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Contraceptive vaginal ring

Jennifer Kerns, MD, MPH
Philip D Darney, MD, MSc
Section Editor
Courtney A Schreiber, MD, MPH
Deputy Editor
Kristen Eckler, MD, FACOG


Combined (estrogen-progestin) hormonal contraception is a popular method of contraception worldwide [1] and is highly effective when used consistently and correctly [2]. The contraceptive vaginal ring offers the same benefits as oral contraceptives (OCs), but has the advantage that daily user compliance is not required [3,4]. The ring is left in place for three weeks and then removed for a single ring-free week.


Formulation — The contraceptive vaginal ring is a flexible device measuring 54 mm in diameter and 4 mm in cross-section (picture 1). The outer ring is composed of ethinyl estradiol (EE) and an ethylene vinyl acetate copolymer that contains crystals of etonogestrel (ENG), the 3 keto-metabolite of desogestrel. The device is latex-free.

Pharmacokinetics — The ring releases 15 mcg of EE and 120 mcg of ENG per day [5]. There is an immediate increase in serum hormonal concentration after insertion with a slow decrease over the cycle [6]. The concentration of EE is lower with the vaginal ring compared to other combined hormonal contraceptives:

In one study, the maximum serum concentration of EE was 30 percent lower than desogestrel-containing oral contraceptives (OCs) (34.7 ± 17.5 ng/L versus 124.9 ± 46.3 ng/L) and systemic exposure to EE was half that of desogestrel-containing OCs [5].

In a randomized trial comparing a levonorgestrel-containing OC, transdermal patch, and vaginal ring, users of the vaginal ring experienced 3.4 times lower EE exposure than patch users, and 2.1 times lower EE exposure than OC users [6]. Exposure to EE in the ring, OC, and patch groups were 10.6 ± 2.5 ng-h/mL, 21.9 ± 2.9 ng-h/mL, and 35.8 ± 5.5 ng-h/mL, respectively. These differences were not all proportional to differences in EE dose of the three contraceptives: 30 mcg/day for the OC, 20 mcg/day for the patch, and 15 mcg/day for the ring.

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Literature review current through: Nov 2017. | This topic last updated: Aug 01, 2017.
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