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Основы консультирования при назначении вагинального контрацептивного кольца с этинилэстрадиолом и этоногестрелом
© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.
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Pustotina OA, Terekhov MA. Basics of counseling when prescribing vaginal contraceptive rings with ethinyl estradiol and etonogestrel: A review. Gynecology. 2025;27(1):54–60. DOI: 10.26442/20795696.2025.1.203067
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Ключевые слова: вагинальное кольцо с этинилэстрадиолом и этоногестрелом, вагинальная контрацепция, вагинальная рилизинг-система с этоногестрелом, пролонгированная контрацепция
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Vaginal contraceptive rings are one of the prolonged methods of preventing unwanted pregnancies that do not require daily use. The vaginal contraceptive rings have high contraceptive efficacy and several advantages over traditional oral pills, increasing adherence to the method due to the absence of the need for daily control by the woman. Also, it has some non-contraceptive properties and features that can be used in specific clinical situations that require tailoring a contraception method. The article presents a literature review on the vaginal contraceptive method, a comparative description of combined oral contraceptives with vaginal contraceptive rings, the main advantages and disadvantages of vaginal contraceptive rings, as well as the basic rules of professional counseling.
Keywords: vaginal ring with ethinyl estradiol and etonogestrel, vaginal contraception, vaginal releasing system with etonogestrel, prolonged contraception
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15. Clinical effectiveness unit. Сombined hormonal contraception. London: Faculty of Sexual and Reproductive Healthcare, 2020.
16. Trussell J. Contraceptive failure in the United States. Contraception. 2011;83(5):397-404. DOI:10.1016/j.contraception.2011.01.021
17. Oddsson K, Leifels-Fischer B, de Melo NR, et al. Efficacy and safety of a contraceptive vaginal ring (NuvaRing) compared with a combined oral contraceptive: A 1-year randomized trial. Contraception. 2005;71(3):176-82. DOI:10.1016/j.contraception.2004.09.001
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21. Verhoeven CH, Dieben TO. The combined contraceptive vaginal ring, NuvaRing, and tampon co-usage. Contraception. 2004;69(3):197-9. DOI:10.1016/j.contraception.2003.10.014
22. Verhoeven CH, van den Heuvel MW, Mulders TM, Dieben TO. The contraceptive vaginal ring, NuvaRing, and antimycotic co-medication. Contraception. 2004;69(2):129-32. DOI:10.1016/j.contraception.2003.10.001
23. Lopez LM, Grimes DA, Gallo MF, et al. Skin patch and vaginal ring versus combined oral contraceptives for contraception. Cochrane Database Syst Rev. 2013;2013(4):CD003552. DOI:10.1002/14651858.CD003552.pub4
24. Gilliam ML, Neustadt A, Kozloski M, et al. Adherence and acceptability of the contraceptive ring compared with the pill among students: A randomized controlled trial. Obstet Gynecol. 2010;115(3):503-10. DOI:10.1097/AOG.0b013e3181cf45dc
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33. Speroff L, Darney PD. Oral contraception. In: A clinical guide for contraception. Philadelphia PA: Lippincott Williams & Wilkins, 2011.
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1. Lopez LM, Steiner M, Grimes DA, et al. Strategies for communicating contraceptive effectiveness. Cochrane Database Syst Rev. 2013;(4):CD006964. DOI:10.1002/14651858.CD006964.pub3
2. Mahaur В, Kaur S, Sharma N. Awareness and attitude towards contraception among medical students. Int J Clin Obstet Gynaecol. 2021;5(1):133-6. DOI:10.33545/gynae.2021.v5.i1c.802
3. Marson C, Cleland J. Relationship between contraception and abortion: A review of the evidence. Int Fam Plan Perspect. 2003;29(1):6-13. DOI:10.1363/ifpp.29.006.03
4. Pustotina OA. Preconception preparation. Meditsinskiy sovet = Medical Council. 2017;(13):64-70 (in Russian). DOI:10.21518/2079-701X-2017-13-64-70
5. Schrager S, Larson M, Carlson J, et al. Beyond birth control: Noncontraceptive benefits of hormonal methods and their key role in the general medical care of women. J Womens Health (Larchmt). 2020;29(7):937-43. DOI:10.1089/jwh.2019.7731
6. World Health Organization. Medical Eligibility Criteria for Contraceptive Use. 3rd ed. Geneva: WHO, 2015. Available at: http://www.who.int/reproductive- health/publications/mec/index.htm. Accessed: 10.08.2024.
