The realities of contemporary counseling and the informed choice of vaginal hormonal contraception

Aganezova N.V., Aganezov S.S.

I.I. Mechnikov North-Western State Medical University, Ministry of Health of the Russian Federation, Saint Petersburg, Russia
The review presents the data of experts from the World Health Organization on the medical, ethical, and socio-economic aspects of pregnancy planning. It reflects the principles of contemporary counseling of patients when choosing a method for preventing unwanted pregnancy, as well as the urgency of the problem for Russia. The review gives the results of studying the advantages of a monthly regimen of the contraceptive vaginal ring NuvaRing versus a daily regimen of combined oral contraceptives: the higher contraceptive effectiveness in real clinical practice; optimal cycle control; fewer side effects, such as nausea/vomiting, mastalgia. The authors notice the minimal systemic effect of NuvaRing on the body, as well as the metabolic neutrality of the drug. The review presents the study data on the absence of a negative effect of the contraceptive ring on vaginal microbiocenosis, cervical mucosa, and sexual life. There is information on the availability of the NuvaRing applicator to ease the insert of the ring into the vagina. The paper gives the study results on an about fourfold increase in the number of women who have chosen the vaginal contraceptive ring after structured counseling, compared to the initial desire to use combined oral contraceptives.
Conclusion. Contemporary structured counseling expands the possibilities of choosing a contraceptive method. The informed choice of vaginal hormonal contraception is optimal for women who are interested in the advantages of the monthly regimen of the contraceptive ring NuvaRing.


contraception counseling
contraceptive vaginal ring NuvaRing
combined oral contraceptives


