What to Do If You Forget to Take Out Your NuvaRing

The NuvaRing is a clear, bendable prescription contraceptive ring placed in the vagina for three weeks each month. This hormonal birth control method slowly releases a low dose of estrogen and etonogestrel (a type progestin) to protect you against pregnancy for the month.

If you're going to use NuvaRing, though, you need to remember when it is time to take it out as well pay attention to whether or not it may have accidentally fallen out.

How to Use It

Each NuvaRing is prescribed on a 28-day cycle. To use the product correctly:

• Insert the NuvaRing on day 1 of week 1
• Leave it in place for week 2 and week 3
• On day 1 of week 4, take out your NuvaRing, which will likely trigger your withdrawal period
• A week later, insert a new NuvaRing to begin the next 28-day cycle

If You Forget to Remove a NuvaRing

If it is day 2 (or later) of week 4, and you just realized that you forgot to take it out, don't worry; you will still have pregnancy protection for this entire week. However, you would need to make a slight adjustment to your prevention schedule.

• Keep your NuvaRing in place for the entire week 4 (completing the 28 days of the cycle).
• Take the NuvaRing out on day 1 of your next 28-day cycle.
• Wait seven days and insert a new NuvaRing. You can consider this the beginning of your next 28-day cycle (day 1 of week 1).
• Use a backup birth control method (like spermicide or condoms) for the first seven days after inserting the NuvaRing.

Forgetting for More Than 28 Days

If you forget to remove the NuvaRing and it remains in place for longer than 28 days, the levels of estrogen and etonogestrel may have dropped to such a level that pregnancy is possible. Under these circumstances:

1. Remove your NuvaRing immediately.
2. Take a home pregnancy test or schedule one at your doctor's office.
3. If you aren't pregnant, insert a new NuvaRing and consider it day 1 of week 1 (the beginning of your next 28-day cycle).
4. You must then use a backup birth control method for the next seven days.

Loss of Effectiveness

Generally speaking, the NuvaRing is 91% to 99.7% effective. Your NuvaRing is still effective if you forgot to take it out during week 4. If you leave it in for more than 28 days (and do nothing), then the NuvaRing may no longer be effective.

However, current research is unclear on exactly how much of the protective benefit, if any, may be lost after 28 days.

A small study from Albert Einstein University suggested that the NuvaRing may provide ample protection for up to 35 days. On the downside, doing so appears to increase the risk of spotting or bleeding (a primary cause of treatment discontinuation).

To this end, until further research can support the extended use of the NuvaRing without complications, it is strongly advised to follow the manufacturer's instructions as approved by the U.S. Food and Drug Administration.

How to Insert a NuvaRing

The NuvaRing is relatively simple to use but requires a little insight and preparation to ensure that is inserted correctly.

1. Choose a position that makes you feel comfortable.
2. Wash and dry your hands before removing NuvaRing from its pouch.
3. Open the resealable foil pouch using the notch on both sides near the top of the package.
4. Take out your NuvaRing.
5. Keep the foil pouch. You can place your used NuvaRing into it before you throw it into the garbage.
6. Hold your NuvaRing between your thumb and index finger. Then compress the sides of the ring together so that it's a long, oval shape.
7. Insert the folded NuvaRing into your vagina.
8. Using your index finger, slowly and gently push it farther up into your vagina.

The NuvaRing doesn't need to be in an exact location to work. Your NuvaRing may slightly move around within your vagina. This is normal.

However, if it feels uncomfortable or hurts, you may not have inserted it far enough. Use your finger to carefully push your NuvaRing as far as you can. Don't worry about pushing too far; it won't get lost.

How to Remove a NuvaRing

The instructions for removing a NuvaRing are very straightforward and simple:

1. Wash and dry your hands.
2. Choose a comfortable position. Either lie down, squat or stand with one leg up on a stool or chair. 
3. Put your index finger into your vagina and hook it through the NuvaRing. Slowly pull downward and forward to remove the NuvaRing and then just pull it all the way out.
4. You can put the NuvaRing in the resealable pouch it came in and dispose of it in a trash can. Do not flush your NuvaRing down the toilet.
5. Seven days after you have taken out your old NuvaRing, it is time to insert a new one. You can still do this even if your period has not yet stopped.