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7423990 
Journal Article 
The Contraceptive Vaginal Ring 
Mandelbaum, RS; Shoupe, D; , 
2020 
Springer International Publishing 
Cham 
The Handbook of Contraception 
73-96 
Contraceptive vaginal rings (CVR) are plastic polymer rings containing sex steroids that are directly absorbed through the vaginal epithelium into systemic circulation for highly effective contraception without the need for daily dosing. There are currently two CVRs that are FDA-approved for use in the United States. The ENG/EE ring (NuvaRing) contains etonogestrel (ENG) and ethinyl estradiol (EE) and was approved for use in the United States in 2001. It is the most widely used and studied CVR. The SA/EE ring (Annovera), which contains segesterone acetate (SA) and ethinyl estradiol (EE), was just approved by the FDA in 2018 and should be available within the next year. Both the ENG/EE and SA/EE rings are highly effective, similar to other combined hormonal methods, and have excellent cycle control. A third progesterone-only CVR, the Progering, is only available in Latin America for postpartum lactating women. This chapter primarily focuses on the ENG/EE ring but also includes currently available data on the SA/EE ring. Pharmacokinetics, mechanism of action, effectiveness, advantages and disadvantages, clinical use, and adverse effects of CVRs are addressed in this chapter.