Combined vaginal ring (EE / etonogestrel)

• Contraception with lower peak-oestrogen exposure than COC

EE + etonogestrel released from ring → anovulation + mucus thickening.

• Insert for 3 weeks
• Remove for 1 week withdrawal bleed
• Or continuous — skip ring-free interval

Regimen

1 ring intravaginally × 3 weeks, remove for 7 days, insert new ring

• AbsoluteAs per COC (migraine with aura, VTE, smoker > 35 y, BMI ≥ 35 with risks)

• Vaginitis, discharge
• Breakthrough bleeding
• Same VTE class risk as COC

• • Remove if pregnancy suspected

• Enzyme inducers

  Avoid

  ↓ efficacy

• 💡 Can be removed up to 3 h for intercourse without loss of efficacy
• 💡 If out > 3 h in week 1/2 → 7 days barrier; week 3 → insert new ring