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Meet the Birth Control Vaginal Ring: Benefits, Side Effects

Meet the Birth Control Vaginal Ring: Benefits, Side Effects

  • Sonia Easaw, M.S., MPH
    Reviewed By: Shannon DeVita DNP, FNP-BC, CPNP-PC, Julie Lamonoff, CNM, OBGYN-NP
    Updated:

You may have heard of the new Annovera™ ring, marketed in ads dripping with a cool, unapologetic vibe, unafraid of saying the "V-word" (let's say it, people, vagina!).

However, this technology is not entirely new because it's been in development for the past 40 years. The first FDA-approved ring in the US, the NuvaRing™, has been around since 2001. What is new, specifically with the Annovera ring's arrival in 2018, is that people are starting to recognize how birth control rings are a huge global step forward.

But how does it work? Is it possible that this innocent-looking, soft and squishy ring is worth trying? The birth control pill is probably the method you know best. But something worth getting to know.

What is the vaginal birth control ring?

As the name suggests, a squishy, soft plastic ring inserted into the vagina to prevent pregnancy. It's different from birth control pills in how it looks and how it's used, but it's similar in the most crucial way: it delivers the hormones estrogen and progestin to your body to prevent pregnancy and works just as well as the pill.

Essentially, it's the "cool kid" on the block because it's a more recent type of hormonal birth control that came after the pill.

Editor's note: Though the birth control ring may be new and "cool," that doesn't mean it's for everyone. For many, the birth control pill is something they're used to taking and is just as effective.

There are two brands of birth control rings currently on the market:

  1. Nuvaring™ - replace with a new ring once a month

  2. Annovera™ - replace with a new ring once a year

The big difference in hormone delivery from the pill is that the birth control ring gradually and constantly releases hormones into your body, unlike the pill, where there can be peaks and valleys in hormone levels.

birth-control-ring-annovera-box-1

An awesome scientific invention

So you might be wondering how a plastic ring is going to help prevent you from getting pregnant. But it's pretty high-tech: Once the birth control ring is in the vagina, it starts to constantly release hormones from its core into the moist membranes (coatings) that line and protect the skin inside the vagina. These membranes will absorb (dare we say, embrace) the hormones and let them start to do their pregnancy-prevention magic.

What's so great about the method?

Okay, so it sounds interesting, but why all the fuss? It's the first time in birth control history that we have a contraceptive ring that women can insert themselves (no need for a doctor to insert it), and in Annovera's case, it lasts a whole year. This is excellent news for women worldwide, especially during a global pandemic where people have less access to contraception and struggle to get reproductive health care regularly.

Let's talk timelines - how long does it last, etc.

The NuvaRing and Annovera are the two brands of birth control rings on the market today.

Annovera is reusable

The Annovera ring lasts for a whole year, as long as it takes our planet to orbit the sun. This is 13 cycles or 13 periods. But that doesn't mean it stays in the vagina for a whole year without coming out! It's more like it stays in place for 3 weeks. You'd take it out every month for 7 days to have your period and then reinsert it for another 21 days.

The NuvaRing must be replaced every month

The NuvaRing launched in 2001 before Annovera came onto the market in 2018, so it doesn't have the flashy new technology to last a whole year. So you'd need to replace the old NuvaRing with a new NuvaRing every month. But that's the only difference - it works just as well.

birth-control-ring-nuvaring-size-in-hands

When to start the ring

Let's say you've talked to your doctor about the ring and decided to try it. They'll write you a prescription for either starting NuvaRing or Annovera and advise you on when to start using it.

Depending on if you were taking other hormonal contraceptives before, or if you're on a specific day of your menstrual cycle, they'll give you instructions on when it will start being effective. Essentially, the ring starts working right away, but you may need to wear another form of protection like a condom for the first 7 days if you have sex.

How about when you want to stop using the ring? You'd be able to return to having your regular periods within 0-6 months of not using the ring.

What the birth control ring is NOT: Clearing up the confusion

There are a bunch of things NOT.

The vaginal birth control ring is NOT:

  • an IUD like Mirena™ or the ParaGard™ copper IUD

  • an implant like Nexplanon™

  • a way to protect against STDs,

  • or what Beyoncé is referring to in Single Ladies (Put A Ring On It).

