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GENITO URINARY SYSTEM AND SEX HORMONES › OTHER GYNECOLOGICALS › CONTRACEPTIVES FOR TOPICAL USE › Intravaginal contraceptives
vaginal ring with progestogen and estrogen
G02BB01
Forms & Strengths
- Vaginal ring releasing ethinyl estradiol and etonogestrel (e.g., NuvaRing: 0.120 mg/0.015 mg per 24 hours)
- Vaginal ring releasing ethinyl estradiol and levonorgestrel (e.g., Annovera: 0.174 mg/0.021 mg per 24 hours)
Adult Dosing
- NuvaRing: Insert one ring vaginally for 3 weeks, followed by a 1-week ring-free interval
- Annovera: Insert one ring vaginally for 3 weeks, followed by a 1-week removal, reusing the same ring for up to 1 year
Pediatric Dosing
- Postmenarchal adolescents: Safety and efficacy are expected to be the same as for adult women of reproductive age
Indications
- Prevention of pregnancy in females of reproductive age
- Choice of combined hormonal contraception
Mechanism of Action
- Suppression of gonadotropins (LH and FSH) via combined estrogen and progestogen actions
- Inhibition of ovulation
- Alteration of cervical mucus to impede sperm penetration
- Alteration of the endometrium to reduce implantation potential
Contraindications
- High risk of arterial or venous thrombotic diseases (VTE)
- Current or history of deep vein thrombosis or pulmonary embolism
- Known thrombogenic mutations
- Cerebrovascular disease or coronary artery disease
- Valvular heart disease with complications
- Diabetes mellitus with vascular involvement
- Known or suspected breast cancer or other hormone-sensitive cancer
- Hepatic tumor, severe hepatic disease, or impaired liver function
- Undiagnosed abnormal uterine bleeding
- Hypersensitivity to any ring component
- Concomitant use with Hepatitis C combination drug regimens containing ombitasvir/paritaprevir/ritonavir
Adverse Reactions
- Vaginitis, leukorrhea, and vaginal discomfort
- Device-related events (expulsion, foreign body sensation, coital interference)
- Headache and migraine
- Nausea and abdominal pain
- Breast tenderness and enlargement
- Weight gain
- Mood changes, depression, and libido decrease
- Increased risk of venous thromboembolism (VTE)
- Hypertension
Drug Interactions
- CYP3A4 inducers (e.g., rifampin, anticonvulsants like phenytoin and carbamazepine, St. John's wort) decrease contraceptive efficacy
- CYP3A4 inhibitors (e.g., ketoconazole, fluconazole) may increase hormone exposure
- Lamotrigine: Combined hormonal contraceptives decrease lamotrigine plasma concentrations, potentially reducing seizure control
- Hepatitis C direct-acting antivirals (ombitasvir/paritaprevir/ritonavir) significantly increase ALT elevations
- Certain antimicrobials (e.g., ampicillin, tetracyclines) may theoretically reduce efficacy via enterohepatic circulation disruption
Curated Content: Needs Vetting Before Put to Clinical Use