Draw the circle wide to add contraceptive ring
When reviewing contraceptive options with patients, what information do you provide on the vaginal contraceptive ring (NuvaRing, Organon USA, Roseland, NJ). Recent information indicates that vaginal administration of contraceptive hormones can result in lower doses, steady drug levels, and less frequent administration than the oral route.1
Advantages of the vaginal ring method are that it is user-controlled, does not interfere with intercourse, does not require daily intake of a pill, and allows continuous delivery of a low dose of steroids.2 With vaginal drug administration, absorption is unaffected by gastrointestinal disturbances, there is no first-pass effect, and use is discreet. Vaginal administration also avoids the highs and lows in hormone levels that characterize daily dosing, which may contribute to side effects.1
Randy Fink, MD, FACOG, initially began using NuvaRing in his Miami-based private practice as a "problem solver" method for those women who had encountered previous problems such as nausea, headache, breast tenderness, and bleeding on other methods. He says he now includes the method as a first-line option in his practice.
Available in the United States since 2002, NuvaRing releases 15 mcg ethinyl estradiol — half the amount of many commonly used oral contraceptives (OCs) — and 120 mcg etonogestrel each day. The device is used for three weeks and then removed for one week during which a withdrawal bleed normally occurs. A new ring is inserted one week later.
Measuring 54 mm in diameter with a 4 mm cross-sectional diameter, NuvaRing’s flexible design allows it to be easily compressed and inserted by the user. Once it is inserted, the ring conforms to fit in the upper vagina and remains in place until removal is required.
The ring alleviates concerns about compliance; a woman is able to insert the device and then forget about it for the rest of the month, says Fink.
Ring now in research
The New York City-based Population Council plans to begin a Phase III trial later in 2005 of a combination ring containing Nestorone, its proprietary progestin, and ethinyl estradiol, says Irving Sivin, Population Council senior scientist. Investigators expect to enroll 1,280 women in the one-year study, which will be held in study centers in the United States, Europe, Latin America, and the Caribbean, he reports.
If results are favorable, the product will be registered in the United States and Europe, Sivin states. The combination ring appears to be effective for one year, which would be an advantage over the existing product on the market, he adds.
In a study of three dose combinations of Nestorone/ethinyl estradiol, results indicated that each combination ring, used on a 21-day-in and seven-day-out regimen, provided women effective, acceptable, and safe long-acting contraception under their own control.3 In the entire trial, only two women discontinued because of bleeding problems.3
Ring for nursing moms?
The Population Council also has developed a progesterone-releasing ring, which is on the market in Chile and Peru (Progering, Laboratorio Silesia, Santiago, Chile) for contraception in breast-feeding women. Research indicates the ring also may be effective for progesterone therapy during in vitro fertilization.2
In a multicenter trial conducted in Asia, Latin America, North Africa, and the United States, researchers found that the progesterone-releasing vaginal ring is a safe, effective option for lactating women.4 Contraceptive efficacy was comparable for the ring and the control method, the Copper T380A intrauterine device; lactation performance and the health and weight gain of the infants were similar among users of either regimen.4
The progesterone-only ring prolongs lactational amenorrhea; the fact that it is a user-controlled long-term contraceptive that delivers a natural hormone makes it an attractive option for breast-feeding women.5 The method may be expanded to other markets, but probably will not enter the United States, says Sivin. Many U.S. mothers return to work approximately six weeks postpartum, which makes it difficult to adhere to the necessary guidelines for the lactational amenorrhea method.6
References
1. Alexander NJ, Baker E, Kaptein M, et al. Why consider vaginal drug administration? Fertil Steril 2004; 82:1-12.
2. Johansson ED, Sitruk-Ware R. New delivery systems in contraception: Vaginal rings. Am J Obstet Gynecol 2004; 190(4 Suppl):S54-59.
3. Sivin I, Mishell DR Jr, Alvarez F, et al. Contraceptive vaginal rings releasing Nestorone and ethinyl estradiol: A 1-year dose-finding trial. Contraception 2005; 71:122-129.
4. Sivin I, Diaz S, Croxatto HB, et al. Contraceptives for lactating women: A comparative trial of a progesterone-releasing vaginal ring and the copper T 380A IUD. Contraception 1997; 55:225-232.
5. Massai R, Diaz S, Jackanicz T, et al. Vaginal rings for contraception in lactating women. Steroids 2000; 65:703-707.
6. Contraception during breast-feeding. Contraception Report 2003; 13:7-13.
When reviewing contraceptive options with patients, what information do you provide on the vaginal contraceptive ring (NuvaRing, Organon USA, Roseland, NJ). Recent information indicates that vaginal administration of contraceptive hormones can result in lower doses, steady drug levels, and less frequent administration than the oral route.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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