Combined vaginal ring

Question 1

Combined vaginal ring

The Nuvaring is a relatively new method of contraception, licensed in 2001. You may not need to memorise the method failure rules as they can be easily looked up. However it’s worth having a read of the following advice taken from the BNF

Answer 1

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.

Question 2

Combined vaginal ring

Answer 2

• 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 weekspregnancy 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.