Contraceptive Vaginal Ring Effective, Well-Tolerated, Convenient

Laurie Barclay, MD

September 05, 2002

Sept. 6, 2002 — The combined contraceptive vaginal ring was effective and well tolerated by both partners, according to results of a multicenter but not controlled trial reported in the September issue of Obstetrics and Gynecology.

"The ring is an effective contraceptive with excellent cycle control that is convenient, well-tolerated, and highly acceptable to users," write Thom O. M. Dieben, MD, from NV Organon in the Netherlands, and colleagues.

In this one-year, multicenter study, 2,322 healthy women requesting contraception used the vaginal ring for three weeks of every four. Each ring released 120 mcg etonogestrel and 15 mcg ethinylestradiol daily. Compliance was 85.6%. There were 21 pregnancies, giving a Pearl Index of 1.18 (95% confidence interval [CI], 0.73-1.80), but 11 of these pregnancies were attributed to noncompliance. For those patients with strict adherence to protocol, the Pearl Index was 0.77 (95% CI, 0.37-1.44).

Mean incidence of withdrawal bleeding was 98.5% in all cycles. Irregular bleeding, which occurred in 5.5% of all cycles, mostly consisted of spotting. The ring was easy to insert and remove, did not interfere with intercourse, and had a low incidence of adverse events, including vaginitis in 5.6%, leukorrhea in 4.8%, vaginal discomfort in 2.4%, headache in 5.8%, nausea in 3.2%, and breast tenderness in 2.6%. Although 40 women had a shift in Pap smears from normal to abnormal, the authors did not attribute this to use of the ring. Only 2.5% of discontinuations were device-related. Most women (85%) were satisfied with this form of birth control, and 90% reported that they would recommend it to others.

"The findings indicate that the ring is an alternative to combined oral contraceptives, avoiding the necessity of taking medication on a daily basis," the authors write.

NV Organon supported this study and employs its lead author.

Obstet Gynecol. 2002;100:585-593

Reviewed by Gary D. Vogin, MD

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