PRODUCT BRIEF Caucus on New and Underused Reproductive Health Technologies

Progesterone vaginal ring

Description Efficacy

The progesterone vaginal ring Progering® is Clinical trials have shown a high contraceptive efficacy used to extend the contraceptive effectiveness (over 98.5 percent) and a good safety profile. There are of lactational amenorrhea among breastfeeding reports of some side effects such as vaginal discharge, women. Progesterone vaginal rings are inserted in urinary discomfort, bleeding disturbances, and rare the vagina for continuous use for up to three months reproductive tract infections. In a Chilean study, less and replaced with a new ring if breastfeeding is than 5 percent of users experienced any one of these continued and extended contraception is desired. side effects.3 Women can use these rings continuously for up to The effectiveness of the progesterone ring during the one year. Although not recommended, the ring may recommended three months of use has been shown be removed during sexual intercourse for a period of to be comparable to that of the Copper T-380A up to two hours. If the ring is removed for a longer intrauterine device. While progesterone rings are period of time, an additional contraceptive method less effective overall than rings containing both a should be used for the following seven days. Upon progestin and an estrogen, they are highly effective introduction of complementary foods or a reduction among breastfeeding women because exclusive in the frequency of breastfeeding, progesterone rings breastfeeding itself provides some protection from should be replaced with another effective method if pregnancy. Also, they are more appropriate for use continued contraception is desired.1 by breastfeeding women because they do not contain The progesterone vaginal ring functions by diffusing a estrogen, which can reduce milk production. The most continuous flow of progesterone through the vaginal common reason for discontinuation of progesterone walls—approximately 10 mg per day—which then rings is weaning, as mothers choose more effective enters the bloodstream and regulates the woman’s contraception after they reduce breastfeeding fertility by suppressing ovulation. Progesterone episodes. Bleeding disturbances, a common side effect also thickens the cervical mucus, inhibiting sperm of all progesterone-only methods, is another frequent penetration into the uterus. reason for discontinuation.3 The progesterone ring does not provide protection from sexually transmitted Progesterone vaginal rings play an important role infections, including HIV. in today’s contraceptive method mix, especially as a contraceptive choice for breastfeeding women. Acceptability studies conducted with other Current program/sector use contraceptive rings in Australia, Canada, Chile, Dominican Republic, the United States, and Europe The product Progering® is sold commercially in six have demonstrated that women generally like countries in Latin America through gynecologists and the vaginal ring for many reasons, including its pharmacies. There is limited data on commercial sales effectiveness; its ease of use, including insertion and in these countries and available information suggests removal; the user control of these actions; and the lack that market penetration is weak. Further clinical trials of need to check it regularly.2 and social research are also being conducted on this product in India in anticipation of its registration and commercialization there once approved by the Drug Controller of India. Further acceptability studies will be conducted in Kenya, Nigeria, and Senegal prior to introduction in these markets. CAUCUS ON NEW AND UNDERUSED REPRODUCTIVE HEALTH TECHNOLOGIES PRODUCT BRIEF launched in2010other countries America inLatin for by use breastfeeding women. It was approved and Progering® was registered and inChile Peru in1998 Registration status ABL Pharma.subsidiary pharmacies by Laboratorios Andrómaco or its The product is supplied to providers and/or Laboratorios Andrómaco SAinSantiago, Chile. for contraceptive and use is manufactured by ringvaginal currently available America inLatin Progering® is brand the name of progesterone the Manufacturer endorsement by theCoalition orits wider membership. For additional information, please contact health sectors. Responsibility for theselectionand contents of theproduct briefs rests solely with theCaucus and does not imply broaden thediscussion within theCoalition of reproductive health technologies that are not well integrated into thepublic orcommercial Technologies, athematic group established under theauspices of theReproductive Health Supplies Coalition. The Caucus’ aimis to This publication forms part of aseries of technical briefs, written by members of theCaucus onNewand Underused Reproductive Health http://www.rhsupplies.org/working-groups/caucus-on-newunderused-rh-technologies.html For more information ontheCaucus onNewand Underused RHTechnologies, please visit our web page at partnerships to expand access to product. the None, but Andrómaco public-private is seeking Public-sector price agreements Andrómaco its SAfunded development 1990s. inthe CONRAD, and private the companies SAand Silesia Honduras, and Peru. The PopulationCouncil, including Ecuador, Chile, Bolivia, Guatemala,

3. 2. 1. References 1999;60(1):9–14. nursing ringvaginal inChilean women. safetythe and contraceptive ofa efficacy progesterone releasing Massai Miranda R, P, Valdes P, etal. Preregistration study on at: www.infoforhealth.org/pr/m19/. ofSchool Public Health, INFOProject; April 2005.Available M,No.Series 19.Baltimore: The Johns Hopkins Bloomberg Upadhyay UD. New contraceptive choices. Population Reports, 2010;82(5):428–434. contraceptive during use lactation. Nath A,Sitruk-Ware Progesterone R. ring vaginal for [email protected] This brief was last updated May 2013 May updated waslast brief This Contraception Contraception . . . .

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