots

• have severe liver problems

• have migraine with aura (warning symptoms)

• have had a history of breast cancer 

• have diabetes with complications

• overweight or obese

• can’t hold the ring in your vagina

• are a mother that breastfeeds because the hormones can reduce milk production

What are the side effects of the birth control ring?

Birth control rings, like any hormonal contraceptive method, may have potential side effects. It's important to note that individuals may react differently, and not everyone will experience these side effects. Common side effects of birth control rings, such as NuvaRing or Annovera, may include:

• nausea

• breast tenderness

• headaches

• vaginal discharge/irritation

• spotting or irregular bleeding

• changes in mood

• changes in libido

• changes in weight: some individuals may experience slight weight gain or changes in appetite.

• changes in skin: hormonal changes can affect the skin, and some individuals may notice changes in acne or skin condition.

• changes in vision: in rare cases, contact lens intolerance or vision changes may occur.

It's important to discuss potential side effects with a healthcare professional before starting any contraceptive method. Additionally, serious but rare side effects, such as blood clots, stroke, or heart attack, have been associated with hormonal contraceptives. Individuals with a history of certain medical conditions, including a history of blood clots or cardiovascular issues, may be advised against using hormonal contraceptives. Always consult with a doctor to determine the most suitable contraceptive method based on individual health considerations.

Does the birth control ring cause weight gain?

• The birth control ring has not been shown to cause weight gain.

• It can potentially cause short-term weight changes, but these are generally related to fluid retention due to hormonal changes rather than fat accumulation.

Does the ring stop your period?

• Yes. Some women use the ring to skip their period.

• As the birth control ring is a combination of hormonal contraceptive methods (containing both oestrogen and progesterone). These hormones will stabilise the endometrium lining, you will not experience menses when the ring is inside. 

• You can keep the ring inside the vagina for 3 weeks, then removed it for 1 week to allow withdrawal bleeding. The bleeding may not have stopped by the time a new ring should be placed. To maintain the effectiveness to prevent pregnancy, a new ring should be placed exactly 7 days after ring removal. 

• However, some women can experience unplanned bleeding (aka intermenstrual bleeding, which is bleeding and spotting between periods) while using the ring. Such bleeding occurs most often during the first few months, it is the temporary side effect of the ring insertion and usually does not indicate any serious problems.

When can I start using birth control ring after giving birth?

• If you are not breastfeeding, you may start using the ring earlier, on day 21 after giving birth.

• If you are breastfeeding, you can start using the ring 42 days (6 weeks) after giving birth. Do not use a birth control ring until you baby is 6 weeks old as it may reduce your breastmilk supply.

When can I start using the ring after a miscarriage or abortion?

• You can start the ring immediately after the miscarriage or abortion, no additional contraception needed to protect against pregnancy

• If it is inserted 5 days after the miscarriage or abortion, you will need additional contraception (such as condoms) for 7 days.

Does the birth control ring cause discomfort?

Most women don’t feel the ring after it is in place. If it doesn’t feel comfortable, it can be pushed further back or removed and reinserted. The exact position of the ring in the vagina is not critical as long as it feels comfortable.

Can I still have sex when the ring is in place?

Yes, you can still continue to have sex while the ring is inside your vagina. You and your partner may feel the ring during sex, but this is not harmful.

Does birth control ring protect against STIs?

No, birth control rings do not protect against STIs. Couples having sex must always use barrier methods (such as condoms) along with the ring to protect against STIs.

Can the birth control ring fall out?

It is uncommon for a properly inserted birth control ring to fall out on its own. When inserted correctly, the ring should stay in place within the vagina, and users usually do not feel its presence. However, there are instances where the ring might come out unintentionally. Here are some factors to consider:

• incorrect insertion

• expulsion during bowel movements

• tampon use

• sexual activity

If the ring falls out and has been outside the vagina for more than three hours, it may not provide full contraceptive protection for that cycle. In such cases, follow the instructions provided by your healthcare provider or the contraceptive's package insert regarding what to do in the event of accidental expulsion. Additionally, it's crucial to contact your doctor for guidance and to consider using a backup contraceptive method, such as condoms, until the situation is resolved.

What to do if the ring comes out?

• Vaginal muscles will hold the ring in place, so it is unlikely that it will fall out.

• However, the ring can sometimes come out (expulse) after or during sex, or if it wasn’t put in place properly.

• If the ring comes out, it can be rinsed with cool or lukewarm water and put it back as soon as possible (within 3 hours).

• If it was put in after 3 hours, you may need additional contraception until the ring has been in place for 7 days.

Birth control patch vs ring: Which is better?

• Both birth control rings and birth control patches contain the hormones oestrogen and progestin.

• Both work in the same way in preventing pregnancy. They are equally effective at preventing pregnancy if used correctly.

• The birth control ring is inserted into the vagina, thus it is not visible to others. While birth control patch is applied to the skin, so it may be visible externally.

• One of the disadvantages of using a birth control patch is it can get wet in the shower or when you are sweating. You might need to move it or pull the patch off to reposition it, these actions may cause the patch to lose its stickiness and it might detach/fall off easily.

• Birth control patches might also cause skin irritation, itching and soreness.

Is the ring safer than the pill?

The safety and suitability of these contraceptive methods can vary from person to person, and the choice between them often depends on individual preferences, lifestyle, and health considerations.

• Birth control pills and birth control rings work essentially the same way and are about equally effective.

• However, you need to be fully compliant with the pill regime to achieve its full contraceptive benefits.

• The NuvaRing is designed to be replaced monthly, while the Annovera Ring can be used over the course of 1 year (13 cycles).

• Since the birth control ring only requires you to change it once a month, it is more convenient and safer for you if you do not desire to take pills or you tend to forget to take pills daily at the same time.

• The NuvaRing releases a lower dose of oestrogen than released by the contraceptive pills, resulting in fewer side effects due to oestrogen. For example, the ring is associated with a lower risk of intermenstrual or irregular bleeding.

• Since the contraceptive ring is administered vaginally, it still works well even if you are having gastrointestinal upsets (vomiting or diarrhoea) whereas the pills might fail to work properly in such situations.

It's essential to consult with a healthcare provider to discuss your medical history, any potential side effects, and other factors that may influence the choice between the birth control ring and the pill. They can provide personalised advice based on your health needs and preferences.