Patients or carers should be
given advice on how to administer vaginal ring.
Counselling The presence of the ring should be checked
regularly.
Missed doses
Expulsion, delayed insertion or removal, or broken vaginal
ring If the vaginal ring is expelled for less than 3 hours,
rinse the ring with cool water and reinsert immediately; no
additional contraception is needed.
If the ring remains outside the vagina for more than
3 hours or if the user does not know when the ring was
expelled, contraceptive protection may be reduced:
. If ring expelled during week 1 or 2 of cycle, rinse ring
with cool water and reinsert; use additional precautions
(barrier methods) for next 7 days;
. If ring expelled during week 3 of cycle, either insert a
new ring to start a new cycle or allow a withdrawal bleed
and insert a new ring no later than 7 days after ring was
expelled; latter option only available if ring was used
continuously for at least 7 days before expulsion.
If insertion of a new ring at the start of a new cycle is
delayed, contraceptive protection is lost. A new ring
should be inserted as soon as possible; additional
precautions (barrier methods) should be used for the first
7 days of the new cycle. If intercourse occurred during the
extended ring-free interval, pregnancy should be
considered.
No additional contraception is required if removal of the
ring is delayed by up to 1 week (4 weeks of continuous
use). The 7-day ring-free interval should be observed and
subsequently a new ring should be inserted. Contraceptive
protection may be reduced with continuous use of the ring
for more than 4 weeks—pregnancy should be ruled out
before inserting a new ring.
If the ring breaks during use, remove it and insert a new
ring immediately; additional precautions (barrier
methods) should be used for the first 7 days of the new
cycle.
PDF page 866
