Exploring FDA-approved vaginal rings for birth control

Vaginal Rings 

Vaginal rings are a form of hormonal contraception designed to be placed inside the vagina, where they release hormones that prevent pregnancy. These rings are typically made of flexible plastic and release a combination of hormones — estrogen and progestin — which are absorbed through the vaginal mucosa into the bloodstream. The primary mechanism of action includes the inhibition of ovulation, thickening of cervical mucus to block sperm penetration, and alteration of the uterine lining to prevent implantation. 

FDA-Approved Vaginal Rings 

There are currently three FDA-approved birth control vaginal rings available in the US market: 

• NuvaRing (etonogestrel/ethinyl estradiol vaginal ring) 
• Annovera (segesterone acetate and ethinyl estradiol vaginal system) 
• EluRyng (etonogestrel/ethinyl estradiol vaginal ring) 

NuvaRing 

NuvaRing is a widely recognized vaginal ring. It is a flexible, latex-free device that releases 0.12 mg/day of etonogestrel and 0.015 mg/day of ethinyl estradiol over three weeks. Inserted into the vagina and left in place for three weeks, it is followed by a one-week ring-free period during which withdrawal bleeding occurs. It should be inserted on the first day of the menstrual cycle or the first Sunday after menstruation begins. After three weeks, the ring is removed, and a new one is inserted one week later. Some users may experience side effects such as vaginal irritation, discharge, or infections. It is unsuitable for women with a history of thromboembolic disorders, certain cancers, or liver disease. 

• Benefits: offers once-a-month administration, steady hormone release, minimal daily involvement, cycle control, and reduced menstrual cramps 
• Cost: $48 per ring ($576 annually) 
• Dosage: 0.12 mg/day of etonogestrel and 0.015 mg/day of ethinyl estradiol 
• Efficacy: 99% effective when used correctly 
• FDA Approval Date: October 3, 2001 
• Manufacturer: Organon, part of Merck 

Annovera 

Annovera is a reusable ring containing segesterone acetate and ethinyl estradiol, designed for an entire year with 13 cycles of three weeks on and one week off. It releases 0.15 mg/day of segesterone acetate and 0.013 mg/day of ethinyl estradiol, following a 21/7 regimen like NuvaRing but without monthly replacement. Potential side effects include headaches, nausea, and breast tenderness. It is not suitable for women with conditions such as uncontrolled hypertension or a history of cardiovascular issues. 

• Benefits: reduces pharmacy visits and costs and is convenient for those with difficulty accessing monthly supplies 
• Cost: $575 per ring ($575 annually) 
• Dosage: 0.15 mg/day of segesterone acetate and 0.013 mg/day of ethinyl estradiol 
• Efficacy: around 97.3% effective when used correctly 
• FDA Approval Date: August 10, 2018 
• Manufacturer: Mayne Pharma 

EluRyng 

EluRyng is an affordable, reusable ring designed for year-long use. Each ring lasts 13 cycles, with three weeks of use and one week off. EluRyng releases 0.12 mg of etonogestrel and 0.015 mg of ethinyl estradiol per day, following a 21/7 regimen like NuvaRing but without the need for monthly replacements.  Potential side effects may include vaginal irritation, discharge, or infections. It is not suitable for women with a history of thromboembolic disorders, certain cancers, or liver disease. 

• Benefits: an affordable alternative to NuvaRing without compromising efficacy or convenience 
• Cost: $51.50 per ring ($51.50 annually) 
• Dosage: 0.12 mg/day of etonogestrel and 0.015 mg/day of ethinyl estradiol (same as NuvaRing) 
• Efficacy: over 99% efficacy when used correctly 
• FDA Approval Date: December 12, 2019 
• Manufacturer: Amneal Pharmaceuticals 

Mechanism of Action

The primary mechanism of birth control vaginal rings is the suppression of ovulation. The hormones released by the ring inhibit the release of follicle-stimulating hormone and luteinizing hormone from the pituitary gland, preventing the maturation and release of eggs from the ovaries. The thickened cervical mucus also acts as a barrier to sperm, and the altered endometrium reduces the likelihood of implantation. 

Advantages 

Vaginal rings offer several advantages over other contraceptive methods. They require less frequent administration compared to daily oral contraceptives, significantly reducing the likelihood of user error. The continuous release of hormones ensures stable blood hormone levels, minimizing the risk of hormonal fluctuations and associated side effects. Additionally, once inserted, the ring is not noticeable and does not interfere with sexual activity, providing a discreet and convenient option for users. Many women also experience more predictable and lighter menstrual periods, along with reduced dysmenorrhea, making vaginal rings an appealing choice for effective cycle control.

The development and FDA approval of vaginal rings such as NuvaRing, Annovera, and EluRyng represent significant advancements in contraceptive technology, providing healthcare providers with reliable and patient-friendly birth control options. For businesses in the healthcare technology sector, these products illustrate the potential of innovative delivery systems to enhance patient adherence and satisfaction. By offering a convenient, effective, and low-maintenance solution, vaginal rings can reduce the burden on healthcare systems and improve outcomes for a diverse patient population. Investing in and supporting such technologies can drive market growth and contribute to the broader goal of advancing women's health and autonomy.