Download PDF
Semin Reprod Med 2010; 28(2): 133-139
DOI: 10.1055/s-0030-1248138
© Thieme Medical Publishers

The Contraceptive Vaginal Ring

Jill Edwardson1 , Roxanne Jamshidi2
  • 1Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland
  • 2Department of Gynecology and Obstetrics, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
Further Information

Publication History

Publication Date:
29 March 2010 (online)

    Permissions and Reprints

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
    CrossrefPubMedGoogle Scholar
  • 2 Johansson E DB, Sitruk-Ware R. New delivery systems in contraception: vaginal rings.  Am J Obstet Gynecol. 2004;  190(4, suppl) S54-S59
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 4 Rowlands S. New technologies in contraception.  BJOG. 2009;  116(2) 230-239
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 11 Veres S, Miller L, Burington B. A comparison between the vaginal ring and oral contraceptives.  Obstet Gynecol. 2004;  104(3) 555-563
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 14 Verhoeven C H, Dieben T O. The combined contraceptive vaginal ring, NuvaRing, and tampon co-usage.  Contraception. 2004;  69(3) 197-199
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 28 Haring T, Mulders T M. The combined contraceptive ring NuvaRing and spermicide co-medication.  Contraception. 2003;  67(4) 271-272
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar

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

      >