Traditional Methods of Contraception
The benefits, side effects, and potential complications of traditional methods of contraception are reviewed in detail elsewhere.

It is important to note certain changes that have occurred in the past several years. For example, no contraceptive sponges currently are available in the United States, although a new vaginal sponge (Protectaid) is under investigation. Likewise, the levonorgestrel implant system marketed as Norplant is no longer being manufactured; however, a single-rod implant (Implanon), presently used outside the United States, may become available in the future.

Newer Methods of Contraception
Traditional methods of contraception have some drawbacks.Consequently, patient dissatisfaction and inconsistent or incorrect use may result in unintended pregnancy. For example, the success of OCPs, the most widely used reversible contraceptive method, is highly dependent on daily adherence. In one study,14 approximately 47 percent of OCP users failed to take one or more pills per cycle, and 22 percent failed to take two or more pills.

In designing the newer contraceptives, attention has been given to improving the side effect profiles of older methods and to developing delivery systems that do not require daily patient adherence.

VAGINAL CONTRACEPTIVE RING
The combined hormonal vaginal ring (NuvaRing) has a unique delivery system. The ring works in a similar manner as OCPs, but daily action by the patient is not required. The ring (Figure 1), which releases ethinyl estradiol at a rate of 15 mcg per day and etonogestrel at a rate of 120 mcg per day, is placed in the vagina for three weeks. If for some reason the ring is out of the vagina for more than three hours, back-up contraception should be used until the ring has been back in place for seven days. After three weeks, the ring is removed for one week, and a new ring is inserted. Withdrawal bleeding occurs during the ring-free week.

In a one-year study,15 the overall failure rate for the vaginal ring was 0.65 pregnancies per 100 women-years. The majority of women in the study considered insertion and removal of the vaginal ring to be easy, and 90 percent used the device correctly. Adverse effects that led to discontinuation of vaginal ring use most often were related to foreign body sensation, coital problems, and expulsion of the device. However, only 3.6 percent of women in the study stopped using the device for these reasons.

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