ResearchGeneral gynecologyPharmacokinetics and ovarian suppression during use of a contraceptive vaginal ring in normal-weight and obese women
Section snippets
Materials and Methods
This clinical trial compared ovarian follicle development and serum ethinyl estradiol and etonogestrel levels between normal weight and obese women using the CVR (daily release of 15 mcg ethinyl estradiol [EE2] and 120 mcg etonogestrel [ENG]). Participant-related activities were conducted between July and December 2008. The Columbia University Institutional Review Board approved the study, and all participants gave informed consent. We recruited participants from a cohort of women who had
Results
We enrolled 40 women into the study. Before the study cycle 1 woman fractured her pelvis in a motor vehicle accident and another experienced a venous thromboembolism following a long-haul flight (flight duration >4 hours). We excluded both of these women from continuation in the study. We also excluded 1 woman because of removal of the CVR during the study cycle, leaving 18 normal weight and 19 obese women for analysis. Table 1 presents the baseline characteristics of the participants, whose
Comment
Obese women using the CVR achieve lower serum EE2 levels than normal weight women, but ENG levels are similar. The hormone levels found in this study among normal weight women are nearly identical to those found among normal weight Dutch women supporting the validity of these results.23 Women in both groups had substantial suppression of ovarian follicular development, and we observed no ovulations during the study cycle. To compare follicular development between obese and normal weight women,
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2017, ContraceptionCitation Excerpt :A Cochrane review on hormonal contraceptive effectiveness in overweight and obese women only included studies that reported pregnancy rates for specific CHC formulations, resulting in the exclusion of many studies that we included in this review, but allowing conclusions for each pill formulation [27]. Progestins may be differently affected by obesity based on their degree of protein binding [28,29, 30, 31, 32]. The pooled analysis by Yamazaki et al. reported a statistically higher failure rate in obese women after grouping data from five progestins [12], but it is possible that the clinical meaning of this difference was diluted by combining progestins with different degrees of sex hormone-binding globulin binding [33].
Support was provided by NIH grant R01 HD04578, NIH CTSA grant UL1 RR024156, an anonymous foundation, and the donation by Merck of Nuvarings and laboratory assays.
C.L.W. is an advisory board member of Agile and a consultant for Merck and Bayer. The remaining authors report no conflict of interest.
Reprints are not available from the authors.
Cite this article as: Westhoff CL, Torgal AH, Mayeda ER, et al. Pharmacokinetics and ovarian suppression during use of a contraceptive vaginal ring in normal-weight and obese women. Am J Obstet Gynecol 2012;207:39.e1-6.