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Contraception - Management
Combined contraceptive vaginal ring not changed or new cycle started late: what should be done?

Lengthened ring use

  • If the ring has been left in place for up to 4 weeks (rather than the recommended 3 weeks), contraceptive efficacy is not reduced. Advise the woman to remove the ring and insert a new ring after one ring-free week.
  • If the ring has been left in place for more than 4 weeks (rather than the recommended 3 weeks), contraceptive efficacy may be reduced. Advise the woman to rule out pregnancy and consider emergency contraception (if appropriate) before inserting a new ring.
  • If a woman has not used the ring as recommended and has no withdrawal bleed in the ring-free week, advise her to rule out pregnancy before inserting a new ring.

Lengthened ring-free interval

  • Advise the woman to insert a new ring as soon as she remembers.
  • Advise her to use additional barrier contraception for the next 7 days.
  • If the woman had sexual intercourse in the ring-free interval, advise her to rule out pregnancy and consider emergency contraception (if appropriate) before inserting a new ring.
Basis for recommendation
  • These recommendations are based on the Summary of Product Characteristics for NuvaRing® combined vaginal ring [ABPI Medicines Compendium, 2009b].
    • The longer the ring-free interval the higher the risk of pregnancy.
    • A study has shown that intrauterine concentrations of contraceptive steroids with the vaginal ring are similar to the levels in women who use the combined oral contraceptive. There are currently no reports of the clinical outcomes of pregnancies exposed to the vaginal ring.

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