It's understandable to confuse the birth control ring with the birth control IUD, but you wouldn't get confused if you were to see the two side by side. The IUDs are t-shaped and need to be inserted by a doctor. They are long-acting, reversible birth control methods, meaning the doctor can insert it there to last for a certain max number of years (and you wouldn't have to worry about it), but they can also remove it whenever you choose.

However, the birth control ring is woman-controlled, and you can remove it and place it back in at home without going to the doctor.

How effective is the birth control ring?

The birth control ring is pretty effective. We would have said super effective, but let's face it, humans are not robots, and sometimes, the user herself makes a mistake. She may forget to reinsert the Annovera ring on time after having it out for the period week or have trouble getting a replacement Nuvaring and insert it late. Also, the ring might fall out.

Typical use vs. perfect use

Researchers rely on survey data to estimate contraceptive effectiveness. Calculating the pregnancy rate means counting how many #fail scenarios there were and all of the times that women used the ring correctly and consistently. The CDC notes the birth control ring's pregnancy rate with "typical use" as 9%. This figure means that 9 women out of 100 could get pregnant in a real-world scenario when using the birth control ring. However, if everyone used the ring correctly and consistently, every single time, the pregnancy rate when using the ring would be 0.3% - this is called "perfect use."

Effectiveness of birth control ring vs. the pill

How does the pregnancy rate of 9% stack up against the pill, you might ask? It's precisely the same. Researchers estimate that the pregnancy rate with typical use (not perfect) for the birth control pill is 9%, just like the ring. In an ideal world, if everyone took the pill correctly and consistently, every single time, the CDC says that the pregnancy rate would be 0.3%. This is the same "perfect use" number as the ring.

Here's a handy list (source: FDA chart) of the effectiveness of using the birth control ring vs. other hormonal contraception, with typical use:

  • Ring: 91% effective

  • Pill: 91% effective

  • Patch: 91% effective

  • Shot 94% effective

  • IUD: 99+% effective

  • Implantable rod: 99+% effective

How about if you use the ring perfectly, always remembering to put it back in if it falls out, and replace or reinsert when necessary? Here's how the methods of birth control stack up against each other, with perfect use:

  • Ring: 99.7% effective

  • Pill: 99.7% effective

  • Patch: 99.7% effective

  • Shot: 99.8% effective

  • IUD (copper): 99.4% effective

  • IUD (like Mirena™): 99.8% effective

  • Implantable rod: 99.95% effective

You can see that the typical use and perfect use effectiveness of the IUD and implantable rod are the same; that's because there's no room for user error with these methods.

How does the birth control ring work vs. the pill?

It seems like the birth control ring works like magic. But there's some pretty cool science behind it.

Similar hormones, lower doses

You'll recognize the hormones involved - they're very similar to the pill (progesterone and estrogen).

But unlike the pill, the ring's hormones can be absorbed faster since the vagina's tissues absorb it, and it's carried into the bloodstream. With the pill, you have to swallow it; next, it goes through your digestive system, and then it is absorbed into the bloodstream.

That's why the ring can deliver relatively lower doses of hormones than the standard combination birth control pill. But once the hormones are delivered, the same thing happens with the ring as it does with the pill: the body's ovaries are prevented from releasing an egg (a process called ovulation) to prevent pregnancy.

Not only does the ring prevent ovulation, but it also thickens the cervical mucus (fluid) of your cervix, which is in between the vagina and uterus. This makes it harder for sperm to enter your uterus!

How to use the ring vs. taking a pill

The pill is pretty straightforward to use, in theory. You take it by mouth, at the same, every day, as directed.

birth-control-ring-annovera-in-fingers-squish

The ring is also really straightforward to use. The makers of Annovera describe how to use it like this:

  1. You would first squeeze the ring with your thumb and index finger into an oval shape.

  2. Then, you'd get into a comfortable position and insert it inside the vagina as far as possible (kind of like a tampon, but without an applicator), leaving it in for 3 weeks.

  3. You would then take out the ring for the final week of the month when you'd get your period. The week without any active hormones is just like when you'd get a period during the week of placebo pills in a birth control pack.

