Al-Haddad Sara, Branham Ki'ara K R, Clare Camille A
Department of Obstetrics and Gynecology, Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203-2098, USA.
Department of Obstetrics and Gynecology, Meharry Medical College, Nashville, TN, USA.
Ther Adv Reprod Health. 2023 Jul 14;17:26334941231186733. doi: 10.1177/26334941231186733. eCollection 2023 Jan-Dec.
The vaginal contraceptive ring is very effective and user dependent. In this article, we will discuss the different types of vaginal contraceptive rings, namely, the etonogestrel/ethinyl estradiol (ENG/EE) ring (NuvaRing, Merck, Rahway, NJ, USA) and the segesterone acetate (SA)/EE (Annovera, Mayne Pharma, Raleigh, NC, USA) ring. The details of dosing and administration, indications, advantages, disadvantages, and cost-effectiveness are presented. This literature review was conducted using PubMed and Google Scholar. The search terms included 'vaginal contraceptive ring', 'etonogestrel/ethinyl estradiol ring', and 'segesterone acetate/ethinyl estradiol ring'. The search was then sorted by year from 2000 until present, and the most recent articles were reviewed. The purpose of this article is to provide a comprehensive reference on the two vaginal contraceptive rings widely used in the United States for clinicians to guide management. Both vaginal contraceptive rings are combination of hormonal contraceptives that suppress ovulation and create physiologic conditions unfavorable for pregnancy. The ENG/EE ring is designed to be replaced monthly, while the SA/EE ring is a single device used over the course of 1 year. Common side effects of both devices include headaches, nausea, vomiting, and vaginitis. Serious adverse reactions can occur with the vaginal contraceptive rings including venous thromboembolism, psychiatric events, and hypersensitivity. Both devices are contraindicated in patients at high risk for arterial or venous thrombotic events, patients with a history of breast cancer or other estrogen/progesterone cancers, and patients with severe liver disease. Overall, the vaginal contraceptive ring is well tolerated and liked by patients. Patients should be well counseled on known severe adverse reactions. The vaginal contraceptive ring is more expensive than other forms of contraception and this should be an important point of discussion with patients.
阴道避孕环非常有效且依赖使用者。在本文中，我们将讨论不同类型的阴道避孕环，即依托孕烯/炔雌醇（ENG/EE）环（优思明，默克公司，美国新泽西州拉威市）和醋酸炔诺酮（SA）/EE环（安悦环，美纳里尼制药公司，美国北卡罗来纳州罗利市）。文中介绍了给药和使用方法、适应证、优点、缺点以及成本效益的详细信息。本综述使用PubMed和谷歌学术进行。检索词包括“阴道避孕环”“依托孕烯/炔雌醇环”和“醋酸炔诺酮/炔雌醇环”。检索结果按年份从2000年至今进行排序，并对最新的文章进行了综述。本文的目的是为美国广泛使用的两种阴道避孕环提供全面参考，以指导临床医生进行管理。两种阴道避孕环均为激素避孕组合，可抑制排卵并创造不利于妊娠的生理条件。ENG/EE环设计为每月更换一次，而SA/EE环是一种在1年期间使用的单一装置。两种装置的常见副作用包括头痛、恶心、呕吐和阴道炎。阴道避孕环可能会出现严重不良反应，包括静脉血栓栓塞、精神事件和过敏反应。两种装置均禁用于有动脉或静脉血栓形成事件高风险的患者、有乳腺癌或其他雌激素/孕激素相关癌症病史的患者以及严重肝病患者。总体而言，阴道避孕环耐受性良好且受患者喜爱。应向患者充分告知已知的严重不良反应。阴道避孕环比其他避孕方式更昂贵，这应该是与患者讨论的一个重要要点。
