Clinician question: How soon can women start using the vaginal ring after an abortion?

“Considering that most post-abortion counseling includes “nothing in the vagina” for 1 week and the manufacturer says no backup method is needed if the ring is started within 5 days of aspiration abortion, how do we properly instruct women when to begin to use the ring in order to provide most effective protection against pregnancy?”

Family Physician, Community Health Center, Bellingham, MA

Great question!

Women may ovulate soon after an abortion, so it’s important to start contraception promptly. Although most organizations recommend against inserting anything in the vagina during the first week post-abortion, there is little evidence to support this restriction. We do have evidence that early insertion of the vaginal ring is safe.

The ring takes effect right away if started within 5 days of aspiration abortion and within 7 days of medication abortion. If your patient decides to delay insertion beyond 5-7 days, she should use a barrier method for the first 7 days.

Patients may insert the ring as early as 1 day after misoprostol administration or aspiration abortion. Waiting an extra 2-3 days makes sense for patients with heavy bleeding.

Consult our Quick Start Algorithm for details on starting other contraceptives.

Resources
Ring User Guide
Your Birth Control Choices Fact Sheet
Quick Start Algorithm
Manual Vacuum Aspiration for Abortion Aftercare Instructions
Medication Abortion Aftercare Instructions (vaginal)
Medication Abortion Aftercare Instructions (buccal)

Sources
Fine PM, Tryggestad J, Meyers NJ, Sangi-Haghpeykar H. Safety and acceptability with the use of a contraceptive vaginal ring after surgical or medication abortion. Contraception. 2007; 75(5): 367-371

Mittal, S. Contraception after medical abortion. Contraception. 2006; 74(1): 56-60.

Nobili MP, Piergossi S, Brusati V, Moja EA. The effect of patient-centered contraceptive counseling in women who undergo a voluntary termination of pregnancy. Patient Education and Counseling. 2007; 65: 361-368

World Health Organization. Medical eligibility criteria for contraceptive use, 2015. 5th edition.

Pharma-free
The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.