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The results of clinical trials of vaginal contraceptive pills suggest that this is a safe, effective, and acceptable means of fertility control. Plasma levels of progesterone rise at a slower pace and to a lower peak value when contraception is administered vaginally rather than orally. Despite lower blood levels, ovulation is suppressed in the majority of cycles and fertility control compares favorably with that observed in users of low-dose combined OCs. Lower steroid blood levels and the fact that vaginal pills bypass the liver minimize the occurrence of side effects noted in some OC users such as nausea, gastric intolerance, headaches, weight gain, and dizziness. In 1 clinical trial, 124 women used a vaginal pill containing 500 mcg of d-1-norgestrel and 50 mcg of ethinyl estradiol for 6-20 months, for a total of 1438 women-months. No pregnancies occurred in this series. Bleeding generally developed 3-5 days after insertion of the last pill and lasted 3-5 days in 98% of cycles. The interval between withdrawal bleeding events was 26-30 days in 86% of cycles. Breakthrough bleeding occurred in only 6 subjects. Vaginal discharge, involving pathogenic agents similar to those found in OC users, developed in 26 (20%) of subjects. 44 women (36%) discontinued before 1 year of use: 7 cited medical reasons (mastalgia, vaginal irritation), 6 desired pregnancy, and the remaining 31 found daily insertion tedious or distasteful. No significant changes occurred in blood cell counts, hematocrit, or blood chemistry. Smaller clinical trials of both Gestrinone, an anti-estrogenic progesterone, and a vaginal pill containing 50 mcg of mestranol and 1 mg of norethindrone have obtained similar results. These findings suggest that the vaginal contraceptive pill may offer family planning clinics a better alternative than OCs as the 1st prescribed contraceptive.
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PMID:The vaginal contraceptive pill. 1226 27

Vaginal administration of oral contraceptives (OCs) has been shown to be an acceptable and effective method of contraception. The most widely tested vaginal contraceptive pill (VCP) contains 500 mcg of d-1 norgestrel and 50 mcg of ethinyl estradiol (EE) and is administered on the same 21-day schedule as the oral contraceptive. Other combination OCs used vaginally include 1 mg of norethisterone plus 50 mcg of mestranol, 250 mcg of levonorgestrel plus 50 mcg of EE, and 2 mg of cyproterone acetate plus 50 mcg of EE. Gestrinone, a potent antiestrogenic progestin, has also been used with success. Comparative studies of the various combination pills and Gestrinone revealed that plasma levels of the progestins rose at a slower pace and to a lower peak value after vaginal administration than after ingestion, but ovulation was suppressed in most cycles. Fertility control compared favorably with most low-dosage combined pills taken by mouth. No pregnancies occurred in a group of 124 women who used the vaginal route for 6-20 months totalling 1438 woman-months of use. Cycle control was good, and bleeding episodes occurred following discontinuation and lasted 3-5 days in 98% of cycles. Amenorrhea was rare, and breakthrough bleeding and spotting occurred in fewer than 10% of women. 22% of the women gained more than 2 kg and 9% lost weight. Blood pressure remained unchanged in most women, and fewer than 10% had headache, nausea, acne, nervousness, or mastalgia. Fewer than 20% had vaginal discharge requiring treatment, with Trichomonas vaginalis being the most common pathogenic agent. In 1 study, 44 women discontinued VCP use before completing 1 year of use, 7 for medical reasons (2 for mastalgia, 2 for vaginal irritation, 3 for vaginal discharge unresponsive to treatment), 6 to achieve pregnancy, and the remaining 31 to avoid daily vaginal insertion. The VCP achieved the same results as OCs with a minimum of side effects due to the low steroid levels and because VCPs bypass the liver on the 1st pass. The vaginal ring shares these advantages of the VCPs, but the bulky silastic rubber structure of the ring may cause erosion of the vaginal wall, interfere with coitus, and absorb release unpleasant odors. Problems with vaginal rings also include expulsion, difficulty of insertion and removal, and storage. The VCP may be a better alternative than the OC as the 1st prescribed contraceptive for family planning clinics because the low blood levels of steroid will reduce the occurrence of side effects in longterm use.
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PMID:The vaginal contraceptive pill. 1233 69