E l A screw
Wednesday October 28, 2009
E l A screw
Jaime MD Urdinola.
Wednesday October 28, 2009
E l A screw
Jaime MD Urdinola.
Medical Association Andes CS AK 9116 20 326 Bogotá DC Colombia
blogger: http://www.urdinola.blogspot.com www. urdinolamenopausia2.blogspot.com
Symposium / Luncheon on Women's Health and Menopause Medical Association
Andes Boardroom - Wednesday, October 28, 2009
Summary NuvaRing ® is
a novel contraceptive vaginal ring that has recently come to Colombia.
is a combined hormonal contraceptive for administration parenteral at long intervals, so that is expected to improve the continuity and compliance with treatment.
contains progestin and ethinyl estradiol and etonogestrel as its estrogen, released in small amounts (120 mcg and 15 mcg / day, respectively), from a soft, transparent ring with a diameter of 54 mm and a thickness of 4 mm.
Women in other parts of the world have accepted without reservation, since it is easy to use.
common side effects with combined oral contraceptives are less with the ring, contraceptive efficacy is very good and draws attention to the hormonal serum levels obtained are very low, which implies that its metabolic impact is reduced. These benefits are ideal for healthy women and those with overweight and metabolic syndrome. Introduction
contraceptive vaginal ring NuvaRing ®, developed by Organon company that is now part of Schering Plough Corporation, which in turn has recently merged with Merck Sharp & Dohme, was approved from 2 001 in the Netherlands and by the U.S. FDA and is available from 2 002 in these countries.
just arrived to Colombia in recent months as a real novelty and as a method that actually increases the options in contraception, as it is a method to manage rather than daily as oral contraceptives (COCs), but with intervals of 4 weeks. This feature can improve compliance and continuity of this contraceptive method, as these are no greater than 40% in COCs after 6 months of use.
universal requirements
contraception contraception should be effective, easy to use, have almost no side effects and safe.
Security is an important prerequisite for hormonal contraception in relation to its metabolic impact and long-term consequences on the cardiovascular system. Cardiovascular risk is increased in women with Metabolic syndrome, especially in these times of global epidemic of obesity, underlying disorder which is represented in the reduced insulin sensitivity (SI). Precisely the SI is decreased with the use of hormonal contraceptives currently in use, an effect that can be seen in those containing levonorgestrel (LNG).
vaginal route for the administration of contraceptives, as the case of contraceptive vaginal ring NuvaRing ®, appears to offer an explanation pharmacokinetic advantages later. Acceptance
Contrary to what one might expect, in the studies to date, Most women report that the ring is easy to insert and remove. The proportion of women who report feeling the ring during intercourse was only 18%. For its part, the percentage of sex partners they felt the ring during intercourse was 32%. However, 94% of the companions did not object to the use of the ring. In turn, 85% of participants were satisfied or very satisfied at the end of the study and 90% and indicated they would recommend their familiar ring 1-4. Benefits
long interval for the administration of contraceptive doses
Half the hormonal contraceptive failures are due to incorrect use of contraception. During the first 2 months of method use, 47% of women forget to take a pill and 22% forget 2 of them. The contraceptive ring provides a significant advantage, and to be inserted only once every 4 weeks, using it 3 weeks and resting.
Another advantage is that hormonal fluctuations are much lower with the vaginal route, compared with administration of oral tablets or even against the contraceptive skin patch, and thus a reduced systemic exposure to ethinyl estradiol (EE) 5 . Therefore, vaginal route seems the best route for low doses, constant and accurate control hormones, which results in stable serum concentrations and low exposure to EE.
Comparison with the contraceptive patch and contraceptive efficacy
In 2 002 hit the market the contraceptive patch and vaginal ring. In 2005 the FDA modified the prescribing information for the patch, and that serum levels of EE obtained with the patch can be up to 60% higher than those obtained with the AOC. This could lead to more side effects occur and possible thromboembolic complications. Women who switched to the patch AOC compared with the contraceptive ring users experienced longer periods (38% vs. 9%), increased dysmenorrhea (29% vs. 16%), frequent nausea (8% vs. 1%), mood swings (14% vs. 8%) and frequent skin rash (12% vs. 2%). The contraceptive vaginal ring users preferred it compared to COCs (p <0.001) color="#3366ff"> 6. There were 6 pregnancies in 12 109 cycles studied, for a Pearl Index of 0.65 (CI = confidence interval 95%, 0.24- 1.41). In the international study on the patch 7 15 pregnancies occurred during 22 160 cycles studied, Pearl Index of 0.88 (95% CI, 0.44-1.33).
cycle control and body weight compared with the AOC
The results obtained after observation for 6 cycles, indicate that withdrawal bleeding (obtained by removing the method) is presented as equal in both groups. The incidence of irregular bleeding in all cycles with NuvaRing ® was <5> 8, compared with COCs.
weight changes observed were very small, in one study ranged from -0.1 to + 0.1 kg 9-10.
