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Vaginal rings (also known as intravaginal rings, or V-Rings) are polymeric
drug delivery Drug delivery involves various methods and technologies designed to transport pharmaceutical compounds to their target sites helping therapeutic effect. It involves principles related to drug preparation, route of administration, site-specif ...
devices designed to provide controlled release of drugs for intravaginal administration over extended periods of time. The ring is inserted into the
vagina In mammals and other animals, the vagina (: vaginas or vaginae) is the elastic, muscular sex organ, reproductive organ of the female genital tract. In humans, it extends from the vulval vestibule to the cervix (neck of the uterus). The #Vag ...
and provides contraception protection. Vaginal rings come in one size that fits most people.


Types

Several vaginal ring products are currently available, including: *Vaginal rings as treatment of peri-menopausal symptoms: **''Estring'' - a low-dose
estradiol Estradiol (E2), also called oestrogen, oestradiol, is an estrogen steroid hormone and the major female sex hormone. It is involved in the regulation of female reproductive cycles such as estrous and menstrual cycles. Estradiol is responsible ...
-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 Hot flushes are a form of flushing, often caused by the changing hormone levels that are characteristic of menopause. They are typically experienced as a feeling of intense heat with sweating and rapid heartbeat, and may typically last from t ...
es and vaginal
atrophy Atrophy is the partial or complete wasting away of a part of the body. Causes of atrophy include mutations (which can destroy the gene to build up the organ), malnutrition, poor nourishment, poor circulatory system, circulation, loss of hormone, ...
associated with
menopause Menopause, also known as the climacteric, is the time when Menstruation, menstrual periods permanently stop, marking the end of the Human reproduction, reproductive stage for the female human. It typically occurs between the ages of 45 and 5 ...
. *Vaginal rings as contraception: **''NuvaRing'' - a low-dose contraceptive vaginal ring, manufactured from poly(ethylene-co-vinyl acetate), and releasing etonogestrel (a
progestin A progestogen, also referred to as a progestagen, gestagen, or gestogen, is a type of medication which produces effects similar to those of the natural female sex hormone progesterone in the body. A progestin is a '' synthetic'' progestogen. ...
) and ethinylestradiol (an
estrogen Estrogen (also spelled oestrogen in British English; see spelling differences) is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three ...
). **''Progering'' - containing
progesterone Progesterone (; P4) is an endogenous steroid and progestogen sex hormone involved in the menstrual cycle, pregnancy, and embryogenesis of humans and other species. It belongs to a group of steroid hormones called the progestogens and is the ma ...
as a sole ingredient, is available only in Chile and Peru. **''Annovera'' - a contraceptive vaginal ring, manufactured from methyl siloxane-based polymers, and releasing segesterone acetate (a
progestin A progestogen, also referred to as a progestagen, gestagen, or gestogen, is a type of medication which produces effects similar to those of the natural female sex hormone progesterone in the body. A progestin is a '' synthetic'' progestogen. ...
) and ethinylestradiol (an
estrogen Estrogen (also spelled oestrogen in British English; see spelling differences) is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three ...
) A number of other vaginal ring products are also in development.


Contraception

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 Progesterone (; P4) is an endogenous steroid and progestogen sex hormone involved in the menstrual cycle, pregnancy, and embryogenesis of humans and other species. It belongs to a group of steroid hormones called the progestogens and is the ma ...
) - the same hormones used in birth control pills. These hormones work mostly by stopping ovulation and thickening the cervical mucus, creating a barrier preventing sperm from fertilizing an egg. They could theoretically affect implantation but no evidence shows that they do. 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. Throughout the additional week, the serum hormone levels will remain in the contraceptive range. When compared with combined hormonal pills, the combined hormonal vaginal ring offers potentially better cycle control and treatment of
heavy menstrual bleeding Heavy menstrual bleeding (HMB), previously known as menorrhagia or hematomunia, is a menstruation, menstrual period with excessively heavy flow. It is a type of abnormal uterine bleeding (AUB). Abnormal uterine bleeding can be caused by stru ...
. 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 Vaginitis, also known as vulvovaginitis, is inflammation of the vagina and vulva. Symptoms may include itching, burning, pain, discharge, and a bad smell. Certain types of vaginitis may result in complications during pregnancy. The three mai ...
, device-related problems and
leukorrhea Leukorrhea or (leucorrhoea British English), also known as fluor albus, is a thick, whitish, yellowish or greenish vaginal discharge. It has also been referred to as "the whites". There are many causes of leukorrhea, the usual one being estrogen ...
. Because they release estrogen, vaginal rings have an increased risk of heart attack, stroke, and other serious side effects. Additionally, certain medicines and supplements, such as the antibiotic
rifampin Rifampicin, also known as rifampin, is an ansamycin antibiotic used to treat several types of bacterial infections, including tuberculosis (TB), ''Mycobacterium avium'' complex, leprosy, and Legionnaires' disease. It is almost always used tog ...
, the anti-fungal griseofulvin, anti-seizure medicines, St. John's wort, and HIV medicines, may compromise the effectiveness of vaginal rings. Vaginal rings do not protect users from sexually transmitted diseases. The only contraceptive measures that does so are latex or polyurethane
condom A condom is a sheath-shaped Barrier contraception, barrier device used during sexual intercourse to reduce the probability of pregnancy or a Sexually transmitted disease, sexually transmitted infection (STI). There are both external condo ...
s. The contraceptive vaginal ring has a failure rate of 0.3% when used as prescribed and 9% when used typically. 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.


Methods of use

Vaginal rings are easily inserted and removed. 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 The cervix (: cervices) or cervix uteri is a dynamic fibromuscular sexual organ of the female reproductive system that connects the vagina with the uterine cavity. The human female cervix has been documented anatomically since at least the time ...
, and the deeper the placement in the vagina, the less likely the ring will be felt. 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.FAQs on nuvaring.com
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. 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. *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 Menstruation (also known as a period, among other colloquial terms) is the regular discharge of blood and Mucous membrane, mucosal tissue from the endometrium, inner lining of the uterus through the vagina. The menstrual cycle is characterized ...
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


External links


EstringFemringNuvaring
{{Hormonal contraceptives Hormonal contraception Drug delivery devices Dosage forms Vagina