Fernando Augusto Barreiros

Extended regimens of the vaginal contraceptive ring: cycle control

BACKGROUND Oral contraceptives used for extended periods of time have been extensively studied because of their potential benefits; however, there have been few publications on extended regimen of vaginal rings. The aim of this study was to compare the bleeding patterns of women using extended regimens of the vaginal ring or oral contraceptives. STUDY DESIGN Prospective cohort involving 150 women: 75 used vaginal rings that release 120 mcg of etonogestrel and 15 mcg of ethinyl estradiol daily, and 75 took oral contraceptives containing ethinyl estradiol 0.3 mcg and desogestrel 150 mcg. Both groups used their respective contraceptive method over continuous periods of 84 days, followed by a 7-day pause, during 1 year. RESULTS The total number of scheduled bleeding and spotting days decreased significantly during the 1-year period of the study for both methods (p=.001), and this decrease was significantly higher for oral contraceptive users. Similarly, during the study period, there was a significant reduction in the total number of unscheduled bleeding and spotting days for both methods (p=.01), but this decrease was significantly higher among vaginal ring users (p=.003). CONCLUSION Vaginal ring used on an extended regimen is a contraceptive method that offers good cycle control.

Extended regimens of the contraceptive vaginal ring: evaluation of clinical aspects

BACKGROUND Oral contraceptives used for extended periods of time have been extensively studied because of their potential benefits; however, there have been few publications on extended regimens of vaginal contraceptive rings. The aim of this study was to evaluate the clinical symptoms, body weight and blood pressure changes in women using the vaginal ring continuously over a 1-year period. STUDY DESIGN This prospective cohort evaluated clinical aspects (dysmenorrhea, headache, breast tenderness, leg pain and irritability), body weight and blood pressure changes in 75 women (18-37 years of age) using a vaginal ring releasing 120 mcg of etonogestrel and 15 mcg of ethinyl estradiol daily, over a continuous period of 84 days, followed by a 7-day ring-free interval, during 1 year. The chi-square, Wilcoxon and paired t tests were used to analyze differences in the outcomes of interest. RESULTS Compared to pre-enrollment status, at the end of the study period, the patients reported significantly less dysmenorrhea and irritability, a nonsignificant decrease in breast tenderness, leg pain and headaches. Blood pressure measurements remained unchanged. Although weight and body mass index increased significantly among users, they remained within the expected biological variation range. CONCLUSION The vaginal ring used on an extended regimen is a well-tolerated contraceptive method and also offers noncontraceptive benefits.

Extended regimens of the combined contraceptive vaginal ring containing etonogestrel and ethinyl estradiol: effects on lipid metabolism

BACKGROUND Oral contraceptives used for extended periods of time have been studied because of their potential benefits; however, there have been few publications on extended regimens of vaginal contraceptive rings. The aim of this study was to evaluate modifications in the lipid profile of women using the vaginal ring continuously over a 1-year period. STUDY DESIGN This prospective cohort enrolled 75 women (18-37 years) who used a contraceptive vaginal ring releasing 120 mcg of etonogestrel and 15 mcg of ethinyl estradiol daily continuously for 84 days, followed by a 7-day ring-free interval, during 1 year. At baseline and every 3 months during the 1-year study period, blood was collected to assess cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides and apolipoproteins A-I and B. The ANOVA test was used to analyze differences in the results of these exams over time. RESULTS After 1 year of continuous contraceptive use, there was a significant increase in triglycerides as well as in total and HDL-C levels. There was a nonsignificant decrease in the mean concentration of LDL-C during the study period. Apolipoprotein A-I increased and apolipoprotein B decreased, but the apolipoprotein A-I/apolipoprotein B ratio did not change significantly. CONCLUSION The combined contraceptive vaginal ring used on an extended regimen causes changes in the lipid profile metabolism of users. Despite the vaginal route of administration, the steroids released by the ring caused significant changes in lipids and lipoproteins, which were typical of those seen with ethinyl estradiol given either orally or parenterally.

Effects of extended regimens of the contraceptive vaginal ring on carbohydrate metabolism

BACKGROUND There are few publications on the metabolic effects of extended regimens of the contraceptive vaginal ring. The aim of this study was to assess changes in fasting plasma glucose levels and insulin concentration of women using the contraceptive vaginal ring continuously over a 1-year period. STUDY DESIGN This prospective cohort enrolled 75 women (ages 18-37 years) who used a contraceptive vaginal ring releasing 120 mcg of etonogestrel and 15 mcg of ethinyl estradiol daily continuously for 84 days, followed by a 7-day ring-free interval, during 1 year. Fasting glucose and insulin levels were measured, and homeostatic model assessment was calculated at baseline and every 3 months during the 1-year study period. The repeated-measures analysis of variance test was used to analyze differences in the results of these exams over time. RESULTS None of the 75 participants had results outside the normal range in any of the assessments. There were no pregnancies during the 1-year period, and a total of 62 participants completed the study. There were no significant changes in mean fasting glucose levels (79.3 and 78.9 mg/dL at baseline and after 12 months, respectively), mean fasting insulin concentration (9.6 and 10.1 μU/mL) or mean homeostatic model assessment results (1.88% and 1.97%). CONCLUSION Fasting plasma glucose concentration, insulin levels and homeostatic model assessment values of women using the vaginal ring on an extended regimen did not change significantly over a 1-year period.

Metabolic effects of contraceptive implants in adolescents

BACKGROUND This prospective study analyzed the metabolic effects of an etonogestrel implant used for 1 year by adolescents. STUDY DESIGN The study population comprised 47 postpartum adolescents (mean 17.2 years old) managed at the Family Planning Sector of São Paulo Federal University. Participants received an implant containing etonogestrel (68 mg) within 6 months of delivery (on average 102 days after giving birth) and were followed for 1 year. Blood was collected at baseline and 12 months later to assess total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), hemogram, urea, creatinine, sodium, potassium, fasting glucose, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT) and bilirubin. RESULTS Three adolescents did not return after receiving the implant despite telephone messages and a telegram and were excluded from the clinical and final laboratory analyses. All 44 patients completed the 12 months of follow-up, resulting in a study discontinuation rate of 0%. No implants were removed. Laboratory analyses were completed in 37 adolescents. After 1 year of using the implant, there was a significant increase in mean hemoglobin, hematocrit and indirect bilirubin concentrations and of the HDL-C/TC and HDL-C/LDL-C ratios. Additionally, there was a significant decrease in mean TC level as well as LDL-C, very low-density lipoprotein cholesterol, TG, SGOT and SGPT. These results suggest that the etonogestrel implant does not interfere directly with the risk of cardiovascular diseases because it improves the lipid profile. There were no pregnancies during the study. CONCLUSION Our results indicate that an etonogestrel implant used by adolescents for 1 year is associated with changes in the lipid profile and hepatic function without adverse clinical effects.