NuvaRing ® and lipids
total cholesterol and cholesterol HDL did not change with the contraceptive vaginal ring use, whereas in the group of AOC levels of HDL cholesterol, HDL2 and HDL3 decreased. The levels of apolipoprotein A-1 increased with NuvaRing ®, but decreased with the AOC. In both groups, nievels of apolipoprotein B and triglycerides were increased and lipoprotein (a) decreased. These changes reflect the low androgenicity of etonogestrel versus. levonorgestrel and show that NuvaRing has minimal effects on lipid profile 11.
The contraceptive vaginal ring and insulin sensitivity (SI)
A prospective randomized study using AOC (30 or 20 mcg EE and desogestrel [DSG] 150 mg) and NuvaRing ® 12 for 6 months, analyzed via oral or vaginal administration of hormonal contraceptives, to assess whether the route has a similar effect on the SI. The SI decreased with AOC regardless of high or low dose COCs. But the SI did not decrease with the use of contraceptive vaginal ring. These data indicate that in contrast to the AOC, the vaginal contraceptive SI deteriorates. NuvaRing ® thus represents an appropriate choice for long-term contraception in women who are at risk for developing diabetes mellitus or metabolic syndrome, Known risk factors for cardiovascular disease.
Conclusions It was concluded according to the data, which is characterized by NuvaRing ®:
high
● ● Acceptance Better adherence to treatment, greater continuity and compliance
● No interference
● Very sexuality ● With
effectively reduced exposure to ethinyl estradiol
● Good cycle control side effects
● ● Reduced metabolic neutrality
For the foregoing reasons NuvaRing ® can be considered as
● A birth de primera línea
● Un anticonceptivo para usar a largo plazo debido a su neutralidad metabólica
Referencias
1- Roumen FJME, Apter D, Mulders TMT, Dieben ThOM. Efficacy, tolerability and acceptability of a novel contraceptive vaginal ring releasing etonogestrel and ethynil oestradiol. Hum Reprod. 2001;16:469-75.
2- Dieben ThOM, Roumen FJME, Apter D. Efficacy, cycle control, and user acceptability of a novel combined contraceptive vaginal ring. Obstet Gynecol. 2002; 100: 585-93.
3- Novák A, de la Loge C, Abetz L, van der Meulen EA. The combined contraceptive vaginal ring, NuvaRing®: an international study of user acceptability. Contraception. 2003; 67:187-194.
4- Novák A, de la Loge C, Abetz L. Development and validation of an acceptability and satisfaction questionnaire for a contraceptive vaginal ring, NuvaRing®. Pharmacoeconomics. 2004; 22:245-256.
5- van den Heuvel MW, van Bragt AJM, Alnabawy AKM, Kaptein MCJ . Comparison of ethynilestradiol pharmacokinetics in three hormonal contraceptive forrulations: the vaginal ring, the transdermal patch and an oral contraceptive. Contraception .2005; 72: 168-174.
6- Creinin MD, Meyn LA, Borgatta L, Barnhart K, Jensen J, Burke AE, Westhoff C, Gilliam M, Dutton C, Ballagh SA. Multicenter comparison of the contraceptive ring and patch. Obstet Gynecol. 2008; 111: 267-77.
7- Zieman M, Guillebaud J, Weisberg E, Shangold GA, Fisher AC, Creasy GW. Contraceptive efficacy and cycle control with the Ortho Evra/Evra transdermal system: the analysis of pooled data. Fertil Steril. 2002;77( Suppl 2):S13-8.
8- Bjarnadóttir RI, Tuppurainem M, Killick SR. Comparison of cycle control with a combined contraceptive vaginal ring and oral levonorgestrel/ethynil estradiol. Am J Obstet Gynecol. 2002; 186: 389-95.
9- Merki-Feld GS, Hund M. Clinical experience with NuvaRing® in daily practice in Switzerland: Cycle control and acceptability among women of all reproductive ages. Eur J Contracept Reprod Health Care. 2007;12:240-7.
10- Milsom I, Lete I, Bjertnaes A, Rokstad K, Lindh I, Gruber CJ, Birkhäuser MH, Aubeny E, Knudsen T, Bastianelli C. Effects of cycle control and bodyweight of the combined contraceptive ring, NuvaRing, versus an oral contraceptive containing 30 μg ethynil estradiol and 3 mg drospirenone. Hum Reprod. 2006; 21: 2304-11.
11- Tuppurainen M, Klimscheffskij R, Venhola M, Dieben ThOM. The combined contraceptive vaginal ring (NuvaRing®) and lipid metabolism: a comparative study. Contraception. 2004; 69: 389-94.
12- Cagnacci A, Ferrari S, Tirelli A, Zanin R, Volpe A. Route of administration of contraceptives containing desogestrel / etonogestrel and insulin sensitivity: a prospective randomized study. Contraception. 2009, 80:34-9.
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