Combined hormonal contraception

Potential causes for poor adherence

• Wish to get pregnant
• Accessibility
• Price
• Ambivalence about avoiding pregnancy
• Side effects/development of contraindications
  • Bleeding, cramps, weight gain, headache, decrease in sexual function….
• Estrogen dose
• Type of progestin
• Difficult to use
• Packaging

Rosenberg M et al. Am J Obstet Gynecol 1998; 179: 577-82
Rosenberg MJ et al. Contraception 1999; 60: 321-9
Rosenberg MJ et al. Contraception 1995; 51: 283-8
ESHRE. Hum Reprod 2000; 15: 1865-71
Frost JJ et al. Perspect Sex Reprod Health 2008; 40: 94-104

NuvaRing^TM: adaptive design optimized for vaginal hormone delivery

• Soft, flexible, latex-free ²
• Easily inserted and removed ³
• Long-acting reversible method avoids need for daily administration.⁴
• Controlled release of low-level hormones reduces fluctuations in blood levels. ^5,6
• Highly effective when used consistently and correctly⁷
• Discreet ⁵
• Acceptable to women and partners ⁸
• Rapid return to preexisting fertility ⁷

¹ NuvaRing Summary of Product Characteristics. www.medicines.org.uk/EMC/medicine/21419/SPC/Nuvaring/. Accessed 10 January 2011; ² Nanda K. In: Hatcher RA et al, eds. Contraceptive Technology. 19th rev ed. Ardent Media Inc; 2009:271-295; ³ Alexander NJ et al. Fertil Steril. 2004;82(1):1-12; ⁴ Mishell DR Jr. In: Katz VL et al, eds. Comprehensive Gynecology. 5th ed. Mosby Elsevier; 2007:275-325; ⁵BalogluE et al. J Pharm Pharm Sci. 2009;12(3):312-336; ⁶ Darney PD. In: Kronenberg HM et al, eds. Williams Textbook of Endocrinology. 11th ed. Saunders Elsevier; 2008:615-644; ⁷World Health Organization. Family planning. A global handbook for providers. info.k4health.org/globalhandbook/handbook.pdf. Accessed 9 September 2010; ⁸Novák A et al. Contraception. 2003;67;187-194.

Key goals for hormonal contraception in women

Effectiveness¹
Reduced unintended/unwanted pregnancy
Tolerability¹
Few side effects
Good cycle control²
Reduced breakthrough bleeding
Convenience³
Avoid need for daily administration
Patient Satisfaction

¹Trussell J. In: Hatcher RA et al, eds. Contraceptive Technology. 19th rev ed. Ardent Media; 2009;19-47; ²Bjarnadóttir RI et al. Am J Obstet Gynecol. 2002;186:389-395; ³World Health Organization. Contraceptive technology. www.who.int/reproductivehealth/topics/family_planning/broadening/en/index.html. Accessed 24 November 2010.