Providing a logical choice for your patient

R. Nappi

The once-a-month regimen of NuvaRing® contributes to higher overall satisfaction than traditional oral contraceptives (OCs) because it requires no daily action from users. In addition, NuvaRing provides excellent cycle control balanced with a low incidence of estrogen-related side effects, both of which are key factors in influencing contraceptive acceptability and compliance.

The user-friendly aspect of the NuvaRing regimen has been demonstrated in an open-label randomized trial that compared NuvaRing with a 25 µg ethinylestradiol (EE) triphasic combined OC (COC) using the "QuickStart" protocol-the initiation of a woman's contraceptive method on the same day of the physician's visit regardless of her menstrual cycle day. The likelihood of being very satisfied with NuvaRing use were three times the likelihood of being very satisfied with COC use (odds-ratio 3.0; CI 1.5-5.8). Furthermore, when women were asked to choose a method of contraception for continuation during their exit interviews, the likelihood of continuation with NuvaRing was eight times the likelihood of continuation with the COC (odds-ratio 8.4; CI 3.9-18.6).

The high level of satisfaction during NuvaRing use has been well established in various clinical trials, especially among women with an age range of 18-40 years. Recently, a randomized study compared acceptability with NuvaRing and a low dose COC (35 µg EE/0.25 mg norgestimate) in young women aged 15-21 years. The study showed that women preferred NuvaRing to COCs; NuvaRing was also seen to be easier to use and resulted in fewer concerns about health risks. Method approval was higher with NuvaRing use compared with COC use as women liked the rings more and stated that they were more likely to recommend NuvaRing to friends and use them in the future, compared with COCs.

NuvaRing's high acceptability and ease of use in the clinical study setting has been borne out by women's positive experiences in daily practice. In the many clinical experience programs that have now been carried out around the world (in Europe, more than 22,000 women were included in 12 countries), women are unanimous in their satisfaction with the method, preferring NuvaRing to other methods as the best contraceptive choice available.

Patient acceptability of a method can also be reflected by the degree of follow-up care required by physicians. In the United States, two physicians noticed that when they prescribed NuvaRing, women were less likely to call their offices with questions or complaints. To quantify this finding, a longitudinal observational study was undertaken involving over 200 women starting a hormonal contraceptive method of their choice (COCs, the transdermal patch and the vaginal ring). The number of phone calls per woman was least in the NuvaRing group, followed by the group using COCs and then the patch group, respectively. An analysis of the reasons for patient callbacks showed that NuvaRing users made fewer callbacks for nausea, headache and breast pain compared with the patch and the group using COCs. This lower rate of callbacks provides yet another perspective to NuvaRing's high patient acceptability and illustrates the fact that NuvaRing allows physicians to provide women with confidence for the contraceptive success that they seek.