  4. You have the option to skip your period for either NuvaRing or Annovera.

Annovera is a reusable ring that lasts for 1 year, so it needs to be washed with mild soap and lukewarm water and pat dry when it's taken out to store and before you reinsert it the next month. The NuvaRing is not reusable, so you'd simply use a new one each month.

Benefits and disadvantages of the birth control ring

Despite being revolutionary and safe for most women, Annovera or the Nuvaring isn't for everyone. Not to worry, though; if the birth control ring isn't the right choice for you, there will probably be another method that should work. Let's start with who shouldn't use it and possible side effects.

Who shouldn't use the birth control ring

For every method of hormonal birth control, there will be some people who shouldn't use it. Your doctor will ask you about your medical history before prescribing the ring.

The FDA says that you should not use the ring if:

  • You're over 35 and a smoker

  • You have a high risk of arterial or venous thrombotic disease

  • You have or have had breast cancer in the past

  • You have liver disease

  • You have unexplained vaginal bleeding

  • You're hypersensitive to the physical components of the ring

  • You're on Hepatitis C drug combinations

  • You have certain kinds of migraine headaches

  • You have high blood pressure that can't be controlled with medicine

If you have something in the list above, you may not be able to take other hormonal birth control methods, including the combination birth control pill. Check with your doctor to make sure.

Side effects of birth control rings

As with all medications, there are side effects you should know. The birth control ring is safe for most people, but your doctor will first take your medical history and confirm that it's something safe for you as an individual.

The Office on Women's Health lists the minor and more severe side effects from birth control rings (the NuvaRing, specifically).

The minor side effects of birth control rings that could go away over time are:

  • Headache

  • Upset stomach

  • Sore breasts

  • Menstrual period changes

  • High blood pressure

  • Vaginal irritation and discharge (a side effect unique to birth control vaginal rings)

More serious (and less common) side effects of birth control rings include:

  • Blood clots

  • Stroke and heart attack

Sometimes in the conversation about birth control, we lose sight of the risks inherent to childbirth and pregnancy itself. It's good to be aware of them, just for perspective's sake. For example, if you are pregnant, the CDC says you are 5 times more likely to experience a blood clot than if you were not pregnant. While taking some forms of birth control pills, the Cleveland Clinic says your risk of developing a blood clot increases 2 to 4 times. This risk level on birth control is lower than the level of risk for blood clots if you were pregnant.

How do the ring's side effects compare to the pill's?

As you can see above, birth control rings have one unique side effect that you won't get with birth control pills: vaginal irritation and discharge.

However, when scientists compared the ring to the pill, they found these differences in side effects between the two:

  • After trials with NuvaRing were over, fewer women stopped using the ring than the number of women who stopped using the pill. This could be that the women were more satisfied with the ring.

  • The women in the trials had fewer bleeding problems with fewer episodes of breakthrough bleeding or spotting. This might be because hormone levels tend to stay steady when you're on the ring vs. the pill.

  • Researchers found that ring users had less nausea and acne.

Editor's Note: Here's a slight caveat with the above differences: These studies were on the older side (about 10-15 years ago), and they weren't studying Annovera then because it didn't yet exist!)

What are the pros of using the birth control ring?

Naturally, here's what everyone looking into birth control rings wants to know: What are the pros? It can be a big step going from taking the pill to using the ring, and there needs to be a good enough reason for someone to go that route.

To make your birth control decisions easier (and, just maybe, make your life easier), here's a list of pros of the ring:

  1. Highly effective. The birth control ring (Annovera or Nuvaring) is very effective when you use it correctly. It is just as effective as the birth control pill (91% effective in preventing pregnancy with typical use, and 99.7% effective with perfect use).

  2. Safe for most women. Though some women shouldn't use the ring, it's been shown to be safe for most people. However, this is a call that your doctor will make when they write you a prescription for birth control.

  3. Convenient. You don't have to worry about taking a pill every day.

  4. Greater control. It's woman-controlled, meaning that you can insert it and remove it at home without going to a doctor's office.

  5. No refrigeration necessary. You don't have to store it in the refrigerator, a big plus in places with fewer resources.

  6. Lower dose of hormones. One of the ring's advantages is its lower dose of hormones because it's constantly releasing them (unlike the pill, where it takes time to release and hormone levels fluctuate).

