Vaginalring

The vaginal ring is a flexible, silicone-based device used for contraception. It is inserted into the vagina and releases synthetic hormones—ethinyl estradiol and a progestin (etonogestrel)—over about three weeks.

Mechanism of action involves hormone delivery that suppresses ovulation in most cycles, thickens cervical mucus to hinder sperm entry, and partially thins the uterine lining to reduce the chance of implantation. This combination decreases the likelihood of pregnancy during use.

Usage typically involves wearing the ring continuously for three weeks, followed by a one-week ring-free interval during which a withdrawal bleed may occur. After the ring-free week, a new ring is inserted to begin the next cycle. If the ring is accidentally expelled or left out for a short period, it should be reinserted promptly; if out for longer, guidance from a clinician or backup contraception may be advised.

Effectiveness varies with use. With typical use, about 7% of users may become pregnant in the first year; with perfect use, the rate is much lower. The vaginal ring’s effectiveness is similar to that of other combined hormonal contraceptives.

Advantages include not requiring daily action and reversible fertility after discontinuation. Common side effects can include nausea, headache, breast tenderness, vaginal discharge, and irregular bleeding. Rare but serious risks include venous thromboembolism, stroke, or heart attack, particularly in older users who smoke or have certain health conditions.

Contraindications and cautions include pregnancy, a history of venous thromboembolism or certain cardiovascular diseases, liver disease, abnormal vaginal bleeding, breast cancer or other estrogen-sensitive cancers, and uncontrolled hypertension. Caution is advised with migraines with aura or in women over 35 who smoke.

Interactions with certain antibiotics (for example, rifampin) and anticonvulsants can reduce effectiveness. Breastfeeding considerations may favor progestin-only methods. Availability generally requires a clinician’s prescription. Storage is at room temperature, away from heat and sunlight.