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Contraception - Management
What are the advantages, disadvantages, and risks of the combined contraceptive vaginal ring?

  • In general, the advantages, disadvantages, and risks of the combined contraceptive vaginal ring are similar to those of the combined oral contraceptive (COC).
  • Advantages of the ring compared with COCs include:
    • The woman does not have to think about it every day, only having to remember to remove the ring after 3 weeks and replace it a week later, each month.
    • The ring does not become less effective if the woman vomits or has diarrhoea (because the hormones are absorbed through the vaginal mucosa, not through the gastrointestinal tract).
  • Disadvantages of the ring compared with COCs include:
    • It may occasionally cause vaginal irritation and vaginitis in some women.
    • It may occasionally cause a foreign body sensation in the vagina or coital problems.
    • It may become broken during use, or may be expelled, compromising efficacy.
    • It may very rarely be inserted inadvertently in the urethra and possibly end up in the bladder.
  • The risks of rare but serious adverse effects for users of the ring are thought to be similar to those for users of COCs.
    • The most frequently reported undesirable effects in clinical trials of the ring are headache, vaginal infections and vaginal discharge, affecting 5–6% of women.
  • The ring appears to be at least as effective as COCs at preventing pregnancy — see Effectiveness of contraceptives.
Basis for recommendation
  • Information about the advantages, disadvantages, adverse effects, and risks of the combined contraceptive vaginal ring are based on the Summary of Product Characteristics for NuvaRing® combined vaginal ring [ABPI Medicines Compendium, 2009b] and a Faculty of Sexual and Reproductive Healthcare review [FSRH, 2009a].
    • The adverse effects identified are based on spontaneous reporting, and exact frequencies are not yet available on the basis of current data.
    • The vaginal route has the advantage that it avoids first-pass metabolism and gastrointestinal interference with drug absorption.
    • Serum concentrations of ethinylestradiol from NuvaRing® are lower than that from the combined oral contraceptive, which results in lower systemic exposure to ethinylestradiol from NuvaRing®. It is not yet known whether this results in any clinical benefits.

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