ABSTRACT
The contraceptive vaginal ring offers effective contraception that is self-administered,
requires less frequent dosing than many other forms of contraception, and provides
low doses of hormones. NuvaRing (Organon, Oss, The Netherlands), the only contraceptive
vaginal ring approved for use in the United States, contains etonogestrel and ethinyl
estradiol. It is inserted into the vagina for 3 weeks, followed by a 1-week ring-free
period, and works by inhibiting ovulation. Most women note a beneficial effect on
bleeding profiles and are satisfied with NuvaRing. Commonly reported adverse events
include vaginitis, leukorrhea, headaches, and device-related events such as discomfort.
Serious adverse events are rare. In Chile and Peru, progesterone-only vaginal contraceptive
rings are available for nursing women. Studies are ongoing examining new formulations
of vaginal contraceptive rings.
KEYWORDS
Vaginal contraception - vaginal ring - NuvaRing
REFERENCES
- 1
Timmer C J, Mulders T M.
Pharmacokinetics of etonogestrel and ethinylestradiol released from a combined contraceptive
vaginal ring.
Clin Pharmacokinet.
2000;
39(3)
233-242
- 2
Johansson E DB, Sitruk-Ware R.
New delivery systems in contraception: vaginal rings.
Am J Obstet Gynecol.
2004;
190(4, suppl)
S54-S59
- 3
Sarkar N N.
Low-dose intravaginal estradiol delivery using a Silastic vaginal ring for estrogen
replacement therapy in postmenopausal women: a review.
Eur J Contracept Reprod Health Care.
2003;
8(4)
217-224
- 4
Rowlands S.
New technologies in contraception.
BJOG.
2009;
116(2)
230-239
- 5
Mulders T M, Dieben T O.
Use of the novel combined contraceptive vaginal ring NuvaRing for ovulation inhibition.
Fertil Steril.
2001;
75(5)
865-870
- 6
van den Heuvel M W, van Bragt A JM, Alnabawy A KM, Kaptein M CJ.
Comparison of ethinylestradiol pharmacokinetics in three hormonal contraceptive formulations:
the vaginal ring, the transdermal patch and an oral contraceptive.
Contraception.
2005;
72(3)
168-174
- 7
Duijkers I J, Klipping C, Verhoeven C H, Dieben T O.
Ovarian function with the contraceptive vaginal ring or an oral contraceptive: a randomized
study.
Hum Reprod.
2004;
19(11)
2668-2673
- 8
Mulders T M, Dieben T OM, Bennink H J.
Ovarian function with a novel combined contraceptive vaginal ring.
Hum Reprod.
2002;
17(10)
2594-2599
- 9
Roumen F J, Apter D, Mulders T M, Dieben T O.
Efficacy, tolerability and acceptability of a novel contraceptive vaginal ring releasing
etonogestrel and ethinyl oestradiol.
Hum Reprod.
2001;
16(3)
469-475
- 10
Barnhart K T, Timbers K, Pretorius E S, Lin K, Shaunik A.
In vivo assessment of NuvaRing placement.
Contraception.
2005;
72(3)
196-199
- 11
Veres S, Miller L, Burington B.
A comparison between the vaginal ring and oral contraceptives.
Obstet Gynecol.
2004;
104(3)
555-563
- 12
Creinin M D, Meyn L A, Borgatta L et al..
Multicenter comparison of the contraceptive ring and patch: a randomized controlled
trial.
Obstet Gynecol.
2008;
111(2 Pt 1)
267-277
- 13
Dieben T O, Roumen F J, Apter D.
Efficacy, cycle control, and user acceptability of a novel combined contraceptive
vaginal ring.
Obstet Gynecol.
2002;
100(3)
585-593
- 14
Verhoeven C H, Dieben T O.
The combined contraceptive vaginal ring, NuvaRing, and tampon co-usage.
Contraception.
2004;
69(3)
197-199
- 15
Oddsson K, Leifels-Fischer B, de Melo N R et al..
Efficacy and safety of a contraceptive vaginal ring (NuvaRing) compared with a combined
oral contraceptive: a 1-year randomized trial.
Contraception.
2005;
71(3)
176-182
- 16
Novák A, de la Loge C, Abetz L, van der Meulen E A.
The combined contraceptive vaginal ring, NuvaRing: an international study of user
acceptability.
Contraception.
2003;
67(3)
187-194
- 17
Oddsson K, Leifels-Fischer B, Wiel-Masson D et al..
Superior cycle control with a contraceptive vaginal ring compared with an oral contraceptive
containing 30 microg ethinylestradiol and 150 microg levonorgestrel: a randomized
trial.
Hum Reprod.
2005;
20(2)
557-562
- 18
Milsom I, Lete I, Bjertnaes A et al..
Effects on cycle control and bodyweight of the combined contraceptive ring, NuvaRing,
versus an oral contraceptive containing 30 microg ethinyl estradiol and 3 mg drospirenone.
Hum Reprod.
2006;
21(9)
2304-2311
- 19
Brucker C, Karck U, Merkle E.
Cycle control, tolerability, efficacy and acceptability of the vaginal contraceptive
ring, NuvaRing: results of clinical experience in Germany.
Eur J Contracept Reprod Health Care.
2008;
13(1)
31-38
- 20
Camacho D P, Consolaro M E, Patussi E V, Donatti L, Gasparetto A, Svidzinski T I.
Vaginal yeast adherence to the combined contraceptive vaginal ring (CCVR).
Contraception.
