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{{redirect|V-ring|the use in [[mathematics]]|V-ring (ring theory)}}
{{redirect|V-ring|the use in mathematics|V-ring (ring theory)}}
{{Refimprove|date=December 2007}}
[[File:NuvaRing in hand.jpg|thumb|NuvaRing]]
[[File:NuvaRing in hand.jpg|thumb|NuvaRing]]
'''Vaginal rings''' (also known as '''intravaginal rings''', or '''V-Rings''') are polymeric [[drug delivery]] devices designed to provide controlled release of drugs for [[intravaginal administration]] over extended periods of time. The ring is inserted into the [[vagina]] and provides contraception protection. Vaginal rings come in one size that fits most women.
'''Vaginal rings''' (also known as '''intravaginal rings''', or '''V-Rings''') are polymeric [[drug delivery]] devices designed to provide controlled release of drugs for [[intravaginal administration]] over extended periods of time. The ring is inserted into the [[Human vagina|vagina]] and provides contraception protection. Vaginal rings come in one size that fits most people.

⚫
The correlation between breast cancer and the use of vaginal rings is under investigation, but recent literature suggests that the hormones used in vaginal rings has little, if any, relation to the risk of developing breast cancer.<ref name=":2" />


== Types ==
Several vaginal ring products are currently available, including:
Several vaginal ring products are currently available, including:

⚫
* ''Estring'' - a low-dose [[estradiol]]-releasing ring, manufactured from silicone elastomer, for the treatment of vaginal atrophy ([[atrophic vaginitis]]).
*Vaginal rings as treatment of peri-menopausal symptoms:
* ''Femring'' - a low-dose estradiol-acetate releasing ring, manufactured from silicone elastomer, for the relief of [[hot flash]]es and vaginal [[atrophy]] associated with [[menopause]].
* ''NuvaRing'' - a low-dose [[contraceptive vaginal ring]], manufactured from poly(ethylene-co-vinyl acetate), and releasing [[etonogestrel]] (a [[progestin]]) [[ethinyl estradiol]] (an [[estrogen]]).
**''Estring'' - a low-dose [[estradiol]]-releasing ring, manufactured from silicone elastomer, for the treatment of vaginal atrophy ([[atrophic vaginitis]]).
⚫
**''Femring'' - a low-dose estradiol-acetate releasing ring, manufactured from silicone elastomer, for the relief of [[hot flash]]es and vaginal [[atrophy]] associated with [[menopause]].
⚫
* ''Progering'', containing [[progesterone]] as a sole ingredient, is available only in Chile and Peru.<ref>[http://www.drugs.com/international/progering.html Drugs.com - Progering]</ref>
*Vaginal rings as contraception:
**''NuvaRing'' - a low-dose [[contraceptive vaginal ring]], manufactured from poly(ethylene-co-vinyl acetate), and releasing [[etonogestrel]] (a [[progestin]]) and [[ethinylestradiol]] (an [[estrogen]]).
⚫
**''Progering'' - containing [[progesterone]] as a sole ingredient, is available only in Chile and Peru.<ref>[https://www.drugs.com/international/progering.html Drugs.com - Progering]</ref>
**''Annovera'' - a [[contraceptive vaginal ring]], manufactured from methyl siloxane-based polymers, and releasing [[segesterone acetate]] (a [[Progestogen (medication)|progestin]]) and [[ethinylestradiol]] (an [[Estrogen (medication)|estrogen]])<ref>{{Cite web |url=https://www.fda.gov/news-events/press-announcements/fda-approves-new-vaginal-ring-one-year-birth-control |title=FDA approves new vaginal ring for one year of birth control |last=Health |first=Center for Devices and Radiological |date=2020-03-24 |website=FDA |language=en|access-date=2020-04-27}}</ref><ref>{{Cite journal |last=Research |first=Center for Drug Evaluation and |date=2020-03-30 |title=Drug Trial Snapshot: ANNOVERA |url=https://www.fda.gov/drugs/drug-approvals-and-databases/drug-trial-snapshot-annovera |journal=FDA |language=en}}</ref>


A number of other vaginal ring products are also in development.
A number of other vaginal ring products are also in development.


