Deviations from the intended schedule of the contraceptive vaginal ring

The contraceptive vaginal ring may be ineffective if insertion or removal deviates from the usual schedule. The ‘riskiest’ time to deviate from the schedule is in the first 7 days after the hormone-free interval, when the chance of breakthrough ovulation is highest.

If a replacement ring is more than 24 hours late (ie hormone-free interval is 8 days or longer), or it was removed before the end of the usual 3-week interval (either intentionally, or accidentally expelled), see Late reinsertion or early removal of the contraceptive vaginal ring: advice for patients (Figure 20.4) for advice.
If the ring has been in place for longer than the usual 3-week interval, see Late removal of the contraceptive vaginal ring: advice for patients (Figure 20.5) for advice.
Figure 1. Late reinsertion or early removal of the contraceptive vaginal ring: advice for patients (Figure 20.4).

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Note:

NB1: Ulipristal (another type of emergency contraception) is usually not suitable in this scenario; if any hormonal contraception (excluding levonorgestrel-releasing intrauterine contraceptive devices) has been used in the past week, it may reduce the effectiveness of ulipristal. The vaginal ring also can’t be reinserted for 5 days after taking ulipristal, so condoms are required for 12 days after taking ulipristal.

Modified with permission from: Contraception: an Australian clinical practice handbook. 4th ed. Ashfield, New South Wales: Family Planning New South Wales, Family Planning Victoria, and True Relationships and Reproductive Health; 2016.

Figure 2. Late removal of the contraceptive vaginal ring: advice for patients (Figure 20.5).

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Note: NB1: Ulipristal (another type of emergency contraception) is usually not suitable in this scenario; if any hormonal contraception (excluding levonorgestrel-releasing intrauterine contraceptive devices) has been used in the past week, it may reduce the effectiveness of ulipristal. The vaginal ring also can’t be reinserted for 5 days after taking ulipristal, so condoms are required for 12 days after taking ulipristal.