The vaginal ring is a combined hormonal contraceptive method. It is a small, soft ring that is flexible, transparent, composed of non-toxic and non-irritant material, latex and silicone-free, and that has an outer diameter of 54 mm and a transverse diameter of 4 mm. The ring must be inserted inside the vagina to be able to perform its contraceptive action.

Each ring contains a small amount of two female sex hormones – a progestin (etonogestrel) and an estrogen (ethinyl estradiol). The ring slowly releases these hormones, which are then absorbed by the vaginal mucosa and pass into the bloodstream. The ring releases lower and more consistent amounts of estrogen than the combined pill and the patch, and is therefore considered a true low-dose combined hormonal contraceptive.

It works just like a combined contraceptive pill (the pill), but instead of taking a pill every day, the ring is left in the vagina for three weeks in a row. The two female sex hormones prevent the release of an egg cell from the ovaries. If no egg cell is released (ovulation), you cannot get pregnant.

The vaginal ring is an estrogen-progestin contraceptive. What changes, with respect to the pill and the patch, is the method of administration. The pre-established dose of hormones is released locally in the vagina, and not taken orally every day. The vaginal ring is recommended for all women who want an effective hormonal contraceptive, and more so for those women who have problems of any kind with taking the pill. It is therefore suitable for women who have digestive intolerance (heartburn, nausea, vomiting, etc.) with oral contraceptives, women who take the combined pill but have difficulties taking it on a regular schedule (because they travel, are particularly forgetful, have a hectic lifestyle, etc.), women with metabolic problems for which the oral route of administration is not recommended.

You can be the one to insert the ring into your vagina as well as take it out. Your gynecologist will give you all the instructions on how to use it when you do it for the first time. If you were not using another method, the vaginal ring must be inserted on the 1st day of the menstrual cycle, and left in the vagina for 3 weeks in a row.

If you insert it on the first day of your cycle, you will have immediate contraceptive protection. If you insert it 2-5 days afterward, you should use an additional method of contraception for 7 days (such as a condom).

It is a good habit to regularly check to make sure that the ring is still in your vagina. After the third week, you should remove the ring for a period of one week. Usually, menstrual-like flow occurs during this ring-free interval.

How to insert and remove the ring

1. Before inserting the ring into the vagina, make sure that it has not expired.
2. Always wash your hands thoroughly before inserting or removing the ring.
3. Choose a position that will be convenient, for example, standing with one leg up, squatting, or lying down.
4. Remove the ring from its package. Hold it between your thumb and forefinger, squeeze it and gently insert it into your vagina. Once it has been inserted you won't feel it. If you feel an irritating sensation, push the ring further into the vagina, always being very gentle. The exact position of the ring inside the vagina is not important. What is important is that it is inserted in a way that is comfortable for you. ** After 3 weeks, remove the ring from the vagina. You can remove it by hooking your index finger under the front edge of the ring, or by grabbing the rim and pulling it out.

** An alternative option is to insert the ring using the special applicator

The insertion of the vaginal ring is as simple as the use of a tampon – the ring is small and soft. To insert it, just hold it between your thumb and forefinger. Once inserted, the ring easily adapts to your body. In any case, its position in the vagina will not affect its effectiveness, so you don't have to worry too much about its correct insertion. In any case, relax. There is also a convenient applicator that can make the insertion easier.

I didn't know that it was also available in Italy, no one told me about it before. Ever since I discovered it, I have found it to be very comfortable and hygienic. I recommend it to all my friends.

There are several women who have the same opinion as Eleanor. One of the reasons for this choice, they say, is the convenience of not having to remember to take the pill every day. Insert the ring and that's it, for three weeks, and you don't have to think about it anymore.

Wilma highlights another advantage of this method compared to the pill. While the hormones of the combined pill are absorbed from the intestine and metabolized in the liver before being discharged into the blood, with the vaginal ring (or patch), the hormones skip this extra step and are absorbed directly into the bloodstream. This is ideal for anyone who has difficulty swallowing, or for those who have problems with intestinal absorption and/or intolerance. The effectiveness of the vaginal ring is also not altered in case of vomiting or diarrhea.

Do you have the same fear as Elisa? It is unfounded, you can check this for yourself when using it. The ring cannot be felt and does not cause irritation because it positions itself naturally in the upper part of your vagina, which is insensitive. It is rare that a partner will notice its presence, and in the rare cases where this does happen, it does not cause discomfort.

In the case where you are the one that feels its presence, all you have to do is push it a little further up using your index finger.

The experience that Erica mentions is actually very rare. The ring may be expelled accidentally from the vagina if, for example, it has not been inserted properly, during the removal of a tampon, during sexual intercourse, in conjunction with constipation or in the case of uterine prolapse. If any of these cases apply to you, you should regularly check that the ring is still in your vagina.