==Birth control==
==Contraception==
It is self-administered once a month. Leaving the ring in for three weeks slowly releases hormones into the body, mainly [[vaginally administered estrogens]] and/or [[progestogen]]s (a group of hormones including [[progesterone]]) - the same hormones used in birth control pills.<ref name=":1">{{Cite journal|last=Angello|first=Anthony|date=January 2013|title=Vaginal Contraceptive Ring|url=http://web.b.ebscohost.com/ehost/detail/detail?vid=1&sid=13274cb4-841b-4916-835e-fbd7fc552ec3%40sessionmgr1&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#AN=36257422&db=hxh|journal=CRS - Adult Health Advisor|volume=|issue=|doi=|pmid=|access-date=September 16, 2016|via=EBSCOhost}}</ref> These hormones work mostly by stopping ovulation and thickening the cervical mucus, creating a barrier preventing sperm from fertilizing an egg.<ref name=":1" /> They could theoretically affect implantation but no evidence shows that they do.<ref>{{cite journal |vauthors=Rivera R, Yacobson I, Grimes D |year=1999 |title=The mechanism of action of hormonal contraceptives and intrauterine contraceptive devices |journal=Am J Obstet Gynecol |volume=181 |issue=5 Pt 1 |pages=1263–9 |pmid=10561657 |doi=10.1016/S0002-9378(99)70120-1|quote=The hormonal methods, particularly the low-dose progestin-only products and emergency contraceptive pills, have effects on the endometrium that, theoretically, could affect implantation. However, no scientific evidence indicates that prevention of implantation actually results from the use of these methods.}}</ref> Worn continuously for three weeks followed by a week off, each vaginal ring provides one month of birth control. For continuous-use contraception, users can also choose to wear the vaginal ring for the full four week cycle. This manner of contraception will eliminate monthly periods.<ref name=":2">{{Cite web|url=https://www.plannedparenthood.org/learn/birth-control/birth-control-vaginal-ring-nuvaring|title=NuvaRing Effectiveness {{!}} Birth Control Vaginal Ring|website=www.plannedparenthood.org|access-date=2016-09-16}}</ref> Throughout the additional week, the serum hormone levels will remain in the contraceptive range.<ref name=":0">{{Cite web|url=http://www.arhp.org/Publications-and-Resources/Quick-Reference-Guide-for-Clinicians/choosing/Vaginal-Ring|title=Choosing a Birth Control Method|last=Phelps|first=Rachel|date=June 2014|website=Association of Reproductive Health Professionals|publisher=Bayer Healthcare Pharmaceuticals, Conceptus, Inc., and Teva Pharmaceuticals|access-date=September 16, 2016}}</ref>
The combined hormonal contraceptive vaginal ring is self-administered once a month. Leaving the ring in for three weeks slowly releases hormones into the body, mainly [[vaginally administered estrogens]] and/or [[progestogen]]s (a group of hormones including [[progesterone]]) - the same hormones used in birth control pills.<ref name=":1">{{Cite journal |last=Angello |first=Anthony |date=January 2013 |title=Vaginal Contraceptive Ring |url=http://web.b.ebscohost.com/ehost/detail/detail?vid=1&sid=13274cb4-841b-4916-835e-fbd7fc552ec3%40sessionmgr1&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#AN=36257422&db=hxh |journal=CRS - Adult Health Advisor|access-date=September 16, 2016 |via=EBSCOhost}}</ref> These hormones work mostly by stopping ovulation and thickening the cervical mucus, creating a barrier preventing sperm from fertilizing an egg.<ref name=":1" /> They could theoretically affect implantation but no evidence shows that they do.<ref>{{cite journal |vauthors=Rivera R, Yacobson I, Grimes D |year=1999 |title=The mechanism of action of hormonal contraceptives and intrauterine contraceptive devices |journal=Am J Obstet Gynecol |volume=181 |issue=5 Pt 1 |pages=1263–9 |pmid=10561657 |doi=10.1016/S0002-9378(99)70120-1 |quote=The hormonal methods, particularly the low-dose progestin-only products and emergency contraceptive pills, have effects on the endometrium that, theoretically, could affect implantation. However, no scientific evidence indicates that prevention of implantation actually results from the use of these methods.}}</ref> Worn continuously for three weeks followed by a week off, each vaginal ring provides anywhere from one month (NuvaRing) to one year (Annovera and Progering) of birth control. For continuous-use contraception, users can also choose to wear the vaginal ring for the full four week cycle. This manner of contraception will eliminate monthly periods.<ref name=":2">{{Cite web |url=https://www.plannedparenthood.org/learn/birth-control/birth-control-vaginal-ring-nuvaring |title=NuvaRing Effectiveness {{!}} Birth Control Vaginal Ring|website=www.plannedparenthood.org|access-date=2016-09-16}}</ref> Throughout the additional week, the serum hormone levels will remain in the contraceptive range.<ref name=":0">{{Cite web |url=http://www.arhp.org/Publications-and-Resources/Quick-Reference-Guide-for-Clinicians/choosing/Vaginal-Ring |title=Choosing a Birth Control Method |last=Phelps |first=Rachel |date=June 2014 |website=Association of Reproductive Health Professionals |publisher=Bayer Healthcare Pharmaceuticals, Conceptus, Inc., and Teva Pharmaceuticals|access-date=September 16, 2016}}</ref>


