title: Prevalence of combined contraceptive vaginal rings in Norway.
abstract: BACKGROUND
  Little is known about vaginal ring (VR) prescribers and user patterns in Norway and internationally. With data from the Norwegian Prescription Database, we explore user and prescriber characteristics of women initiating VR use.
  
  
  METHODS
  In a cross-sectional study design, we analyzed 47 127 first-time VR users from 1 January 2006 to 31 December 2012. Follow up ended on 30 June 2013. We applied strict definitions for switching from any other hormonal contraceptive before and at the end of VR use. All analyses were performed using SPSS, with chi-squared test, t-test, and survival analysis.
  
  
  RESULTS
  At study end, the prevalent use of VR reached 10 per 1000 women of fertile age, which amounted to 3% of all hormonal contraceptive use. The number of first-time VR users increased from 2006 to 2008 only among women under the age of 20. Nearly three out of four new users discontinued after 3 months. Physicians without specialist status and general practitioners accounted for over 70% of the prescriptions, whereas gynecologists accounted for 17% of the prescriptions. Gynecologists were significant prescribers of VR to women aged 35 or more.
  
  
  CONCLUSIONS
  Gynecologists are important providers of VR to first-time users above 30 years of age. When prescribing VR to first-time users, it is important to discuss the need for contraception in a longer time perspective. Authorizing public health nurses/midwives as VR prescribers to teenagers, from 1 March 2006, may explain the relative increase in VR usage at a younger age.
authors.affiliation: Research Group Epidemiology of Chronic Diseases, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: Vanja Poppe
authors.initials: VP
authors.lastname: Skipenes
authors.affiliation: Research Group Epidemiology of Chronic Diseases, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: Finn Egil
authors.initials: FE
authors.lastname: Skjeldestad
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003274:Contraceptive Devices, Female / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006176:Gynecology / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D015995:Prevalence; D055815:Young Adult
keywords: Contraception; contraceptives; female; healthcare provider; hormonal; vaginal rings; women health