7. WHO/SRH and Johns Hopkins Bloomberg School of Public Health / Center for Communication Programs (CCP), Knowledge SUCCESS. Family Planning: A Global Handbook for Providers. Baltimore and Geneva: CCP and WHO, 2022.
8. Natsional'nye meditsinskie kriterii priemlemosti metodov kontratseptsii. Adaptirovannyi dokument. Pod red. GT Sukhikh, VN Prilepskoi. Moscow. 2023 (in Russian).
9. Roumen FJ, Mishell DR Jr. The contraceptive vaginal ring, NuvaRing(®), a decade after its introduction. Eur J Contracept Reprod Health Care. 2012;17(6):415-27. DOI:10.3109/13625187.2012.713535
10. Sarkar NN. The combined contraceptive vaginal device (NuvaRing): A comprehensive review. Eur J Contracept Reprod Health Care. 2005;10(2):73-8. DOI:10.1080/13625180500131683
11. Duijkers I, Klipping C, Heger-Mahn D, et al. Phase II dose-finding study on ovulation inhibition and cycle control associated with the use of contraceptive vaginal rings containing 17β-estradiol and the progestagens etonogestrel or nomegestrol acetate compared to NuvaRing. Eur J Contracept Reprod Health Care. 2018;23(4):245-54. DOI:10.1080/13625187.2018.1506101
12. Fischer-Holzhausen S, Röblitz S. Hormonal regulation of ovarian follicle growth in humans: Model-based exploration of cycle variability and parameter sensitivities. J Theor Biol. 2022;547:111150. DOI:10.1016/j.jtbi.2022.111150
13. Taylor HS, Pal L, Seli E, eds. Clinical gynecologic endocrinology and infertility. 9th ed. Philadelphia: Lippincott Williams and Wilkins, 2019.
14. Bastianelli C, Farris M, Rosato E, et al. Pharmacodynamics of combined estrogen-progestin oral contraceptives 3. Inhibition of ovulation. Expert Rev Clin Pharmacol. 2018;11(11):1085-98. DOI:10.1080/17512433.2018.1536544
15. Clinical effectiveness unit. Сombined hormonal contraception. London: Faculty of Sexual and Reproductive Healthcare, 2020.
16. Trussell J. Contraceptive failure in the United States. Contraception. 2011;83(5):397-404. DOI:10.1016/j.contraception.2011.01.021
17. Oddsson K, Leifels-Fischer B, de Melo NR, et al. Efficacy and safety of a contraceptive vaginal ring (NuvaRing) compared with a combined oral contraceptive: A 1-year randomized trial. Contraception. 2005;71(3):176-82. DOI:10.1016/j.contraception.2004.09.001
18. Ahrendt HJ, Nisand I, Bastianelli C, et al. Efficacy, acceptability and tolerability of the combined contraceptive ring, NuvaRing, compared with an oral contraceptive containing 30 microg of ethinyl estradiol and 3 mg of drospirenone. Contraception. 2006;74(6):451-7. DOI:10.1016/j.contraception.2006.07.004
19. López-Picado A, Lapuente O, Lete I. Efficacy and side-effects profile of the ethinylestradiol and etonogestrel contraceptive vaginal ring: A systematic review and meta-analysis. Eur J Contracept Reprod Health Care. 2017;22(2):131-46. DOI:10.1080/13625187.2017.1287351
20. Haring T, Mulders TM. The combined contraceptive ring NuvaRing and spermicide co-medication. Contraception. 2003;67(4):271-2. DOI:10.1016/s0010-7824(03)00002-7
21. Verhoeven CH, Dieben TO. The combined contraceptive vaginal ring, NuvaRing, and tampon co-usage. Contraception. 2004;69(3):197-9. DOI:10.1016/j.contraception.2003.10.014
22. Verhoeven CH, van den Heuvel MW, Mulders TM, Dieben TO. The contraceptive vaginal ring, NuvaRing, and antimycotic co-medication. Contraception. 2004;69(2):129-32. DOI:10.1016/j.contraception.2003.10.001
23. Lopez LM, Grimes DA, Gallo MF, et al. Skin patch and vaginal ring versus combined oral contraceptives for contraception. Cochrane Database Syst Rev. 2013;2013(4):CD003552. DOI:10.1002/14651858.CD003552.pub4
