New Long-cycle Vaginal Ring

The best contraceptive methods are “forgetable”, affordable, and effective, and give you the fewest periods. The fever menstrual periods, with hormonal methods, means the fewer chances for escape ovulation so better protection against pregnancy. The newest contraceptive alternative approved by US Food and Drug Administration (FDA) can be just that. The segesterone acetate and ethinyl estradiol vaginal system (Annovera, made by the The Population Council, Inc) as the the first vaginal ring contraceptive that can be used for an entire year to prevent pregnancy.

Up to now the only vaginal ring contraceptive has been the NuvaRing, designed to be changed monthly. Annovera is a reusable, nonbiodegradable, flexible vaginal ring placed in the vagina for 3 weeks and then removed for 1 week during which women experience a menstrual period, or only removed for fewer days to not get a lighter or no menstrual periods. The schedule is repeated every 4 weeks for 1 year, covering 13 menstrual cycles of 28 days each, so the treatment cycle is virtually identical to the NuvaRing, but no need for 13 separate rings.

The efficacy and safety of Annovera were studied in healthy women ranging in age from 18 to 40 years. about two to four women out of 100 may get pregnant during the first year they use Annovera. These hormonal contraceptive rings should be able to bring the same non-contraceptive benefits to women that the oral contraceptive pill has brought, including:

• less pelvic inflammatory disease,

• fewer menstrual cramps,

• lighter menstrual bleeding,

• less anemia,

• fewer uterine fibroids,

• less rheumatoid arthritis,

• fewer ovarian cysts,

• less uterine and ovarian cancer

• greater bone density.

• fewer tubal pregnancies

• fewer tubal infections

• less fibrocystic breast disease, and

• possibly protection against atherosclerosis and heart disease

Annovera, like NuvaRing, and the oral contraceptive pill, carries a boxed warning relating to cigarette smoking and serious cardiovascular events. The press release information states that women aged over 35 years who smoke should not use Annovera. Cigarette smoking increases the risk for serious cardiovascular events from combination hormonal contraceptive use. The current recommendation in women with migraines are to discuss your options with your provider.

Annovera is contraindicated in women with a high risk for arterial or venous thrombotic diseases; current or history of breast cancer or other estrogen- or progestin-sensitive cancers; liver tumors, acute hepatitis, or decompensated cirrhosis; undiagnosed abnormal uterine bleeding; hypersensitivity to any of the components of Annovera.

The most common side effects in women using Annovera are similar to those of other combined hormonal contraceptive products and include headache/migraine, nausea/vomiting, yeast infections, abdominal pain, dysmenorrhea, breast tenderness, irregular bleeding, diarrhea, and genital itching.

The choice of a contraceptive is individual, and should be done at your yearly gynecologic visit. Call WHP health for an appointment.

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Suzanne Trupin, MD, Board Certified Obstetrician and Gynecologist and owner of Women's Health Practice, Hada Cosmetic Medicine, and Hatha Yoga and Fitness

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