A new birth control option that can last for a year
Similar to a form of contraception popular among younger women, a new vaginal ring that can be used for a year is expected to offer a convenient option when it’s made available, possibly by fall 2019.
Developed by the nonprofit research organization Population Council, the combined hormonal ring was approved Aug. 10 by the U.S. Food and Drug Administration. TherapeuticsMD is licensed to produce and sell Annovera in the U.S.
“It gives women one more option for birth control,” said Beatrice Chen, director of family planning at UPMC Magee-Womens Hospital. Magee was a site for clinical research in the development of the new vaginal ring.
Gillian Dean, senior director of medical services at the Planned Parenthood Federation of America, released a statement praising the new birth control option for women, saying, “Annovera will provide patients with a full year of safe, effective contraception that they can control on their own while removing barriers to care like repeat visits to a health care provider or pharmacy and easier storage since it doesn’t require refrigeration.”
The Population Council is behind the development of several widely used long-acting reversible contraceptives: the Copper T and Mirena IUDs and the Jadelle and Norplant rod implants. The council promotes a variety of options for women, saying women’s needs change over a lifetime and women with few resources face barriers to effective birth control.
The flexible nonbiodegradable silicone Annovera ring uses a combination of hormones, segesteroine acetate and ethinyl estradiol, which are gradually released to prevent pregnancy. The four-week system of use calls for placing the ring into the vagina, where it is held in place by the vaginal walls. It stays there for three weeks and then is taken out for one week, when women may experience a menstrual period. The ring, which
has been cleaned and stored in a case, is then reinserted after the fourth week, and the cycle is repeated for a year.
Currently, the combined-hormone NuvaRing is effective for one month and must be replaced every 28 days. The hormones used in the rings are similar to those in birth control pills.
With Annovera, Dr. Chen said, “The same ring is used for an entire year.” Women will not have to go to a pharmacy every month or every three months to fill their ring prescription, she said, a process that now causes some women to have a gap in contraception and risk an unplanned pregnancy.
“There can be more convenience and control in preventing pregnancy,” she said. Protection is similar to the birth control patch and the currently available vaginal ring, she added. Research found about two to four women out of 100 may get pregnant during the first year they use Annovera. NuvaRing has to be refrigerated when not used, Dr. Chen said; Annovera does not need to be refrigerated.
“The Population Council … hopes to make it available worldwide and in parts of the world where refrigeration [isn’t available],” Dr. Chen said.
As with other contraceptives with estrogen, she said, there are cautions against using Annovera, including women who smoke or have blood pressure or heart disease concerns. Dr. Chen added that there’s limited data on how effective Annovera is for women with a body mass index of 29 or above — in the overweight or obese range.
The new vaginal ring that lasts a year “creates an interesting opportunity for women,” said Eric Lantzman, Allegheny Health Network’s director of family planning. Already, he said, “the NuvaRing has slowly grown a group of fans.”
The more convenient version would cut down on the number of visits to a pharmacy or a doctor, he said, and would potentially cut down on the number of pregnancy tests because the contraceptive coverage would be more consistent.
“It takes down a lot of barriers,” Dr. Lantzman said. “And should cut down on unintendedpregnancies.”
Hesaid he expects doctors will continue to follow the standard of care in prescribing the right kind of contraception for their patients, which includes consideration of who wouldbe a good candidate for Annovera.
Molly Grodin, a Population Council spokeswoman, explained the group works with partners to make their products available to women. Annovera may become available as early as fall 2019, she said. Although the estimated cost hasn’t been determined, she said TherapeuticsMD plans to promote insurance coverage that will make the out-of-pocket cost affordable to women. She said the company also agreed to provide “significantly reduced pricing to federally designated Title X family-planning clinics servinglower-income women.”
Dr. Lantzman is part of a group of Pittsburgh women’s health care providers — known as the Reproductive Bridges Coalition — who work to improve contraception knowledge and women’s access to birth control. Barriers continue to keep some women from getting contraception, he said, and one might be the convenience of a year’s supply of contraception.
He cited a 2006 study of a large California family-planning program that found dispensing a year’s supply of birth control pills was associated with more women using them continuously compared to giving the women one or three months’ supply at a time. The year’s supply was also linked to lower costs for the program.
Pills continue to be the most common form of hormone-based contraception, he said, still more than a hormone patch, ring, IUD or implant. Fading from use, he added, are diaphragms and cervical caps.
Dr. Dean of Planned Parenthood said about 90 percent of women use birth control at some point, but no one method works for every person: “The best birth control method is that which meets your needs, and those needs can change throughout your life — for example, if you start or end a relationship. Studies have shown that women who use a birth control method that fits their needs are more likely to avoid unintended pregnancy because they are more likely to continueusing their method.”
Magee’s family planning researchers are recruiting women for several new studies, Dr. Chen said, including one involving a new copper IUD, another studying a vaginal ring for both birth control and HIV prevention, and another investigating a morning-after pill. For information, go to birthcontrolstudies.org.
“It’s not one-size-fits-all,” she said. “The best method is one that fits a woman’s lifestyle, her preference, one that she will use.” Jill Daly: jdaly@post-gazette.com or 412263-1596.