Frans J M E Roumen1, Daniel R Mishell. 1. Department of Obstetrics and Gynaecology, Atrium Medical Centre Parkstad, Heerlen, the Netherlands. f.roumen@atriummc.nl
Abstract
OBJECTIVES: To review the clinical experience with the contraceptive vaginal ring (CVR, NuvaRing(®)) since its introduction over ten years ago. METHODS: The literature was searched on efficacy, cycle control, safety, user preference and satisfaction of the CVR in comparison with combined oral contraceptives (COCs) and the patch, with special attention to recent developments. RESULTS: The ring has the same working mechanism and contraindications as COCs. Serum levels of steroids are steadier, whereas oestrogenic exposure is lower. Contraceptive efficacy is similar, as are metabolic changes. Cycle control is better, and compliance and continuation rates are equal or higher. Oestrogen-related adverse symptoms appear to be fewer, but reports on the incidence of venous thrombosis are conflicting. Expulsion of the ring is reported by 4% to 20% of women. Local adverse events are the main reason for discontinuation. Acceptability is as high as with COCs and, after structured counselling, the ring is preferred by many women to the pill or the patch. CONCLUSIONS: Efficacy of the CVR, and the metabolic changes and adverse events it elicits, are generally comparable to those of COCs, yet oestrogenic exposure is lower and cycle control superior. After counselling, the ring is preferred to the pill by many women.
OBJECTIVES: To review the clinical experience with the contraceptive vaginal ring (CVR, NuvaRing(®)) since its introduction over ten years ago. METHODS: The literature was searched on efficacy, cycle control, safety, user preference and satisfaction of the CVR in comparison with combined oral contraceptives (COCs) and the patch, with special attention to recent developments. RESULTS: The ring has the same working mechanism and contraindications as COCs. Serum levels of steroids are steadier, whereas oestrogenic exposure is lower. Contraceptive efficacy is similar, as are metabolic changes. Cycle control is better, and compliance and continuation rates are equal or higher. Oestrogen-related adverse symptoms appear to be fewer, but reports on the incidence of venous thrombosis are conflicting. Expulsion of the ring is reported by 4% to 20% of women. Local adverse events are the main reason for discontinuation. Acceptability is as high as with COCs and, after structured counselling, the ring is preferred by many women to the pill or the patch. CONCLUSIONS: Efficacy of the CVR, and the metabolic changes and adverse events it elicits, are generally comparable to those of COCs, yet oestrogenic exposure is lower and cycle control superior. After counselling, the ring is preferred to the pill by many women.
Authors: Sara E Vargas; Miriam M Midoun; Melissa Guillen; Melissa L Getz; Kristen Underhill; Caroline Kuo; Kate M Guthrie Journal: Perspect Sex Reprod Health Date: 2019-05-20
Authors: Herman Weiss; Bridget Martell; Ginger D Constantine; Sarah M Davis; Justin D Vidal; Philip R Mayer; Martin Doorbar; David R Friend Journal: Drug Deliv Transl Res Date: 2019-10 Impact factor: 4.617
Authors: Eleanor McLellan-Lemal; Roman Gvetadze; Mitesh A Desai; Esther M Makanga; Yi Pan; Richard E Haaland; Angela N Holder; Victor Mudhune; Tiffany Williams; Taraz Samandari Journal: J Glob Health Rep Date: 2018
Authors: Evelyne Kestelyn; Stephen Agaba; Jennifer Ilo Van Nuil; Mireille Uwineza; Marie Michelle Umulisa; Lambert Mwambarangwe; Jean Claude Ndagijimana; Irith De Baetselier; Jozefien Buyze; Thérèse Delvaux; Tania Crucitti; Vicky Jespers; Janneke H H M van de Wijgert Journal: PLoS One Date: 2018-06-01 Impact factor: 3.240
Authors: Evelyne Kestelyn; Jennifer Ilo Van Nuil; Marie Michelle Umulisa; Grace Umutoni; Alice Uwingabire; Lambert Mwambarangwe; Mireille Uwineza; Stephen Agaba; Tania Crucitti; Janneke van de Wijgert; Thérèse Delvaux Journal: PLoS One Date: 2018-06-18 Impact factor: 3.240