When compared with combined hormonal pills, the combined hormonal vaginal ring offers potentially better cycle control and treatment of [[heavy menstrual bleeding]].<ref name=":3">{{Cite journal|last=Dahiya|first=P|date=May 20, 2016|title=Efficacy of combined hormonal vaginal ring in comparison to combined hormonal pills in heavy menstrual bleeding|journal=Eur J Obstet Gynecol Reprod Biol.|volume=147|issue=51|doi=10.1016/j.ejogrb.2016.05.009|pmid=27285306|via=PubMed}}</ref> However, both methods are effective short-term treatments in the reproductive age group. Vaginal rings may lead to increased normal vaginal secretions, decreased body weight, reduced symptoms of [[Premenstrual syndrome|PMS]], and occasionally cases of [[vaginitis]], device-related problems and [[leukorrhea]].<ref name=":1" /><ref name=":0" /><ref name=":3" /> Because they release estrogen, vaginal rings have an increased risk of heart attack, stroke, and other serious side effects.<ref name=":2" /> Additionally, certain medicines and supplements, such as the antibiotic [[Rifampicin|rifampin]], the anti-fungal [[griseofulvin]], anti-seizure medicines, [[Hypericum perforatum|St. John's wort]], and [[HIV]] medicines, may compromise the effectiveness of vaginal rings.<ref name=":2" /> Vaginal rings do not protect users from [[Sexually transmitted infection|sexually transmitted diseases]]. The only contraceptive measures that does so are latex or polyurethane [[condom]]s.<ref name=":1" />
When compared with combined hormonal pills, the combined hormonal vaginal ring offers potentially better cycle control and treatment of [[heavy menstrual bleeding]].<ref name=":3">{{Cite journal |last=Dahiya |first=P |date=May 20, 2016 |title=Efficacy of combined hormonal vaginal ring in comparison to combined hormonal pills in heavy menstrual bleeding |journal=Eur J Obstet Gynecol Reprod Biol |volume=203 |doi=10.1016/j.ejogrb.2016.05.009 |pmid=27285306 |pages=147–51}}</ref> However, both methods are effective short-term treatments in the reproductive age group. Vaginal rings may lead to increased normal vaginal secretions, decreased body weight, reduced symptoms of [[Premenstrual syndrome|PMS]], and occasionally cases of [[vaginitis]], device-related problems and [[leukorrhea]].<ref name=":1" /><ref name=":0" /><ref name=":3" /> Because they release estrogen, vaginal rings have an increased risk of heart attack, stroke, and other serious side effects.<ref name=":2" /> Additionally, certain medicines and supplements, such as the antibiotic [[Rifampicin|rifampin]], the anti-fungal [[griseofulvin]], anti-seizure medicines, [[Hypericum perforatum|St. John's wort]], and [[HIV]] medicines, may compromise the effectiveness of vaginal rings.<ref name=":2" /> Vaginal rings do not protect users from [[Sexually transmitted infection|sexually transmitted diseases]]. The only contraceptive measures that does so are latex or polyurethane [[condom]]s.<ref name=":1" />


