If your NuvaRing fell out less than 3 hours ago, rinse it in cool to lukewarm (not hot) water and put it back in. After that, two official sources split. The NuvaRing label calls for backup birth control after 3 hours. The CDC's 2024 chart for clinicians waits until 48 hours.
The NuvaRing label says: "If the expelled ring has been out of your vagina for less than 3 hours, rinse the expelled NuvaRing in cool to lukewarm (not hot) water and insert it again right away." In that window, it says, "contraceptive efficacy is not reduced." The CDC's 2024 contraception guidance agrees no backup is needed then. (Annovera, a different ring, has a 2-hour rule; see the FAQ.)
In a one-year trial of 2,322 women led by researchers at the ring's maker, there were 21 pregnancies, and the researchers wrote that "Eleven of the pregnancies were attributable to noncompliance." That's about half.
This article provides general information about medication management and is not a substitute for professional medical advice. Consult your doctor or pharmacist for advice specific to your medications.
How Long Can NuvaRing Be Out? (3, 8, 12, 24 Hours or 2 Days)
Find your row, then your week below. "Week 1" means the first 7 days after you put this ring in.
| How long it was out | NuvaRing label | CDC 2024 chart |
|---|---|---|
| Less than 3 hours | Rinse in cool to lukewarm water and put it back in. No backup. | Put it back in as soon as you can. No backup. |
| More than 3 hours, less than 48 (for example 8, 12 or 24 hours) | Weeks 1 and 2: put it back in and use backup until it has been in 7 days in a row. Week 3: throw it away and start a new ring (two options below), with backup for 7 days. | Put it back in as soon as you can and keep it in until your usual removal day. No backup. |
| 48 hours (2 days) or more | Same as the row above. | Put it back in as soon as you can. Use condoms or skip sex until a ring has been in 7 days in a row. Week 3: skip the ring-free week (below). |
| You don't know how long | You may not be protected. Take a pregnancy test before putting in a new ring, and call your provider. | Count it as 48 hours or more. |
This table covers NuvaRing, EluRyng and generic etonogestrel rings, not Annovera.
For backup, the label names "male condoms with spermicide." It rules out a diaphragm, cervical cap or female condom, because the ring can interfere with how they sit: "These methods are not recommended as back-up methods with NuvaRing use."
Why Does the CDC Say 48 Hours for NuvaRing?
The label is the product's own instructions, and its patient leaflet says it was approved by the U.S. Food and Drug Administration. The CDC chart is part of the U.S. Selected Practice Recommendations, which the CDC calls "recommendations for health care providers."
The CDC lays out its evidence. It says "Seven days of continuous CHC use is deemed necessary to reliably prevent ovulation" (CHC means combined hormonal birth control, like the ring). For the ring, it reports that "three studies found that nondeliberate extension of the hormone-free interval for 24 to <48 hours from the scheduled period did not increase the risk for pregnancy." Those studies looked at a ring-free week that ran long, not at a ring that fell out mid-cycle.
That evidence is thin. The CDC's own review of missed birth control notes, "Fewer studies examined the transdermal patch and vaginal ring than combined oral contraceptives."
So which do you follow? Ask your pharmacist or prescriber which rule they want you to use. If you can't reach anyone yet, know that the label asks for backup sooner: after 3 hours, not 48. Pills have similar splits; see missed dose of birth control and the vomiting rules.
NuvaRing Out for More Than 3 Hours in Week 1 or 2
The label is direct: "During Weeks 1 and 2, you may not be protected from pregnancy." It says to put the same ring back in as soon as you remember and to use backup until it has been in 7 days in a row.
The CDC chart splits this at 48 hours. Under 48 hours, it says to put the ring back in and keep it in until your usual removal day, with no backup. At 48 hours or more, it says to put it back in and use condoms or skip sex until a ring has been in 7 days in a row. If that happened in the first week and you had unprotected sex in the past 5 days, the CDC says emergency contraception other than ella should be considered (and may be at other times; see the FAQ). If you're unsure which applies, ask your pharmacist.
NuvaRing Fell Out in Week 3
Here the two sources tell you to do different things with the same ring.
The label says, for a ring out more than 3 hours in week 3, "do not reinsert the NuvaRing that has been out of your vagina." Throw it away and pick one option:
- Put in a new ring right away. That starts a new 3-week cycle. You may not get your usual period, but you may spot or bleed.
- Put in a new ring no later than 7 days after the old one came out. You may get your period in between. The label adds: "You should only choose to do option 2 if you used NuvaRing for 7 days in a row, prior to the day that your previous NuvaRing was accidentally removed or expelled."
With either option, the label says to use backup until the new ring has been in for 7 days in a row.
The CDC chart works differently. Under 48 hours, it says to put the ring back in and keep it in until your usual removal day. At 48 hours or more, it says to put the ring back in and use condoms or skip sex until a ring has been in 7 days in a row. It also says to finish week 3, then skip the ring-free week and start a new ring right away. If you can't start the new ring right away, it says to keep that backup until the new ring has been in 7 days in a row. Ask your pharmacist which path fits you.
