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Contraception - Management
Reduced cycle control with the combined contraceptive vaginal ring: what should be done?
- If irregular bleeding (spotting or breakthrough bleeding) occurs after previously regular cycles while the ring has been used as recommended, then consider other non-hormonal causes. Consider excluding pregnancy and refer the woman according to clinical judgement.
- Some women do not experience a withdrawal bleed in the ring-free week.
- If the ring has been used as recommended, it is unlikely the woman is pregnant.
- If the ring has not been used as recommended prior to the first missed withdrawal bleed, or if there are two missed withdrawal bleeds, advise the woman that pregnancy should be ruled out before use of the ring is continued.
Basis for recommendation
- These recommendations are based on the Summary of Product Characteristics of NuvaRing® combined vaginal ring [ABPI Medicines Compendium, 2009b].
- A large comparative study of a combined oral contraceptive (levonorgestrel with ethinylestradiol) and NuvaRing® combined contraceptive vaginal ring over 13 cycles found low incidences of breakthrough spotting or bleeding for the ring (2-6.4%), with most bleeding occurring during the ring-free interval.
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