Experience of more than 3000 cycles of Brazilian women using the contraceptive vaginal ring (nuvaring^®)

Denise Leite Maia Monteiro, Ricardo Vasconcelos Bruno, Zuleide A. F. Cabral, Célia Regina da Silva, Danielle Bittencourt Sodré Barmpas, Nádia Cristina Pinheiro Rodrigues

Gynecology and Obstetrics Department, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.
Gynecology and Obstetrics Department, Universidade Federal de Mato Grosso (UFMT), Cuiabá, Brazil.
Obstetrics Department, Maternidade Escola Universidade Federal do Rio de Janeiro (ME-UFRJ), Rio de Janeiro, Brazil.
Ongoing MSc at UERJ, Rio de Janeiro, Brazil.
Public Health Researcher of Instituto Oswaldo Cruz (FIOCRUZ)/Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.
Reproduction Department, Institutode Ginecologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.

DOI: 10.4236/ojog.2014.41003                

Abstract

Objective: To evaluate the profile of the Brazilianvaginal ring user, reasons for choosing it, satisfaction, menstrual pattern, tolerability, efficacy, side effects and reasons for discontinuation. Methods: We reviewed the files of 148 users who attended the Hospital de Jacarepaguáand private clinics, between 2005 and 2011, in a total of 3107 cycles. Kaplan-Meier survival curves and regression models were used in statistical analysis. Results: The profile was: single, nulligravida, 30 years (mean) and with university education. The previous contraception used was mostly the oral hormonal contraception (75.7%). Women chose the ring for: practicality (32.4%), forgetting the pill (32.4%) and irregular vaginal bleeding (13.5%). The satisfaction degree was 80.5% (119). There were good cycle control and no pregnancies. Thirty-eight patients discontinued the use (25.7%). The main reasons were wish for pregnancy (6%), spotting (3.4%) and increased vaginal discharge (2.7%). At the end of the first year, use of the greatest reduction of continuity probability was observed (19.3%). Women with side effects were 68% less likely to be satisfied with the method than those without (p-value <0.0001). Conclusion: Nuvaring^® is an excellent contraceptiveoption due to its sefficacy, cycle control, tolerability, practicality and safety.

Keywords

Vaginal Ring; Hormonal Contraception; Efficacy; Tolerability

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Mosher, W.D., Martinez, G.M., Chandra, A., Abma, J.C. and Wilson, S.J. (2004) Use of contraception and use of family planning services in the United States: 1982-2002. Advanced Data, 10, 1-36.
[2]	Trussel, J. (2004) Contraceptive failure in the United States. Contraception, 70, 89-96. http://dx.doi.org/10.1016/j.contraception.2004.03.009
[3]	Melo, N. And Zuccato, A.P. (2004) Satisfaction and non contraceptive benefits with Nuvaring, a novel vaginal combined contraceptive method in a clinical experience program in Brazil. European Journal of Contraception Reproduction Heath Care, 9, 93-98.
[4]	Novak, A., de la Loge, C., Abetz, L. and van der Meulen, E.A. (2003) The combined contraceptive vaginal ring, NuvaRing: An international study of user acceptability. Contraception, 67, 187-194. http://dx.doi.org/10.1016/S0010-7824(02)00514-0
[5]	Potter, L., Oakley, D., de León-Wong, E. and Canamar, R. (1996) Measuring compliance among oral contraceptive users. Family Planning Perspectives, 28, 154-158. http://dx.doi.org/10.2307/2136191
[6]	Burkman, R.T. (2001) Oral contraceptives: Current status. Clinical Obstetrics and Gynecology, 44, 62-72. http://dx.doi.org/10.1097/00003081-200103000-00010
[7]	Creinim, M.D., Meyn, L.A., Borgatta, L., Barnhart, K., Jensen, J., Burke, A.E., Westhoff, C., Gilliam, M., Dutton, C. and Ballagh, S.A. (2008) Estudo multicêntrico comparando anel e adesivo na contracep??o. Obstetrics & Gynecology, 111, 267-277.
[8]	Food and Drug Administration (Estados Unidos) (2001) “sz” (PDF), 8. http://www.fda.gov/cder/ foi/nda/2001/21-187_NuvaRing_corres_P1.pdf
[9]	Bitzer, J. (2012) The vaginal ring (NuvaRing®) for contraception in adolescent women. Gynecological Endocrinology, 28, 125-129. http://dx.doi.org/10.3109/09513590.2011.579665
[10]	Carey, A.S., Chiappetta, L., Tremont, K., Murray, P.J. and Gold, M.A. (2007) The contraceptive vaginal ring: Female adolescents’ knowledge, attitudes and plans for use. Contraception, 76, 444-450. http://dx.doi.org/10.1016/j.contraception.2007.07.013
[11]	Lete, I., Doval, J.L., Pérez-Campos, E., et al. (2007) Factors affecting women’s selection of a combined hormonal contraceptive method: The TEAM-06 Spanish cross-sectional study. Contraception, 76, 77-83. http://dx.doi.org/10.1016/j.contraception.2007.04.014
[12]	Ahrendt, H.J., Nisand, I., Bastianelli, C., et al. (2006) Efficacy, acceptability and tolerability of the combined contraceptive ring, NuvaRing, compared with an oral contraceptive containing 30 μg of ethinyl estradiol and 3 mg of drospirenone. Contraception, 74, 451-457. http://dx.doi.org/10.1016/ j.contraception.2006.07.004
[13]	Fine, P.M., Tryggestad, J., Meyers, N.J. and Haghpeykar, H.S. (2007) Safety and acceptability with the use of a contraceptive vaginal ring after surgical or medical abortion. Contraception, 75, 367-371. http://dx.doi.org/10.1016/j.contraception.2007.01.009
[14]	Schafer, J.E., Osborne, L.M., Davis, A.R. and Westhoff, C. (2006) Acceptability and satisfaction using quick start with the contraceptive vaginal ring versus an oral contraceptive. Contraception, 73, 488-492. http://dx.doi.org/10.1016/j.contraception.2005.11.003
[15]	Westhoff, C.L., Heartwell, S., Edwards, S., et al. (2007) Oral contraceptive discontinuation: Do side effects matter? American Journal of Obstetrics & Gynecology, 196, 411-417. http://dx.doi.org/10. 1016/j.ajog.2006.12.015
[16]	Roumen, F.J., Apter, D., Mulders, T.M. and Dieben, T.O. (2001) Efficacy, tolerability and acceptability of a novel contraceptive vaginal ring releasing etonogestrel and ethinyloestradiol. Human Reproduction, 16, 469-475. http://dx.doi.org/10.1093/humrep/16.3.469
[17]	Oddsson, K., Leifels-Fischer, B., Wiel-Masson, D., et al. (2005) Superior cycle control with a contraceptive vaginalring compared with an oral contraceptive containing 30 microgethinylestradiol and 150 microglevonorgestrel: A randomized trial. Human Reproduction, 20, 557-562. http://dx.doi.org/10.1093/humrep/deh604
[18]	Roumen, F.J. and Mishell Jr., D.R. (2012) The contraceptive vaginal ring, NuvaRing(®), a decade after its introduction. European Journal of Contraception Reproduction Heath Care, 17, 415-427. http://dx.doi.org/10.3109/13625187.2012.713535