Ovulation suppression in women following vaginal administration of oral contraceptive tablets

Coutinho, Elsimar Metzker; Coutinho, Elsior J.; Gonçalves, Maria Tereza; Barbosa, Ione Cristina

doi:10.1016/s0015-0282(16)46523-4

Cited by 22 publications

(3 citation statements)

References 3 publications

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“…For example, NuvaRing use results in maximum serum hormone concentrations that are 30%–40% lower than those seen with orally administered contraceptive hormones 42. Further, by avoiding first pass metabolism in the gut, IVR users typically have fewer hormonal side effects than do oral hormonal contraceptive users, including adverse effects on the coagulation system 43–45. Many ARVs either induce or inhibit hepatic cytochrome P450 enzymes, which are required for the metabolism of commonly used contraceptive steroid hormones 46,47.…”

Section: Advantages Of Ivrs For Delivery Of Microbicides and Mptsmentioning

confidence: 99%

Intravaginal rings as delivery systems for microbicides and multipurpose prevention technologies

Thurman

Clark

Hurlburt³

et al. 2013

IJWH

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There is a renewed interest in delivering pharmaceutical products via intravaginal rings (IVRs). IVRs are flexible torus-shaped drug delivery systems that can be easily inserted and removed by the woman and that provide both sustained and controlled drug release, lasting for several weeks to several months. In terms of women’s health care products, it has been established that IVRs effectively deliver contraceptive steroids and steroids for the treatment of postmenopausal vaginal atrophy. A novel application for IVRs is the delivery of antiretroviral drugs for the prevention of human immunodeficiency virus (HIV) genital infection. Microbicides are antiviral drugs delivered topically for HIV prevention. Recent reviews of microbicide IVRs have focused on technologies in development and optimizing ring design. IVRs have several advantages, including the ability to deliver sustained drug doses for long periods of time while bypassing first pass metabolism in the gut. IVRs are discreet, woman-controlled, and do not require a trained provider for placement or fitting. Previous data support that women and their male sexual partners find IVRs highly acceptable. Multipurpose prevention technology (MPT) products provide protection against unintended/mistimed pregnancy and reproductive tract infections, including HIV. Several MPT IVRs are currently in development. Early clinical testing of new microbicide and MPT IVRs will require a focus on safety, pharmacokinetics and pharmacodynamics. Specifically, IVRs will have to deliver tissue concentrations of drugs that are pharmacodynamically active, do not cause mucosal alterations or inflammation, and do not change the resident microbiota. The emergence of resistance to antiretrovirals will need to be investigated. IVRs should not disrupt intercourse or have high rates of expulsion. Herein, we reviewed the microbicide and MPT IVRs currently in development, with a focus on the clinical aspects of IVR assessment and the challenges facing microbicide and MPT IVR product development, clinical testing, and implementation. The information in this review was drawn from PubMed searches and a recent microbicide/MPT product development workshop organized by CONRAD.

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Section: Advantages Of Ivrs For Delivery Of Microbicides and Mptsmentioning

confidence: 99%

Intravaginal rings as delivery systems for microbicides and multipurpose prevention technologies

Thurman

Clark

Hurlburt³

et al. 2013

IJWH

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“…A recent review [5] provides a helpful overview of the drugs most commonly administered via the vagina and their potential therapeutic value. The vaginal application of oral contraceptive tablets was first reported to inhibit ovulation in 1982 [6], and subsequent studies have demonstrated that steroid hormones used in Hormone Replacement Therapy (HRT) can be administrated effectively through the vagina [7]. As explained in the course of this review, the vagina has several advantages over the oral route with respect to the administration of contraception.…”

Section: Introductionmentioning

confidence: 99%

Is the Vagina an Adequate Route for the Administration of Hormonal Contraceptives?

Lete

Dueñas²,

Esplugues³

et al. 2010

CDM

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The vaginal route of drug administration provides women with a valid alternative to more conventional methods of contraception. Drugs absorbed in the upper part of the vagina can bypass the liver and, if metabolized, are subject to a reduced hepatic first-pass effect. Current vaginally-administered contraceptive formulations deliver similar doses of gestagens to those provided by oral methods but release lower amounts of oestrogens. This results in a systemic exposure to gestagens similar to that achieved via other routes, thereby maintaining contraceptive efficacy while limiting systemic, but not uterine, exposure to oestrogen. In this way, the probability of systemic oestrogen-related adverse effects are theoretically reduced without compromising cycle control. In addition, the fact that the effects of a contraceptive ring last a complete cycle makes it more user-friendly than other methods and results in better patient compliance. The present review will explain in detail the specificities of this route of delivery of hormonal contraception and will compare it to more classic forms of contraception received via the oral (pill), intramuscular (injected), transdermic (patch) and subcutaneous (implants) routes of administration.

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“…9 For almost 30 years, we have known that the hormones in certain COCs can be administered vaginally without losing any contraceptive efficacy. 10 More recently, this route of administration has been shown to be feasible for the delivery of steroid hormones used in hormone replacement therapy. 11 Current knowledge of the vagina suggests that this organ is appropriate for administration of many different drugs; in particular, for the administration of steroid hormones.…”

Section: Introductionmentioning

confidence: 99%

Efficacy, safety, and patient acceptability of the etonogestrel and ethinyl estradiol vaginal ring

Lete¹,

Arrilucea²,

Rodríguez³

et al. 2014

OAJC

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Abstract:The contraceptive vaginal ring (CVR) is a combined hormonal contraceptive method, containing ethinyl estradiol and etonogestrel, that works by inhibiting ovulation. It differs from combined oral contraceptives (COCs) in the route of administration, which is vaginal, and the frequency of administration, which is monthly. The efficacy of the CVR is similar to that of COCs but compliance appears to be better in typical users. The CVR enables appropriate control of the menstrual cycle, with a similar side effect profile to COCs, while achieving good user acceptance. Different studies have established noncontraceptive beneficial effects of the CVR; for example, it can be useful for treating dysmenorrhea or excess menstrual bleeding. Recent epidemiological studies have confirmed that the risk of venous thromboembolism with the CVR is similar to that of COCs, including COCs that contain levonorgestrel.

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Ovulation suppression in women following vaginal administration of oral contraceptive tablets

Cited by 22 publications

References 3 publications

Intravaginal rings as delivery systems for microbicides and multipurpose prevention technologies

Intravaginal rings as delivery systems for microbicides and multipurpose prevention technologies

Is the Vagina an Adequate Route for the Administration of Hormonal Contraceptives?

Efficacy, safety, and patient acceptability of the etonogestrel and ethinyl estradiol vaginal ring

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