Vaginal ring

Vaginal Rings. Vaginal epithelium is readily permeable to contraceptive steroids. Since the vascular drainage of the vagina bypasses the Hver, this route of adrninistration potentially permits utilisation of dmgs that have low oral activity. 

When using Hie vaginal ring, press Hie ring into an oval and insert into the upper Hiird of Hie vaginal vault. 

Vaginal rings Estradiol (Estring , Femring ) 1 ring every 3 months... 

Estradiol 2 mg vaginal ring (1 ring PV every 3 months) Use local route to minimize systemic BA and side effects... 

New evidence indicates that lower doses of estrogens are effective in controlling postmenopausal symptoms and reducing bone loss (see Table 31-2). Even ultralow doses of 17 /J-estradiol delivered by vaginal ring improved serum lipid profiles and prevented bone loss in elderly women. 

Vaginal products Estradiol vaginal ring may not be suitable for women with narrow, short, or stenosed vaginas. Women with signs or symptoms of vaginal irritation should alert their physician. 

If a vaginal infection develops during use of the estradiol vaginal ring, remove the ring and reinsert only after the infection has been appropriately treated. 

Starting the contraceptive vaginal ring - Consider the possibility of ovulation and conception prior to the first use of the contraceptive vaginal ring. 

Switching from a combination oral contraceptive Insert the contraceptive vaginal ring anytime within 7 days after the last combined (estrogen plus progestin) oral contraceptive tablet and no later than the day that a new cycle of pills would have started. No backup method is needed. 

Switching from a progestin-only method Insert the first contraceptive vaginal ring as follows ... 

Any day of the month when switching from a progestin-only pill do not skip any days between the last pill and the first day of contraceptive vaginal ring use ... 

Following complete first-trimester abortion The patient may start using the contraceptive vaginal ring within the first 5 days following a complete first trimester abortion and does not need to use an additional method of contraception. If use is not started within 5 days following a first trimester abortion, the patient should follow the instructions for No preceding hormonal contraceptive use in the past month. Advise the patient to use a nonhormonal contraceptive method. 

Consider the possibility of pregnancy if the ring-free interval has been extended beyond 1 week. Use an additional method of contraception until the contraceptive vaginal ring has been used continuously for 7... 

In the event of a missed menstrual period If the patient has not adhered to the prescribed regimen, consider the possibility of pregnancy at the time of the first missed period and discontinue the use of the contraceptive vaginal ring if pregnancy is confirmed. 

Elderly This vaginal ring has not been studied in women 65 years of age and older and is not indicated in this population. 

Vaginal ring - Advise women who are breast-feeding not to use the contraceptive vaginal ring but to use other forms of contraception until the child is weaned. 

Vaginal use The contraceptive vaginal ring may not be suitable in conditions that make the vagina more susceptible to vaginal irritation or ulceration. 

The contraceptive vaginal ring may interfere with the correct placement and position of a diaphragm. A diaphragm is not recommended as a backup method with contraceptive vaginal ring use. 

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