A late ring, patch or injection: what to do

A ring slips out after sex. A patch peels off and you only notice that evening. An injection appointment comes and goes while life is busy. Each of these is common, and there’s clear advice for each, but timing matters, so it’s worth acting today if you’ve had sex. What to do depends on your method, which week of your cycle you’re in and how long the gap lasted. So the first job is to find the leaflet or ask someone who can read it with you.

Why a gap matters

These methods work very well when they’re used on schedule, and less well when they’re not. The NHS gives these figures:

Method	Used correctly all the time	When not used correctly or late
Vaginal ring	More than 99% effective	91% effective, about 9 in 100 women get pregnant in a year
Patch	More than 99% effective	91% effective, about 9 in 100 women get pregnant in a year
Injection	More than 99% effective	94% effective if you get it late, 6 in 100 women get pregnant in a year

The NHS lists forgetting to replace a ring or patch at the right time as examples of incorrect use. US figures are measured a little differently. CDC says about seven out of 100 people using combined methods (pill, patch or ring) and about four out of 100 using the injection become pregnant in the first year with typical use.

For the patch and ring, CDC describes inconsistent or incorrect use as a major cause of these methods failing. Its guidance also explains why so much advice mentions 7 days: seven days of continuous use is considered necessary to reliably prevent ovulation (the release of an egg).

If your ring came out or went in late

The NHS names three things that can go wrong with the ring: forgetting to take it out after 21 days, forgetting to put in a new ring after the 7 days break, and the ring coming out of the vagina. For any of these, it says to speak to a pharmacist, nurse or doctor, or read the leaflet that comes with your ring.

NHS inform, the health information service for Scotland, calls a ring coming out on its own “expulsion”. It says this is most likely during or after sex, or when you’re constipated. It also says that if a ring is out for more than 3 hours, you are not protected against pregnancy, and what to do next depends on which week of use you’re in. If your ring came out and you’re not sure what applies, check your leaflet or ask a pharmacist.

In the US, CDC’s guidance for clinicians is based on the etonogestrel ring. For a different ring that contains segesterone acetate, CDC points to that ring’s package label. That’s one reason the leaflet for your own ring matters more than general advice. Rules from another country can differ too.

If your patch came off or you changed it late

The NHS says what to do depends on where you are in your 28-day patch cycle and when the patch came off or was due to be replaced. Its advice is to talk to a pharmacist, doctor or nurse, or read the information leaflet that comes in your patch pack.

When you ask, it helps to have the answers to a few questions ready:

• the name of your patch
• which week of the cycle you’re in
• roughly when the patch came off, or when it was due to be changed
• whether you’ve had sex in the last few days

If you don’t know when it came off, say so rather than guessing. If patches keep coming loose, the NHS suggests a sexual health clinic or pharmacist can check you’re putting them on correctly.

If your injection is late

The NHS says the injection is given once every 8 to 13 weeks, depending on the type, and your clinic should tell you when the next one is due.

The NHS advice for a late injection is plain. If your injection is due and you don’t have it on time, there’s a risk of pregnancy if you have sex without a condom. It says to use condoms until you can get your injection, and for 7 days afterwards.

Clinical guidance gives clinicians some leeway after the due date, and this differs between countries:

Where	What guidance for clinicians says
UK (CoSRH)	A DMPA injection can be given up to 7 days late (up to 14 weeks after the last injection) without extra precautions. For NET-EN (Noristerat), the limit is 10 weeks.
US (CDC)	Repeat DMPA injections are given every 3 months (13 weeks), and can be given up to 2 weeks late (15 weeks from the last injection) without extra protection.
WHO	CDC reports that WHO extended its grace period from 2 weeks to 4 weeks.

These windows are for your clinician to apply, and they don’t change the NHS advice to use condoms once you’ve missed the date. Advice differs between countries, so ask your own clinic what applies to you. If you’re past the US window, CDC says the injection can still be given if the clinician is reasonably certain you’re not pregnant, with no sex or condoms for the next 7 days. So a late appointment may include questions about recent sex, or a pregnancy test.

Asking about emergency contraception

If you’ve had sex that might not have been covered, ask about emergency contraception soon. NHS inform says it is effective at preventing pregnancy if it’s used soon after unprotected sex. There are two types. An emergency pill needs to be taken within 72 hours (3 days) or 120 hours (5 days), depending on which pill it is. A copper coil (IUD) can be fitted up to 5 days after sex, is 10 times more effective than the pills, and can be left in as your regular contraception.

Your usual method matters here. The NHS says the patch, the ring and the injection can each affect how some emergency contraception works. Which emergency pill is suggested after a patch, ring or injection problem can differ between countries, so let the pharmacist or clinic advise. It helps to tell them which method you use, when it was last on schedule and when you had sex.

In the UK, the emergency pill and the IUD are free from sexual health services and from GP practices that provide contraception, and the emergency pill is also free from most pharmacies.

Both emergency pills can make your next period earlier or later than usual. After emergency contraception, contact a doctor or nurse if you think you might be pregnant, your next period is more than 7 days late, or your period is shorter or lighter than usual. Sudden or unusual pain in your lower tummy needs medical help straight away, as it could be a sign of an ectopic pregnancy, which is rare but serious.

Who to contact, and when

Contact a pharmacist, sexual health clinic or GP, or call NHS 111, today if your ring, patch or injection was off schedule and you’ve had sex that might not have been covered. In the US and elsewhere, a pharmacist or your clinician can help.

If you’re under 16, you can still ask for help. NHS inform says contraception services are confidential, and that staff might encourage you to tell your parents, but you do not have to. Elsewhere, ask a local clinic how confidentiality works for young people.

If gaps keep happening, it’s worth raising. CDC suggests that clinicians talk through other methods with people who often have problems with the patch or ring. Book with a sexual health clinic or GP in the UK, or your clinician elsewhere, to look at what would suit your routine.