Vaginal Ring

How it works

The ring releases hormones through the vaginal wall. Together, estrogen and progestin suppress ovulation. Progestin thickens cervical mucus. The endometrium becomes thinner. Hormone levels stay steadier throughout the day; as a result, some women may have less nausea and headache than with the pill. After stopping, fertility usually returns in the next cycle. The ring does not protect against STIs; a condom should be added.

Types

• Monthly ring (etonogestrel + ethinyl estradiol): In for 21 days, out for 7 days. A new ring is used each cycle. It is the most widely available form in Turkey.
• Annual ring (segesterone acetate + ethinyl estradiol): The same ring is used for 1 year. In for 21 days, out for 7 days. Availability in Turkey may be limited.

At SoftCare, which ring is suitable is decided based on availability and patient preference.

Who it is suitable for

• Those who forget to take a pill every day
• Those who want to regulate their periods
• Those with acne or painful periods
• Those who had stomach side effects with the patch or the pill

Contraindications (the same as for the combined pill):

• Over 35 and smoking more than 15 cigarettes a day
• Migraine with aura
• Uncontrolled high blood pressure
• Past venous thromboembolism
• History of breast cancer
• Severe liver disease
• Suspected pregnancy

The CDC US MEC 2024 criteria are used. In breastfeeding women, it is not recommended in the first 6 months.

Insertion and removal

Insertion:

• Wash your hands.
• Squeeze the ring between two fingers.
• Push it into the vagina. Exact positioning is not essential; it just needs to stay inside the vagina.
• It can also be inserted with a tampon applicator.

Removal:

• Hook the ring with your index finger and pull it out.
• Take a 7-day break. A withdrawal bleed occurs during this time.
• Insert a new ring on day 7, even if the bleeding has not stopped.

The ring may be felt during sex. If you prefer, it can be removed and put back in within 3 hours after sex. Water-based lubricants can be used. Oil-based products may damage the ring.

If it falls out or you forget

If the ring has been out for less than 3 hours:

• Rinse it with lukewarm water and put it back in right away.
• Protection continues.

If the ring has been out for more than 3 hours (week 1 or 2):

• Put it back in right away.
• Use condoms for the next 7 days.
• If it has been out for more than 3 hours in week 3:
• Throw the ring away.
• Insert a new ring right away, or wait 7 days and then insert a new ring.
• Use condoms for 7 days.

If the break lasts longer than 7 days:

• A pregnancy test is done.
• Insert a new ring and use condoms for 7 days.

At SoftCare, written instructions for what to do if the ring falls out are provided.

Changes in bleeding

Breakthrough bleeding or spotting may occur in the first 1–3 months. This is part of adjusting. It decreases over time. Periods usually become more regular and lighter. Amenorrhea is rare. If no bleeding occurs, a pregnancy test is done. Heavy or ongoing bleeding needs a check-up.

Side effects

Common:

• Headache
• Breast tenderness
• Nausea
• Increased vaginal discharge or irritation
• Breakthrough bleeding
• Mood changes

These effects usually decrease within 2–3 months. If they continue, the ring can be changed or another method discussed.

Rare but serious risks:

• Venous thromboembolism (at the level of the combined pill)
• Arterial thrombosis (in smokers over 35)
• Vaginal infection

If you have chest pain, shortness of breath, leg swelling, a sudden headache or vision loss, remove the ring and seek urgent care.

Benefits

• Regulates periods and reduces bleeding
• May ease period pain
• May improve acne
• No daily pill to remember
• Steadier hormone levels

These benefits are seen with regular use.

How it differs from the gold IUD and other methods

At SoftCare, the gold IUD is our first choice. The vaginal ring may be preferred in these situations:

• A patient who forgets the pill and does not want an IUD
• A patient who wants to regulate her periods
• A patient who had skin irritation with the patch

The gold IUD is hormone-free and carries no risk of forgetting. The hormonal IUD reduces bleeding. The implant is effective for 3 years. The ring is changed every 3 weeks. It does not protect against STIs; a condom should be added. The decision is based on risk of forgetting, menstrual profile and thrombosis risk.

Follow-up

• Check for bleeding and side effects in the first 3 months
• Annual blood pressure measurement
• Pap smear and HPV screening continue as routine
• Stop the ring if you are over 35 and smoke, or develop migraine with aura
• Urgent evaluation if there are signs of thrombosis

At SoftCare, patients starting the ring receive an insertion video or written instructions, plus urgent care criteria.

Our approach at SoftCare

At SoftCare Clinic, assessment for the vaginal ring starts with your gynecological history, blood pressure and questions about smoking. The gold IUD is our first recommendation; the ring is discussed with patients who forget the pill or want to regulate their periods. You are taught how to insert it. A check-up is planned within the first 3 months. Written instructions are given for when the ring falls out or is forgotten. If there is a thrombosis risk, another method is recommended. If there is an STI risk, condoms and testing are recommended.

Appointments: +90 212 241 30 10 · softcareclinic.com

References

• 1. Centers for Disease Control and Prevention (CDC). U.S. Medical Eligibility Criteria for Contraceptive Use, 2024.
• 2. Cleveland Clinic. Vaginal Ring for Birth Control.
• 3. UpToDate. Contraception: Hormonal contraceptive vaginal rings.
• 4. Organon. NuvaRing prescribing information.
• 5. TherapeuticsMD. Annovera prescribing information.
• 6. Trussell J. Contraceptive failure in the United States. Contraception. 2011;83(5):397–404.
• 7. T.C. Sağlık Bakanlığı. Gebeliği Önleyici Yöntemler.
• Note: Rules for when the ring falls out or for breaks may vary by type of ring. At SoftCare, the gold IUD is our first choice; the vaginal ring is discussed with selected patients. This reference list is for information purposes.

A citation does not mean that SoftCare wrote that text.

Medically reviewed by Op. Dr. Şükrü Sanus, Obstetrician & Gynecologist · Last medical review: 2 October 2026