  1. Всемирная организация здравоохранения. База данных «Информационные бюллетени. Планирование семьи/методы контрацепции». [The world health organization. Database "Newsletters. Family planning/contraceptive methods»]. Available at:
  2. Kantorová V., Wheldon M.C., Ueffing P., Dasgupta A.N.Z. Estimating progress wards meeting women’s contraceptive needs in 185 countries: A Bayesian hierarchical modelling study. PLoS Med. 2020; 17(2): e1003026.
  3. United Nations, Department of Economic and Social Affairs, Population Division. Family Planning and the 2030 Agenda for Sustainable Development. New York: United Nations; 2019. Available at:
  4. Sedgh G., Singh S., Hussain R. Intended and unintended pregnancies worldwide in 2012 and recent trends. Stud. Fam. Plann. 2014; 45(3): 301-14.
  5. Family Planning Can Reduce High Infant Mortality Levels. Guttmacher Institute. Available at:
  6. Основные показатели здоровья матери и ребенка, деятельность службы охраны детства и родовспоможения в Российской Федерации в 2018 году. М.: Минздрав Российской Федерации, ФГБУ «ЦНИИОИЗ» Минздрава Российской Федерации; 2019. 169с. [The main indicators of maternal and child health, the activities of the child protection and obstetric services in the Russian Federation in 2018. "Central Research Institute for Organization and Informatization of Health Care" of the Ministry of Health of the Russian Federation. Moscow, 2019, 169 p. (in Russian)].
  7. Ensuring human rights in the provision of contraceptive information and services. Guidance and recommendations, Geneva: WHO; 2014. Available at:
  8. Family Planning 2020: rights and empowerment principles for family planning. Available at:
  9. Аганезова Н.В. Психосоциальные и медицинские аспекты консультирования современной женщины при выборе метода контрацепции. Вопросы гинекологии, акушерства и перинатологии. 2009; 8(5): 62-8. [Aganezova N.V. Psychosocial and medical aspects of counseling a modern woman when choosing a method of contraception. Voprosy ginekologii, akusherstva i perinatologii/ Issues of gynecology, obstetrics and perinatology, 2009.8 (5): 62-8 (in Russian)].
  10. WHO. Medical eligibility criteria for contraceptive use. 5th ed. 2015. Available at:
  11. Trussell J. Contraceptive failure in the United States. Contraception. 2011; 83(5): 397-404.
  12. Lete I., Doval J.L., Perez-Campos E., Lertxundi R., Correa M., de la Viuda E. et al. Self-described impact of noncompliance among users of a combined hormonal contraceptive method. Contraception. 2008; 77(4): 276-82.
  13. López-Picado А., Lapuente O., Lete I. Efficacy and side-effects profile of the ethinylestradiol and etonogestrel contraceptive vaginal ring: a systematic review and meta-analysis. Eur. J. Contracept. Reprod. Health Care. 2017; 22(2): 131-46.
  14. Jain S., Vaid N.B., Narang Y., Suneja A., Guleria K. A randomised controlled trial comparing the efficacy and side-effects of intravaginal ring (Nuvaring(®)) with combined oral hormonal preparation in dysfunctional uterine bleeding. J. Clin. Diagn. Res. 2016; 10(3): QC21-4.
  15. Ahmed M.M. Mohamed, Wael S.M., El-Sherbiny, Walaa A.I. Mostafa. Combined contraceptive ring versus combined oral contraceptive (30-μg ethinylestradiol and 3-mg drospirenone). Int. J. Gynaecol. Obstet. 2011; 114(2): 145-8.
  16. Fan G.S., Ren M., Di W., Su P., Chang Q., Wu S. et al. Efficacy and safety of the contraceptive vaginal ring (NuvaRing) compared with a combined oral contraceptive in Chinese women: a 1-year randomised trial. Eur. J. Contracept. Reprod. Health Care. 2016; 21(4): 303-9.
  17. Bustillos-Alamilla E., Zepeda-Zaragoza J., Hernández-Ruiz M.A., Carlos Humberto Briones-Landa C. Combined hormonal contraception in cycles artificially extended. Ginecol. Obstet. Mex. 2010; 78(1): 37-45.
  18. Weisberg E., Merki-Feld G.S., McGeechan K., Fraser I.S. Randomized comparison of bleeding patterns in women using a combined contraceptive vaginal ring or a low-dose combined oral contraceptive on a menstrually signaled regimen. Contraception. 2015; 91(2): 121-6.
  19. Dahiya P., Dalal M., Yadav A., Dahiya K., Jain S., Silan V. Efficacy of combined hormonal vaginal ring in comparison to combined hormonal pills in heavy menstrual bleeding. Eur. J. Obstet. Gynecol. Reprod. Biol. 2016; 203: 147-51.
  20. Agarwal N., Gupta M., Kriplani A., Bhatla N., Singh N. Comparison of combined hormonal vaginal ring with ultralow-dose combined oral contraceptive pills in the management of heavy menstrual bleeding: A pilot study. J. Obstet. Gynaecol. 2016; 36(1): 71-5.