In the case where it remains outside the vagina for less than 3 hours, once repositioned in the correct position, the ring will still continue to protect. Thus, you can rinse it in cold or warm water (not hot water) and reinsert it. If, however, the ring has been out of the vagina for more than 3 hours, contraceptive efficacy is not guaranteed. In this case, contact your gynecologist.

The ring breaks very rarely, so do not panic!

If your ring should break, get rid of it and put in a new ring as soon as possible. For the first 7 days, use a condom for complete protection. If you had sexual intercourse before you noticed that the ring was broken, consult your gynecologist.

Did you ever forget to remove a ring? If it is left inserted in the vagina for more than 3 weeks, but no later than four weeks, it can still protect you from an unwanted pregnancy. In this case, remove it and let the regular one-week interval pass ring-free before inserting a new ring.

If, however, the ring has been left in place for a period greater than 4 weeks, there is a chance that pregnancy can occur if you have had sex during that time. Contact your gynecologist before inserting a new ring.

If you forgot to insert a new ring after the ring-free interval, and it has been more than 7 days, insert a new ring as soon as you can. For the first week, if you have sex, it's best that you use an additional contraceptive method, such as a condom. If you have had sexual intercourse during the break between one ring and the next, you have to consider the possibility of pregnancy. Talk about it with your gynecologist immediately. The longer the ring-free interval, the higher the risk of pregnancy.

Lucia's sister is right, things do change based on whether you used the ring correctly or not.

If you have used it correctly, following all instructions, and you have not taken any other medicines, it is very unlikely that you are pregnant. In this case, you can continue to use the ring as usual. However, in the case that the pseudo-menstruation fails to appear two times in a row, you may be pregnant. Immediately consult your gynecologist. Do not start using a new ring until he/she has ruled out pregnancy.

In the case that you have used the ring incorrectly, lack of pseudo-menstrual flow could signify the start of a pregnancy, which must be verified by the gynecologist. Contact him/her before using a new ring.

The appearance of unexpected vaginal bleeding between one cycle and the next is really very rare, especially with the ring, which is the hormonal contraceptive method that best controls the monthly cycle. The things to do in this case are different depending on whether you inserted the ring correctly or not. It may be necessary to use hygienic protection. In any case, leave the ring in the vagina and continue to use it normally. Consult your gynecologist if the irregular bleeding continues, becomes intense or reoccurs.

What Nina asks is possible by paying a little attention. If you are using the ring according to the instructions (as for all combined hormonal methods), your menstrual flow (withdrawal bleeding) will begin during the ring-free interval. If you want to change the start day of the flow, you can shorten the ring-free interval (but never lengthen it!)

For example, if your menstrual flow usually starts on Thursday and you want to change it to Monday (3 days earlier), you will have to start the following month. All you have to do is insert the new ring 3 days earlier than usual.

If your ring-free interval is very short (e.g. it lasts 3 days or even less), you may not have the usual withdrawal bleeding, but could manifest spotting (small spots or drops of blood) during the use of the next ring.

If you're not sure how to proceed, or if you have any questions, don't hesitate to contact your gynecologist for clarification.

This question posed by Caterina is delicate. Postponing your menstrual cycle is never recommended, even though you could do it once, for all combined hormonal methods. In any case, before you proceed, always ask your gynecologist's advice.

You can postpone your pseudo-menstruation (withdrawal bleeding) by inserting a new ring immediately after removing the old one, without having a ring-free interval. The new ring can remain inserted for a maximum period of 3 weeks. While using the new ring, spotting (small spots or drops of blood) may occur. Remove the ring whenever you decide you want to have your new flow. Wait for the regular ring-free interval of one week before inserting a new ring to begin a new cycle.

There are usually no issues in the case of any procedures or operations. As with other combined hormonal methods, the vaginal ring should not be interrupted. In any case, talk with your gynecologist to get proper guidance, also based on the type of procedure you will be undergoing.

Being an estrogen-progestin contraceptive, the contraindications are the same as for the pill. The vaginal ring is not recommended for women older than 35 years of age, (especially if they are heavy smokers), during lactation (a condition for which the progestin-only pill is recommended), in the case of a family history of thrombosis (presently or in the past), for women with serious chronic diseases (type 2 diabetes, hypertension, hyperlipidemia, cancer, Crohn's disease and others), for women with irregular vaginal bleeding, liver disease, severe obesity (BMI ≥ 30) or with allergies to the ingredients (active and/or inactive ingredients).

Ludovica's question is not trivial because the number of over-weight people is increasing, and many false beliefs are in circulation that should be clarified. The vaginal ring may also be recommended in the case of excess weight and mild obesity since its main mechanism of action (inhibition of ovulation) is NOT affected by body weight. Several studies have in fact shown, contrary to what was thought up until a few years ago, that the hormone serum concentration levels reached, and thus the contraceptive efficacy and safety, are reliable even in the case of obesity.