Vaginal contraceptive ring reduces bleeding days
Using a contraceptive-releasing vaginal ring for extended cycles of up to one year can reduce the number of days with menstrual bleeding, according to new research reported in the journal Obstetrics and Gynecology.
Lead investigator Dr. Leslie Miller of the University of Washington, Seattle and colleagues write that “the dogma that women using contraception must menstruate is changing, and (a reversible absence of bleeding) has become more acceptable to women.”
The researchers note that an oral contraceptive that reduces menstruation by means of an 84-day active cycle was recently approved. They determined whether similar results might be achieved by extending the usage cycles of the NuvaRing (NV Organon).
The team compared the bleeding patterns and tolerability of the standard 28-day cycle ring use schedule (21 days of contraceptive vaginal ring use followed by 7 ring-free days) with three different extended ring regimens.
The menstrual cycle is not the same for every woman. On average, menstrual flow occurs every 28 days and lasts about 4 days. However, there is wide variation in timing and duration that is still considered normal, especially if your periods began within the last two years.
If you soak through a sanitary pad or tampon every hour for 6 consecutive hours, this is considered a very heavy period. A prolonged period is one that lasts longer than 7 days. Irregular periods happen more often than every 21 days or less often than every 35 days.
After a run-in 28-day ring cycle, 429 women were randomly assigned to a treatment schedule that was monthly (28-day cycle), every other month (49-day cycle), every third month (91-day cycle), or continuous (364-day cycle).
The subjects were treated for one year and about 67 percent completed the study. The authors report that the number of bleeding days decreased with fewer scheduled ring-free days, but the number of spotting days increased.
For example, those on the 364-day cycle had no reported bleeding days, but 10 to 12 days of spotting during the first 3 months. The traditional 28-day cycle was associated with the lowest unscheduled bleeding during ring use.
Most women were satisfied with use of the ring. Those treated with the shorter cycles had the highest satisfaction. All of the schedules were well tolerated. Women on shorter cycles had the highest completion rates. Side effects were similar for the four groups.
“It is not FDA approved to skip periods on the ring,” Miller told, “but this study and other studies using the oral contraceptive are finding that for many women this might be an option.”
SOURCE: Obstetrics and Gynecology, September 2005.
Revision date: July 7, 2011
Last revised: by Jorge P. Ribeiro, MD