Contraceptive Vaginal Rings
Introduction to Contraceptive Vaginal Rings
- The American Academy of Pediatrics recommends the use of contraceptive vaginal rings, such as NuvaRing, which releases 15 μg ethinyl estradiol and 120 μg etonogestrel daily 1, 2
Dosing Regimen
- The Centers for Disease Control and Prevention guidelines suggest inserting the NuvaRing vaginally for 3 consecutive weeks, then removing for 1 week to allow withdrawal bleeding, with a new ring inserted after the 7-day ring-free interval, even if bleeding has not ceased 1, 2, 3
- The ring can be used for extended or continuous cycles by replacing it once every calendar month, as it contains sufficient medication for up to 35 days of use, according to the Pediatrics journal 1, 2, 4
Efficacy and Safety
- The typical-use failure rate of NuvaRing is 9%, comparable to combined oral contraceptives, with a perfect-use failure rate of 0.3%, as reported by the MMWR Recommendations and Reports 2, 5, 6
- The ring has the same eligibility criteria, risks, and benefits as combined oral contraceptives, according to the Pediatrics journal and MMWR Recommendations and Reports 1, 7
Adverse Effects
- Common side effects of NuvaRing include vaginal discharge, vaginal discomfort, headache, and device-related events such as expulsion, as reported by the Pediatrics journal 1, 4
- Unscheduled bleeding is the most common adverse effect with extended or continuous use, according to Praxis Medical Insights 3
Contraindications
- The Centers for Disease Control and Prevention recommends that ANNOVERA is contraindicated in women with high risk of arterial or venous thrombotic diseases, undiagnosed abnormal uterine bleeding, and other conditions, as reported by the MMWR Recommendations and Reports 7
Important Considerations
- Neither ring protects against sexually transmitted infections or HIV; condoms should be recommended for dual protection, as suggested by the MMWR Recommendations and Reports 7
- Most male partners do not notice the ring during intercourse, though it can be temporarily removed for up to 3 hours (NuvaRing) or 2 hours (ANNOVERA) if desired, according to the Pediatrics journal 2