  7. Can get it online. Telemedicine companies like ours offer and prescribe the Annovera ring and can send it through the mail to your door.

What are the cons of using the birth control ring?

Here's what some women say are the disadvantages of using the ring. Keep in mind that a lot of it comes down to individual preference.

Here are some considerations that Harvard Medical School says you should know about the ring:

  1. Insertion method. Though the ring may be relatively easy to use for some, others may find it to be a bit much to have to insert the ring into the vagina with their fingers and remove it when it's time. However, the ring is quite squishy and soft and should be inserted inside so that it's no longer felt. Comfort is key!

  2. Remembering to insert/reinsert. If you have a million things going on, sometimes it's hard to remember to take out the ring when it's time and reinsert it on time. Though you have to remember to do it twice a month instead of every day, as you would with the birth control pill, it's still something to add to your list. However, the makers of Annovera have a handy app on the App store™ or Google Play™ that can help with that. There are also other apps out there, like "MyRing - contraceptive ring™" that can help remind you to insert or remove your birth control ring.

  3. Falling out of the vagina. No matter how careful you are, the ring could fall out; for example, when you're in the "throne room" doing your business (no shame, everyone must defecate!). If it falls out, simply wash it with soap and lukewarm water, dry, and reinsert it within 3 hours.

  4. No protection against STDs. This statement is true of all hormonal birth control methods like the ring or pill. Only a condom can protect you against STDs.

How to get the birth control ring

To get the birth control ring, you'd need to get a prescription from a doctor first.

  1. Doctor's office. We know it's not always easy to get an appointment at the doctor's office, but if you already have an OB-GYN, you may be able to make a phone or virtual appointment.

  2. Prescribed online. You can also get the ring prescribed online and paid for in full by your health insurance provider. Our company, The Pill Club, prescribes the Annovera ring online and offers free delivery to your door. A couple of other companies provide online prescription and delivery - check it out on the official Annovera website.

  3. Health clinic. Health clinics like Planned Parenthood can prescribe the birth control ring.

How much does it cost

If you have medical insurance, the ring should be free. If you have to pay out of pocket, that's where things can get expensive. Before you decide to pay out of your pocket, check if you qualify for government health insurance programs like Medicaid.

Planned Parenthood says that the NuvaRing costs anywhere from $0 to $200 per month, which is pretty steep. Make sure to use your health insurance (if you have it) to get it for free.

We looked it up, and it seems that Annovera has a savings program where you can get it for as little as $60, but make sure to check if there are any caveats. They also have a handy insurance checker to see how much your insurance will cover (probably the entire cost but important to check).

Is the ring any better than the pill?

This is a question we, unfortunately, can't answer for you. Whether you prefer the ring over the pill or vice versa is something entirely up to you. But we're here to help give you the correct information.

The Office on Women's Health breaks it down well. They say that the best birth control method for you depends on multiple factors that can change over time.

Before you decide on a birth control method, whether the ring, the pill, or something else, you can think about:

  • Whether you want to get pregnant soon, later, or ever

  • How effective is the method; in the case of the ring and the pill, they're equally as effective

  • How comfortable you are with the method; e.g., inserting/removing the ring vs. taking the pill

  • Side effects and your overall health

Takeaways: The birth control ring

The Annovera ring and the NuvaRing are pretty cool methods of birth control:

  • They are flexible plastic rings that are squishy and should be comfortable to use.

  • You'd insert the ring into the vagina and remove the ring yourself, saving you a bunch of trips to the doctor since they need to be removed and reinserted each month.

  • In the case of Annovera, it's reusable and lasts for an entire year. The NuvaRing would need to be replaced each month.

  • The ring gradually releases the same hormones like the birth control pill into your body, preventing pregnancy at a rate of 91% with typical use.

  • Neither ring requires refrigeration.

It's been said that the contraceptive ring is "a global step forward." Especially in places with fewer resources globally, having a woman-controlled contraceptive method that can last a whole year without refrigeration is pretty amazing. And it's also pretty useful during a global pandemic when it's harder to go into a doctor's office or pharmacy every month to pick up birth control pills. Whatever birth control method you choose, just know that it's your choice, and knowing the facts will help you make the right decision.

Sources:

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