Contraception with the vaginal ring

Op.Dr.Kenan Ertopcu
I will tell you about a different method of contraception that has been in our country for several years. After many European countries, Brazil and Chile, the vaginal ring was approved and made available in 2001 by the FDA (the agency that gives drug and food approval) in the USA. In 2010, more than 5.5 million women in the United States (USA) started using the vaginal ring.
What is Vaginal Ring?
It is produced from a material called Nobel Prize-winning ethylene venyl acetate (EVA), which can secrete hormones at body temperature. It is a flexible and transparent hormone-containing ring with an outer diameter of 54 mm and a thickness of 4 mm. It contains the synthetic estrogen and progesterone hormones found in birth control pills.
How does it prevent pregnancy?
When the ring is inserted into the vagina at body temperature The hormones in it regularly mix with the blood with a slow release. These hormones prevent pregnancy by suppressing the hormones coming from the pituitary, which stimulates ovulation. When the vaginal ring is used regularly, its protection against pregnancy is very high. In 2007, only 3 out of 1000 women who used the vaginal ring regularly in the USA became pregnant. Unwanted pregnancies were encountered at a rate of 8% in women who did not use it regularly (who placed the new ring after 7 days, and put it back in after 3 hours when it came out).
How to use the vaginal ring?
Women insert the flexible ring they take out of the sterile package into the vagina, whether they are lying down, sitting or standing. It does not matter at what depth they are placed, because it will protect against pregnancy by secreting hormones at body temperature.
There is no concept of misplacing the ring, if it is comfortable in the vagina, it means that it has been applied correctly.
The rate of slip and expulsion is given as 2.5% within one year. Even if it is thrown and falls, the contraceptive protection will continue if it is washed in cold or warm water (not hot) and reinserted.
(However, the time it stays outside should not exceed 3 hours, because in this case it cannot suppress ovulation enough in women.)
After 21 days, the vaginal ring can be pulled out by inserting the index finger under the front edge or by squeezing the frame between the index finger and middle finger.
Does the vaginal ring bother the man during sexual intercourse?
In a study, 20% of users sometimes or often felt the ring during sexual intercourse. 30% of users have felt the vaginal ring sometimes or often outside of sexual intercourse. In cases where the man notices during sexual intercourse, the vaginal ring can be removed temporarily (for a maximum of 3 hours).
How long is the vaginal ring used?
When you start using the vaginal ring on the first day of menstruation, it will protect you from pregnancy from the first month. There is a hormone that will protect against pregnancy for 21 days in each ring removed from its package. At the end of 21 days, the woman will pull the ring out of the vagina with her index finger. After exactly 7 days (not 8), the new ring should be inserted into the vagina. During the 7-day ring-free period, the expected bleeding will come. Bleeding is usually less than menstrual bleeding and comes within 2-4 days after removing the ring and lasts for an average of 5 days. During the 7 days without the ring, contraception will continue as in birth control pills. . If the period without the ring exceeds 7 days, considering the possibility of pregnancy, an additional method of contraception should be applied for one week after the new ring is inserted.
Vaginal rings can be used in women throughout the entire reproductive age (from puberty to menopause) just like birth control pills. Nursing mothers can start using it safely 6 months after birth. Non-breastfeeding women can apply the vaginal ring 4 weeks after giving birth. It can be inserted in the first 5 days after abortions and abortions in the first 3 months of pregnancy.
Within one month after stopping the use of the vaginal ring, 92% of women resume their normal menstrual cycle.
Who cannot use the vaginal ring?
Vaginal rings contain synthetics of estrogen and progesterone hormones secreted from the ovaries, as in birth control pills, in lower doses than pills. According to the recommendations of the World Health Organization (WHO) and CDC (Disease and Drug Control Agency) in the USA, updated in 2011, the vaginal ring is not recommended in cases where birth control pills are not used. Situations where vaginal rings cannot be used; Occlusion (thrombosis) and infection (thrombophlebitis) in the deep veins of the leg, clotting in the lungs and brain (thromboembolism), thrombogenic mutations that will affect coagulation, and lupus. Contrary to popular belief, those with varicose veins can safely use the vaginal ring and other hormones..
In addition, women over the age of 35 who smoke, for whom birth control pills are not recommended, those with kidney, eye and liver damage diabetes who have been using insulin for many years, and those with high blood pressure over 150/100 should not use the vaginal ring.
Concomitant use of the vaginal ring with other drugs (pill, injection and suppository);
As with birth control pills, vaginal rings can be used safely with many drugs (WHO 2008, CDC 2011). Antibiotics, pain relievers, drugs for hypothyroidism or hyperthyroidism (goiter), drugs used in the treatment of fungi do not reduce the contraceptive effect of the vaginal ring. In addition, there is no harm in using it with the vaginal ring in suppositories, creams and pomades used in the treatment of vaginal discharge. It can also be used in tampons with the vaginal ring.
The vaginal ring cannot be used together with drugs used in the treatment of tuberculosis such as rifampicin, where only birth control pills cannot be used together, drugs that affect the central nervous system such as barbiturates, anticonvulsants. There is no harm in using a vaginal ring with antidepressants.
What are the side effects of the vaginal ring?
In some 2-6% of women using vaginal ring, irregular bleeding and bloody discharge may occur between menstruation in some months. Bleeding may not occur rarely (0.6-2.1%) for 7 days, sometimes early (5-8%) and sometimes late (20-27%) in vaginal ring users.
An increase in vaginal discharge is sometimes observed in 12% of women with vaginitis. However, increased discharge is an advantage for women who have pain and burning during sexual intercourse due to dryness.
In addition, as with birth control pills, hormonal side effects such as headache, chest tightness and nausea, which are more common in the first three months, are also encountered in women who use vaginal ring.
Vaginal rings do not cause weight gain. It is also used safely in overweight women.
Vaginal rings reduce menstrual pain like birth control pills.
Storage or storage of the vaginal ring;
While the vaginal ring is in the pharmacy or drugstore, it is stored in the refrigerator at a temperature of 2-8 degrees. Users, on the other hand, can store it at room temperature, preferably at 25 degrees (between 15-30 degrees), for up to 4 months. Vaginal rings should not be stored against sunlight and above 30 degrees.
Advantages of vaginal rings over birth control pills
1-It is suitable for those who forget their birth control pills, after the vaginal ring is placed, it will stay in place for three weeks and prevent pregnancy.
2-The dose of synthetic estrogen in pills is lower than in all birth control pills.
3- Gastrointestinal problems related to absorption from the stomach and mixing with blood, such as birth control pills, are less common.
4- When birth control pills are metabolized in the liver, the hormones released show different estrogen effects in each woman, there is no such problem in the vaginal ring and there is a constant hormone release every day.
5-When necessary, the protection against pregnancy will continue when it is taken outside for a maximum of 3 hours.
6-Increased physiological discharge in women who use vaginal ring, reduces the complaints of women with vaginal dryness and burning during sexual intercourse.
The vaginal ring is one of the new options for contraception in our country. In a study on this method, which is used by millions of women around the world, 66% of women who have just started the method and 81% after three months of use evaluated the vaginal ring as a usable method.
Wishing you healthy days…

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