Birth control

The vaginal ring

Now available in Canada and at least as effective as the Pill (95% to 99% effective), the vaginal ring is a new method of birth control in which a soft, flexible, clear plastic ring is inserted into the vagina where it slowly releases estrogen and progestin over a three-week period. This 54-millimetre (2-inch) diameter ring prevents pregnancy in much the same way the Pill does: the release of hormones prevents a woman's ovaries from releasing eggs. Naturally, if an egg isn't released, it cannot become fertilized and pregnancy cannot occur. In addition, the ring also causes other physical changes in a woman's body that make it difficult for male sperm to reach an unfertilized egg. The ring, however, does not provide a physical barrier to sperm and it does not protect against sexually transmitted infections.

The ring is worn inside the vagina for 3 weeks, followed by a ring-free week. It is during this ring-free interval that a woman has her menstrual period.

The vaginal ring should be left in place during sex. Most couples don't notice it during vaginal intercourse. For those who do notice it, it is usually not bothersome.

Available in only one size, the ring does not have to be in a particular position inside the vagina in order to be effective. This is because it's held in place by the vaginal walls. As such, it should not fall out. If by chance it does, it should be rinsed off and replaced as soon as possible. If it's been less than 3 hours since the ring has fallen out, you should be protected against unwanted pregnancy. If, on the other hand, it has been more than 3 hours since the ring has been out, a backup method of birth control should be used for the next 7 days. The ring must stay in for at least 7 more days if it's been out longer than 3 hours. This could mean that it's worn more than 21 days in a single month. A 7-day ring-free interval follows before the next ring is inserted.

If you forget to take the ring out and it has been in for less than 28 days, (that is, up to one week too long) remove it as soon as you remember. Leave it out for 7 days, then insert a new ring. You are still protected against pregnancy. If the ring has been in for more than 28 days, remove it immediately, insert a new ring and use a backup method of birth control for the next 7 days. You may not have a period at all that month, or you may have irregular bleeding.

If you forget to insert a ring after the ring-free week, insert the ring as soon as you remember and use a backup method of birth control for 7 days. If you've had unprotected sex after the ring has been out for longer than a week, consider using emergency contraception. You should not go longer than 7 days without wearing a ring or you may become pregnant. If in doubt, speak to your doctor or pharmacist.

A woman usually does not feel the ring once it's in place. She inserts and removes the ring herself, and most women find this easy to do.

The ring may be a more suitable option for women who have trouble remembering to take their pill every day. Women who cannot take the Pill for medical reasons should not use the vaginal ring. This includes women with a history of blood clots, heart attack, stroke, women with active liver disease, and women over 35 who smoke. Only your doctor can determine whether the ring is right for you.

In addition to preventing unwanted pregnancy, the vaginal ring also has benefits similar to those of the birth control pill. It can regulate a woman's periods, while reducing menstrual flow and cramping and alleviating premenstrual symptoms. It's also thought to help reduce acne, alleviate symptoms of endometriosis, and aid in the prevention of endometrial and ovarian cancers, but none of these has been studied. As with the Pill, the vaginal ring is completely reversible: when a woman stops using the ring, her body resumes its normal menstrual cycle and she is able to become pregnant.

Although uncommon, reported side effects of the vaginal ring include headaches, vaginal irritation, discomfort and discharge, breast tenderness and nausea. Bleeding between periods also occurred in about 5% of the women studied, particularly in the first few months. The ring, however, does not cause vaginal infections or weight gain.

The ring cannot protect against sexually transmitted infections. It's important to use both condoms and the ring in order to safeguard against pregnancy and sexually transmitted infections. Knowing your partner or believing you're in a monogamous relationship is not enough. You may have chosen to have sex only with your partner, but do not assume your partner feels the same way. Do not assume you're in a monogamous relationship. If you wish to stop using condoms, be sure to see your doctor for regular HIV testing and tests for sexually transmitted infections. Following that, talk with your partner and make sure you both agree to be strictly monogamous.