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Medical Therapies
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Simone Ferrero, Fabio Barra, Giulio Evangelisti, Matteo Tantari
Desogestrel (DSG) is a third-generation progestin. It is a prodrug that is converted to 3-keto-DSG, the active form of the drug (22). DSG has the advantage of also being approved as a licensed contraceptive. A patient preference trial compared the contraceptive vaginal ring (etonogestrel, ENG, 120 μg and ethinylestradiol, EE, 15 μg; 83 women) administered cyclically with DSG (75 μg/day; 60 women). At the end of the 12-month treatment, the satisfaction of the patients was higher in the DSG group. DSG was more efficacious than the vaginal ring in improving NMPP, deep dyspareunia and intestinal symptoms (23). In another patient preference study, DSG (75 μg/day) and cyclic COC (EE 20 μg + DSG 150 μg) were administered to 74 women with symptomatic rectovaginal endometriosis and migraine without aura (24). Although both treatments were equally effective in decreasing endometriosis-related pain, the satisfaction rate was higher for patients receiving DSG. In fact, the severity and number of migraine attacks were significantly different between baseline and the end of treatment in the DSG group but not in the COC group. Recently, an RCT compared DSG and placebo in 40 patients with endometriosis and moderate-to-severe dysmenorrhea or non-menstrual pelvic pain (NMPP) (25). DSG was more efficacious than placebo in improving dysmenorrhea and NMPP. Patients treated with DSG were more satisfied than those receiving placebo. The most frequent adverse effects caused by DSG are breakthrough bleeding, acne, nausea, breast pain and weight gain (22).
Combined methods
Published in Suzanne Everett, Handbook of Contraception and Sexual Health, 2020
NuvaRing is a non-biodegradable latex-free combined contraceptive vaginal ring which releases in 24 hours 120 micrograms of the progestogen etonogestrel and 15 micrograms of the oestrogen ethinylestradiol and remains in the vagina for three weeks. It is then removed for one week when a withdrawal bleed will occur, and then a new ring is inserted. NuvaRing is 4 mm thick and 54 mm in diameter and can be inserted into the vagina and removed by women.
The ins and outs of drug-releasing vaginal rings: a literature review of expulsions and removals
Published in Expert Opinion on Drug Delivery, 2020
Peter Boyd, Ruth Merkatz, Bruce Variano, R. Karl Malcolm
As part of a questionnaire-based acceptability study for the combined contraceptive vaginal ring NuvaRing®, Novak et al. captured self-reported information on the reasons why users removed rings during the study period [183]. Less than 40% of women reported removing the ring during the ring cycles, despite being permitted to do so for up to 3 hr. Of those women who completed the study, 1046 (69.7%) reported that they never temporarily removed the ring compared with 334 (51.8%) of those who prematurely discontinued. For women who completed and had temporarily removed the ring, 212 (14.1%) did so because of interference with intercourse and 64 (4.1%) because the ring fell out. The main reasons for temporarily removing the ring for discontinuers were interference with intercourse [91 women; 14.1%], the ring fell out [37 women; 5.7%] and discomfort [32 women; 5.0%]. In a smaller study involving 16 healthy Dutch women with the aim of assessing the effects of an extended 35-day NuvaRing® use regimen on ovarian function, temporary ring removal by some women reduced self-reported cumulative ring exposure from the maximum 6,720 hr (8 users per group × 35 days × 24 h) to 6,704 (Group 1) and 6,715 h, respectively [198]. Bjarnadóttir et al. also reported that ~90% of women did not temporarily remove NuvaRing® during six cycles of ring use [184]; of the 10% who did remove the ring, cumulative removal time was 2–4 h per 3-week cycle.
Comparative randomized study on the sexual function and quality of life of women on contraceptive vaginal ring containing ethinylestradiol/etonogestrel 3.47/11.00mg or 2.7/11.7mg
Published in Gynecological Endocrinology, 2019
Salvatore Caruso, Marco Panella, Giuliana Giunta, Maria Grazia Matarazzo, Antonio Cianci
In the field of oral contraception new active formulations, new regimens [1–3], and route of administration such as intravaginal monthly applied method [4] have been realized. However, as regards vaginal contraception, until recently, there has only been one contraceptive vaginal ring (CVR) (NuvaRing®, Msd, Italy) containing 2.7 mg of ethinylestradiol (EE) and 11.7 mg of etonogestrel (ENG); it has an external membrane of ethylene vinylacetate, containing 9% vinylacetate, through which 15 µg of EE and 120 µg of ENG are released daily [5]. After placement, the ring is kept in the vagina, on average, for a 3-week period of use, followed by a 1-week ring-free period, according to a traditional hormonal contraceptive (HC) regimen [6]. Withdrawal bleeding is to be expected within 2–3 days of ring removal. Subsequently, a new ring is placed and the cycle is repeated [7].
Reproductive empowerment and contraceptive self-care: a systematic review
Published in Sexual and Reproductive Health Matters, 2022
Holly M. Burke, Kathleen Ridgeway, Kate Murray, Alexandria Mickler, Reana Thomas, Katie Williams
We followed the WHO guideline on self-care interventions to define the types of contraceptive self-care eligible for inclusion1. Certain user-dependent methods were always considered self-care for this review: oral contraceptive pills (OCP), emergency contraception (EC), contraceptive vaginal ring (VR), contraceptive patch, rhythm method, cycle beads, withdrawal, male condom, female/internal condom, diaphragm, cervical cap, sponge, lactational amenorrhoea method, and spermicide. Other methods were considered self-care in certain circumstances: contraceptive injectables (when self-injected), intrauterine device (when self-removed), traditional/herbal methods (when self-administered), fertility awareness including digital apps and ovulation predictor kits (when used for pregnancy prevention), and urine pregnancy tests (when used for initiating a contraceptive method). Client-facing digital technologies were considered self-care if they (1) were accessible by clients with or without a health care provider and if they (2) were created to provide individualised information, guidance, or self-management of contraception to enhance access, acceptability, use of and/or intention to use contraception. These technologies included short message service (SMS) reminders, telehealth, smartphone apps, interactive voice response systems, chatbots, and decision aids. We excluded studies that combined self-care and non-self-care contraceptive methods (e.g. all contraception or modern methods) if they did not report results specifically for one or more of the self-care methods defined above. We also excluded studies which examined the use of male or female condoms solely for HIV prevention and did not study these methods as pregnancy prevention methods.