The [[contraceptive vaginal ring]] has a failure rate of 0.3% when used as prescribed and 9% when used frequently.<ref name=":0" /><ref>{{Cite journal|last=Trussell|first=J|date=2011|title=Contraceptive failure in the United States|journal=Contraception|volume=83|issue=5|doi=10.1016/j.contraception.2011.01.021|pmid=21477680|via=PubMed}}</ref>
The [[contraceptive vaginal ring]] has a failure rate of 0.3% when used as prescribed and 9% when used typically.<ref name=":0" /><ref>{{Cite journal |last=Trussell |first=J |date=2011 |title=Contraceptive failure in the United States |journal=Contraception |volume=83 |issue=5 |doi=10.1016/j.contraception.2011.01.021 |pmid=21477680 |pmc=3638209 |pages=397–404}}</ref>

⚫
The correlation between breast cancer and the use of vaginal rings is under investigation, but recent literature suggests that the hormones used in vaginal rings has little, if any, relation to the risk of developing breast cancer.<ref name=":2" />


==Methods of use==
==Methods of use==
Vaginal rings are easily inserted and removed.<ref>{{cite journal |last=Mulders |first=Titia |date=May 2001 |title=Use of the novel combined contraceptive vaginal ring NuvaRing for ovulation inhibition |journal=Fertility and Sterility |volume=75 |issue=5 |doi=10.1016/S0015-0282(01)01689-2 |pmid= |url=http://www.sciencedirect.com/science/article/pii/S0015028201016892 |access-date=September 16, 2016 |via=Elsevier Science Direct}}</ref> Vaginal walls hold them in place. Although their exact location within the vagina is not critical for clinical efficacy, rings commonly reside next to the [[cervix]], and the deeper the placement in the vagina, the less likely the ring will be felt.<ref name=":2" /><ref name=":0" /> Rings are typically left in place during intercourse, and most couples report no interference or discomfort. In many cases, neither partner feels the presence of the ring.<ref>
Vaginal rings are easily inserted and removed.<ref>{{cite journal |last=Mulders |first=Titia |date=May 2001 |title=Use of the novel combined contraceptive vaginal ring NuvaRing for ovulation inhibition |journal=Fertility and Sterility |volume=75 |issue=5 |doi=10.1016/S0015-0282(01)01689-2 |pmid=11334895 |pages=865–870|doi-access=free }}</ref> Vaginal walls hold them in place. Although their exact location within the vagina is not critical for clinical efficacy, rings commonly reside next to the [[cervix]], and the deeper the placement in the vagina, the less likely the ring will be felt.<ref name=":2" /><ref name=":0" /> Rings are typically left in place during intercourse, and most couples report no interference or discomfort. In many cases, neither partner feels the presence of the ring.<ref>
[http://www.nuvaring.com/Consumer/commonQuestions/index.asp FAQs on nuvaring.com]
[http://www.nuvaring.com/Consumer/commonQuestions/index.asp FAQs on nuvaring.com]
</ref> Rings can be removed prior to intercourse, but, in the case of the contraceptive NuvaRing, only for one to three hours to maintain efficacy of birth control. If the ring is out for more than 48 hours, back up contraception is necessary for seven days.<ref name=":2" /> It typically takes between one and two months for a user's cycle to return to normal after the use of a vaginal ring is stopped.<ref name=":2" />
</ref> Rings can be removed prior to intercourse, but, in the case of the contraceptive NuvaRing, only for one to three hours to maintain efficacy of birth control. If the ring is out for more than 48 hours, back up contraception is necessary for seven days.<ref name=":2" /> It typically takes between one and two months for a user's cycle to return to normal after the use of a vaginal ring is stopped.<ref name=":2" />
Line 28: Line 32:
*Estring - Estring is inserted into the vagina and left in place for three months, after which it is removed and replaced with a fresh ring.
*Estring - Estring is inserted into the vagina and left in place for three months, after which it is removed and replaced with a fresh ring.
*Femring - Femring is inserted into the vagina and left in place for three months, after which it is removed and replaced with a fresh ring.
*Femring - Femring is inserted into the vagina and left in place for three months, after which it is removed and replaced with a fresh ring.
*NuvaRing - NuvaRing is inserted into the vagina and left in place for three weeks, after which it is removed for a 'ring-free' week to allow [[menstruation]] to occur.
*NuvaRing - NuvaRing is inserted into the vagina and left in place for three weeks, after which it is removed and discarded for a 'ring-free' week to allow [[menstruation]] to occur. At the end of that week, a new NuvaRing is inserted.
*Annovera - Annovera ring is inserted into the vagina and left in place for three weeks, after which it is removed for one week. Unlike the NuvaRing, users will reinsert the same Annovera Ring one week later. A single Annovera Ring is used for 3 week cycles for a total of 13 cycles.