  21. Lethaby A., Wise M.R., Weterings M.A., Bofill Rodriguez M., Brown J. Combined hormonal contraceptives for heavy menstrual bleeding Cochrane Database Syst. Rev. 2019; (2): CD000154.
  22. Priya K., Rajaram S., Goel N. Comparison of combined hormonal vaginal ring and low dose combined oral hormonal pill for the treatment of idiopathic chronic pelvic pain: a randomised trial. Eur. J. Obstet. Gynecol. Reprod. Biol. 2016; 207: 141-6.
  23. Lopez L.M., Grimes D.A., Gallo M.F., Stockton L.L., Schulz K.F. Skin patch and vaginal ring versus combined oral contraceptives for contraception Cochrane Database Syst. Rev. 2013; (4): CD003552.
  24. Национальные медицинские критерии приемлемости методов контрацепции. М.; 2012. [National medical criteria for the acceptability of contraceptive methods, 2012. (in Russian)].
  25. Wang X., Fan X., Deng H., Zhang X., Zhang K., Xu J. et al. Use of oral contraceptives and risk of ulcerative colitis - A systematic review and meta-analysis. Pharmacol. Res. 2019; 139: 367-74.
  26. Cho M.K. Use of combined oral contraceptives in perimenopausal women. Chonnam. Med. J. 2018; 54(3): 153-8.
  27. Lete I., Cuesta M.C., Marín J.M., Guerra S. Vaginal health in contraceptive vaginal ring users - A review. Eur. J. Contracept. Reprod. Health Care. 2013; 18(4): 234-41.
  28. De Seta F., Restaino S., De Santo D., Stabile G., Banco R., Busetti M. et al. Effects of hormonal contraception on vaginal flora. Contraception. 2012; 86(5): 526-9.
  29. Прилепская В.Н., Назарова Н.М., Бестаева Н.В. Микробиоценоз влагалища и контрацептивное кольцо. Вопросы гинекологии, акушерства и перинатологии. 2012; 11(1): 75-8. [Prilepskaya V.N., Nazarova N.M., Bestaeva N.V. Vaginal microbiocenosis and contraceptive ring. Voprosy ginekologii, akusherstva i perinatologii/Issues of gynecology, obstetrics and perinatology. 2012;11(1):75-8 (in Russian)].
  30. Межевитинова Е.А., Прилепская В.Н. Эффективность и приемлемость влагалищной комбинированной гормональной системы, содержащей этинилэстрадиол и этоногестрел. Обзор литературы. Гинекология. 2019; 21(2): 6-11. [Mezhevitinova E.A., Prilepskaya V.N. The efficacy and acceptability of the vaginal combined hormonal system containing ethinyl estradiol and etonogestrel. Literature review. Ginekologiya/Gynecology. 2019;21(2):6-11 (in Russian)].
  31. Feldman R., Tara L., Frenkl T.L., Yacik C., Wang Y., Fox M.C. Safety and efficacy of the NuvaRing® Applicator in healthy females: a multicenter, open-label, randomized, 2-period crosser study. Contraception. 2016; 94(4): 362-5.
  32. Egarter C., Frey Tirri B., Bitzer J., Kaminskyy V., Oddens B.J., Prilepskaya V. et al. Women's perceptions and reasons for choosing the pill, patch, or ring in the CHOICE study: a cross-sectional survey of contraceptive method selection after counseling. BMC Womens Health. 2013; 13: 9.
  33. Bitzer J., Gemzell-Danielsson K., Roumen F., Marintcheva-Petrova M., van Bakel B., Oddens B.J. The CHOICE study: effect of counselling on the selection of combined hormonal contraceptive methods in 11 countries. Eur. J. Contracept. Reprod. Health Care. 2012; 17(1): 65-78.
  34. Gambera A., Corda F., Papa R., Bastianelli C., Bucciantini S., Dessole S. et al. Observational, prospective, multicentre study to evaluate the effects of counselling on the choice of combined hormonal contraceptives in Italy--the ECOS (Educational COunselling effectS) study. BMC Womens Health. 2015; 15: 69.
  35. Yeshaya A., Ber A., Seidman D.S., Oddens B.J. Influence of structured counseling on women's selection of hormonal contraception in Israel: results of the CHOICE study. Int. J. Womens Health. 2014; 6: 799-808. eCollection 2014.

Received 20.08.2020

Accepted 08.09.2020

About the Authors

Natalia V. Aganezova, MD, Dr. Sci. (Med.), Associate Professor, Department of Obstetrics and Gynecology, North-Western State Medical University
named after I.I. Mechnikov. E-mail: ORCID: 0000-0002-9676-1570; SPIN: 2961-5377.
191015, Russia, Saint-Petersburg, Kirochnaya st., 41.
Sergey S. Aganezov, MD, PhD, Associate Professor, Department of Obstetrics and Gynecology, North-Western State Medical University named after I.I. Mechnikov.
E-mail: ORCID: 0000-0002-3523-9922; SPIN: 8186-6778.

For citation: Aganezova N.V., Aganezov S.S. The realities of contemporary counseling and the informed choice of vaginal hormonal contraception.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2020; 9: 208-216 (in Russian).

Similar Articles

By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.