It’s vital that women have options when selecting contraception. A relatively new method, the vaginal ring, adds much value to the current range of options, is gaining popularity, and has many benefits.
Vaginal rings are designed to fit virtually all women and are completely under a woman’s control to insert and remove. In addition to spacing pregnancies, this technology can be used to support breastfeeding and, potentially, to prevent sexually transmitted infections. There is growing interest in this method as pharmaceutical manufacturers recognize its potential to deliver one or more drugs. And developing country health systems are interested in vaginal rings as they place fewer demands on doctors or skilled providers; the products could be distributed to women by trained community health workers.
The vaginal rings of today
Today, there are currently two contraceptive vaginal rings on the market and one currently being developed:
- NuvaRing™, a flexible plastic ring about 2” in diameter releases a continuous low dose of progestin and estrogen —the same hormones that are found in many contraceptive pills —over the course of three weeks. It is then removed by the woman for 7 days, to allow for menstruation, and a new ring is required for each additional month of protection. The NuvaRing™ needs to be refrigerated if not used immediately. In developing country contexts, where health care facilities are often hard to reach and electricity inconsistent, this can be a major drawback. At the moment, NuvaRing is not widely available in developing countries but is increasingly popular in the United States and Europe.
- The progesterone ring is a three-month vaginal ring for breastfeeding women developed by the Population Council. The ring is replaced every three months while the woman is breastfeeding. The ring releases natural progesterone (like that in progesterone contraceptive pills) and is designed to prolong the period when postpartum women who are breastfeeding do not menstruate, therefore allowing for spacing between pregnancies. The ring is commercially available in six Latin American countries, under the brand name Progering™. It’s currently undergoing studies of its acceptability in sub-Saharan Africa, to explore its potential introduction in the region. A trial of this ring is also underway in India.
- One additional contraceptive ring – not yet available on the market – is being developed by the Population Council and is designed to provide a full year of protection – meaning women would not have to go to a health provider or a pharmacy each month for resupply. This would be a major advantage where access to health facilities is limited or services are prohibitively expensive. The one-year ring contains progestin and estrogen.
The vaginal ring of tomorrow
There are technologies being developed which would allow the vaginal ring of the future to serve multiple purposes: delivering different therapeutics for different needs and health concerns. These rings may simultaneously be contraceptive, prevent HIV, and also protect against a range of other sexually transmitted infections.
These rings have the potential to make lasting improvements in women’s health, particularly where unwanted pregnancies are common and HIV is endemic.
Around the world, women have the right to choose from an array of contraceptive methods. There’s no doubt that vaginal rings – those currently available and those on the horizon –could fill a real gap in family planning services, particularly in developing countries.
Investments in ring technology will contribute to the goals of FP2020 and advance efforts to address the unmet needs for women globally. It’s time we bring these products closer to the women and girls in developing countries that could benefit from their vast potential.