Saturday, June 30, 2007

NuvaRing Acceptability

Willingness to use NuvaRing, from a survey of 691 female college students:

OCPs were the most popular method, with more than 86% of respondents indicating that they were willing to use (53.5%) or were already using (32.8%) OCPs, followed by almost 40% who were willing to use the contraceptive patch. Respondents were least likely to be willing to try the contraceptive vaginal ring (20.4%). Respondents were primarily concerned with pregnancy and STD protection, cost, accessibility and side effects.

A very interesting finding from the survey:

Respondents expressed a twofold preference for oral administration over skin administration, threefold preference for oral administration over injection and more than eightfold preference for oral administration over vaginal administration. However, respondents expressed a strong preference for less frequent administration: more than 60% stated that they liked weekly or monthly administration, compared with 43% who preferred a daily method.

The researchers conclude:

[This study] highlights the importance of considering social context in the development of contraceptive methods and reinforces the need to obtain women's feedback on characteristics of the method in acceptability studies. Indeed, despite the desirable dosing schedule, the monthly regimen alone may be insufficient in motivating young women to use a method that entails vaginal insertion, particularly committed oral contraceptive users. Thus, clinicians should emphasize ways of increasing the acceptability of contraceptive vaginal ring insertion. These might include clinician insertion during the office visit, counseling regarding the ease of self-insertion and suggesting insertion devices such as tampon holders. These measures may increase the acceptability of the contraceptive vaginal ring among young women with busy lifestyles who might benefit from a nondaily method.

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At 1:02 PM, Anonymous Anonymous said...

As a dedicated NuvaRing user for exactly the reasons cited above, I've met considerable antagonism from friends/family members that don't realize a tampon is nearly 10x the size and inconvenience. I'd love to see the number of women who also don't use tampons for the same reason -- women with heavy flows and women who frequently use tampons, I suspect, are much more comfortable with a vaginal contraceptive. It amazes me that something vaginally inserted is still considered dirty by a large group of women.

I did a brief search on PubMed the other month to no effect: a doctor friend raised the question that vaginally administered contraceptives might be increasing the risk of estrogen-fueled cancer in those regions. Do you know of any studies that support or deny this idea?

At 3:40 PM, Blogger ema said...

I share your amazement, but then again I'm biased ;).

As to the estrogen-cancer idea, it's unlikely. Not only isn't the effect local, but, based on what we know from COCPs, the estrogen/progestin combo has a protective effect. [Of course, because the ring is relatively new, we don't yet have any long-term studies showing that NuvaRing offers comparable cancer protection.]

In any case, studies to date have shown no effect on the lining of the uterus. For example, from a study looking at 2 years of use (the 3wks on/1 wk off regimen):

In the present study of the combined contraceptive vaginal ring, atrophic or inactive endometrium and secretory changes were present in the majority of the biopsies after 1 year and 2 years of treatment with the vaginal ring. This is in line with the fact that low-dose combined OCs are known to inhibit the normal proliferative changes in the endometrium.


In conclusion, 12 and 24 months of NuvaRing treatment showed good suppression of endometrial activity. After 12 months of NuvaRing treatment, two subjects out of 78 showed abnormal biopsy results and subsequent investigations failed to find any further evidence of abnormalities in these subjects. After 24 months of NuvaRing treatment, normal biopsy results were obtained in all subjects. The described findings demonstrate that continuous, long-term use of NuvaRing has no adverse effects on endometrial histology.

[If the link doesn't work for you, the study is:
Johan Bultena, Johanna Greftea, Bert Siebersa, Thom Dieben. The combined contraceptive vaginal ring (NuvaRing) and endometrial histology. Contraception Volume 72, Issue 5, Pages 362-365 (November 2005)]


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