Advances in contraceptive vaginal rings: what does the future hold?

ABSTRACT

Introduction: Contraceptive vaginal rings (CVRs) are good contraceptive options because they do not require skilled providers, are self-administered, and show a higher stability of drug diffusion.

Area covered: This article provides a review of the developments made with CVRs over the past number of years, while giving focus to the latest CVRs that have gone through clinical development. The author of the article also provides an expert perspective on the future of these useful therapeutic options.

Expert opinion: Pharmacokinetic studies have shown that segesterone, an absorbable progestin that is used alone or in combination with ethinyl estradiol (EE) or E_2, is the CVR of choice at this present time. Indeed, segesterone has demonstrated safety and efficacy as a CVR and is also an appropriate option for lactating women, as they are not absorbed orally. However, good cycle control is important for improved CVR adherence. CVRs that allow the combination of more than one drug may unravel another multi-purpose use when combined with microbicides and could provide combined protection to women who wish to protect themselves from pregnancy and sexually transmitted infection.

KEYWORDS:

• Contraceptive vaginal ring
• menstrual disturbances
• etonogestrel
• segesterone

Article Highlights

• In CVRs, vaginal absorption and the constant release of steroids favor better cycle control and fewer side effects because there is no initial hepatic passage.

• The CVR with ENG/EE is a combined and effective CVR with high satisfaction rates. Despite this, the device is still not used very worldwide. The other combined CVR, containing EE and ENG, is a newly developed combined CVR that could also be well-accepted.

• The CVR containing progesterone-releasing vaginal ring is an effective CVR that releases natural progesterone and has higher rates of amenorrhea in breastfeeding users. Despite its good acceptability, it still has very limited use globally.

• CVRs containing NES (segesterone acetate) may be a good option in lactating women as they are not absorbed orally. Recently, new CVR containing NES and EE used for 1 year was approved by USFDA.

• New models and new polymers that can be reused for a long time have been developed to prevent the initial burst effect, reducing the cost and impact on the environment.

• CVRs that allow the use of more than one drug in the same ring may combine a contraceptive effect with protection against STIs, especially HIV.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

One referee declares that they’ve acted as a consultant for Merck & Co., Bayer Healthcare, Allergan and AMAG Pharmaceuticals. Another declares that they are on the Board of Trustees of the Population Council and their International Committee on Contraceptive Research. The Council has developed a progesterone only ring from lactating women for a combined contraceptive vaginal ring. They also declare that they have completed some studies with Organon on the Nuvaring in the past.

Additional information

Funding

This manuscript was not funded.