Abstract
Contraceptive vaginal rings (CVR) offer a new, effective contraceptive option, expanding
the available choices of hormonal contraception. Various ring prototypes have been
evaluated: progestin-only rings and combined progestin-estrogen rings, as well as
different combination of progestins and estrogens. The progestin-only ring is intended
for continuous use, whereas the combined ring has been designed for cyclic 3-week
in/1-week out use, although several studies have explored alternative schemes of extended
use. However, only two ring designs have reached the market: NuvaRing, a 1-month combined
ring that releases etonogestrel and ethinylestradiol, and Progering, a 3-month progesterone-releasing
ring for use in lactating women. A one year Nestorone/ethinyl estradiol CVR is approaching
the final stages of development, as the Population Council is preparing to submit
a new drug application to the Food and Drug Administration. The main advantages of
CVRs are their effectiveness (similar or slightly better than the pill), ease of use
without the need of remembering a daily routine, user ability to control initiation
and discontinuation, nearly constant release rate allowing for lower doses, greater
bioavailability and good cycle control with the combined ring, in comparison with
oral contraceptives. Current prototypes in development include rings releasing progesterone
receptor modulators, which would provide estrogen-free contraception, as well as combined
rings releasing estradiol, instead of ethinyl-estradiol, providing a safer profile.
Furthermore, intensive efforts towards developing dual protection rings, providing
both contraception and protection against reproductive tract infections, offer hope
that this greatly needed technology will soon undergo clinical testing and will be
in the hands of women worldwide in the near future.
Keywords
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Article info
Publication history
Published online: October 08, 2012
Accepted:
August 26,
2012
Received:
July 12,
2012
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
