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Frequency and Management of Breakthrough Bleeding With Continuous Use of the Transvaginal Contraceptive Ring

2008; Lippincott Williams & Wilkins; Volume: 112; Issue: 3 Linguagem: Inglês

10.1097/aog.0b013e3181842071

1873-233X

Patricia J. Sulak, Virginia Smith, Andrea Coffee, Iris Witt, Alicia L. Kuehl, Thomas J. Kuehl,

Endometriosis Research and Treatment

In Brief OBJECTIVE: To assess bleeding patterns with continuous use of the transvaginal contraceptive ring. METHODS: We did a prospective analysis of daily menstrual flow during a 21/7 cycle followed by 6 months of continuous use and institution of a randomized protocol to manage breakthrough bleeding/spotting. Seventy-four women completed the baseline 21/7 phase and were randomized equally into two groups during the continuous phase. Group 1 was instructed to replace the ring monthly on the same calendar day with no ring-free days. Group 2 was instructed to use the same process, but if breakthrough bleeding/spotting occurred for 5 days or more, they were to remove the ring for 4 days, store it, and then reinsert that ring. RESULTS: Sixty-five women completed the continuous phase with reduced average flow scores in the continuous phase compared with the 21/7 phase (P<.02). Most patients had no to minimal bleeding during continuous use, with group 2 experiencing a statistically greater percentage of days without breakthrough bleeding or spotting (95%) compared with group 1 (89%) (P=.016). Instituting a 4-day hormone-free interval was more (P<.001) effective in resolving breakthrough bleeding/spotting than continuing ring use. CONCLUSION: A reduction in bleeding occurred during continuous use with replacement of the transvaginal ring compared with baseline 21/7 use. Continuous vaginal ring use resulted in an acceptable bleeding profile in most patients, reduction in flow, reduction in pelvic pain, and a high continuation rate. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00475553 LEVEL OF EVIDENCE: I A reduction in bleeding occurred during continuous use with monthly replacement of the transvaginal ring compared with baseline 21/7 use.