2007;
76(6)
439-443
- 21
Roumen F J, op ten Berg M M, Hoomans E H.
The combined contraceptive vaginal ring (NuvaRing): first experience in daily clinical
practice in The Netherlands.
Eur J Contracept Reprod Health Care.
2006;
11(1)
14-22
- 22
Jensen J T, Burke A E, Barnhart K T, Tillotson C, Messerle-Forbes M, Peters D.
Effects of switching from oral to transdermal or transvaginal contraception on markers
of thrombosis.
Contraception.
2008;
78(6)
451-458
- 23
Tuppurainen M, Klimscheffskij R, Venhola M, Dieben T O.
The combined contraceptive vaginal ring (NuvaRing) and lipid metabolism: a comparative
study.
Contraception.
2004;
69(5)
389-394
- 24
O'Connell K J, Osborne L M, Westhoff C.
Measured and reported weight change for women using a vaginal contraceptive ring vs.
a low-dose oral contraceptive.
Contraception.
2005;
72(5)
323-327
- 25
Merki-Feld G S, Hund M.
Clinical experience with NuvaRing in daily practice in Switzerland: cycle control
and acceptability among women of all reproductive ages.
Eur J Contracept Reprod Health Care.
2007;
12(3)
240-247
- 26
Dickinson B D, Altman R D, Nielsen N H, Sterling M L. Council on Scientific Affairs,
American Medical Association .
Drug interactions between oral contraceptives and antibiotics.
Obstet Gynecol.
2001;
98(5 Pt 1)
853-860
- 27
Dogterom P, van den Heuvel M W, Thomsen T.
Absence of pharmacokinetic interactions of the combined contraceptive vaginal ring
NuvaRing with oral amoxicillin or doxycycline in two randomised trials.
Clin Pharmacokinet.
2005;
44(4)
429-438
- 28
Haring T, Mulders T M.
The combined contraceptive ring NuvaRing and spermicide co-medication.
Contraception.
2003;
67(4)
271-272
- 29
Verhoeven C H, van den Heuvel M W, Mulders T M, Dieben T O.
The contraceptive vaginal ring, NuvaRing, and antimycotic co-medication.
Contraception.
2004;
69(2)
129-132
- 30
Sulak P J, Smith V, Coffee A, Witt I, Kuehl A L, Kuehl T J.
Frequency and management of breakthrough bleeding with continuous use of the transvaginal
contraceptive ring: a randomized controlled trial.
Obstet Gynecol.
2008;
112(3)
563-571
- 31
Miller L, Verhoeven C H, Hout J.
Extended regimens of the contraceptive vaginal ring: a randomized trial.
Obstet Gynecol.
2005;
106(3)
473-482
- 32
Westhoff C, Heartwell S, Edwards S et al..
Initiation of oral contraceptives using a quick start compared with a conventional
start: a randomized controlled trial.
Obstet Gynecol.
2007;
109(6)
1270-1276
- 33
Schafer J E, Osborne L M, Davis A R, Westhoff C.
Acceptability and satisfaction using Quick Start with the contraceptive vaginal ring
versus an oral contraceptive.
Contraception.
2006;
73(5)
488-492
- 34 Quick start initiation of the contraceptive vaginal ring in adolescents. ClinicalTrials.gov.
ClinicalTrials.gov identifier NCT00369967 Available at: http://www.clinicaltrials.gov/ct2/show/NCT00369967?term=%22vaginal + rings%22&rank=7 Accessed October 13, 2009
- 35
Massai R, Miranda P, Valdés P et al..
Preregistration study on the safety and contraceptive efficacy of a progesterone-releasing
vaginal ring in Chilean nursing women.
Contraception.
1999;
60(1)
9-14
- 36
Massai R, Quinteros E, Reyes M V et al..
Extended use of a progesterone-releasing vaginal ring in nursing women: a phase II
clinical trial.
Contraception.
2005;
72(5)
352-357
- 37 Study to evaluate the safety and efficacy of two contraceptive vaginal rings delivering
a daily dose of 1500 or 2500 mcg of CDB-2914. ClinicalTrials.gov. ClinicalTrials.gov
identifier NCT00791297. November 13, 2008 Available at: http://www.clinicaltrials.gov/ct2/show/NCT00791297?term=%22vaginal + rings%22&rank=5 Accessed October 13, 2009
- 38
Silvin I, Mishell Jr D R, Alvarez F et al..
Contraceptive vaginal rings releasing Nestorone and ethinylestradiol: a 1-year dose-finding
trial.
Contraception.
2005;
71
122-129
- 39 Study of the safety, efficacy and cycle control of a contraceptive vaginal ring. ClinicalTrials.gov.
ClinicalTrials.gov identifier NCT00455156 Available at: http://www.clinicaltrials.gov/ct2/show/NCT00455156?term=%22vaginal + rings%22&rank=8 Accessed October 13, 2009
- 40 Safety and efficacy of a contraceptive vaginal ring delivering Nestorone and ethinyl
estradiol. ClinicalTrials.gov. ClinicalTrials.gov Identifier NCT00263341 Available at: http://www.clinicaltrials.gov/ct2/show/NCT00263341?term=%22vaginal + rings%22&rank=10 Accessed October 13, 2009
Roxanne JamshidiM.D.
Assistant Professor, Department of Gynecology and Obstetrics, Johns Hopkins Bayview
Medical Center
4940 Eastern Ave., Baltimore, MD 21224
Email: rjamshi1@jhmi.edu