== References ==
== References ==

Latest revision as of 03:38, 26 June 2024

"V-ring" redirects here. For the use in mathematics, see V-ring (ring theory).
NuvaRing

Vaginal rings (also known as intravaginal rings, or V-Rings) are polymeric drug delivery devices designed to provide controlled release of drugs for intravaginal administration over extended periods of time. The ring is inserted into the vagina and provides contraception protection. Vaginal rings come in one size that fits most people.

Types

[edit]

Several vaginal ring products are currently available, including:

A number of other vaginal ring products are also in development.

Contraception

[edit]

The combined hormonal contraceptive vaginal ring is self-administered once a month. Leaving the ring in for three weeks slowly releases hormones into the body, mainly vaginally administered estrogens and/or progestogens (a group of hormones including progesterone) - the same hormones used in birth control pills.[4] These hormones work mostly by stopping ovulation and thickening the cervical mucus, creating a barrier preventing sperm from fertilizing an egg.[4] They could theoretically affect implantation but no evidence shows that they do.[5] Worn continuously for three weeks followed by a week off, each vaginal ring provides anywhere from one month (NuvaRing) to one year (Annovera and Progering) of birth control. For continuous-use contraception, users can also choose to wear the vaginal ring for the full four week cycle. This manner of contraception will eliminate monthly periods.[6] Throughout the additional week, the serum hormone levels will remain in the contraceptive range.[7]

When compared with combined hormonal pills, the combined hormonal vaginal ring offers potentially better cycle control and treatment of heavy menstrual bleeding.[8] However, both methods are effective short-term treatments in the reproductive age group. Vaginal rings may lead to increased normal vaginal secretions, decreased body weight, reduced symptoms of PMS, and occasionally cases of vaginitis, device-related problems and leukorrhea.[4][7][8] Because they release estrogen, vaginal rings have an increased risk of heart attack, stroke, and other serious side effects.[6] Additionally, certain medicines and supplements, such as the antibiotic rifampin, the anti-fungal griseofulvin, anti-seizure medicines, St. John's wort, and HIV medicines, may compromise the effectiveness of vaginal rings.[6] Vaginal rings do not protect users from sexually transmitted diseases. The only contraceptive measures that does so are latex or polyurethane condoms.[4]

The contraceptive vaginal ring has a failure rate of 0.3% when used as prescribed and 9% when used typically.[7][9]

