Extended regimens of the contraceptive vaginal ring: evaluation of clinical aspects

Barreiros, F.; Guazzelli, Cristina Aparecida Falbo; Barbosa, Ricardo Luís; Assis, Francisco de; Araújo, Fábio Fernando de

doi:10.1016/j.contraception.2009.10.007

Cited by 27 publications

(14 citation statements)

References 8 publications

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“…Two studies described a continuous use regimen and confirmed the good acceptability and good cycle control associated with this method; however, it is currently off-label for that application 55,56. Reports have suggested that the main reason for women to switch from other contraceptive methods to the CVR (47%) is because they view it as an attractive contraceptive method 57. In fact, over 90% of users report being satisfied with the ring 57.…”

Section: New Contraceptive Methods Recently Launched In Different Marmentioning

confidence: 99%

“…Reports have suggested that the main reason for women to switch from other contraceptive methods to the CVR (47%) is because they view it as an attractive contraceptive method 57. In fact, over 90% of users report being satisfied with the ring 57. Nevertheless, despite the low pregnancy rate reported,58 and although tolerability is equivalent to that of COCs and adverse events are few, the continuation rate with the CVR is similar or even lower than that of COCs.…”

Section: New Contraceptive Methods Recently Launched In Different Marmentioning

confidence: 99%

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New and emerging contraceptives: a state-of-the-art review

Bahamondes¹,

Bahamondes²

2014

IJWH

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BackgroundThe first hormonal contraceptive was introduced onto the market in several countries 50 years ago; however, the portfolio of contraceptive methods remains restricted with regards to their steroid composition, their cost, and their ability to satisfy the requirements of millions of women/couples in accordance with their different reproductive intentions, behaviors, cultures, and settings.MethodsA literature review was conducted using Medline, Embase, and Current Contents databases, up to September 1, 2013 to identify publications reporting new contraceptives in development using combinations of the search terms: contraception, contraceptives, oral contraceptives, patch, vaginal ring, implants, intrauterine contraceptives, and emergency contraception (EC). Also, several experts in the field were also consulted to document ongoing projects on contraception development. Additionally, the Clinicaltrial.gov website was searched for ongoing studies on existing contraceptive methods and new and emerging female contraceptives developed over the past 5 years. Information was also obtained from the pharmaceutical industry.ResultsEarly sexual debut and late menopause means that women may require contraception for up to 30 years. Although oral, injectable, vaginal, transdermal, subdermal, and intrauterine contraceptives are already available, new contraceptives have been developed in an attempt to reduce side effects and avoid early discontinuation, and to fulfill women’s different requirements. Research efforts are focused on replacing ethinyl-estradiol with natural estradiol to reduce thrombotic events. In addition, new, less androgenic progestins are being introduced and selective progesterone receptor modulators and new delivery systems are being used. In addition, research is being conducted into methods that offer dual protection (contraception and protection against human immunodeficiency virus transmission), and contraceptives for use “on demand.” Studies are also investigating non-hormonal contraceptive methods that have additional, non-contraceptive benefits.ConclusionThe most pressing need worldwide is, first, that the highly effective contraceptive methods already available should be affordable to most of the population and also that these methods should fulfill the needs of women of different ages and with different reproductive requirements. The development of new contraceptive methods should also take advantage of the knowledge obtained over the past 30 years on gamete physiology and gamete interaction to avoid the use of steroid compounds.

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Section: New Contraceptive Methods Recently Launched In Different Marmentioning

confidence: 99%

Section: New Contraceptive Methods Recently Launched In Different Marmentioning

confidence: 99%

New and emerging contraceptives: a state-of-the-art review

Bahamondes¹,

Bahamondes²

2014

IJWH

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“…The experience of unscheduled bleeding and spotting episodes is often a reason for discontinuation of hormonal contraception, particularly in association with extended use regimens [15,16] Assessment of continuous NuvaRing® use (back–to-back 3 week regimens of serial rings) has shown good cycle control; however, longer durations of continuous ring use precipitate more unscheduled bleeding and spotting days for some women [15]. In our study, minimal bleeding or spotting occurred up to day 21; bleeding or spotting that was reported during this interval most commonly occurred during the first week of the study cycle, and reflects the end of the previous episode of scheduled withdrawal bleeding.…”

Section: Discussionmentioning

confidence: 99%

Contraceptive vaginal ring effectiveness is maintained during 6 weeks of use: a prospective study of normal BMI and obese women

et al. 2013

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Background A single study shows that contraceptive vaginal ring (CVR) use for up to 35 days in women with a normal BMI maintains serum hormone levels sufficient to suppress ovulation. This study is intended to confirm those results and to evaluate prolonged CVR use up to 42 days in both normal BMI and obese women. Study Design Twenty women with a normal BMI and 20 obese women enrolled in a prospective open label clinical study of ethinyl estradiol (EE) and etonogestrel (ENG) pharmacokinetics during six weeks of use of a single CVR. Participants underwent twice weekly evaluations to determine serum hormone concentrations, ovarian follicle development, endometrial thickness and bleeding patterns. Results Thirty-seven women completed follow-up including eighteen women with a normal BMI and nineteen obese women. EE and ENG concentrations remained in therapeutic range for all women. Follicular development and endometrial proliferation were minimal. By the sixth week, 30% of participants reported spotting or bleeding. Conclusions A single CVR used for six weeks demonstrates therapeutic serum levels of EE and ENG among women with normal and obese BMI. Women who forget to remove the CVR at day 21 may well have continued contraceptive protection during the next three weeks.

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“…An extended regimen of use has been described, with good acceptability and good cycle control; however, this use is currently offlabel [22,23]. Reports suggest that the main reason for women to switch from other contraceptive methods to the CVR (47%) is that this device represents a new, attractive contraceptive method and that, furthermore, > 90% of users were shown to be satisfied with the ring [24]. Despite the low pregnancy rate observed in clinical trials [25], tolerability equivalent to that found with COCs and few adverse events, there are differences when comparing the CVR to COC, particularly with respect to continuation rates and it was observed that after 6 months of evaluation, only 26 and 29% of CVR and COC users, respectively, continued using the method [26].…”

Section: Existing Treatmentmentioning

confidence: 96%