Vaginal Ring

Question 1

Efficacy?

Answer 1

93%

Question 2

Acne?
Weight gain?
VTE?

Answer 2

Improves
Neutral
Increases ( maybe higher than COCs)

Question 3

Bleeding
Cycle Control?
Withdrawal/Spotting?

Answer 3

Yes
Continuous or extended use usually results in amenorrhea within 1 year, spotting may increase at first

Question 4

Adverse Effects?

Answer 4

Nausea, Breast Tenderness, Bloating
Vaginitis, leukorrhea, decreased bleeding and nausea compared to other CHCs

Question 5

Drug Interactions

Answer 5

Decrease in hormone levels with CYP34A4 inducers ( anticonvulsants, some anitvirals )

Question 6

Return to Febrility?

Answer 6

Most will ovulate after a month, 99% will ovulate after 3-6 months

Question 7

Additional Considerations?

Answer 7

Decrease in ovarian, endometrial and colorectal cancer
May increase Breast cancer risk and cervical cancer risk
One size fits all
Partner may feel ring during sex
May increase libido

Question 8

Initiation and Dosing

Answer 8

1 ring inserted vaginally for 3 weeks, then HFI for 1 week
1 ring placed for 3-4 weeks with one ring free week every 3,6,12 months
1 ring replaced every 3-4 weeks

Question 9

Dose?

Answer 9

EE15 mcg and etonogestrel 120 mcg released daily