The correlation between breast cancer and the use of vaginal rings is under investigation, but recent literature suggests that the hormones used in vaginal rings has little, if any, relation to the risk of developing breast cancer.[6]

Methods of use

[edit]

Vaginal rings are easily inserted and removed.[10] Vaginal walls hold them in place. Although their exact location within the vagina is not critical for clinical efficacy, rings commonly reside next to the cervix, and the deeper the placement in the vagina, the less likely the ring will be felt.[6][7] Rings are typically left in place during intercourse, and most couples report no interference or discomfort. In many cases, neither partner feels the presence of the ring.[11] Rings can be removed prior to intercourse, but, in the case of the contraceptive NuvaRing, only for one to three hours to maintain efficacy of birth control. If the ring is out for more than 48 hours, back up contraception is necessary for seven days.[6] It typically takes between one and two months for a user's cycle to return to normal after the use of a vaginal ring is stopped.[6]

  • Estring - Estring is inserted into the vagina and left in place for three months, after which it is removed and replaced with a fresh ring.
  • Femring - Femring is inserted into the vagina and left in place for three months, after which it is removed and replaced with a fresh ring.
  • NuvaRing - NuvaRing is inserted into the vagina and left in place for three weeks, after which it is removed and discarded for a 'ring-free' week to allow menstruation to occur. At the end of that week, a new NuvaRing is inserted.
  • Annovera - Annovera ring is inserted into the vagina and left in place for three weeks, after which it is removed for one week. Unlike the NuvaRing, users will reinsert the same Annovera Ring one week later. A single Annovera Ring is used for 3 week cycles for a total of 13 cycles.

References

[edit]
  1. ^ Drugs.com - Progering
  2. ^ Health, Center for Devices and Radiological (2020-03-24). "FDA approves new vaginal ring for one year of birth control". FDA. Retrieved 2020-04-27.
  3. ^ Research, Center for Drug Evaluation and (2020-03-30). "Drug Trial Snapshot: ANNOVERA". FDA.
  4. ^ a b c d Angello, Anthony (January 2013). "Vaginal Contraceptive Ring". CRS - Adult Health Advisor. Retrieved September 16, 2016 – via EBSCOhost.
  5. ^ Rivera R, Yacobson I, Grimes D (1999). "The mechanism of action of hormonal contraceptives and intrauterine contraceptive devices". Am J Obstet Gynecol. 181 (5 Pt 1): 1263–9. doi:10.1016/S0002-9378(99)70120-1. PMID 10561657. The hormonal methods, particularly the low-dose progestin-only products and emergency contraceptive pills, have effects on the endometrium that, theoretically, could affect implantation. However, no scientific evidence indicates that prevention of implantation actually results from the use of these methods.
  6. ^ a b c d e f g "NuvaRing Effectiveness | Birth Control Vaginal Ring". www.plannedparenthood.org. Retrieved 2016-09-16.
  7. ^ a b c d Phelps, Rachel (June 2014). "Choosing a Birth Control Method". Association of Reproductive Health Professionals. Bayer Healthcare Pharmaceuticals, Conceptus, Inc., and Teva Pharmaceuticals. Retrieved September 16, 2016.
  8. ^ a b Dahiya, P (May 20, 2016). "Efficacy of combined hormonal vaginal ring in comparison to combined hormonal pills in heavy menstrual bleeding". Eur J Obstet Gynecol Reprod Biol. 203: 147–51. doi:10.1016/j.ejogrb.2016.05.009. PMID 27285306.
  9. ^ Trussell, J (2011). "Contraceptive failure in the United States". Contraception. 83 (5): 397–404. doi:10.1016/j.contraception.2011.01.021. PMC 3638209. PMID 21477680.
  10. ^ Mulders, Titia (May 2001). "Use of the novel combined contraceptive vaginal ring NuvaRing for ovulation inhibition". Fertility and Sterility. 75 (5): 865–870. doi:10.1016/S0015-0282(01)01689-2. PMID 11334895.
  11. ^ FAQs on nuvaring.com
[edit]
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