24. Gilliam ML, Neustadt A, Kozloski M, et al. Adherence and acceptability of the contraceptive ring compared with the pill among students: A randomized controlled trial. Obstet Gynecol. 2010;115(3):503-10. DOI:10.1097/AOG.0b013e3181cf45dc
25. Victor I, Fink RA. Comparing patient telephone callback rates for different hormonal birth control delivery systems. Am J Ther. 2006;13(6):507-12. DOI:10.1097/01.mjt.0000212893.28081.b8
26. Ridgeway K, Montgomery ET, Smith K, et al. Vaginal ring acceptability: A systematic review and meta-analysis of vaginal ring experiences from around the world. Contraception. 2022;106:16-33. DOI:10.1016/j.contraception.2021.10.001
27. Feldman R, Frenkl TL, Yacik C, et al. Safety and efficacy of the NuvaRing® Applicator in healthy females: A multicenter, open-label, randomized, 2-period crossover study. Contraception. 2016;94(4):362-5. DOI:10.1016/j.contraception.2016.04.017
28. Alexander NJ, Baker E, Kaptein M, et al. Why consider vaginal drug administration? Fertil Steril. 2004;82(1):1-12. DOI:10.1016/j.fertnstert.2004.01.025
29. Srikrishna S, Cardozo L. The vagina as a route for drug delivery: A review. Int Urogynecol J. 2013;24(4):537-43. DOI:10.1007/s00192-012-2009-3
30. Chabi K, Sleno L. Estradiol, estrone and ethinyl estradiol metabolism studied by high resolution LC-MS/MS using stable isotope labeling and trapping of reactive metabolites. Metabolites. 2022;12(10):931. DOI:10.3390/metabo12100931
31. Grow DR. Metabolism of endogenous and exogenous reproductive hormones. Obstet Gynecol Clin North Am. 2002;29(3):425-36. DOI:10.1016/s0889-8545(02)00009-8
32. ESHRE Capri Workshop Group. Ovarian and endometrial function during hormonal contraception. Hum Reprod. 2001;16(7):1527-35. DOI:10.1093/humrep/16.7.1527
33. Speroff L, Darney PD. Oral contraception. In: A clinical guide for contraception. Philadelphia PA: Lippincott Williams & Wilkins, 2011.
34. De Leo V, Musacchio MC, Cappelli V, et al. Hormonal contraceptives: Pharmacology tailored to women’s health. Hum Reprod Update. 2016;22(5):634-46. DOI:10.1093/humupd/dmw016
35. van den Heuvel MW, van Bragt AJ, Alnabawy AK, Kaptein MC. Comparison of ethinylestradiol pharmacokinetics in three hormonal contraceptive formulations: the vaginal ring, the transdermal patch and an oral contraceptive. Contraception. 2005;72(3):168-74. DOI:10.1016/j.contraception.2005.03.005
36. Creinin MD, Vieira CS, Westhoff CL, Mansour DJA. Recommendations for standardization of bleeding data analyses in contraceptive studies. Contraception. 2022;112:14-22. DOI:10.1016/j.contraception.2022.05.011
37. Critchley HO, Maybin JA, Armstrong GM, Williams RW. Physiology of the endometrium and regulation of menstruation. Physiol Rev. 2020;100(3):1149-79. DOI:10.1152/physrev.00031.2019
38. Pustotina ОА. A prospective multicenter study of the use of a combined hormonal contraceptive with drospirenone. Vopr. ginekol. akus. perinatol. = Gynecology, Obstetrics and Perinatology. 2020;19(4):163-71 (in Russian). DOI:10.20953/1726-1678-2020-4-163-171
39. Dieben TO, Roumen FJ, Apter D. Efficacy, cycle control, and user acceptability of a novel combined contraceptive vaginal ring. Obstet Gynecol. 2002;100(3):585-93. DOI:10.1016/s0029-7844(02)02124-5
40. Stewart FH, Brown BA, Raine TR, et al. Adolescent and young women’s experience with the vaginal ring and oral contraceptive pills. J Pediatr Adolesc Gynecol. 2007;20(6):345-51. DOI:10.1016/j.jpag.2007.06.001
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ЧОУ ДПО «Академия медицинского образования им. Ф.И. Иноземцева», Санкт-Петербург, Россия
*Pustotina@gmail.com
________________________________________________
Olga A. Pustotina*, Matvei A. Terekhov
Inozemtsev Academy of Medical Education, Saint Petersburg, Russia
*Pustotina@gmail.com