Contraceptive rings; self-administered treatment governed by bleeding

Abstract

In an attempt to overcome bleeding problems and reduce the risk of ovulation during treatment, a new treatment schedule for contraceptive Silastic intravaginal rings (IVR) was studied in 16 women. The IVRs released about 300 μg of d-norgestrel (d-Ng) per day. They were used continuously and removed for five days only when bleeding occurred or after several days of spotting. A total treatment period of 2279 days was studied corresponding to 81 28-day cycles. After an initial peak, the height of which was correlated with the plasma sex hormone binding globulin capacity (SHBGc), the d-Ng concentrations in plasma decreased and stabilized at mean concentrations between 0.8 and 2.2 ng/ml. The mean d-Ng concentration correlated well with the body weight of the women. Follicular activity was depressed during treatment as judged by plasma estradiol concentrations and no ovulations occurred. Four women were amenorrheic for treatment periods between 101 and 197 days. In most of the other women the incidence of bleeding and spotting was less than would have been expected during a comparable period without treatment. Systemic side effects in the form of aggressiveness, weight gain, acne and headache were noted by some of the subjects. No local side effects were obsered and no pregnancy occurred.