New research emerges on NuvaRing contraceptive

Women who switch to the NuvaRing contraceptive vaginal ring (Organon, Roseland, NJ) from other forms of hormonal contraception experience reduced hormone-related adverse events, according to results from a study presented at the recent European Society of Contraception in Istanbul, Turkey.1

NuvaRing is a flexible plastic ring that contains estrogen and progestin, and it releases a steady 15 mcg of ethinyl estradiol each day. It is worn for three weeks, followed by a "ring-free" week. Currently more than 1 million women are using NuvaRing worldwide, says Eliza Ng, MD, MPH, associate director of medical services at Organon. Almost half of those users are in the United States, she says.

To evaluate the adverse effects associated with the use of contraceptive hormones in NuvaRing users, 896 women were invited to participate in an observational, multicenter, prospective, open study. Evaluations were performed at baseline and after three and six cycles of ring use. NuvaRing users were classified as new hormonal contraception users or "switchers" — those switching from another hormonal method to the ring. To evaluate the reduction in hormone-related adverse effects, only the women who had switched from another hormonal method were assessed for specific effects compared with baseline.

A total of 805 women started using NuvaRing, with 722 completing Cycle 3 and 595 completing Cycle 6. For women classified as switchers (47.5% of the total group), the incidence of nausea, headache, and mastalgia was significantly lower after three cycles of ring use, with improvement maintained and strengthened after six cycles. The number of women who had breast hypersensitivity decreased from 6.4% at baseline to 1.7% after six cycles of use; headache also decreased, from 10% of women at baseline to 1.2% after six cycles. While the percentage of women reporting nausea was low at the beginning of the study (4.8%), the number dropped to 0.4% after six cycles of ring use.

Research in the same study population indicates that users achieved excellent cycle control.2 When new users and "switchers" were considered together, the incidence of irregular bleeding after six cycles of use decreased. In the new users group, 11% had irregular bleeding at Cycle 3, and 5.7% reported such incidents at Cycle 6. In the "switcher" group, 26.2% said they had experienced irregular bleeding during use of the pill; however, that percentage dropped to 9.1% after three cycles of ring use and to 7% after six cycles of ring use.2

In an acceptability analysis, more than 85% of the women found insertion and removal of the ring to be easy at baseline, with the number rising to 91% for positioning and 90% for removal after six cycles of use.3

Which woman will be most comfortable in using a contraceptive vaginal ring? Almost any woman who desires contraception, says Anne Davis, MD, assistant professor of obstetrics and gynecology at Columbia University Medical Center in New York City. In newly published research of acceptability and satisfaction with the "Quick Start" method of contraception initiation, data presented by Davis and fellow researchers indicate that women who try the vaginal ring are very likely to be satisfied with it.4

Data for the current report were collected as part of a randomized clinical trial on 201 women comparing immediate start of vaginal ring use with immediate start of low-dose oral contraceptive use. Researchers charted user satisfaction and method continuation three months after ring or pill initiation.4

Women who reported greater comfort in touching their genitals, greater frequency of masturbation, more comfort with intercourse, and past use of vaginal contraceptives and products were not more likely than others to be satisfied with the ring or to continue using it for birth control, according to the report.4 At the three-month interval, 174 of 201 subjects (87%) had follow-up interviews. Among the study participants with follow-up data, 61% of ring users and 34% of pill users were very satisfied with their methods. About 80% of women using the ring chose to continue with the ring following the trial, while 59% of pill users chose to continue with the Pill.4

The vaginal ring lends itself well to the "Quick Start" method because once it is inserted in the office, it stays inserted until the patient removes it, says Davis.

"We feel it's a terrific way to quick-start people, and when I have somebody who I'm concerned is going to be a little overwhelmed with taking pills, I often suggest quick starting them on the NuvaRing, whether we're using it as a bridge [method] or they are going to stay on it as a method," says Davis. "Sometimes we bridge people to DMPA [depot medroxyprogesterone acetate, Depo-Provera, Pfizer, New York City] on it, and sometimes we give it to people for a few weeks until they get a tubal ligation."

References

  1. Lete I. Clinical experience with NuvaRing in Spain shows that the monthly contraceptive ring is associated with a low incidence of hormone-related adverse effects. Presented at the Ninth European Society of Contraception. Istanbul, Turkey; May 2006.
  2. Lete I. Cycle control with the monthly contraceptive ring. Presented at the Ninth European Society of Contraception. Istanbul, Turkey; May 2006.
  3. Lete I. Acceptance of the administration route in users of the monthly contraceptive ring. Presented at the Ninth European Society of Contraception. Istanbul, Turkey; May 2006.
  4. Schafer JE, Osborne LM, Davis AR, et al. Acceptability and satisfaction using Quick Start with the contraceptive vaginal ring versus an oral contraceptive. Contraception 2006; 73:488-492.