Chapter 7

Supporting New and Continuing Users

Instructions for Late Replacement or Removal

Left ring out for 48 hours or less during weeks 1 to 3?
  • Put the ring back in as soon as possible.
  • No need for a backup method.
Left ring out for more than 48 hours during weeks 1 or 2?
  • Put the ring back in as soon as possible.
  • Use a backup method* for the next 7 days.
  • If the ring was left out for more than 48 hours in the first week and unprotected sex occurred in the previous 5 days, consider taking emergency contraceptive pills (ECPs) (see Chapter 3 – Emergency Contraceptive Pills).
Left ring out for more than 48 hours during week 3?
  • Put the ring back in as soon as possible.
  • Use a backup method* for the next 7 days.
  • Start a new ring at the end of the third week and skip the ring-free week. If unable to start the new ring at the end of the third week, use a backup method* and keep using it through the first 7 days after starting a new ring.
Forgot to insert a new ring at beginning of the cycle?

  • Insert a new ring as soon as possible. If late by only 1 or 2 days (48 hours or less)—that is, the ring is left out no longer than 9 days in a row—no need for a backup method.

  • Keep the same ring removal day.

  • If the new ring is inserted more than 2 days (more than 48 hours) late—that is, the ring is left out 10 days or more in a row—use a backup method* for the first 7 days of ring use.

  • Also, if unprotected sex occurred in the past 5 days, consider taking ECPs (see Chapter 3). 
Kept ring in longer than 3 weeks?

  • If the same ring is used for up to 28 days (4 weeks), no backup method is needed. She can take a ring-free week or start a new ring immediately.

    If the same ring is used for 28 to 35 days (more than 4 weeks but less than 5 weeks), insert a new ring and skip the ring-free week. No backup method is needed. 

* Backup methods include abstinence, male and female condoms, spermicides, and withdrawal. Tell her that spermicides and withdrawal are the least effective contraceptive methods. If possible, give her condoms.