How are vaginal rings used for contraception?

Updated: Dec 10, 2018
  • Author: Frances E Casey, MD, MPH; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Answer

The actual design of vaginal rings as a mode of contraception was first developed in the 1970s. [16] The first rings studied were homogenous devices with the steroid mixed uniformly through a polysiloxane matrix. The design was abandoned because of a high initial release of drug with a rapid decrease of drug release thereafter. The vaginal rings can deliver progesterone or progesterone-estrogen combinations. Today, the combination contraceptive vaginal ring is a new form of contraception that was approved by the FDA in October 2001.

NuvaRing, a vaginal contraceptive ring developed by Organon (Roseland, NJ), is a nonbiodegradable, flexible, colorless ring made up of a polymer of ethylene vinyl acetate and magnesium stearate. The outer diameter of the ring is 54 mm and the cross-sectional diameter is 4 mm. The ring contains 11.7 mg of etonogestrel and 2.7 mg of ethinyl estradiol. It releases 120 mcg of etonogestrel and 15 mcg of ethinyl estradiol each day. The hormones are released slowly and are absorbed directly by the reproductive organs.

The ring is used in the same schedule as oral contraceptives, with 3 weeks of ring usage (ring is left in place for 3 wk) and 1 week without to produce a withdrawal bleed. The ring can be inserted any time during the first 5 days of the menstrual cycle. The ring should be placed in the vagina even if the woman has not finished bleeding, and she should use a backup contraceptive method for 7 days. A new ring should be inserted each month. If the ring comes out during the first 3 weeks of use, it should be washed with lukewarm water and replaced. If the ring-free interval is more than 3 hours, a backup contraceptive method should be used for 7 days. The ring should never be left in the vagina for more than 4 weeks. If left in for more than 4 weeks, pregnancy should be excluded before inserting a new ring and a backup contraceptive method should be used for 7 days after inserting a new ring.

Gilliam et al compared satisfaction and adherence to the contraceptive vaginal ring (n=136) with daily low-dose oral contraceptive pill (OCP) (n=137) among college and graduate students. Participants completed daily Internet-based, online diaries during 3 cycles and a final online survey at 3 and 6 months.

The authors found that vaginal ring users were more likely to report perfect use during the 3-month trial period than were OCP users. Participants were equally satisfied with their assigned hormonal contraceptive method. At 6 months, less than 30% of participants were still using their assigned method. [17]


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