The NuvaRing® is a vaginal ring contraceptive that releases a daily dose of 15 μg ethinylestradiol and 120 μg etonogestrel through the vaginal epithelium, thereby avoiding the daily fluctuations in serum levels typically observed with combined oral contraceptives. Each ring is designed for a single 3-week use followed by a 1-week ring-free period. The ring offers robust inhibition of ovulation, yielding a Pearl Index of 0.65 for European women in registration trials. The ring has the same contraindications as combined oral contraceptives. The vaginal ring is a highly effective, safe and well-tolerated method of hormonal contraception designed for reproductive-aged women who desire freedom from the daily pill.
Papers of special note have been highlighted as either of interest (•) or of considerable interest (••) to readers.
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MishellDRJrTalasMParlowAFMoyerDL: Contraception by means of a silastic vaginal ring impregnated with medroxyprogesterone acetate. Am. J. Obstet. Gynecol.107(1), 100–107 (1970).
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RoumenFJApterDMuldersTMDiebenTO: Efficacy tolerability and acceptability of a novel contraceptive vaginal ring releasing etonogestrel and ethinyl oestradiol. Hum. Reprod.16(3), 469–475 (2001).
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One of the large, multicenter Phase III trials offering a vast amount of clinical experience of the vaginal ring
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DeckersGHSchoonenWGKloosterboerHJ: Influence of the substitution of 11-methylene, delta(15), and/or 18-methyl groups in norethisterone on receptor binding, transactivation assays and biological activities in animals. J. Steroid Biochem. Mol. Biol.74(3), 83–92 (2000).
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MuldersTMDiebenTO: Use of the novel combined contraceptive vaginal ring NuvaRing for ovulation inhibition. Fertil. Steril.75(5), 865–870 (2001).
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MuldersTMDiebenTOBenninkHJ: Ovarian function with a novel combined contraceptive vaginal ring. Hum. Reprod.17(10), 2594–2599 (2002).
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Open-label, randomized study describing data from 45 women with respect to ovulation inhibition and different treatment schemes with the vaginal ring
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TimmerCJMuldersTM: Pharmacokinetics of etonogestrel and ethinylestradiol released from a combined contraceptive vaginal ring. Clin. Pharmacokinet.39(3), 233–242 (2000).
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Important pharmacokinetic study on the vaginal ring
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van den HeuvelMWvan BragtAAlnabawyAKapteinMC: Comparison of ethinylestradiol pharmacokinetics in three hormonal contraceptive formulations: the vaginal ring, the transdermal patch and an oral contraceptive. Contraception174(72), 168–174 (2005).
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Interesting comparative pharmacokinetic study comparing the vaginal ring with a combined oral contraceptive (COC) and a transdermal patch
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HaringTMuldersTM: The combined contraceptive ring NuvaRing and spermicide co-medication. Contraception67(4), 271–272 (2003).
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VerhoevenCHDiebenTO: The combined contraceptive vaginal ring, NuvaRing, and tampon co-usage. Contraception69(3), 197–199 (2004).
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MooreLBGoodwinBJonesSA: John's wort induces hepatic drug metabolism through activation of the pregnane X receptor. Proc. Natl Acad. Sci. USA97(13), 7500–7502 (2000).
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DogteromPvan den HeuvelMWThomsenT: Absence of pharmacokinetic interactions of the combined contraceptive vaginal ring NuvaRing with oral amoxicillin or doxycycline in two randomised trials. Clin. Pharmacokinet.44(4), 429–438 (2005).
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OddssonKLeifels-FischerbBde MelocNR: Efficacy and safety of a contraceptive vaginal ring (NuvaRing) compared with a combined oral contraceptive: a 1-year randomized trial. Contraception71, 176–182 (2005).
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Open-label, randomized, Phase III study involving 1030 subjects
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DiebenTORoumenFJApterD: Efficacy, cycle control, and user acceptability of a novel combined contraceptive vaginal ring. Obstet. Gynecol.100(3), 585–593 (2002).
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1-year multicenter study involving 2322 women to assess the contraceptive efficacy, cycle control, tolerability and user acceptability of the contraceptive vaginal ring for up to 13 cycles
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WesthoffC: Higher body weight does not affect NuvaRing's efficacy Poster session. American College of Obstetrics and Gynecology Annual Meeting, Austin, TX, USA (2005).
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FergusonHVreeMLWilpshaarJEskesTK: Multicenter study of the efficacy cycle control and tolerability of a phasic desogestrel-containing oral contraceptive. Eur. J. Contracept. Reprod. Health Care5(1), 35–45 (2000).
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BjarnadottirRITuppurainenMKillickSR: Comparison of cycle control with a combined contraceptive vaginal ring and oral levonorgestrel/ethinyl estradiol. Am. J. Obstet. Gynecol.186(3), 389–395 (2002).
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AhrendtHJBakerE: Comparison of efficacy and tolerability with NuvaRing and Yasmin: a one-year randomized study. Poster session. American College of Obstetrics and Gynecology Annual Meeting, Austin, TX, USA (2005).
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OddssonKLeifels-FischerBWiel-MassonD: Superior cycle control with a contraceptive vaginal ring compared with an oral contraceptive containing 30mg ethinylestradiol and 150mg levonorgestrel: a randomized trial. Hum. Reprod.20(2), 557–562 (2005).
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Open-label, randomized, multicenter, Phase III study to compare cycle control of the vaginal ring with a COC. Cycle control with the vaginal ring was rated as superior to that of the COC
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MagnusdottirEMBjarnadottirRIOnundarsonPT: The contraceptive vaginal ring (NuvaRing) and hemostasis: a comparative study. Contraception69(6), 461–467 (2004).
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TuppurainenMKlimscheffskijRVenholaMDiebenTO: The combined contraceptive vaginal ring (NuvaRing) and lipid metabolism: a comparative study. Contraception69(5), 389–394 (2004).
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DuijkersIKillickSBigriggADiebenTO: A comparative study on the effects of a contraceptive vaginal ring NuvaRing and an oral contraceptive on carbohydrate metabolism and adrenal and thyroid function. Eur. J. Contracept. Reprod. Health Care9(3), 131–140 (2004).
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BultenJGrefteJSiebersBDiebenT: The combined contraceptive vaginal ring (NuvaRing) and endometrial histology. Contraception72(5), 362–365 (2005).
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VeresSMillerLBuringtonB: A comparison between the vaginal ring and oral contraceptives. Obstet. Gynecol.104(3), 555–563 (2004).
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StewartFBrownBAHarperC: Vaginal contraceptive rings: a new alternative for hormonal contraception with important advantages for young women. Poster session. American College of Obstetrics and Gynecology Annual Meeting, Austin, TX, USA (2005).
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MillerLVerhoevenCHHoutJ: Extended regimens of the contraceptive vaginal ring: a randomized trial. Obstet. Gynecol.106(3), 473–482 (2005).
