Vaginal Contraceptive Ring

Aka: Vaginal Contraceptive Ring, NuvaRing, Annovera

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II. Preparations: NuvaRing

  1. Ethylene vinyl ring
    1. Diameter: 2 inch diameter
    2. Thickness: 1/8 inch
  2. Vaginal ring releases Hormones at constant rate
    1. Ethinyl Estradiol 15 mcg/day
    2. Etonogestrel 120 mcg/day
  3. Technique: 4 week cycles
    1. Inserted into vagina on or before day 5 of cycle
    2. Ring left in vagina for 3 weeks
    3. Removed for 1 week for withdrawal bleeding
    4. Backup Contraception needed if ring is out for >3 hours
  4. Efficacy
    1. Failure rate: 0.65 pregnancies per 100 woman years
    2. Compliance is greater than 90%

III. Preparations: Annovera

  1. Vaginal ring releases Hormones at constant rate
    1. Ethinyl Estradiol
    2. Segesterone
  2. Technique: 28 day cycles
    1. Inserted into vagina for 21 days and remove for 7 days
    2. Clean by patting dry after removing and store in case until reinserted
    3. May be repeated with same ring for up to 13 cycles or 1 year
    4. Avoid removing for intercourse (due to forgetting to reinsert)
  3. Efficacy
    1. Avoid in BMI >29 (lower efficacy)
    2. Backup Contraception if the ring is out more than 2 hours during the 21 days of cycle
    3. Efficacy may be reduced by oil or silicone based vaginal products or lubricants
    4. Not recommended for Seasonal Contraception (should be removed for 7 days per cycle)
  4. Cost
    1. Expensive at $2000 per ring, especially if lost (but $160/month similar to NuvaRing)
  5. References
    1. (2019) Presc Lett 26(12): 72

IV. Adverse effects: NuvaRing

  1. Overall ring is well tolerated in 96% of women
  2. Foreign body Sensation in vagina
    1. White Vaginal Discharge
    2. Vaginitis
  3. Difficult intercourse with ring in place
  4. Ring may be expulsed from vagina
  5. Headache may occur

V. Benefits: NuvaRing

  1. Easy insertion and well tolerated
  2. Less break-through bleeding than Levonorgestrel OCP
    1. Normal withdrawal bleeding is however more common
  3. Avoids first pass through liver
    1. No effect on lipids
    2. Allows for low Estrogen (15 mcg Ethinyl Estradiol)
  4. No effect on Lactation

VI. Protocol: NuvaRing

  1. Switching to or from the pill
    1. See Oral Contraceptive
  2. Switching to Vaginal Contraceptive Ring from the Ortho Evra patch
    1. Remove the patch and insert the vaginal ring on the same day (no overlap needed)
    2. Switch may occur prior to the scheduled removal of the patch
  3. Switching to Ortho Evra patch from Vaginal Contraceptive Ring
    1. Apply the Ortho Evra patch for 2 days before removing the ring
    2. Switch may occur prior to the scheduled removal of the ring

VII. References

  1. Lesnewski (2011) Am Fam Physician 83(5): 567-70 [PubMed]
  2. Massai (2000) Steroids [PubMed]
  3. Mulders (2001) Fertil Steril [PubMed]
  4. Roumen (2001) Hum Reprod 16:469-75 [PubMed]

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