Etonogestrel–ethinylestradiol vaginal ring for hormonal contraception

The etonogestrel–ethinylestradiol vaginal ring is the only commercially available vaginal ring for hormonal contraception. The ring can easily be inserted by the woman herself into the vagina. For 3 weeks the hormones are continuously absorbed through the vaginal epithelium, resulting in more constant serum levels than with the pill. The systemic exposure to ethinylestradiol (EE) with the ring is approximately 50% lower than with a 30 µg EE pill, and 3.4-times lower than with the transdermal patch. The vaginal ring has the same working mechanism as the pill and the same contraindications. The ring combines a contraceptive efficacy as high as the pill with consistently better cycle control. The incidence of adverse events such as breast tenderness, headache and nausea is low, but not lower than with the pill. Discontinuations are mainly related to local and ring-related events. Tolerability and acceptability are high, leading to high rates of recommendation.