What contraceptive vaginal rings are available in the US for birth control?

Contraceptive Vaginal Rings Available in the US

Two contraceptive vaginal rings are currently available in the United States: NuvaRing (etonogestrel/ethinyl estradiol) and ANNOVERA (segesterone acetate/ethinyl estradiol). 1, 2, 3

NuvaRing (Etonogestrel/Ethinyl Estradiol)

NuvaRing is a monthly combined hormonal contraceptive ring that releases 15 μg ethinyl estradiol and 120 μg etonogestrel daily. 1, 4

Dosing Regimen

• Insert the ring vaginally for 3 consecutive weeks, then remove for 1 week to allow withdrawal bleeding. 1, 5
• A new ring must be inserted after the 7-day ring-free interval, even if bleeding has not ceased. 1, 5
• The ring can be used for extended or continuous cycles by replacing it once every calendar month, as it contains sufficient medication for up to 35 days of use. 1, 5

Efficacy and Safety

• Typical-use failure rate is 9%, comparable to combined oral contraceptives. 1
• Perfect-use failure rate is 0.3%. 1
• The ring has the same eligibility criteria, risks, and benefits as combined oral contraceptives. 1

Adverse Effects

• Common side effects include vaginal discharge, vaginal discomfort, headache, and device-related events such as expulsion. 1, 3
• Unscheduled bleeding is the most common adverse effect with extended or continuous use. 5
• Serious adverse events are rare but include venous thromboembolism, consistent with other combined hormonal contraceptives. 3

Extended Use Indications

Extended or continuous cycles are particularly beneficial for: 5

• Anemia
• Severe dysmenorrhea
• Von Willebrand disease and other bleeding disorders
• Conditions that worsen cyclically (migraine without aura, epilepsy, irritable bowel syndrome)

ANNOVERA (Segesterone Acetate/Ethinyl Estradiol)

ANNOVERA is a reusable vaginal ring designed for 1 year of use, releasing approximately 0.15 mg/day segesterone acetate and 0.013 mg/day ethinyl estradiol. 2, 3

Dosing Regimen

• Insert the ring for 21 consecutive days, then remove for 7 days. 2
• The same ring is reused for up to 13 cycles (1 year total). 2, 3
• During the 7-day ring-free interval, wash the ring with mild soap and warm water, rinse, pat dry, and store it until reinsertion. 2

Important Deviations and Management

• If the ring is out of the vagina for less than 7 days in a 28-day cycle, pregnancy risk is not increased. 2
• If the ring is out for more than 7 days, use back-up contraception (condoms or spermicide) until the ring has been in place for 7 consecutive days. 2
• If accidentally expelled and replaced within 2 hours, contraceptive efficacy is maintained without need for back-up contraception. 2
• If out for more than 2 continuous hours or more than 2 cumulative hours during the 21-day use period, use back-up contraception until the ring has been in place for 7 consecutive days. 2

Contraindications

ANNOVERA is contraindicated in women with: 2

• High risk of arterial or venous thrombotic diseases (including smoking over age 35, history of DVT/PE, cerebrovascular disease, coronary artery disease)
• Current or history of breast cancer
• Liver tumors, acute hepatitis, or severe cirrhosis
• Undiagnosed abnormal uterine bleeding
• Hypersensitivity to any components

Advantages

• Cost-effective due to 1-year duration of use compared to monthly replacement. 3
• User-controlled with less frequent replacement than NuvaRing. 3

Common Pitfalls and Caveats

Both rings share the same contraindications as combined oral contraceptives, including: 1

• Smoking in women over age 35
• History of venous thromboembolism
• Migraine with aura or migraine in women over age 35
• Uncontrolled hypertension

Neither ring protects against sexually transmitted infections or HIV; condoms should be recommended for dual protection. 1

Most male partners do not notice the ring during intercourse, though it can be temporarily removed for up to 3 hours (NuvaRing) or 2 hours (ANNOVERA) if desired. 1, 2