Current developments in vaginal hormonal contraception

Abstract

A novel combined hormonal vaginal contraceptive ring (VCR) is currently commercially marketed (NuvaRing^®, NV Organon, Oss, The Netherlands). This VCR continuously releases 15 μg of ethinyl estradiol and 120 μg of etonogestrel, the active metabolite of the progestin desogestrel. The VCR is soft and flexible, with an outer diameter of 54 mm and a cross section of 4 mm. Each VCR is intended for one monthly cycle, comprising 3 weeks of ring use and 1 week ring-free period. The VCR is easily inserted at a woman’s discretion. Due to the controlled release mechanism of the contraceptive ring, steroid concentrations remain uniform throughout the cycle. Large mulicenter studies of the VCR have revealed a high contraceptive efficacy, with a Pearl Index of 0.65 and 1.18. Cycle control is excellent with irregular bleeding reported in about 5% or less of all cycles with the VCR. The most frequently reported adverse events are device-related events (e.g. foreign body sensation, coital problems and device expulsion), vaginal discomfort, headache, vaginitis and leucorrhea. The overall acceptance of the VCR is high, as 96% of patients are satisfied with the ring and 97% would recommend the ring. The VCR represents an important new option for women desiring highly effective contraception. The ease of use and exceptional cycle control all lead to high patient compliance with the VCR.