NuvaRing Fell Out and I Don't Know When
The label says: "If NuvaRing was out of the vagina for an unknown amount of time, you may not be protected from pregnancy. Perform a pregnancy test prior to inserting a new ring and consult your healthcare provider."
The CDC chart has a footnote for this. If you're not sure when the ring came out, it says to "consider the ring to have been removed for ≥48 hours." That puts you in the 48-hours-or-more row above.
Either way, note the last time you know the ring was in.
Can a NuvaRing Get Lost or Stuck Inside You?
The label says "There is no danger of NuvaRing being pushed too far up in the vagina or getting lost."
It also warns: "Some women have accidentally inserted NuvaRing into their bladder. If you have pain during or after insertion and you cannot find NuvaRing in your vagina, call your healthcare provider right away."
It also reports rings stuck to the vaginal tissue that a healthcare provider had to remove: "Call your healthcare provider if you are unable to remove your NuvaRing."
NuvaRing Fell Out in the Toilet
For any ring that slipped out, the label's cleaning step is a rinse in cool to lukewarm (not hot) water. The NuvaRing and EluRyng labels mention a toilet only to say not to throw a used ring in it; neither gives a step for a ring that fell into one. Whether a ring that landed in toilet water is fine to rinse and reuse is a question for your pharmacist.
If the ring was flushed or you can't get it back, MedlinePlus says: "If your ring falls out and gets lost, you should replace it with a new ring and remove the new ring at the same time you were scheduled to remove the ring that was lost." Away from home? See getting a same-day refill on vacation.
Why Does My NuvaRing Keep Falling Out?
The label gives examples: while "removing a tampon, during intercourse, or with straining during a bowel movement." In the ring's trials, 6.3% of women reported a device problem such as the ring coming out, discomfort or feeling it. A few label lines help:
- Push it further. "If the NuvaRing feels uncomfortable, you may not have pushed the ring into your vagina far enough."
- Ring first, tampon second. "Be sure to insert NuvaRing before inserting a tampon." If a tampon pulls it out, rinse it and put it back right away.
- Look for a break. If a broken ring slips out, the label says to throw it away and insert a new one.
If it keeps happening, MedlinePlus is clear: "Call your doctor if your contraceptive ring slips out often." The CDC guidance also tells clinicians to consider offering other methods to people who keep having ring mix-ups. Pill packs have their own mix-ups, like taking the wrong day's pill.
How Pillo Helps
The ring's schedule is three weeks in, one week out, and the label asks you to check regularly that it's in. Pillo can run a reminder on a 21-days-on, 7-days-off cycle, so a daily ring check fires during your ring weeks and stays quiet during the break. Its persistent alarm keeps ringing until you tap it.
A once-a-day check can't keep you inside the label's 3-hour window. It turns "I don't know when it fell out" into "sometime since yesterday's check." If the ring does come out, add a dose note with when you found it and when it went back in, so your pharmacist can find your row in the table. Tie the check to something you already do daily (building a medication routine). Pillo is free for unlimited medications, with ads.
FAQ
Do I need Plan B if my NuvaRing fell out?
It depends on the hours and the week. Under 48 hours, the CDC chart says emergency contraception is not usually needed, but may be considered if it happened earlier in the cycle or during the last week of the previous cycle. At 48 hours or more in the first week, with unprotected sex in the past 5 days, it says emergency contraception should be considered, and it may be considered at other times too. In both cases the CDC excludes one type, ulipristal acetate (sold as ella). Ask a pharmacist today.
Can I put the same NuvaRing back in?
Under 3 hours, yes: the label says to rinse it and put it back in. Over 3 hours in weeks 1 or 2, the label still says to reinsert it, with backup for 7 days. Over 3 hours in week 3, the label says to throw it away. The CDC chart, in every row, says to put a ring back in as soon as possible.
Does the 3-hour rule apply to EluRyng and generic rings?
Yes. We searched seven etonogestrel/ethinyl estradiol ring labels: NuvaRing, EluRyng, EnilloRing, and generic rings from Teva, Prasco, Northstar and AvKARE. All seven use the same 3-hour wording and week-by-week steps, and the CDC chart covers all of them.
What if I use Annovera?
The CDC chart points Annovera users to the package label. The Annovera label allows 2 hours, and it counts time out added up across the 21 days: "more than 2 continuous hours or more than 2 cumulative hours" means backup until it has been in 7 days in a row. Annovera is washed with mild soap and warm water.
What if I miss my period after my ring fell out?
The NuvaRing label says to consider that you may be pregnant if "you miss a period and NuvaRing was out of the vagina for more than 3 hours during the 3 weeks (21 days) of ring use." Take a pregnancy test and call your provider. If pregnancy is confirmed, the label says to stop using NuvaRing. The same label notes that "Some women miss periods on hormonal birth control, even when they are not pregnant," so a test is the way to know.
This article is for informational purposes only and does not constitute medical advice.
