title: The contraceptive vaginal ring, NuvaRing(®), a decade after its introduction.
abstract: OBJECTIVE
  To review the clinical experience with the contraceptive vaginal ring (CVR, NuvaRing(®)) since its introduction over ten years ago.
  
  
  METHODS
  The literature was searched on efficacy, cycle control, safety, user preference and satisfaction of the CVR in comparison with combined oral contraceptives (COCs) and the patch, with special attention to recent developments.
  
  
  RESULTS
  The ring has the same working mechanism and contraindications as COCs. Serum levels of steroids are steadier, whereas oestrogenic exposure is lower. Contraceptive efficacy is similar, as are metabolic changes. Cycle control is better, and compliance and continuation rates are equal or higher. Oestrogen-related adverse symptoms appear to be fewer, but reports on the incidence of venous thrombosis are conflicting. Expulsion of the ring is reported by 4% to 20% of women. Local adverse events are the main reason for discontinuation. Acceptability is as high as with COCs and, after structured counselling, the ring is preferred by many women to the pill or the patch.
  
  
  CONCLUSIONS
  Efficacy of the CVR, and the metabolic changes and adverse events it elicits, are generally comparable to those of COCs, yet oestrogenic exposure is lower and cycle control superior. After counselling, the ring is preferred to the pill by many women.
authors.affiliation: Department of Obstetrics and Gynaecology, Atrium Medical Centre Parkstad, Heerlen, the Netherlands. f.roumen@atriummc.nl
authors.forename: Frans J M E
authors.initials: FJ
authors.lastname: Roumen
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Mishell
mesh_terms: D000282:Administration, Intravaginal; D003268:Contraception Behavior; D003270:Contraceptive Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology*; D003274:Contraceptive Devices, Female / Q000639:trends*; D003277:Contraceptives, Oral, Combined / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology*; D017135:Desogestrel / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D004967:Estrogens / Q000378:metabolism; D004997:Ethinyl Estradiol / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008597:Menstrual Cycle / Q000187:drug effects; D010342:Patient Acceptance of Health Care; D057968:Transdermal Patch; D016896:Treatment Outcome
chemical_list: D003270:Contraceptive Agents; D003277:Contraceptives, Oral, Combined; D004338:Drug Combinations; D004967:Estrogens; C516519:NuvaRing; D004997:Ethinyl Estradiol; D017135:Desogestrel